School-aged Children In China Research Articles

Dietary patterns and bone density among school-aged children: a cross-sectional study in China.

Diet is an essential modifiable determinant of bone health, yet the associations between dietary patterns (DPs) and bone mineral density (BMD) in Chinese children remain limited. This study aimed to investigate the relationship between overall diet and low BMD risk among school-aged children in China. A total of 1,099 children aged 9-12 in China were recruited for this cross-sectional study. A semi-quantified food frequency questionnaire (FFQ) was used to assess dietary intake. A priori numerical index, the Chinese Dietary Guidelines Index for Children and Adolescents [CDGI (2021)-C] was utilized to assess dietary quality. Specific DPs were identified by using principal components analysis (PCA). The BMD of the left forearm was assessed using dual-energy X-ray absorptiometry (DXA). Spearman correlation test was conducted to investigate the associations between DPs. Multivariate logistic regression analysis and restricted cubic spline models (RCS) were applied to explore the associations between DPs and BMD. Three distinct DPs were identified: the plant-animal balanced pattern, the grain-tuber-meat pattern, and the bean-dairy pattern. We found a weak but significant positive correlation of the CDGI (2021)-C with the plant-animal balanced pattern (R = 0.318, P < 0.001), and with the bean-dairy pattern (R = 0.266, P < 0.001), respectively. After adjusting for covariates, adherence to the CDGI (2021)-C (Q4 vs. Q1, OR = 0.45, 95% CI: 0.27-0.75), the plant-animal balanced pattern (Q4 vs. Q1, OR = 0.50, 95% CI: 0.31-0.81), and the bean-dairy pattern (Q3 vs. Q1, OR = 0.57, 95% CI: 0.33-0.96) were associated with a lower risk of low BMD. No significant association was observed between the grain-tuber-meat pattern and low BMD (Q4 vs. Q1, OR = 1.09; 95% CI: 0.90-1.31). Adherence to the CDGI (2021)-C and the plant-animal balanced pattern is advantageous for bone health and inversely correlated with the risk of low BMD among school-aged children in China. Additionally, moderate adherence to the bean-dairy pattern may also confer benefits to bone health. A balanced and overall healthy diet should be recommended in our daily life.

The influence of parents on children's consciousness of gender equality: a multi-group structural equation modeling approach.

This study aimed to understand the consciousness of gender equality among school-aged children in China and its influencing factors using structural equation modeling to explore the pathways, intensity and group differences among these factors. A cross-sectional survey was conducted using stratified random whole-group sampling of primary school students in grades 1-6 and their parents who met the inclusion and exclusion criteria. In this study, 1,312 valid questionnaires were collected from a total of 1,500 school-aged children in Hunan Province, China (effective response rate of 87.5%). Statistical analysis was conducted using SPSS 26.0 and AMOS 24.0 software. Statistical inference consisted of t-tests, analysis of variance, the LSD test, Pearson correlation analysis, multiple stepwise linear regression analysis and structural equation modeling. School-aged children had the lowest consciousness of gender equality in the area of occupation and relatively higher consciousness in the areas of family and school. Children's age, gender, gender role, parent-child relationship, teacher-student relationship and parents' gender equality consciousness had predictive effects on children's consciousness of gender equality. The structural equation model constructed in this study is applicable to school-aged children of different genders. There was a significant difference in the structural equation modeling for children in different study period groups. In the education process, parents and teachers should attempt to improve their own consciousness of gender equality, integrate the concept of androgynous education, enhance close relationships with children, and adopt appropriate education methods according to the characteristics of different groups of children.

Effect of artificial natural light on the development of myopia among primary school-age children in China: a three-year longitudinal study.

