Health-related quality of life in Chinese rural-to-urban migrants: Investigating the roles of working conditions and job satisfaction.

The existing research aims to explore the relationships between working conditions, job satisfaction and health-related quality of life (HRQL) of Chinese rural-to-urban migrants. Both probability and nonprobability sampling methods were done in four randomly chosen jurisdictions of Nanjing (N = 712). Results reveal that the working environment has the strongest and positive correlation with job satisfaction. In addition, job satisfaction is negatively correlated with the number of working days per week, and affects the physical and psychological health status of Chinese rural-to-urban migrants. This study highlights the importance to improve working conditions for migrants and their HRQL and recommends government policies to provide services to Chinese migrants and protect their human rights, as well as promote awareness of their working conditions and HRQL.

Equity in patient experiences of primary care in community health centers using primary care assessment tool: a comparison of rural-to-urban migrants and urban locals in Guangdong, China.

BACKGROUND: The equity of rural-to-urban migrants' health care utilization is already on China's agenda. The Chinese government has been embarking on efforts to improve the financial and geographical accessibility of health care for migrants by strengthening primary care services and providing universal coverage. Patient experiences are equally vital to migrants' health care utilization. To our knowledge, no studies have focused on equity in the patient experiences between migrants and locals. Based on a patient survey from Guangdong, China, which has a large number of rural-to-urban migrants, our study assessed the equity in the primary care patient experiences between rural-to-urban migrants and urban locals in the same health insurance context, since different forms of insurance can affect the patient experiences of primary care. METHODS: We stratified our samples by different insurance types into three layers. We assessed primary care patient experiences using a validated Chinese version of the Primary Care Assessment Tool (PCAT), including eight primary care attributes. A 'PCAT total score' was calculated. Data were collected through face-to-face and one-on-one surveys in 2014. Propensity score matching (PSM) was used for each layer to generate comparable samples between rural-to-urban migrants and urban locals. Based on the matched dataset, a t-test was employed to compare the primary care patient experiences of the two groups. RESULTS: Using PSM, 220 patients in the rural-to-urban migrants group were matched to 220 patients in the urban locals group. After the matching, the observed confounding variables were balanced, and the PCAT scores were almost equal between the two groups. The only slight differences existed in the Urban Employee Basic Medical Insurance layer and in the without basic medical insurance coverage layer. CONCLUSIONS: Equity in the primary care patient experiences between rural-to-urban migrants and urban locals seems to have been achieved to some extent. However, there is room for improvement in the equity of coordination of care and comprehensiveness. Policy makers should consider strengthening these two dimensions by integrating the health care system. More attention should be focused on helping migrants break down language and cultural barriers and improving the patient-physician communication process.

Comparing the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016.

BACKGROUND: With a large population of internal migrants from all over the world, China has the largest number of internal floating migrants, and most of them (up to 169 million in 2016) are rural-to-urban migrants. Those migrants have difficulty accessing essential health care services because of Hukou, leading to disparities in health needs and utilization between rural-to-urban migrants and residents. To compare the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016. METHOD: We used longitudinal data from the Chinese Labor Dynamic Survey (CLDS) with three waves in 2012, 2014 and 2016. Descriptive analysis was employed to show self-reported illnesses and health services utilization among locals and migrants in the most recent 2 weeks in China. Chi-square tests and log binomial regression models were constructed to explore factors influencing health care needs and utilization. RESULT: A total of 19.97% of respondents were rural-to-urban migrants, with an upward trend from 2012 to 2016. Rural-to-urban migrants (11.99%) had higher needs for health services than urban residents (10.47%) in general, while urban residents and migrants had no differences in needs in 2012. Besides, there was no difference in the utilization of health services between residents and migrants in 2012, 2014 or 2016. In addition, increased age, male sex, poor medical insurance coverage and dissatisfaction with income were found to have negative effects on health care needs. CONCLUSION: This study has shown that the rural-to-urban migrants had higher health care needs but the same health care utilization compared with urban residents in China. Health policies focusing on equitable health outcomes should pay more attention to rural-to-urban migrants in China's health care system reform.

