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Purpose: To determine the prevalence of visual impairment and glasses ownership among Han Chinese and Hui minority junior high school children in Ningxia Hui Autonomous Region, China. 

Design: Population-based cross-sectional study. 

Methods: Vision screening was conducted on 20,376 children (age 12–15 years) in all 124 rural junior high schools in Ningxia. Personal and family characteristics, glasses ownership, and academic performance were assessed through a survey questionnaire and standardized mathematics test, respectively. 

Results: The prevalence of visual acuity (VA) ≤6/12 in either eye was significantly higher among Han (54.5%) than Hui (45.2%) children (P<0.001), and was significantly positively associated with age, female sex, Han ethnicity, parental outmigration for work, shorter time spent outside during recess, shorter time spent watching television and higher time spent studying. Among children with VA≤6/12 in both eyes, only 56.8% of Han and 41.5% of Hui children had glasses (P<0.001). Glasses ownership was significantly associated with worse vision, greater family wealth, female sex, higher test scores, age, parental outmigration for work, understanding of myopia and glasses, higher time spent studying and Han ethnicity. 

Conclusion: One of the first of its kind, this report on Han and Hui ethnic schoolchildren confirms a high prevalence of visual impairment among both populations, but slightly higher among the Han. Both groups, especially the Hui, have low rates of glasses ownership. Future interventions and policies designed to improve glasses usage should focus on populations with lower incomes and seek to correct erroneous beliefs about the safety of glasses and efficacy of traditional eye exercises.

Journal Publisher
PLOS ONE
Authors
Huan Wang
Huan Wang
Brandon Barket
Sharon Du
Dimitris Friesen
Ezra Kohrman
Esther Tok
Baixiang Xiao
Wenyong Huang
Ving Fai Chan
Graeme MacKenzie
Nathan Congdon
Shorenstein APARC Encina Hall E301 Stanford University
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Visiting Scholar at APARC, 2021-2022
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Ph.D

Dr. Cynthia Chen joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as visiting scholar with the Asia Health Policy Program during the 2022 winter and spring quarters. She is an Assistant Professor at the National University of Singapore (NUS). Her current research focuses on the well-being and older adults, healthcare financing, and the economics of ageing. She is interested in how demographic, economic and social changes can affect the burden of care, financing needs and optimal resource allocation in the future. Her research has been supported by the Singapore’s Ministry of Health, Ministry of Education, the US National Institutes of Aging, and the Thai Health Promotion Foundation among others. To date, she has published more than 45 internationally peer-reviewed journals on societal ageing, the burden of chronic diseases, and cost-effectiveness research. Dr. Chen obtained her Ph.D. in Public Health, Masters and BSc in Statistics from NUS.

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Jason Wang and his team working on a project to prevent preterm births received a $150,000 grant from the Richard King Mellon Foundation to complete their randomized control trial testing a digital app that tries to prevent recurrent preterm births.

PretermConnect uses a digital strategy for prevention and follow-up of preterm births in Allegheny County, PA, to optimize the health and well-being of mothers and children. Instead of the standard care, Stanford Health Policy is collaborating with the University of Pittsburg Medical Center (UPMC) in the randomized control trial with women who have delivered a preterm baby. The women are invited to participate and then randomly put into the group that uses the digital or a control group who received paper-based discharge packets with supplemental health education on postpartum care.

“This grant allows us to continue recruiting participants through UPMC and expanding PretermConnect’s features to enhance user engagement, including a function to search for resources by geography and topic,” said Wang, MD, a professor of pediatrics and health policy. “We also intend to scale the project with additional content on high-risk infant follow-up and preterm-specific developmental care guidelines, additional engagement features — and eventually support for different languages, starting with Spanish.”

In the long term, we hope to see an overall decrease in infant morbidity and mortality, by way of reducing preterm births.
Jason Wang
Professor of Pediatrics and Health Policy

The women in the digital app group receive in-app health education and resources to improve well-being for mothers and their infants. The app includes a social interaction feature designed to foster social connections and promote self-care. They have enrolled 30 women during the pilot phase and 15 mother-infant dyads in the randomized control trial, with a goal of reaching 250.

“The digital approach also allows us to administer brief surveys and gather information on dynamic social determinants of health more frequently than can be done through traditional means,” said Shilpa Jani, an SHP project manager. She said social determinants of health — such as persistent housing instability, food insecurity and concerns of personal safety — contribute to chronic stress and health issues as well as an increased risk of pregnancy and birth complications.

“Adverse effects of social determinants of health along with health complications of preterm deliveries may exacerbate morbidities for the mother and child,” Jani said, adding that preterm-related causes of death accounted for two-thirds of infant deaths in 2019 in the United States.

Wang and Jani said the immediate project goals include increasing health education for preterm baby care, improving postpartum maternal health, and encouraging usage of local resources in Allegheny County. They eventually hope to see reductions in risk for subsequent preterm delivery and infant mortality and postpartum depression, as well as increases in mother-infant bonding and larger proportions of breastmilk feeding.

