Potential factors associated with resilience among older adults in rural China: a multilevel analysis.

BACKGROUND: Resilience is crucial for older adults who experience adversities, but research on the issue in rural China remains limited. This study aims to examine factors associated with resilience among older adults in rural China, as related to different types of resilience, and under different levels of adversity. METHODS: Data were taken from the eight-wave (2001-2021) Longitudinal Study of Older Adults in Anhui Province, China. We used data from the eighth wave (2021) for the outcome variables and lagged predictors (2018) to avoid reverse causal effects. The study sample included individuals 60 years and above, excluding new participants from 2021, those without any adverse events, and any respondents with incomplete analytic data. Resilience was operationalized as residuals of the regressions of life satisfaction (Life Satisfaction Scale) and depressive symptoms (CES-D) on adversity, referred to as Type-1 and Type-2 resilience respectively. These two types of resilience were then treated as the outcome variables in subsequent multilevel regressions, with the predictors focusing on individual, social, and environmental characteristics and resources. This study adheres to STROBE guidelines. RESULTS: 43% of rural older adults exhibited both Type-1 and Type-2 resilience, whereas 18% exhibited only Type-1 resilience and 7% exhibited only Type-2 resilience. Common factors associated with both types of resilience included self-rated health, satisfaction with one's own financial situation, and the prestigiousness of social networks. Predictors for higher levels of Type-1 resilience included higher levels of financial and emotional support and more options for places of leisure. Predictors for higher levels of Type-2 resilience included greater access to medical care. The prestigiousness of social networks, higher levels of emotional support and instrumental support, access to medical care, and more options of places of leisure were positively associated with resilience in the low-adversity group (first tertile of adversity), only satisfaction with financial situation was positively correlated with the resilience of the middle-adversity group (second tertile), while better self-rated health, satisfaction with financial situation, and financial support yielded greater resilience in the high-adversity group (third tertile). CONCLUSIONS: We examined two types of resilience among older adults in rural China, and found that they have shared and unique associated factors. In addition, the potential factors influencing resilience varied with the level of adversity.

Widowhood and depression: a longitudinal study of older persons in rural China.

Using six waves of longitudinal data (2001-2015) collected in Anhui, China (N = 2,131) and generalized estimating equations (GEE) models, this study fulfilled several objectives. First, the study compared the widowed to the married to examine if the transition to and duration of widowhood contributes to changes in depression. Second, the study examined if the bereavement-depression relationship is a process that precedes widowhood or is an abrupt change following the death of a spouse. Third, the study examined if social resources influence the bereavement-depression relationship. The study found that there is pre-widowhood effect on depression and that the widowhood event also contributes to increases in depression. Levels of post-widowhood depressive symptoms peak during the first six months bereavement and taper off within 25 months. Controlling for social support, contact with children, and living arrangements does not change the bereavement-depression relationship. The findings support Attachment Theory, which suggests that the loss of a spouse leads to emotional isolation that cannot be overcome with kin-based social support and social integration.

The decline in China's fertility level: a decomposition analysis.

Many factors have contributed to the decline in China's fertility level. Using China's population census data from 1990, 2000 and 2010, the present study investigates the factors causing the decline in China's fertility rate by decomposing changes in two fertility indices: the total fertility rate (TFR) and the net reproduction rate (NRR). The change in the TFR is decomposed into the change in the marital fertility rate (MFR) and the change in the proportion of married women (PMW). Four factors contribute to the change in the NRR. The following are the main findings. A drop in the MFR caused a decrease in the TFR and the NRR between 1989 and 2000. However, the change in MFR increased TFR and NRR between 2000 and 2010. Marriage postponement caused a decline in the fertility level between 1989 and 2000 as well as between 2000 and 2010. The effect of the MFR and marriage postponement varied with age and region and also between urban and rural areas.

Impacts of conservation and human development policy across stakeholders and scales.