To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children. This is a prospective, randomized control, intervention study. A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study. The whole randomization method was adopted to include classes as a group according to 1:1 randomized control. Classrooms in the control group were illuminated by usual light, and classrooms in the intervention group were illuminated by artificial natural light. All students received uncorrected visual acuity and best-corrected visual acuity measurement, non-cycloplegic autorefraction, ocular biometric examination, slit lamp and strabismus examination. Three-year follow-up, the students underwent same procedures. Myopia was defined as spherical equivalent refraction ≤ -0.50 D and uncorrected visual acuity <20/20. There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y. The three-year cumulative incidence rate of myopia was 26.4% (207 incident cases among 784 eligible participants at baseline) in the control group and 21.2% (164 incident cases among 774 eligible participants at baseline) in the intervention group [difference of 5.2% (95%CI, 3.7% to 10.1%); P=0.035]. There was also a significant difference in the three-year change in spherical equivalent refraction for the control group (-0.81 D) compared with the intervention group [-0.63 D; difference of 0.18 D (95%CI, 0.08 to 0.28 D); P<0.001]. Elongation of axial length was significantly different between in the control group (0.77 mm) and the intervention group [0.72 mm; difference of 0.05 mm (95%CI, 0.01 to 0.09 mm); P=0.003]. Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

Development of a risk score for myopia: A cohort study conducted among school-aged children in China.

To evaluate the myopia risk in school-aged children one year after lifting a pandemic-related lockdown and develop a tool to identify high-risk groups. In total, 38,079 children without myopia from 38 schools were included. The outcomes were myopia incidence and progression in 1 year after the COVID-19 lockdown was lifted, both obtained by the spherical equivalent refraction (SER). We separated the population into an exploratory (75%) and a validation sample (25%) to construct the risk score model. In total, 9811 (29.57%) students became myopic, and the overall myopia progression was 0.22 ± 0.62 D. Even less myopia progression was noted in the pre-myopia group at baseline (All: P = 0.045, Boy: P = 0.005). The risk score model included seven predictors: gender, grade, SER at baseline, residence, parental myopia, eye discomfort symptoms, and online courses. The model had a score range of 0-46 and an optimal cutoff of 34. The area under the receiver operating curve of the model was 0.726 (0.719-0.732) for the exploratory sample and 0.731 (0.720-0.742) for the validation sample. The risk score can serve as a practical tool for classifying the risk of myopia in school-aged children.

My child and I: self- and child-reference effects among parents with self-worth contingent on children’s performance

ABSTRACT Research shows that parents’ self-worth may be contingent on their children’s performance, with implications for their interactions with children. This study examined whether such child-based worth is manifested in parents’ recognition memory. Parents of school-age children in China (N = 527) reported on their child-based worth and completed a recognition memory task involving evaluative trait adjectives encoded in three conditions: self-reference, child-reference, and semantic processing. The more parents had child-based worth, the more they exhibited a child-reference effect – superior recognition memory of evaluative trait adjectives encoded with reference to the child rather than semantically. Parents exhibited the classic self-reference effect in comparisons of recognition memory between the self-reference and semantic processing conditions, but this effect was not evidenced among parents high in child-based worth. Only parents low in child-based worth exhibited the self-reference effect in comparisons between the self-reference and child-reference conditions. Findings suggest that when parents hinge their self-worth on children’s performance, evaluative information related to children may be an elaborate structure in memory.

Parental Pressure on Child Body Image, BMI, Body Image Dissatisfaction Associated with Eating Disorders in School-Age Children in China: A Path Analysis.