The Prevalence of Cigarette Smoking Among Rural-to-Urban Migrants in China: A Systematic Review and Meta-Analysis.

BACKGROUND: The increasing rural-to-urban migrant population in China may be linked to the susceptibility to tobacco use. We aimed to investigate the prevalence of smoking among rural-to-urban migrants in China. METHODS: Major English and Chinese databases were searched for original studies on smoking prevalence among rural-to-urban migrants in China. A validated quality assessment tool was used to evaluate these studies. Subsequently, data were extracted to calculate the overall pooled estimate of prevalence using random effect model, and then stratified by gender, definition, location, and occupation. Meta-regression analysis was used to identify the source of heterogeneity among variables. RESULTS: We identified 17 eligible studies involving 32,694 migrants. The overall pooled prevalence estimate of smoking among rural-to-urban migrants was 27.25% (95% CI: 23.34, 31.34), with significant heterogeneity (I(2) = 98.2, p < .01). In stratified analysis, specific pooled prevalence estimates were 46.71% for male (95% CI: 40.51, 52.97) and 5.34% for female (95% CI: 2.90, 8.45); 26.71% (95% CI: 17.00, 37.71), and 24.96% (95% CI: 18.65, 31.86) in current and daily smoking group, respectively; 21.89% (95% CI: 15.80, 28.66) and 30.59% (95% CI: 20.04, 42.28) for migrants in North and South China, respectively; 48.34% (95% CI: 24.63, 72.46) in construction industry, 31.77% (95% CI: 15.54, 50.67) in manufacturing industry and 18.69% (95% CI: 11.37, 27.32) in service industry, respectively. Meta-regression analysis revealed that gender and occupation differences contributed to high heterogeneity. CONCLUSION: Cigarette smoking is still prevalent among rural-to-urban migrants, which may be influenced by gender and occupations. Policies should be designed and conducted to control smoking prevalence among these populations.

The effect of haze pollution on rural-to-urban migrants' long-term residence intentions.

Severe haze pollution in China threatens human health, and its negative effect hampers rural-to-urban migrants' settlement intentions in destination cities. Using the 2017 China Migrants Dynamic Survey Data (CMDS), the satellite data of PM2.5, and city-level data, this study investigates the impact of haze pollution on rural migrants, long-term residence intentions in Chinese context with IV-probit model, and mediating effect model. Overall, we find an inverted U-shaped relationship between the level of haze pollutants and rural migrants' long-term settlement intentions. Robustness check using multi-measures and thermal inversion as the instrumental variable supports this conclusion. The mediating effect model shows haze pollution plays its role through two opposite mechanisms: signal effect and health effect. When the size of signal effect is larger than health effect, rural migrants are inclined to settle down in their host cities; otherwise, they show lower settlement willingness. The turning point appears when PM2.5 concentration reaches 38.5 µg/m3; migrants have the highest long-term residence intentions. Currently, the national average PM2.5 concentration is 40.98 µg/m3, indicating that China is at the stage where the health effect of haze pollution holds a dominant position. Haze pollution has heterogeneous impacts on migrants' residence intentions. From the individual level, the younger generation, female, and higher-educated migrants have a higher tolerance for polluted air. From the city level, migrants who work in the city with 5 to 10 million dwellers have the highest long-term residence intention and are less sensitive to haze pollution. Thus, we propose stringent environmental regulations and more inclined public service policies to migrants.

Does Social Capital Improve the Effectiveness of Public Service? An Insight from Rural-to-Urban Migrants in China.

Despite the extensive literature on the effectiveness of public service, measuring it from the user's side among rural-to-urban groups is limited. Moreover, although rich research has explored the factors influencing the effectiveness of public service, in-depth micro-level analysis is scarcely addressed. The current study addresses these gaps by examining the relationship between social capital and the effectiveness of public service in Jiangsu province of China. Overall, the findings revealed that migrant's social capital positively affects their perceptions of public service provision. Specifically, the structural dimension of social capital plays a role in expanding information channels. In contrast, the relational dimension of social capital works through shared norms and trust, eventually improving migrants' fairness perception. Notably, these effects are more prominent in education, employment assistance, and minimum livelihood security than in other services. Further, the findings revealed that regional differences are more pronounced in the central part of the study area, where the current public service system is weak. Put differently; social capital can have a more significant effect when the construction of public service is constrained. It is also found that social capital plays a more important role for migrants working in the manufacturing industry than in other sectors. This study has significant implications for policymakers with a new perspective of social capital for improving the quality of public service and making it more available to migrants.

