School-aged Children In China Research Articles

Active Surveillance, Drug Resistance, and Genotypic Profiling of Staphylococcus aureus Among School-Age Children in China.

Methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization predisposes individuals for endogenous infections and is a major threat to children. Recently, oxacillin/cefoxitin-susceptible mecA-positive S. aureus (OS-MRSA) has been reported worldwide. Herein, a prospective, cross-sectional study was conducted across five schools, representing three educational stages, in Guangzhou, China. Nasal swabs from 2,375 students were cultured for S. aureus and all isolates were subjected to antibiotic susceptibility testing phenotypically and confirmed by femB and mecA genetic detection; all the isolates were classified as MSSA, MRSA, or OS-MRSA. All strains were also analyzed by multi-locus sequence typing. Among the 2,375 swabs, S. aureus was detected in 744 children (31.3%, 95% CI: 25.9–36.7%), of whom 72 had MRSA (3.0%, 95% CI: 0.6–5.4%) and 4 had OS-MRSA (0.2%, 95% CI: 0.1–0.3%), of which an oxacillin- and cefoxitin-susceptible MRSA strain was identified. The prevalence of S. aureus and MRSA was higher in younger children. The highest percentage of drug resistance of the S. aureus isolates (n = 744) was to penicillin (85.5%), followed by erythromycin (43.3%) and clidamycin (41.0%). The most prevalent sequence types (STs) were ST30, ST45, and ST188 in MSSA, accounting for 38.7% of the total isolates, whereas ST45, ST59, and ST338 accounted for 74.6% of the MRSA isolates and ST338 accounted for 50.0% of the OS-MRSA isolates. The MRSA and OS-MRSA isolates (n = 76) were grouped into three clades and one singleton, with clonal complex (CC) 45 as the most predominant linkage. The top nine multi-locus sequence typing-based CCs (CC30, CC45, CC5, CC1, CC15, CC944, CC398, CC59, CC7) represented 86.7% of all S. aureus isolates. All CC30 isolates were resistant to erythromycin and clidamycin, and almost all these isolates were also resistant to penicillin (99.2%). The CC45 and CC59 isolates exhibited high resistance rates to oxacillin at 31.5 and 59.0%, respectively. This study provides updated data valuable for designing effective control strategies to mitigate the burden of disease and to improve the adequacy of empirical antimicrobial treatments for potentially harmful infections.

Sugar-Sweetened Beverage Consumption Status and Its Association with Childhood Obesity among Chinese Children Aged 6-17 Years.

Objective: There is a remarkable growth in sugar-sweetened (SSB) production and obesity prevalence among school-aged children in China. This paper describes SSB consumption and its association with obesity among Chinese children aged 6–17 years in 2012. Methods: in total, 25,553 children aged 6~17 years enrolled in the China Nutrition and Health Surveillance 2010–2013 were included in this study. Data of SSB consumption frequency and quantity were obtained from a food frequency questionnaire, and the children’s nutritional status was assessed. Multivariate logistic regression was used to evaluate the association between SSB consumption and obesity status. Results: SSB intake was estimated as 181.0 g/day, occurring 2.2 times/week. Older children, males, children from urban areas, and children with higher socioeconomic status were more likely to consume SSBs. Children who consumed SSBs 1~<5 times/week (11.7%) and >5 times/week (12.9%) were more likely to be overweight/obesity than those who consumed SSBs less than once/week. Conclusion: SSB consumption was common among Chinese school-aged children, especially among males, older children, and children from urban areas. High consumption of SSBs was associated with a higher prevalence of overweight/obesity. Actions and plans are required to reduce SSB consumption and control childhood obesity in China.

Student Health Implications of School Closures during the COVID-19 Pandemic: New Evidence on the Association of e-Learning, Outdoor Exercise, and Myopia.

