Longitudinal Data Research Articles

The Effect of Mandatory Medicaid HMOs on Health Access, Utilization, and Health Outcomes for Children

ObjectiveMandatory enrollment into Medicaid-contracted Health Maintenance Organizations (HMOs) is the most common form of Medicaid managed care (MMC), but the effects of this enrollment on children are unclear. We leveraged variation in MMC implementation within and across states over time to examine the effect of mandatory Medicaid HMO enrollment on children’s access, utilization, and health outcomes. MethodsUsing Medical Expenditure Panel Survey data from 2000 to 2018 and multivariable regression models, we estimated the effects of living in a county with mandatory Medicaid HMO enrollment only, compared to other MMC types and FFS combined in one comparison group, on outcomes for children under 18 years. We also evaluated potential effect heterogeneity across age, race/ ethnicity, and for children with special healthcare needs (CSHCNs). ResultsThere were small and non-significant associations between mandatory HMO enrollment and most outcome measures. However, mandatory HMO enrollment was associated with a 1.8 percentage-point decline in the likelihood of having a usual source of care,95% CI[-0.035,-0.001], a 4.2 percentage-point increase in the likelihood of delayed access to care,95% CI[0.012,0.072], and a 2.2 percentage-point reduction in the likelihood of having any outpatient physician visits, 95% CI[-0.043,-0.0004], compared to other MMC and FFS combined in one group. Mandatory HMO enrollment was associated with more difficulty seeing a specialist for CSHCNs. ConclusionsOverall, there is little evidence that mandatory Medicaid HMO enrollment has discernable and consistent effects across a broad range of outcomes. Evaluating how mandatory Medicaid HMOs affect more nuanced healthcare measures especially for children with greater healthcare needs remains an important future research question.

Bayesian Predictive Modelling to Ascertain Factors Affecting Cattle Milk Production in Tanzania: Evidence from the National Panel Surveys 2012 – 2020

Bayesian Predictive Modelling to Ascertain Factors Affecting Cattle Milk Production in Tanzania: Evidence from the National Panel Surveys 2012 – 2020

Patients follow four clusters of participation in physical exercise after an ACL injury. Results from the NACOX cohort study

ObjectivesTo explore how participation in physical exercise (PE) changes over time after an anterior cruciate ligament (ACL) injury. Additionally, to identify factors associated with participation in PE by analyzing longitudinal data. DesignAn explorative analysis of the NACOX study, a prospective multicenter cohort study. MethodsPatients with an acute ACL injury aged 15-40 years were followed for three years. The patients regularly reported participation in PE, knee function, new injuries, and surgeries. State sequence analysis and Hierarchical Cluster Analysis were used to analyze participation in PE. Clusters were compared using an analysis of variances, the Chi-square test, and Fischer’s exact test. ResultsThe study included 275 patients, 52% female, with a mean age of 25 years. Four clusters were identified, varying from low to high participation in PE after an ACL injury. Clusters differed regarding the number of ACL reconstructions (ACLR) (p = 0.03); time from injury to ACLR (p = 0.03); patient-reported knee function at the follow-ups at 3-months (p = 0.02), 6-months (p = 0.02), and 12-months (p = 0.02) after injury; PE level before injury (p < 0.001); and number of new injuries and surgeries (other than ACLR) (p = 0.001). ConclusionFour clusters, varying from low to high participation in PE after an ACL injury were identified. The results provide valuable insight into factors associated with different levels of participation in PE, which can be helpful for healthcare personnel working with ACL rehabilitation.

A multiple behaviour temporal network analysis for health behaviours during COVID-19.