Inequalities in the Access to Health Services Among Older Migrants: Evidence From the China Migrant Dynamic Monitoring Survey.

Objectives: To identify differences in healthcare use between older migrant workers (OMWs) and older migrants (OMs) and explore associated factors and paths of healthcare use. Methods: The data came from the 2015 China Migrant Dynamic Monitoring Survey (CMDMS). CMDMS used a multi-stage stratified probability proportionate to size method as the sampling technique and conducted a desk review. The samples include OMWs, OMs for caring offspring (N = 4,439), and OMs for receiving care from family (N = 4,184). We built logistic regression and path analysis models to analyze the data. Results: Social health insurance (SHI) in current place of residence is associated with less expenditure among all subgroups. OMWs and OMs for receiving care from family with SHI in current place of residence are more likely to use healthcare. Conclusion: OMWs are particularly vulnerable in healthcare use and socioeconomic status. Having SHI registered in current place of residence helps decrease expenditure among OMs. We urge policymakers to consider a united health financing scheme across OMWs and other urban employees and streamline policies for migrants to enroll in SHI in current place of residence.

Low Behavioral Intention to Use Any Type of HIV Testing and HIV Self-Testing among Migrant Male Factory Workers Who Are at High Risk of HIV Infection in China: A Secondary Data Analysis.

This study investigated the prevalence of and factors associated with behavioral intention to take up any type of HIV testing and HIV self-testing (HIVST) in the next six months among male migrant workers, who were at high risk of HIV infection, in Shenzhen, China. This was a secondary data analysis. A total of 363 subjects who had sexual intercourse with non-regular female sex partners and/or female sex workers in the past six months were selected. Logistic regression models were fitted for data analysis. About 16.5% of participants reported having used HIV testing in their lifetime and 12.7% for HIVST. Among the participants, 25.6% and 23.7% intended to take up any type of HIV testing and HIVST in the next six months, respectively. Significant factors associated with the behavioral intention to take up HIV testing and HIVST included individual-level factors based of the Health Belief Model (e.g., perceived benefit, perceived cue to action, perceived self-efficacy) and interpersonal-level factors (e.g., frequency of exposure to health-related content or HIV and STI-related content on short video apps). This study provided practical implications for designing interventions to increase the uptake of HIV testing and HIVST among migrant workers.

Local Ties, Trans-Local Ties, and Substance Use among Rural-to-Urban Migrants in China.

China has witnessed unprecedented rural-to-urban migration since the early 1980s. While trying to assimilate into the city, rural-to-urban migrants still maintain close ties with their home communities. This study examines how local ties and trans-local ties of rural-to-urban migrants affect their alcohol and tobacco use. Data were obtained from the 2016 and 2018 China Labor-force Dynamics Survey, a nationally representative sample of adults aged over 15 in 29 provinces in China. Participants included 1426 rural-to-urban migrant workers and 6438 urban residents in China. We found that compared to urban natives, rural-to-urban migrants had higher tobacco use prevalence (logit = 0.19, 95% CI = [0.03, 0.35]; p < 0.05) and more frequent alcohol use (logit = 0.27, 95% CI = [0.11, 0.42]; p < 0.001) after adjusting for sociodemographic characteristics. Migrants with more local social ties engaged in more frequent drinking (having >10 local friends vs. having 0 local friends: logit = 0.58, [0.10, 1.06], p < 0.05), whereas trans-local ties were not a significant correlate. In contrast, migrants who returned to their hometown more times (an indicator of trans-local ties) were more likely to be current tobacco users (logit = 0.01, 95% CI = [0.00, 0.02], p < 0.01) after adjusting for sociodemographic variables. These findings extended the research on social networks and health behaviors by identifying how local and trans-local ties differentially affected the vulnerabilities of tobacco and alcohol use among rural-to-urban migrants in China. The findings suggested that policies and interventions on reducing migrants' health risk behaviors should focus on the role of different types of social ties.