Jason Wang Stanford Health Policy

Jason Wang

Professor of Pediatrics and Health Policy
Develops tools for assessing and improving the quality of health care
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Shilpa Jani

Shilpa Jani

Research Data Analyst
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A father with his son and daughter (paid family leave)
News

New Study Shows Support for Paid Family Leave Grew During Pandemic

In a blow to arguments that a federal paid leave law would harm small businesses, a new study co-authored by SHP's Maya Rossin-Slater finds that support for paid leave among small employers is not only strong, but also increased as the pandemic added new strain to the work-life juggle.
New Study Shows Support for Paid Family Leave Grew During Pandemic
Pupils raise their hands in class.
News

Babies Born Too Early Likely to Face Educational and Lifelong Behavioral Setbacks

SHP's Lee Sanders and his Stanford colleagues found that after adjusting for socioeconomic status and compared with full-term births, moderate and late preterm births are associated with increased risk of low performance in mathematics and English language arts, as well as chronic absenteeism and suspension from school.
Babies Born Too Early Likely to Face Educational and Lifelong Behavioral Setbacks
COVID Contact Tracing
News

Contact-tracing App Curbed Spread of COVID in England and Wales

SHP's Jason Wang writes in this Nature article that digital contact tracing has the potential to limit the spread of COVID-19.
Contact-tracing App Curbed Spread of COVID in England and Wales
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SHP researchers awarded grant to continue their clinical trial testing out a digital app they hope will prevent preterm births.

Authors
Scott Rozelle
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Scott Rozelle introduces his recent publication, "Publishing and Assessing the Research of Economists: Lessons from Public Health" in a blog post for the China Economic Review's official Wechat account to celebrate its 30th anniversary.

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Background: Maternal mental health problems play an important role in infant well-being. Although western countries have extensively studied the associations between maternal mental disorders, hygiene practices and infant health, little is known in developing settings. This study investigates the correlations between postnatal mental health problems, hand washing practices and infant illness in rural western China. Methods: A total of 720 mothers of infants aged 0–6 months from four poor counties in rural western China were included in the survey. Mental health symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Questions about infant illness and hand washing practices followed evaluative surveys from prior studies. Adjusted ordinary least squares regressions were used to examine correlations between postnatal mental health (depression, anxiety, and stress) symptoms, hand washing practices, and infant illness outcomes. Results: Maternal depression, anxiety and stress symptoms were significantly associated with reduced hand washing overall and less frequent hand washing after cleaning the infant's bottom. Mental health symptoms were also associated with a higher probability of infants showing two or more illness symptoms and visiting a doctor for illness symptoms. Individual hand washing practices were not significantly associated with infant illness; however, a composite measure of hand washing practices was significantly associated with reduced probability of infant illness. Conclusion: Postnatal mental health problems are prevalent in rural China and significantly associated with infant illness. Policy makers and practitioners should investigate possible interventions to improve maternal and infant well-being.
Journal Publisher
Frontiers in Global Women's Health
Authors
Qi Jiang
Nourya Cohen
Mika Ohtori
Jie Gao
Qingzhi Wang
Evelyn Zhang
Sabrina Zhu
Hannah Johnstone
Yian Guo
Yian Guo
Sarah-Eve Dill
Huan Zhou
Scott Rozelle
Scott Rozelle
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Sherri Rose, PhD  is an Associate Professor of Health Policy at the Stanford School of Medicine and Co-Director of the Health Policy Data Science Lab. Her research is centered on developing and integrating innovative statistical machine learning approaches to improve human health and health equity. Within health policy, Dr. Rose works on risk adjustment, ethical algorithms in health care, comparative effectiveness research, and health program evaluation. She has published interdisciplinary projects across varied outlets, including BiometricsJournal of the American Statistical AssociationJournal of Health EconomicsHealth Affairs, and New England Journal of Medicine. In 2011, Dr. Rose coauthored the first book on machine learning for causal inference, with a sequel text released in 2018. She has been Co-Editor-in-Chief of the journal Biostatistics since 2019.

Dr. Rose has been honored with an NIH Director's New Innovator Award, the ISPOR Bernie J. O'Brien New Investigator Award, and multiple mid-career awards, including the Gertrude M. Cox Award and the Mortimer Spiegelman Award, the nation’s highest honor in biostatistics, given to a statistician younger than 40 who has made the most significant contributions to public health statistics. She was named a Fellow of the American Statistical Association in 2020 and received the 2021 Mortimer Spiegelman Award, which recognizes the statistician under age 40 who has made the most significant contributions to public health statistics. Her research has been featured in The New York Times, USA Today, and The Boston Globe. 

Title: New and Ongoing Projects at the Interface of Machine Learning for Health Policy

 

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Encina Commons,
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Stanford, CA 94305-6006

 

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Professor, Health Policy
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PhD

Sherri Rose, PhD, is a Professor of Health Policy and Director of the Health Policy Data Science Lab at Stanford University. Her research is centered on developing and integrating innovative statistical machine learning approaches to improve human health and health equity. Within health policy, Dr. Rose works on ethical algorithms in health care, risk adjustment, chronic kidney disease, and health program evaluation. She has published interdisciplinary projects across varied outlets, including Biometrics, Journal of the American Statistical Association, Journal of Health Economics, Health Affairs, and New England Journal of Medicine. In 2011, Dr. Rose co-authored the first book on machine learning for causal inference, with a sequel text released in 2018.