Ideally, both ecosystem service and human development policies should improve human well-being through the conservation of ecosystems that provide valuable services. However, program costs and benefits to multiple stakeholders, and how they change through time, are rarely carefully analyzed. We examine one of China's new ecosystem service protection and human development policies: the Relocation and Settlement Program of Southern Shaanxi Province (RSP), which pays households who opt voluntarily to resettle from mountainous areas. The RSP aims to reduce disaster risk, restore important ecosystem services, and improve human well-being. We use household surveys and biophysical data in an integrated economic cost-benefit analysis for multiple stakeholders. We project that the RSP will result in positive net benefits to the municipal government, and to cross-region and global beneficiaries over the long run along with environment improvement, including improved water quality, soil erosion control, and carbon sequestration. However, there are significant short-run relocation costs for local residents so that poor households may have difficulty participating because they lack the resources to pay the initial costs of relocation. Greater subsidies and subsequent supports after relocation are necessary to reduce the payback period of resettled households in the long run. Compensation from downstream beneficiaries for improved water and from carbon trades could be channeled into reducing relocation costs for the poor and sharing the burden of RSP implementation. The effectiveness of the RSP could also be greatly strengthened by early investment in developing human capital and environment-friendly jobs and establishing long-term mechanisms for securing program goals. These challenges and potential solutions pervade ecosystem service efforts globally.

Natural capital and ecosystem services informing decisions: From promise to practice.

The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals.

Female fertility history and mid-late-life health: Findings from China.

China's middle-aged and older women suffer from poorer health than men. Using national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies logistic models to investigate the association between female fertility history (parity, early childbearing, late childbearing) and middle-aged and late-life health. We find that parity is related to the mid-late-life health of women. Women with four children or more are more likely to suffer from activities of daily living (ADL) impairment and poorer self-rated health than those with one to three children. Early childbearing is associated with ADL impairment; however, the correlation is mediated by socioeconomic status. Early childbearing is related to self-rated health in later life by an indirect-only mediation effect via educational attainment and personal income.

Commercial sex behaviours among involuntary male bachelors: findings from a survey of migrants in Xi'an, China.

BACKGROUND: The highly male-biased sex ratio at birth has produced a severe male 'marriage squeeze' in China. However, with an imbalanced sex ratio, the marriage-squeezed or involuntary bachelors can meet their sexual needs only through ways other than marriage. METHODS: To investigate the commercial sex behaviours of involuntary bachelors, we conducted a survey on reproductive health and family living among male migrant bachelors in Xi'an City, the capital of Shaanxi Province, from December 2009 to January 2010. RESULTS: The prevalence of commercial sex use was 37.2% among unmarried men, 30.1% among married but separated men and 17.2% among married and cohabitating men (χ(2) = 31.33; P = 0.000; df = 2). Marital status, knowledge about acquired immunodeficiency syndrome (AIDS), age and income were associated with the prevalence and frequency of commercial sex behaviours. Condom use was less frequent among involuntary bachelors and was significantly associated with knowledge about AIDS and other sexually transmitted diseases, the frequency of commercial sex behaviours, marital status and age. CONCLUSIONS: The higher prevalence of commercial sex behaviours and the lower frequency of condom use indicate a higher risk of disease from commercial sex among involuntary bachelors, implicating both individual and public health.

HIV knowledge among male labor migrants in China.

BACKGROUND: This study described knowledge about HIV prevention and transmission among labor migrants in China and assessed the factors that associate with HIV knowledge. METHODS: The study is based on primary data collected in Xi'an city, China. The study includes 939 male rural-to-urban migrants aged 28 and older. The multivariate analysis used OLS regression techniques to examine the correlates of HIV knowledge. RESULTS: Most migrants know what AIDS/HIV is, but many have deficient knowledge about self-protection and the transmission routes of HIV. About 40% of migrants fail to understand that condoms decrease the risk of HIV infection. Higher levels of education and internet usage associate with better HIV knowledge. Migrants who have engaged in sex with commercial sex workers have better HIV knowledge than migrants who have never paid for sex. This includes better knowledge of self-protection. CONCLUSION: Labor migrants are a high risk population for HIV infection. Their lack of HIV knowledge is a serious concern because they are a vulnerable group for infection and their sexual behaviors are spreading HIV to other members of the population and across geographic areas.