The coronavirus disease 2019 (COVID-19) pandemic forced many education systems to consider alternative remote e-learning modalities, which have consequential behavioral and health implications for youth. In particular, increased e-learning engagement with digital screens and reduction in outdoor activities are two likely channels posing adverse risks for myopia development. This study investigated the association between e-learning screen use, outdoor activity, lighting condition, and myopia development among school-age children in China, during the first wave of the COVID-19 pandemic. Data were collected from 3405 school-age children attending primary, lower-secondary, and upper-secondary schools in China. Univariate parametric and nonparametric tests, and multivariate logistic regression analysis were used. Findings show that each diopter hour increase in daily e-learning screen use is significantly associated with progression of myopia symptoms (OR: 1.074, 95% CI: 1.058–1.089; p < 0.001), whereas engaging in outdoor exercise four to six times per week (OR: 0.745, 95% CI: 0.568–0.977; p = 0.034) and one to three times per week (OR: 0.829, 95% CI: 0.686–0.991; p = 0.048) is associated with a lower likelihood of myopia progression than none at all. In addition, we found that indoor lighting that is either “too dim” (OR: 1.686, 95% CI: 1.226–2.319; p = 0.001) or “too bright” (OR: 1.529, 95% CI: 1.007–2.366; p = 0.036) is significantly associated higher likelihood of myopic symptoms. Findings in this study uncover the less observable vision consequences of the COVID-19 pandemic on youths through digital online learning and highlight the importance of considering appropriate mitigation strategies to deal with this emerging public health challenge.

The Higher Prevalence of Learning Disabilities in Children With Idiopathic Epilepsy in China

Background: Although school-age children with epilepsy are at a high risk of developing comorbid learning disabilities, there is a lack of empirical research to confirm the prevalence of learning disabilities among children with idiopathic epilepsy in China. Further, previous research has not confirmed whether children with epilepsy have a higher prevalence rate of learning disabilities than other school-age children. Methods: The current study aims to examine the prevalence and gender ratios of dyscalculia, dyslexia, and comorbidity among children with idiopathic epilepsy and other school-age children in China. Specific screening tests in arithmetic fluency (dyscalculia), reading fluency (dyslexia), and their co-occurrence were administered in a large population-based sample of children with epilepsy (N = 2,282) and other school-age children (N = 2,371). The prevalence of dyscalculia, dyslexia and comorbidity were calculated based on three cutoff criteria. Findings: The results showed that children with idiopathic epilepsy, when compared to other school-age children, have significantly higher prevalence rate of dyscalculia (-1 SD cutoff: 7·6% vs. 3·8%, -1·5 SD cutoff: 4·1% vs. 2·4%), dyslexia (-1 SD cutoff: 9·0% vs. 3·7%, -1·5 SD cutoff: 3·9% vs. 2·0%) and comorbidity (-1 SD cutoff: 5·1% vs. 1·4%, -1·5 SD cutoff: 1·5% vs. 0·4%, -2 SD cutoff: 0·4% vs. 0·1%). Moreover, gender differences in the prevalence rate of dyslexia only appeared among other school-age children. Interpretation: The results suggest that children with idiopathic epilepsy are more vulnerable to dyscalculia and dyslexia compared to other school-age children. Risk factors in the idiopathic epilepsy population should be identified to formulate effective prevention strategies. Moreover, gender differences on the prevalence of dyscalculia, dyslexia and comorbidity only exist among typical school-age children, which might be explained by clinical factors related to idiopathic epilepsy, therefore, future studies could make further examination. Funding: Funding Natural Science Foundation of China (Grant No. 31700977, 31671151), Natural Science Foundation of Beijing (Grant No. 5212004), The 111 Project (Grant No. BP0719032), Advanced Innovation Center for Future Education (Grant No. 27900-110631111), Directional Guidance Fund for the Capital Institute of Pediatrics (Grant No. FX-2019-03). Declaration of Interest: We declare no competing interests. Ethical Approval: This study was approved by the Human Research Ethics Committee at the Capital Institute of Pediatrics (approval no.: SHERLL 2019001). We also obtained oral consent from participants and informed consent signed by their guardians.