Children's eating behaviors, body shape and body image cognition may be more susceptible to the influence of their parents, but these influences may be weakened with age. There may be different association pathways between parental pressure on children's body image (PPCBI), body mass index (BMI), body image dissatisfaction (BID) and eating disorders (EDs) among children and adolescents at different developmental stages. The stratified cluster sampling method (Stratified by grade, and took the classes as clusters) was used to select 486 students aged 8-15 years in two 9-year schools. Children's body height, weight, testicular volume and breast development were measured. PPCBI, BID, and EDs were investigated using the Appearance-related Social Stress Questionnaire, Body Size Questionnaire (BID-14), and EDI-1 scale, respectively. The boys before puberty initiation had significantly higher EDs score (182.3±50.8) than girls before puberty initiation (164.1±58.1) (P<0.05). There were significant association pathways of PPCBI→BMI→BID→EDs and PPCBI→BID→EDs in boys before puberty initiation (β=0.035, P<0.01; β=0.059, P<0.01), in boys after puberty initiation (β=0.032, P<0.01; β=0.175, P<0.001), and in girls after puberty initiation (β=0.026, P<0.01; β=0.172, P<0.001). There was a positive association pathway of PPCBI→EDs in boys before puberty initiation (β=0.30, P<0.001) and PPCBI→BID→EDs in girls before puberty initiation (β=0.176, P<0.01). Parental pressure on children's body image may positively associate with children's eating disorders through BMI and body image dissatisfaction in boys and girls after puberty initiation and directly associate with eating disorders in boys before puberty initiation; however, it may indirectly associate with eating disorders only through BID in girls before puberty initiation.

Differential patterns of association between PM1 and PM2.5 with symptoms of attention deficit hyperactivity disorder

Few studies have evaluated the association between ambient particulate matter (PM) exposure and childhood attention deficit hyperactivity disorder (ADHD). We explored associations between long-term exposure to ambient PM1 and PM2.5 (particles with airborne diameters of <1 µm and <2.5 µm, respectively) with positive screening for ADHD among 164,081 school-aged children in China. Parents or guardians completed a checklist using DSM-IV, and PM1 and PM2.5 exposures linked via residential addresses were estimated using a spatial statistical model. Long-term exposure to higher ambient PM1 (odds ratio = 1.74; 95% confidence interval = 1.47–2.06 per 10.0 μg m–3) and PM2.5 (odds ratio = 1.65; 95% confidence interval = 1.45–1.88 per 10.0 μg m–3) was associated with greater odds of screening positive for ADHD. The associations were heterogenous across regions, with stronger associations for PM1 exposure than for PM2.5. Our findings highlight the potential importance of ambient PM mass concentrations, sizes, components and sources for protecting children’s neurological health in China, and in the design of interventions to decrease the health burden of children’s ADHD. This large study, conducted in school-aged children in China, evaluates the relationship between long-term exposure to ambient particulate matter and positive screening for attention deficit hyperactivity disorder (ADHD). The authors report stronger associations between ADHD and PM1 exposure than between ADHD and PM2.5.

The effectiveness of an egg-based intervention on improving the nutrition of poor school-age children in China: A quasi-experimental assessment

ObjectivesAlthough egg-based interventions are effective in alleviating undernutrition for infants and toddlers, little is known regarding their effectiveness for children in remote and poor areas of China. For policy and intervention implications, the aim of this study was to examine the effects of offering one hard-boiled egg per school day to school-age children in less-developed areas of China. MethodsThis analytical sample included 346 school-age children. Children in the treatment group received one egg per school day. Applying propensity score weighting to the difference-in-difference models, this study examined the effects of the egg intervention on child nutrition status measured in height-for-age Z score (HAZ), weight-for-age Z score (WAZ), and body-mass-index-for-age Z score (BMIZ). ResultsAfter applying propensity score weighting, the average treatment effect (ATE) and the average treatment effects on the treated (ATT) estimations showed that the increase in HAZ scores from wave 1 to wave 3 for the program participants was 0.28 points higher compared with the increase in HAZ scores from wave 1 to wave 3 for the control group (P < 0.05). The ATE and the ATT estimations showed that the increase in WAZ scores from wave 1 to wave 3 for the program participants was 0.50 and 0.49 points higher compared with the increase in WAZ scores from wave 1 to wave 3 for the control group (P < 0.001). Regarding BMIZ score improvement from wave 1 to wave 3, the program participation had relatively larger effects by 0.57 and 0.55 points based on the ATE and ATT estimations (P < 0.001), respectively. ConclusionsThe egg intervention can be an effective intervention to improve child development in less-developed areas of China.