Family structure and quality of life of elders in rural China: the role of the new rural social pension.

Using data from a survey in Ankang district of Shaanxi province of China in 2011, this article examines the protective effect of the New Rural Social Pension (NRSP) on quality of life of rural elders, as well the moderating effect on association between family structure and quality of life. An instrumental variable approach is used. NRSP is shown to significantly improve the quality of life of rural elders, and a robustness check shows that this effect is consistent across different sets of subgroups. Compared with the elders who have at least one son, the quality of life of those who are childless or have only one child is significantly lower. The NRSP is more likely to significantly improve the quality of life of one-child elders. In addition, the associations between the NRSP and the different facets of quality of life of the elders are significant except for the facet of sensory abilities.

Rural household income and inequality under the Sloping Land Conversion Program in western China.

As payment for ecosystem services (PES) programs proliferate globally, assessing their impact upon households' income and livelihood patterns is critical. The Sloping Land Conversion Program (SLCP) is an exceptional PES program, in terms of its ambitious biophysical and socioeconomic objectives, large geographic scale, numbers of people directly affected, and duration of operation. The SLCP has now operated in the poor mountainous areas in China for 10 y and offers a unique opportunity for policy evaluation. Using survey data on rural households' livelihoods in the southern mountain area in Zhouzhi County, Shaanxi Province, we carry out a statistical analysis of the effects of PES and other factors on rural household income. We analyze the extent of income inequality and compare the socio-demographic features and household income of households participating in the SLCP with those that did not. Our statistical analysis shows that participation in SLCP has significant positive impacts upon household income, especially for low- and medium-income households; however, participation also has some negative impacts on the low- and medium-income households. Overall, income inequality is less among households participating in the SLCP than among those that do not after 7 y of the PES program. Different income sources have different effects on Gini statistics; in particular, wage income has opposite effects on income inequality for the participating and nonparticipating households. We find, however, that the SLCP has not increased the transfer of labor toward nonfarming activities in the survey site, as the government expected.

Family Members' Abuse of Older Adults, Psychological Well-Being, and Sleep Quality Among Older Women and Men in China.

Despite the well-documented detrimental health effects of elder abuse, scholars have rarely considered whether and how family members' abuse of older adults is associated with sleep. Data from the 2018 China Longitudinal Aging Social Survey (N = 8110) were used to assess the association between elder abuse committed by family members and sleep quality, and how psychological well-being (depression and loneliness) mediates and gender moderates the above association. Results indicated that those who experienced family members' abuse were more likely to report poor sleep quality than their non-abused counterparts. Depression and loneliness partially mediated the elder abuse-sleep relationship. Furthermore, among those who experienced one elder abuse, older women had a higher risk of poor sleep quality than their male counterparts. However, two or more elder abuse experiences had similar negative effects on older women and men. Preventing elder abuse and improving psychological well-being is critical to promoting late-life sleep.

Life Course Risk and Protective Factors of Multimorbidity Resilience Among Older Adults in Rural China: A Longitudinal Study in Anhui Province Before and During COVID-19.

OBJECTIVES: Multimorbidity resilience reflects older adults' ability to cope with, adapt to, and rebound from its adverse effects through mobilizing resources. This study revised the multidomain Multimorbidity Resilience Index based on the Lifecourse Model of Multimorbidity Resilience referring to the life situations of older adults in rural China to measure the multimorbidity resilience from 2018 to 2021 and to explore factors influencing multimorbidity resilience from the perspective of Life Course theory. METHODS: This study used the seventh and eighth waves of longitudinal data (2018-2021) collected in Anhui, China. Older adults (945) with 2 or more chronic diseases were selected, and 1,201 (person-year) observations were collected and studied. A mixed linear model examined the effects of early- and later-factors on multimorbidity resilience. RESULTS: Multimorbidity resilience was negatively correlated with age and decreased faster with age after the outbreak of the coronavirus disease-2019 (COVID-19) pandemic. Married older adults have higher multimorbidity resilience. Exposure to hunger was associated with lower multimorbidity resilience when later factors were considered. Self-reported health before age 15, access to medical resources, and multimorbidity resilience were positively correlated. In addition, this study verified the relationship between multimorbidity resilience and the number of chronic diseases, exercise frequency, religious beliefs, self-reported health, and economic satisfaction, among other factors. DISCUSSION: The associations between life course factors and multimorbidity resilience emphasize the long-term impact of early-life experience and the adverse effects of increasing age, especially after the outbreak of the COVID-19 pandemic. The findings will drive policy development from a life course perspective encompassing prevention and follow-up treatment to promote active aging.