Association between acculturation surrogates and alcohol consumption in rural-to-urban migrants: The PERU MIGRANT study.

INTRODUCTION: There is a paucity of information about the association between acculturation and alcohol consumption in rural-to-urban migrants who move to urban environments usually characterized by a higher prevalence of alcohol consumption than their rural places of origin. OBJECTIVES: To evaluate the cross-sectional association between surrogates of acculturation and alcohol consumption in Peruvian rural-to-urban migrants; to explore the effects of sex and age at migration on these associations; and to explore this association longitudinally. METHODS: Data from the PERU MIGRANT Study, which evaluated a cohort of Peruvian rural-to-urban migrants from 2007 to 2012, were analyzed. Four acculturation surrogates were evaluated: language preference on the radio, language spoken at home, Spanish proficiency, and length of residence in urban area. Alcohol consumption was defined as having consumed alcohol in the last year at the time of the baseline survey, while onset of alcohol consumption was defined as having consumed alcohol in the last year at the follow-up survey. Poisson regressions with robust variance were performed to estimate crude and adjusted prevalence ratios (PR) and relative risks (RR) with a 95% confidence interval (95% CI) to cross-sectional and longitudinal analyses respectively. RESULTS: Data from 567 rural-to-urban migrants, mean age 47.6 years (SD ±11.5), 52% females, was included in the study. Crude cross-sectional analyses showed an association between acculturation surrogates and alcohol consumption, but these were not observed in adjusted regressions. In the sex-stratified analyses, only women showed an association between Spanish proficiency and alcohol consumption, where those with higher language proficiency had a 22% higher prevalence of alcohol consumption (PR: 1.22, 95% CI: 1.04-1.43). Analyses stratified by age at migration showed no association between acculturation surrogates and alcohol consumption. On the longitudinal analyses, acculturation surrogates were not associated with the onset of alcohol consumption. CONCLUSIONS: No association between acculturation surrogates and alcohol consumption in cross-sectional and longitudinal analyses were found. The only exception was observed in female migrants according to their Spanish proficiency and alcohol consumption .

The Interactive Effect of Social Capital and Duration of Migration on Suicidal Behaviors Among Rural-to-Urban Migrants in China: Evidence from a GIS/GPS-Assisted Probability Sample.

Suicide for rural-to-urban migrants in China presents a challenge. Social capital as a modifiable factor is associated with suicidal behaviors at different levels for different populations. This study focuses on the social capital-suicidal behavior relationship among rural migrants with detailed social capital measures and their interaction with migration duration. Data were collected from a rural migrant sample in Wuhan, China. Outcome variable was reported suicidal ideation and attempts in the past 12 months. Social capital was measured using the Personal Social Capital Scale. Year of migration was measured as the number of years a subject migrated to the city. Multivariate logistic regression (coefficients [95%CIs]) was used for data analysis. Time of crossover for interaction was estimated as the year when the effect of social capital on a suicidal behavior revered from negative to positive. Study findings show a negative association between social capital and suicidal ideation (-1.48 [-2.86, -0.10]), but the association was not significant for suicidal attempts (-1.30 [-2.68, 0.08]) after considering the positive interaction between social capital and year of migration (0.11 [0.03, 0.19] for ideation and 0.11 [0.02, 0.19] for attempts). Similar effects were found for detailed social capital measures. The estimated time of crossover ranged from 7.0 to 14.8 years for different social capital measures. The findings of this study confirm the protective relationship between social capital and suicidal behaviors in the early years of migration among rural migrants. These findings inform suicide prevention among rural migrants by considering social capital during the first 7 to 15 years of migration.

Public and Commercial Medical Insurance Enrollment Rates of Rural-to-Urban Migrants in China.

