Family Structure and Child Malnutrition in China: Three Essays by Wei He Public Policy Studies ...

188 Pages·2012·2.91 MB·English

Family Structure and Child Malnutrition in China: Three Essays
by
Wei He
Public Policy Studies
Duke University

Date:_______________________
Approved:

___________________________
Sherman A. James, Co-Supervisor

___________________________
M. Giovanna Merli, Co-Supervisor

___________________________
Amar A. Hamoudi

___________________________
Elizabeth Frankenberg

Dissertation submitted in partial fulfillment of
the requirements for the degree of Doctor of Philosophy
in Public Policy Studies
in the Graduate School of Duke University

2013
ABSTRACT

Family Structure and Child Malnutrition in China: Three Essays
by
Wei He
Public Policy Studies
Duke University

Date:_______________________
Approved:

___________________________
Sherman A. James, Co-Supervisor

___________________________
M. Giovanna Merli, Co-Supervisor

___________________________
Amar A. Hamoudi

___________________________
Elizabeth Frankenberg

An abstract of a dissertation submitted in partial fulfillment of
the requirements for the degree of Doctor of Philosophy
in Public Policy Studies
in the Graduate School of Duke University

2013
Copyright by
Wei He
2013
Abstract
Over the past three decades, the co-existence of overweight and underweight has
characterized the phenomenon of children’s health in China. As the primary institution
for a child, family is an opportune place for child malnutrition intervention. By
advancing a framework that addresses the contextual factors which shape the
heterogeneity of socioeconomic gradients of child overweight/obesity, this dissertation
has sought to understand the channels through which access to family resources
influences child overweight/obesity in China. Based on these developed understandings,
I identified the mechanisms by which having any younger siblings and three generation
living together or in proximity affect child malnutrition in China. Using data drawn
from the China Health and Nutrition Survey, this dissertation uncovered remarkable
differences in multiple levels of contextual factors that shape a child’s risk of
overweight/obesity and underweight in China as compared to Western society. China’s
stage of economic development and the ever-increasing wealth disparity have created a
growing socioeconomic gap in child overweight/obesity, especially after 1997. This
finding confirmed the position of the Ecological System framework that access to
obesogenic environment is much more important than willpower based on knowledge
in shaping one’s obesity-related risk behavior. Despite the tremendous economic growth
and the dramatic decrease in in fertility level, resource dilution effect on basic nutrition
intake still existed among girls, especially for those exposed to poverty and food
insecurity. Children in the care of grandparents are healthier, probably due to the
generally low degree of access to obesogenic foods and a closer intergenerational
iv
relationship that facilitates effective communication and promotes healthy lifestyle
formation.

v
Dedication

To my mother, husband and daughter

vi
Contents

Abstract ......................................................................................................................................... iv
List of tables ............................................................................................................................... xiii
List of figures ..............................................................................................................................xvi
Acknowledgments ................................................................................................................... xvii
Chapter 1: Introduction ................................................................................................................ 1
1.1 The coexistence of overnutrition and undernutrition among children in China ........... 1
1.1.1 The magnitude of overweight/obesity and underweight over years ........................... 1

1.1.2 Consequences of child malnutrition .................................................................................. 1

1.2 Child malnutrition with a focus on family .......................................................................... 2
1.3 Data ........................................................................................................................................... 5
1.4 How this dissertation is organized ....................................................................................... 6
Chapter 2: The roles of family SES and family structure in child nutrition status .............. 8
2.1 The role of family socioeconomic status in child overweight/obesity in Western social
science literature ............................................................................................................................ 8

2.1.1 Family SES directly influences child nutritional risk behavior ..................................... 8

2.1.2 Family SES shapes exposure to risk regulators ............................................................... 9

2.1.3 A framework for a broader context ................................................................................. 11

2.2 The roles of two family structural factors in child overweight/obesity and
underweight................................................................................................................................. 14

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2.2.2 The role of presence of grandparents in the household or neighborhood in child
overweight/obesity and underweight ...................................................................................... 16

Chapter 3: Data and Measurement ........................................................................................... 19
3.1 Description of Study Data.................................................................................................... 19
3.2 Measurements ....................................................................................................................... 20
3.2.1 Health Outcomes................................................................................................................ 20

3.2.2 Predictor variables ............................................................................................................. 29

3.3 Data Limitations .................................................................................................................... 32
3.3.1 Lack of sample weights ..................................................................................................... 32

3.3.2 Newly added sample ......................................................................................................... 34

3.3.3 Attrition Issues ................................................................................................................... 35

3.3.4 Missing BMI ........................................................................................................................ 40

3.3.5 Missing on independent variables and descriptive statistics ...................................... 41

3.3.6 A comparison between CHNS and China National Health and Nutrition Survey . 46

Chapter 4: Increasing socioeconomic gap in child overweight/obesity in China .............. 47
4.1 Introduction ........................................................................................................................... 47
4.2 Conceptual framework ......................................................................................................... 48
4.2.1 Price of and general access to high-energy dense diets ................................................ 49

4.2.2 Obesogenic Physical Inactivity Environments .............................................................. 51

4.2.3 Ideal body shape and awareness of obesity-related health problems ........................ 52
viii
4.2.4 The relative importance of the contextual factors ......................................................... 52

4.3 The case of China .................................................................................................................. 53
4.3.1 Price and Access to Energy Dense Foods ....................................................................... 54

4.3.2 Urbanization and declining physical activity ................................................................ 55

4.3.3 The Super slim body ideal and obesity-related knowledge......................................... 56

4.4 Data and methods ................................................................................................................. 57
4.4.1 Measurement ...................................................................................................................... 57

4.4.2 Methods ............................................................................................................................... 58

4.5 Results ..................................................................................................................................... 59
4.5.1 SES trends for child overweight/obesity in China......................................................... 59

4.5.2 The role of energy intake and expenditure .................................................................... 61

4.5.3 Trends in SES gradients of overweight/obesity by gender .......................................... 62

4.5.4 The role of health knowledge ........................................................................................... 64

4.6 Discussion and conclusion ................................................................................................... 65
Chapter 5: The Influence of Having a Younger Sibling on Child Nutrition Status in
China---Under the One Child Policy Regime ......................................................................... 69

5.1 Introduction ........................................................................................................................... 69
5.2 Conceptual framework ......................................................................................................... 71
5.3 Setting ..................................................................................................................................... 74
ix
5.4 Data ......................................................................................................................................... 77
5.5 Measurement ......................................................................................................................... 77
5.5.1 Dependent variables .......................................................................................................... 78

5.6 Methods .................................................................................................................................. 79
5.7 Results ..................................................................................................................................... 84
5.7.1 Descriptive analyses .......................................................................................................... 85

5.7.2 Having younger siblings and nutrition status ............................................................... 86

5.7.3 Having younger siblings and nutrition intake .............................................................. 92

5.8 Discussion and Conclusions ................................................................................................ 92
Chapter 6: Co-residence with grandparent(s) benefits child nutrition status in China .... 97
6.1 Introduction ........................................................................................................................... 97
6.2 Background ............................................................................................................................ 99
6.3 Potential pathways ............................................................................................................. 100
6.4 Data ....................................................................................................................................... 105
6.5 Measurement ....................................................................................................................... 105
6.6 Methods ................................................................................................................................ 106
6.7 Results ................................................................................................................................... 110
6.7.1 Descriptive analysis ......................................................................................................... 110

6.7.2 Causal inference analysis ................................................................................................ 112

6.8 Discussions and conclusion ............................................................................................... 120
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