Xiaopeng Pang

Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial

Objective To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia. Design Cluster randomized, investigator masked, controlled trial. Setting 252 primary schools in two prefectures in western China, 2012-13. Participants 3177 of 19 934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study. Interventions Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class. Main outcome measures Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations. Results Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, −0.04 to 0.09) or family wealth (0.01, −0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect. Conclusions The provision of free glasses to Chinese children with myopia improves children’s performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting. Trial Registration Current Controlled Trials ISRCTN03252665.

Gender Inequality in Education in China: A Meta‐Regression Analysis

Although there is evidence that there was gender inequality in Chinas education system in the 1980s, the literature in China has mixed evidence on improvements in gender inequality in educational attainment over the past three decades. Some suggest gender inequality is still severe; others report progress. We seek to understand the progress China has made (if any) in reducing gender inequality in education since the 1980s. To meet this goal, we use a meta-analysis approach which provides a new quantitative review of a relatively large volume of empirical literature on gender educational differentials. This article analyzes differences across both time and space, and also across different grade levels and ethnicities. Our results indicate that gender inequality in educational attainment still exists, but it has been narrowing over time. Moreover, it varies by area (rural versus urban) and grade level. There is nearly no significant gender inequality in the case of girls in urban areas or in the case of the 9 years of compulsory education (primary school and junior high school). Girls, however, still face inequality in rural areas (although inequality is falling over time) and when they reach high school or beyond. (JEL I24)

Computers and the academic performance of elementary school-aged girls in China's poor communities

Experts agree that computers and computing play an important role in education. Since the 1980s there has been a debate about gender as it relates to computers and education. However, results regarding gender differences concerning computer use in education are not consistent. In particular there is little work done in China on this issue. Therefore, the overall goal of this paper is to demonstrate whether girls and boys can gain equally from computer-based education in Chinas elementary schools. To do so we analyze results from three randomized field experiments of a Computer Assisted Learning (CAL) program and One Laptop Per Child (OLPC) program. The field experiments are carried out in three kinds of schools: Shannxi rural public schools; Qinghai minority public schools; and Beijing migrant schools. Although CAL and OLPC have been considered cost effective means to improve learning outcomes, it is not known whether the programs impact girls differently than boys. Our analysis shows that, in fact, there were no differences between female and male students in either the improvement in standardized math test scores or Chinese test scores with either the CAL or OLPC programs. Our study suggests that among disadvantaged students in Chinas rural areas and migrant communities, there is reason to believe that computer based learning can benefit both girls and boys equally. This finding has possible implications for Chinas ongoing efforts to integrate computers and computing technologies into the nations underserved schools.

Factors Underlying Different Myopia Prevalence between Middle- and Low-income Provinces in China

Currently available data on myopia and spectacle wear are drawn largely from China’s richer and middle-income areas, and little is known about refractive error and spectacle wear in the lowest income provinces. Studies from China and elsewhere suggest that large differences in myopia prevalence may exist between areas of different socioeconomic status within countries, but reasons for these differences are not well understood. The current report details the prevalence and predictors of myopia measured using the identical protocols and equipment in 2 adjoining provinces of western China, middle-income Shaanxi and low-income Gansu. Study methods including institutional review board approvals and consent have been described elsewhere. The study was carried out in Yulin prefecture, Shaanxi, and Tianshui prefecture, Gansu Province, which are nearby areas. Shaanxi’s gross domestic product per capita is

The impact of teacher training on teacher and student outcomes: evidence from a randomised experiment in Beijing migrant schools

US6108 and was ranked 14th among China’s 31 administrative regions in 2012, while Gansu is the second-poorest province in the country (per capita gross domestic product of