The aim of this study was to examine the temporal dynamics of multiple health behaviours (physical activity, alcohol consumption, healthy eating, cigarette consumption, recreational drug use, vaping), and pandemic-related health behaviours (e.g., hand washing, physical distancing) using network psychometrics. The International COVID-19 Awareness and Responses Evaluation (iCARE) study is an international multi-wave observational cohort study of public awareness, attitudes, and responses to public health policies implemented to reduce the spread of COVID-19 on people around the world. A sub-sample of longitudinal data from Canadians (n = 254) was analysed across four waves (February-July 2020). We used temporal network models to fit temporal networks, contemporaneous networks, and between-subject networks from items within the iCARE survey. Positive temporal associations were observed between physical activity and healthy eating, and a bidirectional relationship was evident between outdoor mask use and vaping. A contemporaneous network revealed positive associations between consumption behaviours (vaping, cigarette use, alcohol use, and recreational drug use), and negative associations between physical activity and drug use, and healthy eating and cigarette use. Health behaviours are interconnected and can be modelled as networks or behavioural systems. The application of temporal network analysis to the study of multiple health behaviours is well suited to address key research questions in the field such as 'how do multiple health behaviours co-vary with one another over time'. Future research using time series data and measuring affective and cognitive mediators of behaviour, in addition to health behaviours, has the potential to contribute valuable hypothesis-generating insights.

The global burden of enteric fever, 2017–2021: a systematic analysis from the global burden of disease study 2021

Enteric fever is a major public health challenge in developing countries. We conducted a systematic analysis from the Global Burden of Diseases 2021 Study to provide updated estimates of enteric fever's burden. We presented estimates for incident cases and deaths, age-standardized incidence and mortality rates, years of life lost (YLLs), and case-fatality rates spanning the study period of 2017-2021, stratified by region, country, socio-demographic index (SDI), and age group. Random-effects Poisson regression for longitudinal data was used to estimate the association between SDI and case-fatality rates, adjusting for antimicrobial resistance patterns. In 2021, there were 9.3 million global cases of enteric fever (95% uncertainty interval: 7.3-11.9) and 107.5 thousand deaths (56.1-180.8). The age-standardized incidence rate decreased from 152/100,000 person-years (118-195) in 2017 to 128/100,000 person-years (100-163) in 2021, and the mortality rate decreased from 1.87/100,000 person-years (0.95-3.18) to 1.50/100,000 person-years (0.78-2.54). There were wide geographical differences, with South Asia contributing the most cases and deaths. Age-standardized incidence exceeded the threshold for "high burden" of enteric fever (100/100,000 person-years) in 23 countries in2021.Children under five accounted for 40% of deaths and 47% of YLLs, with incidence and mortality peaking during the second year. Case-fatality was highest in low SDI countries and showed a global trend toward reduction, except among children aged 1-4 years. After adjusting for the prevalence of multidrug resistance, fluoroquinolone non-susceptibility, and third-generation cephalosporin resistance, a higher SDI was associated with a lower case-fatality rate, with a 1.1% (0.7-1.7) reduction for each percentage point increase in SDI. Despite notable improvements, several countries still showed a high burden of enteric fever, which remains a significant global health concern, especially among children under five. Although enhancing water and sanitation systems is crucial, the most significant reductions in the global disease burden are likely to be achieved through broader vaccine coverage. This includes the use of typhoid conjugate vaccines, which are effective in infants and young children and offer extended protection, along with improved data collection and surveillance to guide vaccine distribution efforts across high-incidence areas. This work was partially supported by "Ricerca Corrente" funding from Italian Ministry of Health to IRCCSHumanitas Research Hospital.

Longitudinal Evolution of the Brain Microstructure in Cirrhotic Patients on Diffusion Kurtosis Imaging.