The Development of Cognitive Reflection in China.

Cognitive reflection is the tendency to override an intuitive response so as to engage in the reflection necessary to derive a correct response. Here, we examine the emergence of cognitive reflection in a culture that values nonanalytic thinking styles, Chinese culture. We administered a child-friendly version of the cognitive reflection test, the CRT-D, to 130 adults and 111 school-age children in China and compared performance on the CRT-D to several measures of rational thinking (belief bias syllogisms, base rate sensitivity, denominator neglect, and other-side thinking) and normative thinking dispositions (actively open-minded thinking and need for cognition). The CRT-D was a significant predictor of rational thinking and normative thinking dispositions in both children and adults, as previously found in American samples. Adults' performance on the CRT-D correlated with their performance on the original CRT, and children's performance on the CRT-D predicted rational thinking and normative thinking dispositions even after adjusting for age. These results demonstrate that cognitive reflection, rational thinking, and normative thinking dispositions converge even in a culture that emphasizes holistic, nonanalytic reasoning.

The factors of family management affecting asthma control status in school-age children with asthma in China

Objective To identify the factors of family management affecting asthma control status in school-age children with asthma in China. Method The cross-sectional descriptive study was conducted among 139 children with asthma and their parents. The age range of the children was 7 to 14 years of age (Mage = 9.85; 76.26% boys). Eight dimensions (Children Identity, View of Condition, Management Mindset, Parental Mutuality, Parenting Philosophy, Management Approach, Family Focus, Future Expectation) of the Family Management Scale for Children with Asthma (FMSCA) were used as factors of family management. The Asthma Control Test (ACT) and the Children Asthma Control Test (C-ACT) were used to measure the asthma control status of children. A parental questionnaire was used to collect information regarding demographic data of familial socioeconomic status, general data about the child, and medical services status (Follow-Up Plan, received manual of asthma education, attended a lecture on asthma) received from medical institutions. A multivariate ordinal logistic regression model was performed. Results Factors significantly associated with asthma control were “Follow-Up Plan” (OR, 2.004; 95% CI, 1.009–3.981), “Attended a Lecture on asthma” (OR, 2.586; 95% CI, 1.103–6.066) and two dimensions of the FMSCA, “Children Identity” (OR = 1.133; 95% CI, 1.024–1.254) and “Family Focus” (OR = 1.114; 95% CI, 1.007–1.232). Conclusion This study shows that asthma control status of school-age children in China is related to the parents’ views of their child as having a “normal condition” and the parents’ satisfaction with the balance between asthma related management and other aspects of family life.

Picky eating behavior and its association with health status among school-age children in Wuhan

Objective To investigate the picky eating behavior among school-age children and to analyze its association with their health status, providing scientific basis for health promotion of school-age children in China. Methods A total of 796 students of grade 3 to grade 6 from two primary schools in Hongshan, Wuhan were selected through cluster sampling. Statistical analysis was conducted according to the results of the 3-day food record and questionnaire survey on children and their caregivers. Results In the current study, 40.58% of the children had picky eating problems, the incidence of picky eating behaviors of migrant children was higher than that of local children (χ 2 = 3.92, P <0.05). Most of the picky eaters (23.87%) tended to reject vegetables. Compared to the others, picky eaters had lower intake of vitamin B 2 [(0.49±0.01) (0.46±0.01) mg] and vitamin C [(57.35±0.76)(54.32±0.90) mg] ( t = 2.03, 2.57, P <0.05) and had a higher risk of stunting ( OR = 1.42, P <0.05). Conclusion Picky eating behaviors are common among school-age children, which is significantly associated with stunting. Nutritional education for children (especially migrant children) are urgently needed to improve their dietary structure and promote healthy growth and development. 【摘要】 目的 调查学龄儿童挑食状况及其与健康状况的关系, 为中国学龄儿童的健康促进工作提供科学依据。 方法 采用整群抽样法, 抽取武汉市洪山区2所小学三至六年级的796名学生, 开展为期3d的膳食调查, 同时对儿童及其看护 人进行营养问卷调查, 根据调查结果进行分析。 结果 40.58%的儿童存在挑食问题, 流动儿童与本地儿童间挑食行为报 告率差异有统计学意义 (χ 2 = 3.92, P <0.05), 拒绝蔬菜类食物的儿童最多 (23.87%)。与非挑食者[(0.49±0.01) (57.35± 0.76)mg]相比, 挑食者[(0.46±0.01)(54.32±0.90)mg]维生素 B 2 和维生素C的每天摄人量较低 ( t 值分别为 2.03,2.57, P 值均<0.05), 且挑食者身高发育生长迟缓的发生风险比非挑食者更高 ( OR =1.42, P <0.05)。 结论 挑食行为普遍存在于学 龄儿童中, 且与儿童身高发育迟缓显著相关。亟需针对儿童(特别是流动儿童) 的营养教育活动, 改善中国儿童膳食结构, 促进健康成长。