Accuracy of Rural Refractionists in Western China

US3100). Yulin is a relatively wealthy region in a middle-income province and Tianshui constitutes a poor region of one of China’s lowest-income provinces. A complete list of primary schools was obtained, and 1 school from each township in the 2 prefectures was selected at random (Yulin, Shaanxi n 1⁄4 132; Tianshui, Gansu n 1⁄4 120). Within each school, 1 class was randomly chosen in each of the 4th and 5th grades. The following data were collected in September 2012: children’s age, sex, boarding at school, parental schooling and migration for work, family wealth, classroom blackboard use, and visual acuity. Children with uncorrected visual acuity of 6/12 in either eye underwent cycloplegic refraction. A study-specific mathematics test was administered as an index of academic achievement. In May and June 2013, we collected data on parental spectacle wear, children’s time spent outdoors and in near/middle distance work using validated instruments. Clinically significant myopia was defined as uncorrected visual acuity of 6/12 in either eye and a spherical equivalent of 0.5 diopter in both eyes. Characteristics were compared between children in the 2 prefectures, accounting for sampling weight and school clustering. Relative risk (RR) estimation using general linear modeling with Poisson regression and robust error variance was used to determine the association between potential risk factors and myopia for the 2 provinces separately and for the total study population. Subjects with missing myopia data (n 1⁄4 306 [1.5%]) were excluded. Among 9489 children in Shaanxi (mean age, 10.4 1.03 years; 53.1% boys), the prevalence of clinically significant myopia (22.9%; 95% CI, 21.2%e24.7%) was nearly twice that of 10 137 children (mean age, 10.7 1.24 years; 49.1% boys) in Gansu (12.7%; 95% CI, 11.3%e14.1%; RR for Shaanxi vs Gansu 1.81 [95% CI, 1.58e2.07; P < 0.001]). Parents out-migrating for work were less common in the Shaanxi cohort (8.10%) than in the Gansu cohort (16.8%; P < 0.001), and families were less likely to be in the lowest wealth tertile for the total sample in Shaanxi (17.2% vs 38.7%; P < 0.001). One-half of our Shaanxi cohort (49%) versus 3.6% in Gansu lived in low population density areas (P < 0.001). Mathematics scores were higher in Shaanxi (P 1⁄4 0.03), and the blackboard was used less in Shaanxi than in Gansu (26.7% of classes spending the majority of classtime directed at the blackboard in Shaanxi vs 45.5% in Gansu; P < 0.001; Table 1, available at www.aaojournal.org). Differences in outdoor activity and near and middle distance work were minimal between Shaanxi and Gansu, and between children with and without myopia (Table 2, available at www.aaojournal.org). Older age (RR, 1.07; 95% CI, 1.02e1.13), parental glasses wear (RR, 1.57; 95% CI, 1.39e1.77), and higher math score (RR, 1.20 [95% CI, 1.13e1.28] per increase of 1 standard deviation in score) were associated with increased risk for myopia in both provinces separately and in the total study population (above RRs are for the total study population). Male sex (RR, 0.81; 95% CI, 0.73e0.91) was associated with lower risk and near work (RR, 1.02 [95% CI, 1.00e1.03] per hour/week increase), with greater risk in the total study population and in Shaanxi alone, but not in Gansu alone. Blackboard use and family wealth were not associated with myopia risk in the multivariate model and no clear linear pattern was found for population density across quartiles (Table 3). Residence in Shaanxi was associated with a 69% increased risk of myopia (RR, 1.69; 95% CI, 1.39; 2.06) after adjusting for other risk factors. The likelihood ratio test (P < 0.001) and pseudo R (<20%) both suggest that the current model fits the data well, and that the conclusion is valid that real, as-yet-unexplained differences exist between myopia prevalence in Shaanxi and Gansu. Even after adjusting for differences in factors associated with myopia, such as near work, school achievement, and outdoor activity, we could not explain much of the large variation in prevalence of clinically significant myopia between middleincome Shaanxi and low-income Gansu. The current study is among the first to compare known myopia risk factors between nearby areas with large differences in myopia rates. It is possible that the low near work demand in the current cohort (8 hours in both Gansu and Shaanxi vs 23e30 hours in Singapore and Australia) might explain the lack of large effects of near work and outdoor activity. Greater blackboard use was protective against myopia in univariate analyses (data not shown), perhaps owing to lower near work demands: weekly near work was lower with highest (6.7 hours) versus lowest (7.6 hours; P < 0.05) blackboard use. Greater blackboard use was also associated with less wealth here (data not shown), because schools in low-income areas could not afford textbooks, which may confound the association with myopia. More research is needed on myopia risk and classroom use of near and distance teaching tools. Our definition of myopia included visual acuity, which limits comparisons with other studies, although not internal comparison between Shaanxi and Gansu. Primary school attendance rates are >95% in the area; thus, this school-based sample is likely representative of the population. It is unlikely that genetic factors