Although improvement of cognitive function after liver transplantation has been demonstrated in several neuropsychological studies, there is limited research on longitudinal changes in the cirrhotic patients' brain structure before and after transplantation. To investigate longitudinal changes of brain microstructure in cirrhotic patients using diffusion kurtosis imaging (DKI). Prospective. A total of 153 cirrhosis patients, comprising 60 hepatic encephalopathy (HE) patients (16 females/44 males) and 93 no-HE patients (35 females/58 males), along with 93 healthy controls (HCs) (53 females/40 males) were enrolled. Subsequently, 58 recipients completed 1-month postoperative follow-up, 29 patients completed 1-, 3-months, and 17 patients completed 1-, 3-, 6-month follow-up. Spin-echo single-shot echo-planar sequence using a 3.0 T scanner. Diffusion kurtosis estimator software was used to estimate the DKI parameter maps by a MR imaging physicist (Y.-Y.C. with 12 years of experience). The diffusion metrics (eg, radial kurtosis [RK], mean kurtosis, fractional anisotropy, mean diffusivity) of the patients before transplantation were compared with those of the HCs using voxel-wise analysis of variance (ANOVA), along with t tests for post hoc analysis. Linear mixed-effects models were applied to the longitudinal data. We imposed a cluster level Family Wise Error (FWE) correction rate of PFWE = 0.05 with voxel-wise cutoff of P = 0.001 together with a cluster-size cutoff of N ≥ 56, and generated smoothness estimates from the preprocessed data using the mixed-model autocorrelation function. The RK metrics of the patients decreased significantly in the anterior cingulate cortex (HE/no-HE < HC, ANOVA-F = 21.91). After transplantation, the RK of the pallidum showed a continuous upward trend (time effect T = 11.26); whereas the RK of the right postcentral gyrus showed a continuous downward trend (time effect T = -9.56). In addition, the RK in superior longitudinal fasciculus showed new-onset decrease after transplantation. Longitudinal changes in DKI metrics reveal the course of brain microstructural changes before and after transplantation in cirrhotic patients, potentially associated with cognitive alterations after surgery. 1 TECHNICAL EFFICACY: Stage 4.

The Influence of Urban New Energy Development Orientation on New Energy Technology Innovation in Firms

Unlike existing energy policies that adopt a macro-level perspective, this paper examines the impact of China’s new energy demonstration cities (NEDC) policy on micro-agents. Using longitudinal data covering Chinese publicly listed firms in new energy industries, the empirical results show that the NEDC policy significantly increases firm’s new energy patents in pilot cities compared to those in non-pilot cities. We examine the potential channels via industrial upgrading effect, relative scale effect, direct incentive effect, and factor aggregation effect. In addition, we find that the NEDC policy performs better in areas with more governmental new energy attention and higher infrastructure levels, and state-owned businesses are more proactive.

Birth expectations, birth experiences and childbirth-related post-traumatic stress symptoms in mothers and birth companions: Dyadic investigation using response surface analysis.

During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS. Dyadic longitudinal data from the Self-Hypnosis IntraPartumTrial. Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum). Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS. Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.

Anomalous venous collaterals in Apert and Crouzon syndromes and their relationship to ventricle size and increased intracranial pressure.

The exact association between the frequently present anomalous intracranial venous vasculature, emissary collaterals, ventriculomegaly, and increased intracranial pressure (ICP) in children with Apert and Crouzon syndromes remains an enigma. This study aimed to evaluate the association between the aberrant venous system and ventricle size and increased ICP, and to assess the development of the venous structures over time. This retrospective cohort study included all patients with Apert or Crouzon syndrome with available CT venography (CTV) scans of the brain. Anomalous venous vasculature was assessed by the total collateral score (TCS), which scored 9 intra- and extracranial venous structures (TCS range 0-16). Ventricle size (fronto-occipital horn ratio [FOHR]) was measured on the same scan. The presence of increased ICP, a shunt, tonsillar herniation, and head circumference were extracted from electronic patient records and were used as secondary covariates. Subsequent CTV scans were scored when available. Ninety patients were included in this study. The mean TCS was 7.5 ± 2.5, and was comparable for patients with Apert and Crouzon syndromes (mean 8.0 and 7.3, respectively). The presence of an extra abnormal venous structure was associated with an increase of the FOHR of 3.2% (p < 0.01). After dividing the venous structures into intra- and extracranial, a similar association between both and the FOHR was found (4.1% and 2.3%, respectively; p < 0.01). The TCS was similar for patients with normal and increased ICP at the time of the scan. Sixteen patients had dual CTV scans. The median time between both scans was 3.2 years. The presence of collaterals remained stable over time (median ΔTCS = 0.3). Seven patients with functioning shunts also maintained high TCSs (median TCS = 9). In patients with Apert and Crouzon syndromes, a close relationship between venous collaterals and ventricle size was observed, in which a more extensive aberrant venous drainage pattern, both intra- and extracranial, was associated with larger ventricles. Preliminary longitudinal data suggested that the presence of venous collaterals remained constant over time despite effective treatment of increased ICP, indicating reliance on these collaterals even in cases of normal ICP. The authors hypothesize that this dependence on collateral drainage is the result of their aberrant internal venous anatomy and predisposes individuals to increased ICP.