Physical activity, transportation mode and sedentary time on the development of overweight and obesity in school-age children in China: China Health and Nutrition Survey (CHNS) 2010–2012

Physical activity, transportation mode and sedentary time on the development of overweight and obesity in school-age children in China: China Health and Nutrition Survey (CHNS) 2010–2012

Association Between Sedentary Behavior and Obesity in School-age Children in China: A Systematic Review of Evidence.

China has experienced a rapid increase in the number of obese and overweight children, and sedentary behavior has been recognized as an important factor. The purpose of this review is to summarize studies on the relationship between sedentary behavior and obesity in school-age children in China. A systematic search was conducted to identify studies that investigate the relationship between sedentary behavior and obesity in children between the ages of 6 and 18 years in China. Two researchers independently screened studies, assessed their methodological quality, and extracted relevant data. Findings on the relationship between sedentary behavior and obesity in children were synthesized and analyzed. A total of 17 studies were included in the review. Fifteen out of 17 studies indicated that spending too much time engaged in sedentary behavior, especially screen-based sedentary behavior, was associated with obesity in children and adolescents in China. Possible reasons for this association are less energy expenditure, increased energy intake, and insufficient sleep owing to overtime sedentary behavior. Moreover, seven, six, and three studies justified children's physical activity, dietary intake, or sleep, and most of the studies (five, three, and two) indicated that association between sedentary behavior and obesity is independent of these justified variables. Although differences in gender and area of residence in the association between sedentary behavior and obesity were examined in five studies, definite conclusions could not be drawn because of inconsistent findings or limited research. Future research is necessary to enhance understanding of demographic differences in the association between sedentary behavior and obesity in children as well as on the contributions of different types of sedentary behavior to child obesity in China.

Does Performing the Chinese Eye Exercises Help Protect Children's Vision? - New Evidence from Primary Schools in Rural Northwestern China.

BackgroundThe high prevalence of myopia among school-age children in China has raised serious concerns about protecting Chinese students’ vision. While the regular performance of the Chinese eye exercises has been adopted as a preventive approach in China since the mid-1960s, these exercises’ effectiveness at protecting students’ vision has remained largely unknown. This study attempts to provide new evidence of the impact of regularly performing the exercises on Chinese students’ visual outcomes, based on a large-scale dataset.MethodsA school-based survey was conducted among 9842 randomly selected students (fourth graders) from 252 primary schools in rural Northwestern China in 2012. To address potential estimation bias, we adopted both an instrumental variable (IV) approach and a bivariate-probit model to estimate the impacts on students’ visual acuity and the incidences of visual impairment and myopia.ResultsBoth IV and bivariate-probit estimates reveal a detrimental impact of regularly performing the Chinese eye exercises on students’ vision. Compared with students who did not regularly perform the exercises, those who did were 6.2 percentage points more likely to have impaired vision and 7.6 percentage points more likely to be myopic. The estimates are robust to different estimation strategies, various specifications, and the majority of subsamples.ConclusionUnder the assumption that the correct performance of the Chinese eye exercises would not undermine students’ vision, our findings suggest that the commonly-observed incorrect performance of these exercises among Chinese students imposes non-trivial threats to their vision health.

