Using individual mortality records from three cohorts of newborns (1954-1958, 1959-1962, and 1963-1967) from a large national fertility survey data conducted in 1988 in China, I examine the effect of being conceived or born during the 1959-1961 Great Leap Forward Famine on postnatal mortality. The results show strong evidence of a short-term (period) effect of the famine, caused directly by starvation or severe malnutrition during the period of the famine. After controlling for period mortality fluctuation, however, the famine-born cohort does not show higher postnatal mortality than either the pre-famine or the post-famine cohort – as would have been expected from the “fetal origins” hypothesis. Aggregate-level cross-temporal comparisons using published cohort population counts from China’s 1982 Census, 1990 Census, 1995 micro Census, 2000 Census, and 2005 micro Census lead to the same conclusion. The relevance of these new findings for the “fetal origins” hypothesis and the selection effect hypothesis is discussed.

We re-visit the issue of “compensatory growth hypothesis”. The main idea is that some infants who experience substandard growth due to nutrition deficiency may grow faster than other children at a later age, and eventually catch up. We test this hypothesis using the data from the Cebu longitudinal study that records two developmental phases for each individual: the first developmental phase includes 12 bi-monthly records from age zero to age two, and the second developmental phase includes three records measured around age 7, 10 and 14. To test the compensatory growth hypothesis is to identify a subgroup in the sample that grows slower than others from age 0-2, but catches up from age 7-14. Being able to simultaneously identify the optimal number of subgroups that has qualitatively different growth trajectories and the growth trajectory within each subgroup based on empirical data is the major strength of growth mixture modeling technique.

Using individual retrospective mortality records for three cohorts of newborns (1956- 1958, 1959-1961, and 1962-1964) drawn from a large national fertility survey conducted in 1988 in China, I examined cohort differences in mortality up to age 22, aiming to identify debilitation and selection effects of the 1959-1961 Great Leap Forward Famine. The results revealed the presence of a mortality crossover between ages 11 and 12, when the mortality level of the non-famine cohort caught up to and exceeded the level of the famine cohort. The presence and timing of the mortality crossover suggests that both debilitation and selection effects influenced the post-famine cohort mortality pattern. In addition, the multilevel multiprocess models established a direct connection between frailties for infant mortality and mortality at subsequent ages, thus demonstrating the theoretical inevitability of mortality crossover after famine as the result of the convergence process caused by selection due to frailty.

The fundamental cause argument represents a distinctively sociological approach to explaining persistent social disparities in health across a range of sociohistorical contexts. We elaborate and test this U.S.-based argument using nationally representative survey data from China covering births from 1970 to 2001, and focusing on social disparities in infant mortality over a period of dramatic social, political, and macroeconomic change. Our results show that despite the massive changes during the last several decades, the increasing use of medical pregnancy care, and the steady decline in the overall risk of infant mortality, disparities in infant mortality by mother’s education and urban/rural place of residence remained largely unchanged. During this period, more educated women were increasingly likely to take advantage of the newly-available prenatal care and delivery assistance facilities, while urban women maintained a stable advantage over rural women in use of these facilities. This differential utilization of highly-effective maternal care technology has maintained social disparities in infant mortality over a period of major social and technological change in China, providing support for the fundamental cause argument.

A substantial body of research has demonstrated that son preference has a serious impact on the survival and well-being of female infants and children in some parts of South and East Asia, but little is known about the consequences of son preference in later childhood and adolescence. We compare male and female children’s growth trajectories in height over childhood and adolescence in China, where the level of son preference is relatively high, and the Philippines, where the level of son preference is relatively low. Children’s height indexes well-being because it reflects long-term nutritional status and exposure to infectious diseases, both influenced by household decision-making and, presumably, by a preference for sons. Using longitudinal data from the China Health and Nutrition Survey and the Cebu Longitudinal Health and Nutrition Survey and multilevel growth models, we find that male children in China show an excess height advantage relative to their female counterparts, when compared to the male-female difference in growth trajectories in the Philippines. Further analysis reveals that the excess male advantage in China is evident only in rural areas. These findings are discussed in the context of the reproduction of gender inequality across the life course in high son preference settings.

Study Objectives: Insomnia is influenced by psychosocial and environment factors. This study aims to examine the differential of insomnia symptoms between rural-to-urban migrants and non-migrants in China. Design: A cross-sectional study. Setting: Ten townships throughout China. Patients or Participants: One hundred and ninety-seven Chinese adults aged 18 to 64 years, with an oversample of migrants. Measurements and Results: Professional interviewers and community doctors used a questionnaire to collect information on migration, insomnia symptoms, and other variables. Multivariable binomial logistic regression models were used to examine the relations between migration status and presence of at least one insomnia symptom, while adjusting for age, sex, education, income, number of chronic medical conditions, depression, and other covariates. The numbers of permanent urban residents, rural non-migrants, and rural-to-urban migrants in the study were 93 (47%), 47 (24%), and 57 (29%), respectively. The probability of reporting at least one of the five insomnia symptoms measured was 40% for permanent urban residents, 62% for rural non-migrants, and 68% for migrants (P = 0.001). Using permanent urban residents as the reference group, the multiply-adjusted odd ratios of having at least one insomnia symptom were 3.00 (95% CI: 1.36 – 6.62) for migrants and 1.86 (95% CI: 0.73 – 4.74) for rural non-migrants. The adjusted odd ratio for insomnia symptoms predicted from each additional chronic medical condition was 1.71 (95% CI: 1.13 – 2.60). 2 Conclusions: Compared to permanent urban residents, rural-to-urban migrants in China have higher prevalence of insomnia symptoms. The number of chronic medical conditions reported is also independently related to sleep disturbance. Key words: migration status, insomnia, China

Surveys in China conventionally sample from local area residential registers, which until recently have been of sufficient accuracy to function as de facto population registers. Due to a combination of large scale internal migration and massive replacement of housing in urban areas, a large fraction of the population currently does not live where registered. Individuals not living where registered are thus ineligible for inclusion in conventionally generated samples. Surveys whose samples depend on access to residential registers are inherently based on an under-enumeration of the population, as well as on a biased representation of the population due to exclusion of unregistered local residents. We report conclusions from, and observations related to, a pilot study designed to test the feasibility and effectiveness of a sampling method that does not depend on residential registers. In the pilot we (1) purposively selected small areas; (2) enumerated the small areas; (3) randomly sampled individuals from the enumeration lists; and (4) interviewed sampled individuals. This approach substantially reduced the underenumeration problem. As implemented, however, its point of departure required previously selected small areas. We describe an extension designed to achieve full coverage of the population of China through sampling of small areas as the penultimate stage of a multi-stage design.