Reconfiguring Social Disconnectedness and Its Link to Psychological Well-Being among Older Adults in Rural China.

Using data from 2015 to 2018 waves of the Longitudinal Study of Older Adults in Anhui Province, China, this study investigated associations between different forms of social disconnectedness (social isolation, loneliness, living alone) and psychological well-being of older adults longitudinally. The results showed that social isolation and loneliness were independently associated with psychological well-being, whereas living alone was not. Different forms of social disconnectedness had additive and interactive effects on psychological well-being of older adults. Those who were exposed to all three forms of social disconnectedness suffered from the lowest level of psychological well-being. Moreover, the adverse effects of social disconnectedness on psychological well-being were found to be stronger for older women than for older men. The results underscore the necessity to consider multiple forms of social disconnectedness as well as their different combinations in explaining psychological well-being in later life.

Children's Divorce and their Financial Support to Older Parents in Rural China.

This study examined how adult children's divorce affected their financial support to older parents in rural China and how that relationship was dependent on children's gender. The sample was from rural Anhui Province and the working sample included 1629 older parents who reported their interactions with 6210 children across six waves of observations in 14 years (2001-2015). Generalized Estimating Equations showed that divorced sons provided less financial support to their parents than married sons. In contrast, divorced daughters did not necessarily provide less financial support than married daughters. This gender difference was statistically significant. The findings were discussed in the context of changing rural Chinese families, where the norm of filial piety is still strong but patrilineal tradition and gender ideology have experienced desynchronized changes.

Forced bachelors, migration and HIV transmission risk in the context of China's gender imbalance: a meta-analysis.

China has experienced continual increase in the sex ratio at birth (SRB) since the 1980s, which has led to a serious gender imbalance. To identify whether the future forced bachelors, especially those who migrate to cities, will increase the risk of HIV spread, a systematic review was carried out of studies published since 2000 that include the sexual risks of male migrants of China. Five studies comparing risk differences between migrants and non-migrants showed male migrants had greater risk of having multiple sexual partners and engaging in commercial sex. Ten studies concerning the relationship between sexual risks and socio-demographic characteristics showed that unmarried male migrants were more likely to engage in commercial sex and be infected with STDs than married migrants, while male migrants with higher income were more likely to have multiple sexual partners and be infected with STDs. In an analysis stratified by sample characteristics, the association between marriage and sexual risk was greater among samples with lower mean age, higher average income and education. In addition, the risk selection on education and income disappeared in the samples of migrants of whom more than half were unmarried.

What Could Interfere with a Good Night's Sleep? The Risks of Social Isolation, Poor Physical and Psychological Health among Older Adults in China.

This study provides one of the first population-based investigations of the longitudinal association between social isolation and sleep difficulty among older adults in China. We analyzed three waves of longitudinal data from the China Longitudinal Aging Social Survey (2014-2018), in which 8456 respondents contributed 16,156 person-year observations. Results from multilevel logistic regression models showed that social isolation was related to a higher risk of sleep difficulty. We also found that socially isolated older adults were more likely to report higher levels of depressive symptoms, a greater prevalence of loneliness and pain, and more chronic diseases compared to their socially integrated counterparts, which in turn increased their risks of sleep difficulty. Moreover, socially isolated older adults with chronic diseases were particularly vulnerable to the risk of sleep difficulty. These findings provide helpful guidance for policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

Factors Associated with Death Anxiety Among Rural Chinese Older Adults: The Terror Management Perspective.