The Prevalence of Congenital Heart Disease among School-Age Children in China: A Meta-Analysis and Systematic Review

<b>Objectives:</b> To estimate the prevalence of Congenital Heart Disease (CHD) in school-age children, to identify the extent to which altitude affects the prevalence of the disease, and to examine trends in prevalence over time in China. <b>Methods:</b> Seven databases were systematically searched and last retrieved on September 10, 2021 for all studies reporting the prevalence of CHD in children after 1970 in China, which were then divided into high and low altitude regions based on 2500 meters above sea level. The random-effected model was used to combine prevalence data and subgroups analysis. The baseline data of all cases and individuals were used for comparison to calculate the odds ratio (OR) for overall and different altitude prevalence. <b>Results:</b> A total of 12,926,083 individuals (aged 3-18 years), with 31,835 cases from 86 studies, were included in the analysis. The pooled CHD prevalence of total children was 4.69 [95% confidence interval (CI): 4.10 to 5.29] per 1000 children. Overall, temporal trends analysis indicated that the prevalence of CHD in children continuously decreased with time, from 6.19 (95% CI: 4.50 to 7.88) per 1000 children in 1976–1985 to 3.30 (95% CI: 2.49; 4.38) per 1000 children in 2016–2021. The OR for the prevalence of CHD in children from high and low altitudes with baseline data was 2.84 (95% CI: 2.48 to 3.27) and 1.31 (95% CI: 1.13 to 1.53) (<i>χ</i>² = 53.89, <i>p</i> < 0.01), respectively. The OR of the prevalence of CHD in male children compared to females was 0.60 (95% CI: 0.53 to 0.68) at high altitudes and 0.79 (95% CI: 0.71 to 0.89) at low altitudes. Among the seven most common subtypes, patent ductus arteriosus was the most common at high altitudes, while atrial septal defects were the most common at low altitudes. <b>Conclusion:</b> This study provides valuable insights for further disease prevention and etiological exploration. The overall decreasing trend in the prevalence of CHD in children over time may indicate a positive effect of perinatal management and treatment during infancy.

Parental Psychological Control and Children's Prosocial Behavior: The Mediating Role of Social Anxiety and the Moderating Role of Socioeconomic Status.

Complementing internalizing and externalizing developmental outcomes of parental psychological control, in this study, we shift the focus to children’s prosocial behaviors. Drawing on self-determination theory and problem-behavior theory, this study addresses the relationship between parental psychological control, social anxiety, socioeconomic status (SES), and children’s prosocial behavior. The parental psychological control scale, social anxiety scale for children, and prosocial behavior were applied in the study. Participants were 1202 elementary school-age children in China. The present study showed that parental psychological control was negatively associated with prosocial behavior and social anxiety played a partial mediating role between parental psychological control and prosocial behavior. Meanwhile, SES moderated the relationship between parental psychological control and prosocial behavior. The effect of parental psychological control on prosocial behavior was more significant among students with low levels of SES than the higher ones. The findings showed that parenting plays an essential role in the development of children’s prosociality.

The Relationship between Dietary Pattern and Bone Mass in School-Age Children.

Early bone accrual significantly influences adult bone health and osteoporosis incidence. We aimed to investigate the relationship between dietary patterns (DPs), bone mineral content (BMC) and bone mineral density (BMD) in school-age children in China. Children aged six–nine years (n = 465) were enrolled in this cross-sectional study. DPs were identified by principal component factor analysis. Total body (TB) and total body less head (TBLH) BMC and BMD were measured using dual-energy X-ray absorptiometry. Five DPs were identified. After adjustment for covariates, multiple linear regression analysis showed that the “fruit-milk-eggs” dietary pattern was positively associated with TB (β = 10.480; 95% CI: 2.190, 18.770) and TBLH (β = 5.577; 95% CI: 0.214, 10.941) BMC, the “animal organs-refined cereals” pattern was associated with low TB BMC (β = −10.305; 95% CI: −18.433, −2.176), TBLH BMC (β = −6.346; 95% CI: −11.596, −1.096), TB BMD (β = −0.006; 95% CI: −0.011, −0.001) and TBLH BMD (β = −0.004; 95% CI: −0.007, −0.001). In conclusion, our study recommends home or school meals should be rich in fruit, milk, eggs with a moderate amount of vegetables, coarse grains and meat to promote bone development for school-age children.