Emotional and behavioral problems are associated with hypothalamic development from childhood to adolescence: Findings from a longitudinal cohort study

BackgroundDespite the pivotal role of the hypothalamus in regulating various physiological processes, our understanding of its developmental trajectory and subregional organization during childhood and adolescence remains limited, as well as how emotional and behavioral problems can impact hypothalamic development, potentially leading to neurodevelopmental disorders. MethodsThis population-based longitudinal cohort study utilized data from a representative sample of 702 children, who were followed two to five times. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Linear mixed models were employed to delineate developmental trajectories and behavioral regulation. ResultsUsing an automated segmentation technique, we quantified the volumes and asymmetries of the hypothalamus and its subregions in a large longitudinal sample of 702 subjects aged 6–15 years with 1371 MRI scans, and mapped their developmental trajectories. Our findings indicate that while the anterior and posterior regions of the hypothalamus exhibit a tendency toward decline, the tubular region demonstrates a linear increase which is influenced by lateralization, sex, and intracranial volume. Furthermore, emotional and behavioral problems - particularly emotional symptoms and peer relationship problems - are related to faster development in superior tubular and anterior-superior regions. ConclusionsIn this study, we initially delineated the developmental trajectories of the hypothalamus and its subregions from childhood to adolescence based on a longitudinal cohort study. Our findings revealed that the development of hypothalamus followed the pattern of “lateral early to medial late, and dorsomedial early to ventromedial late”, and the emotional and behavioral problems are associated with faster hypothalamic development. This study provides preliminary evidence regarding the impact of emotional and behavioral problems on the dynamic development of the hypothalamus, offering a crucial foundation for future prevention and intervention strategies targeting cognitive and emotional behavioral problems.

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

A longitudinal panel study exploring associations of urinary phthalate metabolites mixture with renal function in Chinese children

A longitudinal panel study exploring associations of urinary phthalate metabolites mixture with renal function in Chinese children

Can fertility decline help explain gender pay convergence?

Abstract Prior scholarship demonstrates that motherhood wage penalties and fatherhood wage premiums contribute to the gender pay gap. These analyses typically take a cross-sectional perspective, asking to what extent gender inequalities in the association between parenthood and wages can explain gender pay inequality for a given cohort or at a given moment in time. By contrast, explorations of gender pay convergence over time have tended to start at the firm’s door, testing the explanatory power of changes in men’s and women’s human capital and job characteristics and neglecting the contributions of fertility change. We bring these two strands of research together, asking to what extent declines 1980–2018 in US employees’ number of children can explain gender pay convergence over the same period. Using a descriptive decomposition and data from the Panel Study of Income Dynamics, we show that, in gross terms, fertility decline can explain almost one-quarter of gender pay convergence from 1980 to 2018. Even net of a host of controls for human capital and job characteristics, fertility decline explains 8 percent of the attenuation of the US gender pay gap 1980–2018—about half as much as changes in education and about a quarter as much as changes in full-time work experience and job tenure combined. Finally, we show that employees’ fertility decline was fastest in the 1980s and subsequently slowed; this, in conjunction with persistent gender differences in parenthood–wage associations, helps explain stalled progress toward gender pay parity.

Can digital factor participation create opportunities for “rags to riches”? Based on the perspective of intergenerational income mobility

Intergenerational hierarchical solidification threatens the sustainable development of economies and societies in countries worldwide. In this paper, we match macro data on digital factor participation at the city level with micro data from the Chinese Family Panel Studies (CFPS) from 2010 to 2018 to explore whether digital factor participation can break hierarchical solidification and create opportunities for “rags to riches” on the basis of the perspective of intergenerational income mobility. We find that digital factor participation contributes to facilitating upwards income mobility between generations, alleviating intergenerational hierarchical solidification. Additionally, its marginal effects are most pronounced in the low-income groups, indicating that digital factor participation serves as a booster for “poor second generations” to leapfrog rather than an accelerator for wealth accumulation among the “wealthy second generations”. Furthermore, our research reveals that digital factor participation potentially facilitates intergenerational occupational vertical “shift” channels and promotes the horizontal migration of the labour force, which in turn weakens intergenerational transmission effects, promotes intergenerational income mobility, and breaks intergenerational hierarchical solidification. Our study highlights the importance of seizing the opportunities presented by digital factor participation, as such participation offers more equitable opportunities for the lower class, which is particularly concerning in the context of the intensifying global trend of social stratification.