The effects of anonymity, invisibility, asynchrony, and moral disengagement on cyberbullying perpetration among school-aged children in China

In recent years, a growing body of literature has started to document the factors leading to cyberbullying perpetration. However, some remaining issues must be addressed. Drawing on I3 theory and social cognitive theory, the current study investigated: (a) the relationship between moral disengagement and cyberbullying perpetration, which has been explored extensively but yields inconclusive conclusions; (b) the effects of fundamental factors of the online disinhibition effect (online anonymity, invisibility, and asynchrony) on cyberbullying perpetration; and (c) the potential mediating role of moral disengagement between the fundamental factors of the online disinhibition effect and cyberbullying perpetration. A total of 1103 students (mean age 15.3 years, 52.5% girls) answered questionnaires about their cyberbullying involvement, perceived moral disengagement, online anonymity, invisibility, and asynchrony. The results suggested that moral disengagement was positive associated with cyberbullying perpetration. Anonymity was not directly associated with cyberbullying but operated through moral disengagement and then predicted cyberbullying perpetration. Asynchrony not only directly fostered cyberbullying but also operated through moral disengagement and then predicted cyberbullying. Notably, in the Chinese context, online invisibility was not directly associated with cyberbullying perpetration, nor did it operate through moral disengagement to predict cyberbullying perpetration. The findings of the current study have theoretical, practical, and policymaking implications for understanding and curtailing adolescents’ cyberbullying involvement.

Sleeping late is a risk factor for myopia development amongst school-aged children in China

Myopia, a leading cause of distance vision impairment, is projected to affect half of the world’s population in 30 years. We analysed the relationship between certain demographic, environmental, and behavioural factors and myopia from a 2-year school-based, prospective trial conducted in Shanghai, China. This trial enrolled 6295 school-aged children at baseline and followed them up for 24 months. The relationship between abovementioned factors and myopia was examined and the role of sleep in childhood myopia development was highlighted. Our results suggest that ‘sleeping late’ is a risk factor for myopia prevalence at baseline (odds ratio [OR] = 1.55, p = 0.04), 2-year myopia incidence (odds ratio [OR] = 1.44, p = 0.02) and progression over 24 months (p = 0.005), after adjusting for residency area, age, gender, sleep duration, and time spent outdoors. The identification and consistency of results with late sleepers being a susceptible group to both myopia onset and progression suggests a complex relationship between circadian rhythm, indoor environment, habitual indoor activities and myopia development and progression. These results can offer new insights to future myopia aetiology studies as well as aid in decision-making of myopia prevention strategies.

Assessing multiple domains of child well-being: Preliminary development and validation of the multidimensional child well-being scale (MCWBS)

The multidimensional nature of child well-being requires valid and reliable tools for assessing children’s multiple developmental outcomes. This study reports the psychometric properties of the Multidimensional Child Well-Being Scale (MCWBS), a 23-item self-report measure developed on the basis of a sample of school-aged children in China (N = 1322; M = 11.8; SD = 1.56). Exploratory factor analysis identified four well-being factors, namely, Physical, Psychological, Social, and Educational. The four-factor structure is further validated by confirmatory factor analysis (CFA). Cronbach’s α for the total scale (α = 0.894) and each subscale (0.857 for physical well-being; 0.917 for psychological well-being; 0.801 for social well-being; and 0.805 for educational well-being) were satisfactory, indicating high reliability. MCWBS positively correlated with quality of life (r = 0.674, p < 0.01) and happiness (r = 0.519, p < 0.01), and negatively correlated with depressive symptoms (r = −0.437, p < 0.01), indicating convergent validity. Multi-group CFA provided support for gender, hukou, and age-related invariance of the MCWBS at the configural, metric, and scalar level. Overall, this study addresses the measurement gap by developing a reliable and valid instrument containing multiple domains of children’s development outcomes, which can contribute to the child well-being research and practice.