Evaluating an oral health programme for the prevention of dental decay among school-aged children in China: protocol for a mixed-methods study based on the RE-AIM framework.

IntroductionThe objective of the Comprehensive Intervention of Oral Disease for Children (CIODC) in China is to prevent dental decay for school-aged children and provide free prevention services in pilot areas beginning in 2008. It is a potentially affordable, acceptable and effective prevention strategy to use for more school-aged children in the future. There is a shortage of robust evidence regarding the cost-effectiveness, feasibility and scalability of prevention strategies for dental decay for school-aged children in China. This study aims to provide a comprehensive evaluation, including an economic evaluation and process evaluation, to better understand how and why the public health programme may be effective and economical.Methods and analysisMixed methods will be used in this study. Cost-effectiveness analysis (CEA) will be conducted from a societal perspective, based on a modelling study over 6 years (from age 7 to 12) in terms of the incremental cost-effectiveness ratios per dental decay averted. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework informed the process evaluation. An estimated 48–80 semistructured interviews with service providers, patient parents/caregivers and decision-makers under the logic model will be used in the progress evaluation to describe the feasibility and sustainability of CIODC.Ethics and disseminationThe study has all necessary ethical approvals from the Ethics Committee of Anhui Medical University (number 2021H030). All participants will provide informed consent prior to participation. Findings will be disseminated through conference presentations and scientific publications in peer-reviewed journals.

Should myopic students wear eyeglasses?―A regression-discontinuity analysis

ABSTRACT Despite the high prevalence of myopia among school-age children in China, many myopic students are reluctant to wear eyeglasses. This study estimates the effects of wearing eyeglasses on myopic students’ academic performance, using data from a large-scale survey of middle-school students, the China Education Panel Survey. Our fuzzy regression discontinuity (RD) design, which exploits the jump in the probability of wearing eyeglasses at the threshold for myopia diagnosis, reveals that wearing eyeglasses improves myopic students’ Chinese and maths test scores by 0.27 and 0.24 standard deviations, respectively.

A bit of salt, a trace of life: Gender norms and the impact of a salt iodization program on human capital formation of school aged children

This paper evaluates the effect of a national salt iodization program on the cognition of school-aged children in China. We focus on the role of gender preferences. Linking pre-eradication iodine deficiency rates with household survey data, we find a strong positive impact of prenatal exposure to the program on cognition and schooling for girls. For boys, we find no effect. Child preferences play an important role in parental investment decisions and impact program effects. We find that parents invest more in girls with a high initial endowment. For boys, this is different. Parents invest in boys, irrespective of their initial endowment. The nationally implemented program may therefore primarily benefit low endowment girls. We then exploit village-level variation in gender attitudes and find that gender attitudes are related to parental investment behavior and that the program’s impact is stronger for girls born to parents with strong preferences for boys.

Relationship Between Weight Status and Health-Related Quality of Life in School-age Children in China.