Objectives: Large-scale rural-to-urban migration of China has provoked heated discussion about the health of migrants and whether they have equal access to the health resources. This article aimed to compare the public and commercial medical insurance enrollment rates between temporary, permanent migrants and urban natives. Methods: Average marginal effects (AME) of the weighted logistic regression models using 2017 China General Social Survey from 2,068 urban natives, 1,285 temporary migrants, and 1,295 permanent migrants. Results: After controlling for the demographic and socio-economic characteristics, our results show that while the temporary and permanent migrants have a similar public insurance enrollment rate compared with the urban natives, both temporary and permanent migrants have significantly lower commercial insurance enrollment rates (7.5 and 5.3%, respectively) compared with the urban natives. Conclusions: The results highlight significant institutional barriers preventing the temporary migrants from gaining access to public medical insurance and the adverse impact of disadvantaged socio-economic backgrounds on the access of temporary migrants to both public and commercial insurance.

The Quality of Tuberculosis Care in Urban Migrant Clinics in China.

Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we selected and separated clinics into those that mainly serve migrants and those that mainly serve local residents. Using standardized patients, this study provided an objective comparison of the quality of tuberculosis care delivered by both types of clinics and examined factors related to quality care. Only 27% (95% confidence interval (CI) 14⁻46) of cases were correctly managed in migrant clinics, which is significantly worse than it in local clinics (50%, 95% CI 28⁻72). Clinicians with a base salary were 41 percentage points more likely to demonstrate better case management. Furthermore, clinicians with upper secondary or higher education level charged 20 RMB lower out of pocket fees than less-educated clinicians. In conclusion, the quality of tuberculosis care accessed by migrants was very poor and policies to improve the quality should be prioritized in current health reforms. Providing a base salary was a possible way to improve quality of care and increasing the education attainment of urban community clinicians might reduce the heavy barrier of medical expenses for migrants.

Commercial Sexual Behaviors Among Male Rural-to-Urban Migrants in Western China: Implications for HIV Prevention.

Rural-to-urban migrants are at high risk of HIV infection. The goal of this survey was to explore the commercial sexual behavior and condom use among male rural-to-urban migrants in western China. A cross-sectional survey on male rural-to-urban migrants in western China was conducted. Among all the subjects surveyed, 140 (7.4%) had commercial sexual behavior, which is associated with being aged older than 24 years, being of Han or other ethnic minorities, being divorced, separated, or widowed, having experienced drug abuse, having had heterosexual behavior, having had casual sexual partners, having had sex with a homosexual, and being from Xinjiang. A total of 31.4% of them never use condoms when buying sex. Not using condoms is associated with being from Chongqing, having a high school or above education, and having commercial sex monthly. Commercial sexual behavior and not using condoms are common among male rural-to-urban migrants in western China. Strategies and appropriate education should be developed to prevent HIV transmission due to high-risk sexual behaviors.

Dual Identity and Prejudice: The Moderating Role of Group Boundary Permeability.

Past work suggested that dual identity was effective to reduce prejudice. This study extended research on dual identity and prejudice by identifying a boundary condition in this relationship, that is, group permeability. In Study 1, we replicated previous studies with Chinese individuals and found that inducing dual identity (emphasizing subgroup differences and a common nation identity), compared to the control condition, decreased the urban residents' prejudice against rural-to-urban migrants. In Study 2, we manipulated the group boundary permeability using the Hukou system reform, and found that when the group boundary was permeable, dual identity was effective in reducing prejudice against rural-to-urban migrants. However, this effect vanished in the condition where the group boundary was impermeable. These results point to the importance of inducing dual identity under specific conditions for research on decreasing prejudice. Some practical implications of the findings for urbanization and immigration are discussed.

The Effects of Objective and Subjective Socioeconomic Status on Subjective Well-Being among Rural-to-Urban Migrants in China: The Moderating Role of Subjective Social Mobility.

Although previous investigations have agreed that Chinese rural-to-urban migrants' socioeconomic status (SES) increases with their migration, the association between SES and subjective well-being is uncertain. To address this research gap, the present study proposed that the association between objective SES and subjective well-being is mediated by subjective SES. This model was tested with a sample of 432 Chinese rural-to-urban migrants. The results indicate a significant association between objective SES and subjective well-being and a partial mediating effect of subjective SES. Furthermore, subjective social mobility, which is one's expectation about the possibility to move upward in the social hierarchy, was found to moderate both the direct path from objective SES to subjective well-being and the indirect path from subjective SES to subjective well-being. These findings suggest that Chinese rural-to-urban migrants gained in subjective well-being not only because of direct financial achievement but also because of their perceptions and beliefs about their relative social status.