The Effects of Online Homeschooling on Children, Parents, and Teachers of Grades 1-9 During the COVID-19 Pandemic.

BackgroundBeginning in the 2020 spring semester, due to the COVID-19 pandemic, all school-age children in China were homeschooled via live/recorded broadcasts, online group communication, and software-based homework submission. This study assessed the effects of and proper preparation for this educational approach.Material/MethodsThe homeschooling behaviors and feelings of school-age children were assessed with 2010 online surveys obtained separately from students, parents, and teachers of grades 1–9 in 15 Chinese provinces. Answers were compared among low- (grades 1–3), middle- (grades 4–6), and high- (grades 7–9) grade groups. The chi-square test was used to identify significant differences between groups.ResultsWe found that 76% of the respondents thought the homeschooling style was acceptable. However, teachers were concerned that students’ interest, focus, and academic performance would decline. Sixty-nine percent of the parents reported their children had more than 3 hours of daily screen time, and 82% of students had less than 2 hours of daily outdoor activity. Ninety-five percent of the parents were concerned about their children’s eyesight. Additionally, 17.6% of the students were suspected to have emotional or behavioral problems according to the parent-rated Strengths and Difficulties Questionnaire (SDQ) results. The Self-Rating Anxiety Scale (SAS) results of parents and teachers showed higher levels of anxiety than usual.ConclusionsStudents should continue the going-to-school rhythm at home to cope with changes caused by the COVID-19 pandemic. Integrated grade-specific approaches are needed. Because long screen time and insufficient outdoor activities can severely affect children’s eyesight, appropriate eye-protection measures should be implemented.

Reducing Anemia Among School-Aged Children in China by Eliminating the Geographic Disparity and Ameliorating Stunting: Evidence From a National Survey.

Background: The aim of this study was to assess the geographic disparity in anemia and whether stunting was associated with anemia in different geographic groups among school-aged children in China.Methods: 71,129 Han children aged 7, 9, 12, and 14 years old were extracted from the 2014 cycle of Chinese National Surveys on Children Constitution and Health. Anemia, anemia severity, and stunting were defined according to WHO definitions. Binary logistic regression models were used to estimate the association between anemia and stunting in different geographic groups.Results: The prevalence of anemia was significantly higher in girls (10.8%) than boys (7.0%). The highest anemia prevalence was in Group VII (lower class/rural, 12.0%). A moderate/severe prevalence of anemia was concentrated in Group VII and Group VIII (western/lower class/rural) for both sexes. The prevalence of anemia was higher in stunting boys than non-stunting boys in Group IV (lower class/city, χ2 = 12.78, P = 0.002) and Group VII (χ2 = 6.21, P = 0.018), while for girls, it was higher in stunting girls than their non-stunting peers only in Group II (upper class/large city, χ2 = 4.57, P = 0.046). Logistic regression showed that the stunting children have 30% higher risk of anemia than non-stunting children after adjustment for age, sex and school (OR = 1.30, 95% CI: 1.05–1.60).Conclusion: A significant geographic disparity and an association between anemia and stunting among specific groups of school-aged children in China was demonstrated. Consequently, eliminating the geographic disparity and ameliorating stunting might contribute to the improvement of Chinese children's anemia. Specific guidelines and interventions are needed, especially for adolescent girls and the groups with serious anemia burden.