OBJECTIVES: The aim of this study was to examine how the factors suggested by the Terror Management Theory are associated with death anxiety among rural Chinese older adults. METHOD: Data were derived from a longitudinal survey of older adults aged 60 and above, had at least one living child, and were living in rural areas of Anhui Province. The working sample included 1,362 older adults. Two-level random effects models were used. RESULTS: Children's financial support was negatively related to death anxiety, whereas emotional closeness with children was positively related to death anxiety. Older women reported more death anxiety than older men. Functional limitations were positively associated with death anxiety, and the widowed reported less death anxiety than the married. We did not find a significant association between religious belief and death anxiety. DISCUSSION: The study highlights the importance of culture in shaping death anxiety among older adults in rural China.

Economics, cultural transmission, and the dynamics of the sex ratio at birth in China.

In rural China, the ratio of newborn boys to newborn girls [sex ratio at birth (SRB)] has been rising for several decades, to values significantly above its biological norm. This trend has a number of alarming societal consequences, and has attracted the attention of scholars and politicians. The root of the problem lies in a 2,500-year-old culture of son preference. This culture is intricately linked with the economic reality of each couple's life, so that there are financial and psychological repercussions to parents who have no sons. To bring greater clarity and understanding to this issue, we present a quantitative framework that describes the interaction between economics and cultural transmission. We start with an explicit mechanism by which economic incentives can change cultural beliefs of a given individual, and go on to include a mechanism of cultural inheritance from generation to generation. We then show how economic conditions can affect the dynamics of cultural change in an entire society, and may lead to a decrease in the country's sex ratio at birth.

Socioeconomic Status, Institutional Power, and Body Mass Index among Chinese Adults.

Despite the vast literature on the socioeconomic status (SES) gradient of obesity among adult people, no study has investigated the relationship between institutional power and body mass index. Using national survey data from the "China Labor-force Dynamics Survey 2016" (CLDS 2016), multistage cluster-stratified probability proportional to size (PPS) sampling was employed to select cases from 29 provinces, cities, and autonomous regions in China. This study adopts an institutional approach to explore the influences of SES and institutional power on the state of being overweight or severely overweight (obese) among Chinese adults. It is shown that SES has a non-linear influence on being overweight or obese, higher education has a negative effect on being overweight or obese, income has an inverted U-shaped effect on being overweight or obese, and having a managerial or administrative job has a positive effect on being overweight but less so on obesity. These findings reveal that disparities in health outcome and risks are due to inequality in SES. The work unit is a stronger predictor of adults being overweight or obese than occupation. Working in the public sector has a positive effect on being overweight relative to working in the private sector, and only state institutions and government departments have a positive association with obesity. Our results indicate that institutional structure still has effects on individuals' life chances in the era of China's market transition.

Marriage, Health, and Old-Age Support: Risk to Rural Involuntary Bachelors' Family Development in Contemporary China.

In the traditional system of Chinese families, individuals are embedded in the institution of the family with defined obligations to enhance family development. As a consequence of the male-biased sex ratio at birth in China since the 1980s, an increasing number of surplus rural males have been affected by a marriage squeeze becoming involuntary bachelors. Under China's universal heterosexual marriage tradition, family development of rural involuntary bachelors has largely been ignored, but in China's gender-imbalanced society, it is necessary to adopt a family-based approach to identify and study the plight of rural involuntary bachelors. Studies on gender imbalance indicate that these men face multiple risks from the perspectives of their life course, the family life cycle, and the family ethic. To a certain extent, these risks are caused by a conflict between the individual's family life and family ethics and are mainly reflected in problems concerning marriage, health, and old-age support. Not only do these vulnerabilities affect the individual and family development across the whole life cycle but also pose major risks to social development in the face of strong gender imbalance. In order to deal with risks faced by rural involuntary bachelors, core ethical principles, including autonomy, beneficence, and justice, need to be adopted. Through adjustments to informal support provided by the family and formal support provided by policy-makers, risk of uncertainty in family development faced by rural involuntary bachelors could be reduced.