Dr. Rose has been honored with an NIH Director’s Pioneer Award, NIH Director's New Innovator Award, the ISPOR Bernie J. O'Brien New Investigator Award, and multiple mid-career awards, including the Gertrude M. Cox Award. She is a Fellow of the American Statistical Association and received the Mortimer Spiegelman Award, which recognizes the statistician under age 40 who has made the most significant contributions to public health statistics. In 2024, she was recognized with both the ASHEcon Willard G. Manning Memorial Award for Best Research in Health Econometrics and the American Statistical Association Outstanding Statistical Application Award. Her research has been featured in The New York Times, USA Today, and The Boston Globe. She was Co-Editor-in-Chief of the journal Biostatistics from 2019-2023.

She received her PhD in Biostatistics from the University of California, Berkeley and a BS in Statistics from The George Washington University before completing an NSF Mathematical Sciences Postdoctoral Research Fellowship at Johns Hopkins University. 

Director, Health Policy Data Science Lab
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Associate Professor of Health Policy Stanford University
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Title: Customer Discrimination and Quality Signals: A Field Experiment with Healthcare Shoppers

Abstract: This paper provides evidence that customer discrimination in the market for doctors can be largely accounted for by statistical discrimination. I evaluate customer preferences in the field with an online platform where cash-paying consumers can shop and book a provider for medical procedures based on an experimental paradigm called validated incentivized conjoint analysis (VIC). Customers evaluate doctor options they know to be hypothetical to be matched with a customized menu of real doctors, preserving incentives. Racial discrimination reduces patient willingness-to-pay for black and Asian providers by 12.7% and 8.7% of the average colonoscopy price respectively; customers are willing to travel 100–250 miles to see a white doctor instead of a black doctor, and somewhere between 50–100 to 100–250 miles to see a white doctor instead of an Asian doctor. Further, providing signals of provider quality reduces this willingness-to-pay racial gap by about 90%, which suggests that statistical discrimination is an important cause of the gap. Actual booking behavior allows cross-validation of incentive compatibility of stated preference elicitation via VIC. 

Alex Chan, MPH

Alex Chan is a PhD candidate in Health Economics, and a Gerhard Casper Stanford Graduate Fellow. He has research interests in health economics, experimental economics, market design, and labor economics. His projects look at the causes and consequences of discrimination and diversity in medicine, U.S. Health Policy (especially organ transplantation), and market design in health policy and medicine. He holds an MPH from Harvard University. Before Stanford, he developed extensive experience in the healthcare industry starting as a McKinsey consultant, and most recently as Senior Vice President of Market Strategy with Optum/UnitedHealth before joining academia.

Personal Website: https://www.alexchan.net 

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PhD Candidate in Health Economics Department of Health Policy, Stanford University
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Timothy J. Layton, PhD

Associate Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School

His research focuses on the economics of health insurance markets with particular emphasis on understanding insurer behavior in those markets and designing optimal health plan payment systems. 

Dr. Layton and his collaborators are using economic models of health insurer behavior to design payment systems that combat inefficiencies caused by adverse selection. In one project, he and his coauthors are deriving new methods for designing health plan payment systems that set payments to insurers in a way that discourages insurers from inefficiently rationing care used by sick individuals with multiple chronic conditions. This work focuses on designing payment systems for the state and federal Health Insurance Marketplaces, as well as the Dutch health insurance market and the Medicare Advantage program.

Stay Tuned for Details

Timothy J. Layton Associate Professor Department of Health Care Policy, Harvard Medical School
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Stacie B. Dusetzina, Ph.D

Associate Professor, Health Policy
Ingram Associate Professor of Cancer Research, Vanderbilt University Medical Center

Dr. Dusetzina is an associate professor in the Department of Health Policy and an Ingram associate professor of cancer research at Vanderbilt. She is a health services researcher whose work focuses on measuring and evaluating population-level use and costs of medications in the United States. Dr. Dusetzina’s work has contributed to the evidence base for the role of drug costs on patient access to care and policy changes that might improve patient access to high-priced drugs.

She has been recognized for her work at a national level, including being an invited participant for two working group meetings on “Patient Access to Affordable Cancer Drugs,” hosted by the President’s Cancer Panel, and being selected to co-author a National Academies of Sciences, Engineering and Medicine report on the same topic. Dr. Dusetzina’s research has also been broadly covered by The New York Times, NPR, Reuters, The Washington Post, STAT News, ABC News and The Wall Street Journal

In addition to her work on drug pricing, Dr. Dusetzina is a population health scientist and pharmacoepidemologist specializing in large data informatics. She has authored or co-authored more than 163 peer reviewed applied studies using Medicaid, Medicare, and commercial insurance claims data, and contributed several methods papers to the field. 

Seminar Title: Improving Access to Prescription Drugs through Policy Change

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Stacie B. Dusetzina Associate Professor, Health Policy Vanderbilt University
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