The curse of modernization? Western fast food and Chinese children's weight.

The income-adjusted price of fast food in China is five times more than in the United States, yet we show that the introduction of Western fast-food restaurants to China still leads to significant weight gain in children. Using the community-year-level presence of Western fast-food outlets, difference-in-differences estimations find a 4.8-percentage-point increase in the prevalence of overweight/obese children after controlling for child and year fixed effects. The effect decreases at a distance of 3-4 km from a fast-food restaurant, and we find no further weight gain 2 years after the restaurant's introduction. The underweight rate is not affected by fast-food introduction. The increase in fat share of energy intake serves as the channel for weight gain. Children in high-income families, younger than 11 years, and girls are more affected than other Chinese children.

Parental economic insecurity and child health.

We explore the effects of parental economic insecurity on their children's hyperactivity and anxiety. Our central argument is that even after controlling for current family income and employment status, parents may have legitimate feelings of economic insecurity, and these may be detrimental for their children. Data from the National Longitudinal Survey of Children and Youth indicate that the health of 2- to 5-year-old children is worse when parents report themselves to be "worried about having enough money to support the family." In particular, boys are more hyperactive and girls are more anxious when parents feel less economically secure. Changes in parenting styles appear to be channels through which parental economic insecurity affects their children.

Improved Patient-Reported Medication Adherence, Patient Satisfaction, and Glycemic Control in a Collaborative Care Pharmacist-Led Diabetes "Tune-Up" Clinic.

Diabetes complications remain a leading cause of death, which may be due to poor glycemic control resulting from medication nonadherence. The relationship between adherence status and HbA1c (glycemic control) has not been well-studied for clinical pharmacist interventions. This study evaluated medication adherence, patient satisfaction, and HbA1c, in a collaborative pharmacist-endocrinologist diabetes clinic over 6 months. Of 127 referred, 83 patients met the inclusion criteria. Mean medication adherence scores, considered "good" at baseline, 1.4 ± 1.2, improved by 0.05 points (p = 0.018), and there was a 26% increase in patients with good adherence. A significant improvement of 0.40 percentage points (95% CI: -0.47, -0.34) was observed in mean HbA1c across the three time points (p < 0.001). Mean total satisfaction scores were high and increased, with mean 91.3 ± 12.2 at baseline, 94.7 ± 9.6 at 3 months, and 95.7 ± 10.8 at 6 months (p = 0.009). A multimodal personalized treatment approach from a pharmacist provider significantly and positively impacted glycemic control regardless of self-reported medication adherence, and patient satisfaction remained high despite changing to a clinical pharmacist provider and increased care intensity.

The shattered "Iron Rice Bowl": Intergenerational effects of Chinese State-Owned Enterprise reform.

Reform of the Chinese State-Owned Enterprise (SOE) sector in the late 1990s triggered massive layoffs (34 million employees) and marked the end of the "Iron Rice Bowl" guarantee of employment security for the remaining 67 million workers. An expanding international literature has documented the adverse health impacts of economic insecurity on adults, but has typically neglected children. This paper uses the natural experiment of SOE reform to explore the causal relationship between increased parental economic insecurity and children's BMI Z-score. Using province-year-level layoff rates and income loss from the layoffs, we estimate a generalised difference-in-differences model with child fixed effects and year fixed effects. For a medium-build 10-year-old boy, a median treatment effect implies a gain of 1.8 kg and a 2.2-percentage-point increase in the overweight rate due to the reform. Anxiety about potential losses causes weight gain for boys whose SOE parents kept their jobs. Unconditional quantile regressions suggest that boys who are heavier are more likely to gain weight. Girls are not significantly affected. Intergenerational effects therefore increase the estimated public health costs of greater economic insecurity.