Can intergenerational relationships mitigate digital exclusion among China’s elderly population?

ABSTRACT In the burgeoning grey economy, the elderly have been widely praised for their digital readiness dividends. However, there remains a significant gap in the literature regarding solutions to the critical issue of digital exclusion faced by the elderly. This study utilizes the microdata from three waves of the China Family Panel Studies (CFPS) in 2016, 2018, and 2020 to explore how intergenerational relationships influence the digital exclusion of older adults and identify the mechanisms. The findings reveal that strong intergenerational bonds significantly narrow the digital divide for the elderly. The analysis highlights that such relationships have a more pronounced impact on mitigating elderly digital exclusion among early-aged parents, males, residents of rural areas, and families where parents and offsprings cohabit. The mechanisms through which these relationships exert their influence include promoting intergenerational support exchanges, providing digital guidance from children to parents, and enhancing the elderly’s acceptance of digital technology. Furthermore, this paper employs the ‘one-child policy’ as a quasi-natural experiment to examine the moderating role. The findings underscore the value of nurturing parent-child bonds in reducing digital exclusion among the elderly, offering strategic insights for addressing this issue in societies experiencing both ageing populations and declines in birth rates.

Ambient PMs Pollution, Blood Pressure, Potential Mediation by Short-Chain Fatty Acids: A Prospective Panel Study of Young Adults in China

BackgroundThe concurrent effects of particulate matter (PM) on both blood pressure (BP) and short-chain fatty acids (SCFAs) are insufficiently explored, with limited research on the potential mediating roles of SCFAs. MethodsIn this prospective panel study with 4 follow-ups, we recruited 40 college students in Hefei, China, to assess the impacts of short-term exposure to PM (aerodynamic diameter ≤10 μm (PM10), ≤2.5 μm (PM2.5), and ≤1 μm (PM1)) on BP and SCFAs, along with potential mechanisms. Real-time PM data, urinary SCFAs levels, and BP indicators were systematically collected. Linear mixed-effects models assessed the relationships between PM, SCFAs, and BP. Mediation analyses explored SCFAs’ mediating role in the PM-BP association. ResultsPM exposure was positively linked to BP and negatively associated with SCFAs. For a 10μg/m3 rise in PM10 at lag 0-72h, there were notable reductions of 0.0019% (95%CI: -0.0028, -0.0010) in Acetic acid, 0.0262% (-0.0369, -0.0155) in Propionic acid, and 0.0702% (-0.1025, -0.0378) in Butyric acid. Systolic BP, diastolic BP, and mean arterial pressure (MAP) increased by 2.60mmHg (0.96, 4.25), 2.24mmHg (1.18, 3.31), and 2.36mmHg (1.20, 3.53), respectively, per 10-μg/m3 rise in PM1 at lag 0-24h. Decreased SCFAs levels explained significant portions (24.69% to 31.80%) of the elevated MAP due to PM10. Stronger associations were found in females and individuals with abnormal BMI. ConclusionsOur study shows that PM exposure decreases urinary SCFAs levels, which partially mediate the impact of PM on elevated BP. These findings enhance our comprehension of the pathways linking PM exposure to BP changes.