Background: Some studies from high-income countries suggest that overweight and/or obesity in children are negatively associated with health-related quality of life (HRQOL). However, the relationship between weight status and HRQOL is not well established in China, where obesity trends follow a different pattern compared with high-income countries. The risk of obesity is greater in children from higher socioeconomic backgrounds and higher in boys compared with girls.Objective: The aim of this study was to examine the relationship between weight status and HRQOL in children between 6 and 7 years old in this unique country context.Methods: Baseline HRQOL and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention trial in China. HRQOL was measured using the Chinese version of the Child Health Utility-9D (CHU-9D-CHN) and the Pediatric Quality of Life Inventory™ (PedsQL™) instruments. CHU-9D-CHN utility scores were generated using 2 scoring algorithms (UK and Chinese tariffs). Height and weight measures were taken at school by trained researchers using standardized methods, and BMI z scores were calculated using the World Health Organization 2007 growth charts. The relationship between HRQOL and weight status was examined using multivariable analyses, adjusting for age, gender, and socioeconomic status.Results: Full data were available for 1539 children (mean age, 6 years). In both unadjusted and adjusted analyses, HRQOL, using both the CHU-9D-CHN and the PedsQL™, was marginally higher in children who were overweight or living with obesity compared with children with healthy weight, although this difference did not reach statistical significance. Separate analyses and models by gender showed that the relationship between weight status and HRQOL scores was similar in boys and girls.Conclusions: Our results suggest no statistically significant difference in HRQOL between children with overweight/obesity compared with those with healthy weight. These results have implications for the methods of economic evaluation for obesity treatment and prevention interventions within this population cohort and country setting, as there appears to be no discernible consequences on children’s HRQOL from living with overweight and obesity.

The association of grandparental co-residence and dietary knowledge with excess body weight among children aged 7-15years in China.

To investigate the impact of grandparent's co-residence and dietary knowledge on the overweight and obesity risk among school-age children in China. Data of 790 children aged 7-15years were retrieved from the China Health and Nutrition Survey (CHNS). Co-residential status was evaluated using household and individual ID. Dietary knowledge was assessed using 17 dietary statements, which was scored by participants. Three principal factors were extracted by factor analysis. Logistic regression analysis was applied to examine the influence of grandparent's co-residence and dietary knowledge on the weight status of the child. The overweight and obesity incidence of the children increased significantly when they co-reside with two grandparents (OR=1.447, 95CI: 1.001-2.090, p=0.049). Mother's dietary knowledge regarding to protein-related food choices (PT) scored higher was associated with the increased risk (OR=1.270, 95CI: 1.059-1.523, p=0.010). For grandmother's dietary knowledge, the higher score in balanced food consumption (BF) was associated with the decreased overweight and obesity risk (OR=0.456, 95CI: 0.294-0.706, p<0.001). Grandfather's dietary knowledge in BF showed the similar result (OR=0.454, 95CI: 0.271-0.759, p=0.003). Living with two grandparents is associated with higher overweight and obesity risk, but grandparents with an adequate knowledge in the balanced food consumption may decrease the risk.

Gender Differences Influence Gender Equality Awareness, Self-Esteem, and Subjective Well-Being Among School-Age Children in China.

The objective of this study was to investigate and analyze the status and influential factors of gender equality awareness, self-esteem, and subjective well-being in school-age boys and girls. The results can help schools and teachers provide more effective gender equality and mental health education. In the study, 284 valid questionnaires were collected from a total of 323 school-age boys and girls in the Hunan Province, China (effective response rate of 87.93%). The questionnaire covered gender equality awareness, self-esteem, and subjective well-being, with the influencing factors analyzed through multiple linear regression. There was a significant correlation among children’s gender equality awareness in all areas examined (family, occupation, and school), with both boys and girls having the lowest awareness of gender equality in occupational fields. The children’s self-esteem and subjective well-being were significantly correlated as well. Gender equality awareness, self-esteem, and subjective well-being among boys and girls reflected different influential factors. Androgynous traits (neither feminine nor masculine) were conducive to the development of gender equality awareness and self-esteem among the children. Therefore, schools and teachers need to provide gender equality and mental health education according to the specific psychological characteristics of each boy and girl.

Distributions and determinants of time spent outdoors among school-age children in China.