Migration Stress, Poor Mental Health, and Engagement in Sex with High-Risk Partners: A Mediation Modeling Analysis of Data from Rural-to-Urban Migrants in China.

BACKGROUND: There is a growing need for better understanding of mechanisms underpinning the relationship between migration stress and HIV risk behaviors for the development of HIV prevention and control policy. METHODS: Survey data from a random sample of 1,293 Chinese rural-to-urban migrants were analyzed. Stress was assessed using the Domestic Migration Stress Questionnaire (DMSQ), mental health status was assessed using the Brief Symptoms Inventory (BSI), and having sex with high risk partners was assessed as if ever have had sex with high risk partners (e.g., sex workers, intravenous injection drug users, blood donors, persons infected with HIV, persons with sexually transmitted infection, and same gender partners) in the past year. The proposed relationship was tested using mediation modeling method. RESULTS: Among the sample, 5.5% reported having had sex with high-risk partners in the past year. Mediation analysis indicated that the relationship between DMSQ scores and having sex with high-risk partners was mediated by BSI (coefficient =0.41, 95% CI [0.21, 0.65]), including its components of somatization (0.32 [0.15, 0.53]), obsessive-compulsive disorder (0.31 [0.07, 0.55]), depression (0.45 [0.23, 0.72]), anxiety (0.41 [0.23, 0.63]), and hostility (0.35 [0.17, 0.56]). Furthermore, the effect was more pronounced in males than in females. CONCLUSION: The study findings provide new data advancing our understanding of the mechanism of engagement in risky sex, underscoring the need for the HIV prevention policies in China to pay more attention to mental health of the rural-to-urban migrant population.

Comparison of the status of overweight/obesity among the youth of local Shanghai, young rural-to-urban migrants and immigrant origin areas.

BACKGROUND: Obesity in adolescents and children has become a global public health problem and lots of factors influence the status of obesity and overweight. The present study aims to compare the health-related factors which could influence the obesity in Chinese children and adolescents in three different groups which including the local developed city group, rural-to-urban migrants group and immigrants origin areas group. METHODS: We conducted a cross-sectional study consisted of 2457 children and adolescents aged 7-10 years old including 914 rural-to-urban migrants subjects, 795 local Shanghai subjects and 748 from immigrant origin areas. Physique measurements and self-reported information on health-related factors, such as physical activities, dietary habits, socio-economic factors such as family income, sleep habits, etc. were collected by questionnaire. SPSS16.0 was used in the analysis. RESULTS: Mean level of body height, body weight and sitting height were different among the three groups, local youth group was higher in all the indexes than the other two groups. Grip for both hands were higher in local group also, while the heart rate was lowest in rural-to-ruban migrants group. The mean BMI in three groups showed significant difference, highest for local group. Higher SBP level was found in city and rural-to-urban migrants group also. However, no difference of DBP between groups was detected. The distribution of pre-hypertension and hypertension in three groups were significantly different and the distribution of overweight and obesity between genders in all three groups were different. The prevalence of overweight was 19.04% in rural-to-urban migrants group (19.92% for male and 17.64% for female), 28.21% for city group (35.64% for male and 20.72% for female); while no overweight or obesity subjects were found in immigrant origin areas group in this study. When compared the overweight and obesity prevalence between city group and rural-to-urban migrants, we found the overweight was more common in the local youth group. Univariable Logistic regression analysis and multivariable analysis results suggested that the more rice intake, higher family income and SBP higher than 140 mmHg were risk factors to obesity for rural-to-ruban migrants, while good dietary habits (no TV watching during meals) was preventive factor to obesity and SBP higher than 120 mmHg and unsocial factor were associated with obesity for rural-to-urban migrants. CONCLUSIONS: Our study revealed the prevalence of overweight and obesity in developed city children and adolescents and rural-to-urban migrants were relatively high, especially more common in local population and male gender. Lifestyle, dietary and psychological factors offered important contribution in increasing or decreasing the risk of obesity.