Leveraging social capital for digital transformation: The role of ambidexterity and familial orientation

In pursuing competitive advantage, businesses are diffusing new digital technologies across their value chains and, by doing so, catalyzing significant organizational changes in operational processes and strategic approaches. This widespread evolution of businesses has prompted significant questions regarding the drivers of digital change, the necessary resources, and the capabilities that need to be developed or reconfigured. Our paper focuses on the role of intangible resources, such as a firm's social capital, and its specific implications for the broader research on this phenomenon. Consistent with the resource-based view, we examine the role of different types of social capital as critical resources in the digital transformation process while also considering the mediating role of the balancing act of the capabilities around business alignment and adaptation encompassed in the concept of ambidexterity. Furthermore, we introduce a contextual dimension to our study by examining family involvement in a firm as a significant factor influencing how businesses shape their digital goals and allocate resources toward digital transformation. Our paper addresses this under-explored research field by drawing on a large, cross-sectional dataset from an online panel study with 582 management-level participants from UK firms. After testing our hypotheses, our study's results indicate that bridging and bonding social capital resources significantly promote digital transformation by indirectly developing an ambidextrous orientation. Moreover, familial orientation strengthens both relationships. This research is currently one of the few studies providing empirical evidence on the relationship between digital transformation, its antecedents, and, specifically, the role of intangible resources.

Social Security, Digital Literacy, and Relative Poverty in China

In the context of China's rapid economic development and digitalization, relative poverty persists as a pressing concern despite significant strides in poverty alleviation. While the role of social security in poverty reduction has been extensively studied, the potential moderating effect of digital literacy remains largely overlooked, particularly regarding individuals' ability to access and utilize social benefits effectively. To address this gap, we examine the interplay between social security, digital literacy, and relative poverty using data from the China Family Panel Studies 2020. Employing logistic regression models with interaction terms and addressing potential endogeneity, we find that social security coverage significantly reduces the likelihood of relative poverty. Crucially, digital literacy positively moderates this relationship, amplifying the poverty-reducing effect of social security for individuals with higher digital skills. This effect is particularly pronounced for low-income households and varies across regions. These findings highlight the need for integrated policy approaches that combine social protection with digital skill development to effectively combat relative poverty in the digital age, contributing to our understanding of poverty dynamics in digitalized societies and informing more targeted poverty reduction strategies.

Digital literacy, relative poverty, and common prosperity for rural households

Digital transformation has emerged as a crucial driver of economic development, yet its impact on rural China's socioeconomic landscape remains understudied. This research investigates how digital literacy influences common prosperity and relative poverty in rural China using comprehensive household-level data from the 2018 China Family Panel Studies (CFPS). Through robust econometric analysis, including multiple regression models and structural equation modeling, we examine both the direct effects of digital literacy on household economic outcomes and its indirect effects through the mediating channel of relative poverty. Our findings demonstrate that a one standard deviation increase in digital literacy scores corresponds to a 12.3 % reduction in relative poverty and a 15.7 % increase in household income, with these effects amplified in China's western regions and among unmarried individuals. The results are robust to various model specifications and controls for potential endogeneity. By establishing the causal pathways between digital skills and economic well-being, this study provides empirical evidence for policymakers to design targeted interventions that leverage digital literacy as a tool for reducing rural-urban disparities. Our findings contribute to the growing literature on digital inclusion and suggest that investing in digital skills training could be a cost-effective strategy for promoting inclusive growth in rural China.

Breaking the cycle between caregiver mental health and child behavioral issues: Does food insecurity matter?

Food insecurity is a key determinant of not only caregiver’s mental health but also children’s emotional problems and hyperactivity symptoms. Although substantial studies have explored such a relationship, it is unclear to us whether this relation would vary when considering that caregiver’s mental health and aforementioned children’s behavioral issues can be the cause and effect of each other. Addressing this research gap is a key to advancing our understanding of how to promote a healthier family dynamic, especially for those facing material needs. This research applies the family stress model to explore how food insecurity affects caregiver psychological distress and child emotional problems and hyperactivity symptoms, while considering the reciprocal relationships between caregiver mental health and these child behavioral issues. Utilizing data from the 2019 Panel Study of Income Dynamic and 2019-2020 Child Development Supplements, this study conducts path analyses applied with propensity score weighting to support causal inference. Results support the family stress model framework, where food insecurity significantly predicts an increase in psychological distress in caregivers, which in turn leads to more severe child emotional problems and hyperactivity symptoms. This study also shows that food insecurity is a risk factor resulting in a reciprocal association between caregiver psychological distress and child emotional problems, where the strength of both directions is similarly harmful to each other. These findings underscore the need to address food insecurity, not only to meet material needs but also to break the harmful cycle of mental health and behavioral issues within families