Geographical influences on the iodine status in pregnant women, neonates, and school-age children in China

BackgroundPregnant women, neonates, and school-age children are vulnerable to iodine deficiency. The iodine contents in the environment (drinking water and household salt for cooking) vary by geographical location in China. The aim of this study was to assess the iodine status in vulnerable groups from different geographical zones and analyze the iodine content in household salt and drinking water from these zones.MethodsIn coastal and inland regions of Zhejiang Province, China, samples of spot urine, drinking water, and household salt for cooking from both pregnant women and school-age children were determined for iodine concentration between 2017 and 2018. Thyroid-stimulating hormone (TSH) levels from neonates born between 2014 and 2015 were acquired from the Newborns Screening Information System. The iodine status of the vulnerable populations was assessed according to the criteria recommended by the World Health Organization.ResultsThe median UIC of pregnant women was significantly lower in the coastal region (113.0 μg/L) than the inland region (134.9 μg/L; p < 0.001). The median UICs of pregnant women from these two regions were below the lower optimal iodine cutoff level of 150 μg/L. The percentage of neonates with elevated TSH (> 5 mIU/L) was significantly higher in the coastal region (15.8%) than the inland region (10.5%; p < 0.001). The percentage of neonates with elevated TSH from each region decreased within the range of mild iodine deficiency of 3–19.9%. The median UIC of the coastal school-age children was 156.0 μg/L, and the median UIC of inland children was 181.5 μg/L. Both medians fell within the recommended optimal iodine range of 100–299 μg/L. The iodine concentrations in drinking water varied from 1.0 μg/L in the inland region to 2.0 μg/L in the coastal region. The proportion of households that consumed iodized salt was lower in the coastal region (nearly 65%) than the inland region (approximately 95%).ConclusionsIn these two regions with low iodine contents in drinking water, both pregnant women and neonates were iodine-deficient, although school-age children were iodine-sufficient. Urgent efforts are needed to improve the iodine status of pregnant women and neonates.

The associations of economic growth and anaemia for school-aged children in China.

Economic growth has brought improvements in many areas of child health, but its effects on anaemia among school‐aged children remain unknown. However, this is important because iron deficiency anaemia is common and is the main cause of disability‐adjusted life years for school‐aged children. In this study, we included 429,222 Chinese children aged 7–17 years from five consecutive national cross‐sectional surveys during 1995–2014. Using altitude‐adjusted haemoglobin concentration measured from capillary blood samples, we defined anaemia status according to World Health Organization's recommendation. We used logistic regressions weighted by provincial population to examine the association between provincial gross domestic product (GDP) per capita and anaemia, adjusting for sex, age, urban–rural location, regional socio‐economic status (SES), fixed effect of province, and clustering of schools. We used generalised additive mixed models to evaluate a potentially non‐linear relationship. For each 100% growth in GDP per capita, there was a 40% (odds ratio [OR] = 0.60; 95% confidence interval [CI; 0.56, 0.65]) reduction in anaemia. However, the association was weaker for girls and in cities with a lower SES. The association was weaker across 2005–2014 (OR = 0.75, 95% CI [0.62, 0.90]) compared with 1995–2005 (OR = 0.52; 95% CI [0.44, 0.61]), reflecting a weaker association when GDP per capita reaches around $2,000. The results were similar for moderate‐to‐severe anaemia. We concluded that economic growth has been associated with reductions in anaemia among school‐aged children in China but with fewer benefits for girls and those in poorer settings. Further economic development in China is unlikely to bring similar reductions in anaemia, suggesting that additional population level and targeted interventions will be needed.

Low-to-moderate fluoride exposure in relation to overweight and obesity among school-age children in China

High fluoride exposure has been related to harmful health effects, but the impacts of low-to-moderate fluoride on child growth and obesity-related outcomes remain unclear. We performed a large-scale cross-sectional study to examine the association between low-to-moderate fluoride in drinking water and anthropometric measures among Chinese school-age children. We recruited 2430 resident children 7–13 years of age, randomly from low-to-moderate fluorosis areas of Baodi District in Tianjin, China. We analyzed the fluoride contents in drinking water and urine samples using the national standardized ion selective electrode method. Multivariable linear and logistic analyses were used to assess the relationships between fluoride exposure and age- and sex-standardized height, weight and body mass index (BMI) z-scores, and childhood overweight/obesity (BMI z-score > 1). In adjusted models, each log unit (roughly 10-fold) increase in urinary fluoride concentration was associated with a 0.136 unit increase in weight z-score (95% CI: 0.039, 0.233), a 0.186 unit increase in BMI z-score (95% CI: 0.058, 0.314), and a 1.304-fold increased odds of overweight/obesity (95% CI: 1.062, 1.602). These associations were stronger in girls than in boys (Pinteraction = 0.016), and children of fathers with lower education levels were more vulnerable to fluoride (Pinteraction = 0.056). Each log unit (roughly 10-fold) increase in water fluoride concentration was associated with a 0.129 unit increase in height z-score (95% CI: 0.005, 0.254), but not with other anthropometric measures. Our results suggest low-to-moderate fluoride exposure is associated with overweight and obesity in children. Gender and paternal education level may modify the relationship.