The outdoor time is a key factor that determines children's exposure to environmental contaminants. Meanwhile, children reap numerous physical and mental health benefits from playing outdoors. This study aimed to characterize the distributions and identify determinants of the time spent outdoors among school-age children in China. The study recruited 41,439 children aged 6-17 years in Mainland China using a multi-stage cluster random sampling method. This sample was nationally representative with sample weights created to account for the complex survey design. Information on time-activity patterns were collected with a standard questionnaire through face-to-face interviews. Frequency distributions of time outdoors were created by age group, gender, region, and other sociodemographic factors with sample weights. The key factors influencing time outdoors were identified using multivariable linear regression models. The grand mean (±standard deviation) time outdoors was 101 ± 51 min/day for all the study participants, 22.3% having <60 min/day. Children spent longer time outdoors in warm seasons and on weekends. Children's outdoor time was significantly influenced by gender, age, urbanicity, region, annual total household expenditure, building environment, and meteorological conditions (annual mean temperature, sunshine time, and precipitation). Girls, 15-17 year old, and urban children had 6 min/day, 8 min/day, and 13 min/day less outdoor time than boys, 6-8 year old, and rural children, respectively. Most significantly, urban girls and high school students had the shortest outdoor time. The cement ground was the most important type of ground for children playing outside. This was the first national-scale study that characterized the time outdoors and where is it spent among school-age children in China. It revealed that one-fifth of Chinese children spent less than one hour outdoors every day, and urban girls had particular "indoor tendencies". The findings provide bases for future interventions and guidelines aimed at promoting children's physical activities.

Anemia of School-Age Children in Primary Schools in Southern China Should Be Paid More Attention despite the Significant Improvement at National Level: Based on Chinese Nutrition and Health Surveillance Data (2016-2017).

Globally, anemia among school-age children (SAC) remains a serious public health problem, impacting their growth, development, educational attainment and future learning potential. National and subnational anemia prevalence among SAC in China has not been assessed recently. Based on data from Chinese Nutrition and Health Surveillance (2016–2017), the current anemia status of SAC in primary schools in China was investigated. Anemia prevalence of SAC in primary schools in China was 4.4%, dropping 63.6% compared with that in 2002. Even though anemia was no longer a significant public health problem at the national level, there were significant spatial disparities of anemia prevalence in different areas: anemia prevalence in 63% of provinces of northern and eastern China has lowered to below 5%, while in provinces of southern China, it was still ranging from 5% to 11.0%, about 3 times of other areas. For those children in southern China, mother’s education level (OR = 1.24, p = 0.04) and father’s education level (OR = 1.27, p = 0.01) below senior high school, eating meat less than 3 times per week (OR = 1.18, p = 0.01) were risk factors of anemia. Older age (OR = 0.35–0.72, p < 0.01) was a protective factor. Targeted interventions should be taken to improve SAC anemia in Southern China, despite anemia of SAC in primary schools no longer being a significant public health problem.

Development and preliminary evaluation of Chinese School-aged Children\u2019s Eating Behavior Scale

BackgroundThe objective of this study was to develop a scale to assess eating behaviors of school-aged children (6–12 years old) in China.MethodsTo develop the scale, a literature review and qualitative interviews were conducted. The draft scale contained 115 items and went through three evaluations among three groups of caregivers (n = 140, 400, 700) selected from suburban and urban kindergartens in Xi’an, Hanzhong, and Yanan, China, from March 2017 to October 2018. The psychometric properties of the scale were assessed using exploratory, confirmatory factor analysis, and variability analysis.ResultsThe final scale consisted of 46 items across eight dimensions including food fussiness, satiety responsiveness, food responsiveness, bad eating habits, susceptible diet, restrained eating, enjoyment of food, and junk food addiction. The total cumulative variance contribution rate was 52.16%. The scale and dimensions' Cronbach’s α coefficients, Guttman split-half reliability, and test- retest reliability were all above 0.65. The fitting indices for the confirmatory factor analysis were all close to 1. The scores for education of caregiver, family structure, and the body mass index of children were different among dimensions and groups, thus suggesting good discriminative utility.ConclusionsAll of the results indicated that the scale has good reliability and construct validity for evaluating the eating behaviors of school-aged children in China.