Does Women's Knowledge of Voting Rights Affect Their Voting Behavior in Village Elections? Evidence from a Randomized Controlled Trial in China

This article exploits a randomised controlled trial to evaluate the impact of an intensive, short-term inservice teacher training programme on the performance of English teachers in Beijing migrant schools and their students. The results show no significant impacts of teacher training on either teacher or student English test scores and thus imply the ineffectiveness of short-term teacher training programmes on teacher and student performance.

Seeing is Believing: Experimental Evidence on the Impact of Eyeglasses on Academic Performance, Aspirations and Dropout among Junior High School Students in Rural China

PURPOSE We assessed the prevalence and predictors of inaccurate refractive error among rural refractionists in western China. METHODS A subset of primary school children with visual acuity (VA) ≤6/12 in ≥1 eye, undergoing subjective refinement by local refractionists after cycloplegic autorefraction in an ongoing population-based study, received repeat refraction by university optometrists for quality control. RESULTS Among 502 children (mean age 10.5 years, 53.2% girls), independent predictors of poor (inaccurate by ≥1.0 diopter [D]) refraction by 21 rural practitioners (66.7% with high school or lower education) included hyperopia (odds ratio [OR], 4.2; 95% confidence interval [CI], 2.4-7.3, P < 0.001), astigmatism (OR = 3.8; 95% CI, 2.5-5.6; P < 0.001) and VA uncorrectable to >6/12 by the rural refractionist (OR = 4.7; 95% CI, 3.1-7.3; P = < 0.001). Among 201 children whose vision was uncorrectable in ≥1 eye by the rural refractionists, vision could be improved to >6/12 by the university optometrist in 110 (54.7%). We estimate vision could be so improved in 9.1% of all children refracted by these rural refractionists. A reason for inaccuracy in this setting is the erroneous tendency of rural refractionists to adjust instrument values for accommodation, even under cycloplegia. CONCLUSIONS Rural refractionists in western China have little formal training and frequently fail to optimize VA among children, even when autorefractors are used. Training is needed emphasizing better use of automated refraction, particularly in children with astigmatism and hyperopia.

Safety of spectacles for children's vision: a cluster-randomized controlled trial

Officials in China claim that voting rates in rural village elections are high. Unfortunately, these rates are assumptions, not facts. The true voting rate is lower, and much lower for women. We postulate that this could be due to insufficient knowledge about their rights.The objective of this paper is to test whether women and village leaders’ knowledge about women’s voting rights affects women’s voting behavior. We report on the results of a randomized controlled trial (RCT) involving 700 women in China’s Fujian and Liaoning Provinces. Villages were randomly assigned to either a control group or one of three intervention groups. One intervention provided voting training to women only, another provided training to both women and village leaders and the third provided training to village leaders only.The data show that after women received training, their scores on a test of voting knowledge increased and they more fully exercised their voting rights. When only village leaders were trained, test scores and voting behaviors were not statistically different from the control villages.

Poor vision among China's rural primary school students: Prevalence, correlates and consequences

We present results of a randomized trial testing the impact on academic outcomes of providing free eyeglasses to junior high school students in a poor rural area of western China. We find that providing free prescription eyeglasses approximately halves dropout rates over a school year among students who did not own eyeglasses at baseline. Effects on dropout are mirrored by improvements in student performance on standardized exams in math and aspirations for further schooling.