Short sleep duration is associated with specific food intake increase among school-aged children in China: a national cross-sectional study

BackgroundThe relationship between sleep duration and food intake is unclear. This study aims to examine the relationship among children aged 6–17 years in China.MethodsThe sample consisted of 70,519 children aged 6–17 years, which were randomly selected from 7 representative areas from China, from September to November, 2013. In the structured questionnaire, children reported daily sleep hours (less than 7 h, 7–9 h and more than 9 h), weekly food intake amount (including vegetables, fruit, sugar beverages and meat), physical activity and sedentary time. The relationship of sleep duration with vegetable, sugar beverage, fruit and meat intake was evaluated by multi-nominal logistic regression and multi-variable adjusted.ResultsA total of 62,517 children (51.6% boys) completed the study. Short sleep duration (SSD, < 7 h) was independently associated with increased sugar beverage intake (SBI, Odd Ratio, OR: 1.29, 95% CI: 1.19–1.40) but decreased vegetable (VI, OR: 0.94, 95% CI: 0.90–0.98) & fruit intake (FI, OR: 0.94, 95% CI: 0.88–0.99). Stratified by age and gender, SSD increased SBI for boys of both young (6–12 years) & older (13–17 years) groups and older girls (ORs: 1.25, 1.25, 1.49, 95% CI: 1.08–1.44, 1.04–1.50, 1.22–1.81, respectively), but decreased VI and FI for older girls (ORs: 0.84& 0.81, 95% CI: 0.74–0.96& 0.68–0.96, respectively).ConclusionsAmong school-aged children in China, short sleep duration was associated with increased risks of more sugar beverage intake among those younger and boys but less vegetable & fruit intake among those older and girls. Longitudinal research is needed to clarify the causation in between.

Short-term effects of ambient air pollution exposure on lung function: A longitudinal study among healthy primary school children in China

BackgroundShort-term exposure to ambient air pollution has been associated with reduced lung function among asthmatic children. However, there is little information about the effects among healthy children, especially in areas with relatively high exposure background. ObjectiveTo examine the association between short-term effects of ambient air pollutants and lung function among healthy primary school-aged children in China. MethodsA total of 334 healthy children (7–11 years) from four cities (Chengdu (Southwest China), Guangzhou (Southern China), Wuhan (Central China), and Xi'an (Northwest China)) in China with repeated lung function measurement in 2014–2016 were included. Daily ambient concentrations of PM2.5, PM10, NO2, SO2, mean temperature, and relative humidity data were obtained. Linear mixed model was used to estimate the percent change in lung function associated with per inter-quartile range (IQR) exposure (up to 3 days) increase after adjusting for confounders. ResultsAmbient PM2.5 and PM10 exposure were associated with decrements in lung function measurements. The moving average exposures generally showed stronger effect estimates than the single lag day exposures. An IQR increase in two-day average (lag01 day) PM10 exposure (IQR, 144 μg/m3) was significantly associated with 2.56% decrease in FVC, 5.46% in FEV1, 4.23% in PEF, and 7.35% in FEF25%, respectively. The effect estimates were stronger after adjusting for gaseous pollutants in particulate matter (PM) models. The strengths of these associations were stronger in girls than those in boys. ConclusionShort-term exposure to PM was associated with reduced lung function in healthy children. The estimated adverse effects were greater in girls than in boys.