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Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.
Methods
A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.
Results
Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.
Conclusions
The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.
Political connections have been tested for correlation with outward foreign direct investment (OFDI). Both theoretical rationale and research evidence are mixed. To advance this debate, we conceptualize political connections as a dual-dimensional construct and hypothesize the differential effects of the breadth and the depth of political connections on OFDI. Employing a sample of 2,374 Chinese listed firms, encompassing 15,647 firm-year observations from 2008 to 2016, we find evidence supporting our hypotheses: (1) the breadth of political connections reduces the likelihood of a firm engaging in OFDI and (2) greater depth of political connections increases the likelihood of a firm engaging in the OFDI. Thus, we advise firms to exercise caution when adopting corporate political strategies for internationalization in general and OFDI in particular.
The European Union and China have a relationship that is characterized by strong economic interdependence. But since Xi Jinping’s ascent to power, the gap in power and interests between the EU and China has widened, and cooperation has become more difficult. As a result, the EU’s China policy has shifted towards a more structural realist perspective, strategy, and policy. The EU’s realist turn will be analysed in two major areas of the EU–China relationship: security and defense with a focus on Taiwan, and trade. The EU has increased support for Taiwan and for maintaining the status quo in the Taiwan Strait by bandwagoning with the United States. In external trade, the EU is strengthening its own economic security and is balancing against China through diversifying its trade relations in the Indo-Pacific region.
Perceived intergenerational mobility profoundly influences individual attitudes and behaviour, carrying important implications for social stability and development. How do Chinese citizens perceive the intergenerational persistence of family advantages, and how do these perceptions compare with reality? This study conducts multiple randomized vignette experiments across two online surveys to assess public perceptions of correlations between various socio-economic indicators of parents and their children. Respondents estimate moderate to moderately strong correlations across generations. By leveraging the comparability of perceptions and objective estimates made possible by our novel measurement instrument, we find that respondents often overestimate the likelihood of equal opportunities for children from families with differing educational backgrounds. Alongside these largely optimistic perceptions, we also uncover signs of emerging pessimism. These results offer a nuanced snapshot of perceived social mobility in China, highlighting its multidimensional manifestations and divergence from reality, while also providing methodological insights for future research on its evolving dynamics.
Maria Jaschok analyzes the opportunities and challenges faced by Muslim women living as a minority, particularly in contexts where religion is under pressure. The chapter highlights the dynamism exhibited by female imams (ahongs) in China, who have strategically leveraged the pressure on male authority imposed by the Chinese state to carve out a larger role for themselves. The chapter also shows how these women seek to connect with the global Muslim community, or ummah, while relating Islam to their everyday realities.
How do subsidiaries sell initiatives to their headquarters? Multilayer decision-makers at corporate headquarters, with divergent interests and power, can overly complicate the acceptance process. We present a multi-case study to explore how subsidiaries of a Chinese multinational enterprise convince top management teams and department heads at their corporate headquarters to engage in foreign investments. Building on a micropolitical perspective, we develop a process model of subsidiary micropolitical strategy adoption consisting of (a) political tension retrieval regarding divergent interests and power at corporate headquarters around specific initiatives, (b) selective coalition building whose interests and power are aligned with the initiatives, and (c) a transitive relation leveraging strategy based on the ties of allied headquarters' managers. We further reveal the interplay between corporate motivations (i.e., market seeking vs. strategic asset seeking) and specific micropolitical activities adopted by subsidiary managers. We enhance the understanding of micropolitics in subsidiary initiatives by underscoring how to strategically manage differences among multilayer actors at corporate headquarters. Additionally, we reveal a political view of foreign investment decision-making in addition to rationality.
The calibration between national regulatory oversight and local policy autonomy is a prominent feature in the discussion regarding social assistance institutions in large countries. The complex principal-agent structure embedded within such institutions and the resultant information asymmetry make it difficult for the national principal to monitor the behaviour of subnational agents, resulting in prevalent mis-targeting of welfare benefits and petty corruption. Built on a principal-agent framework, this study seeks to explain the puzzling shrinkage of China’s Minimum Livelihood Guarantee Scheme (Dibao) in recent years. Accountability mechanisms are found to exert major impacts on the scale of welfare programs. Using a unique city-level panel dataset and difference-in-differences (DID) strategy, this quantitative study finds that discipline inspection by upper-level government leads to a significant decrease of Dibao coverage in a city, a link reinforced by the local intensity of China’s anti-corruption campaign. Blame avoidance and the defensive reaction of local agents triggered by draconian enforcement of accountability result in distorted welfare administration on the ground. Building informational capacity presents a useful approach in mitigating the vertical control–autonomy dilemma illustrated in this study.
This study examined the underlying types of intergenerational relationship and social support network among impaired older adults in China and explained how they may influence the home- and community-based service (HCBS) purchase intentions of these individuals. Based on the 2018 and 2020 waves of the Chinese Longitudinal Aging and Social Survey, a total of 3,397 older adults (aged ≥ 60 years, with at least one child) were selected. First, we used K-means cluster analysis to identify five types of intergenerational relationship among Chinese families: ‘tight-knit and proximal’, ‘parent-oriented and intimate’, ‘distant but intimate’, ‘independent-intimate’ and ‘child-oriented but emotionally detached’. Second, we examined the sizes of three distinct types of social support network among older Chinese adults: contact, instrumental and emotional. Subsequently, binary logistic regression was conducted to examine the relative impact of intergenerational relationships and social support networks on impaired older adults’ HCBS purchase intentions. Our findings revealed that under the moderation of social support networks, reciprocal intergenerational relationships exhibited fewer HCBS purchase intentions, while imbalanced intergenerational relationships exhibited diverse HCBS purchase intentions. The findings also underscore the ‘bridge’ function of older adults’ social support networks and the importance of community participation in promoting older adults’ utilization of support services.
Cartographic representations of Kashmir and Taiwan act as sites upon which Indian and Chinese state power is exercised to govern the logics of visibility and legibility for these two regions. Despite the differences in regime type, these major non-Western powers represent Kashmir and Taiwan respectively as internal and integral parts of their sovereign territorial form. In this article, we consider two cases that have not hitherto been studied together in International Relations (IR), putting forward ‘cartographic imaginaries’ as a framework to reveal systematic analytical dynamics in relation to representation, nationalism, and diaspora. Cartographic imaginaries are sites of productive power that evoke certain emotions and carry a set of ideas relating to territory that can be naturalised through repeated exposure. We present in-depth investigations providing a range of examples to trace Indian and Chinese states’ efforts, both domestic and international, involved in constructing and controlling cartographic imaginaries of Kashmir and Taiwan. Our analysis relates to significant current concerns in IR about critiques of imperial cartography, impact of rising powers on global order dynamics, and transnational governance of diaspora. Our framework thus demonstrates the connexions between affect, visuality, and state power and offers empirical insights into non-Western projections of imperialism on a global scale.
Considering the alarming energy demand for cooling and seeking sustainable cooling alternatives to over-reliance on air conditioning, our pre-registered study is the first attempt to apply social norm nudges on two cooling behaviors – lighter clothing and the use of personal cooling devices (PCDs). To examine and compare the effectiveness of a descriptive norm message, an injunctive norm signal from leadership, and the two norms combined, we conducted an online randomized controlled survey experiment among financial employees (n = 743) in Guangdong, China. We measured their behavioral intentions before and after the intervention, and their level of commitment to these behaviors as an alternative outcome. We found that while single-norm conditions did not lead to desirable increases in lighter clothing, the both-norm condition nudged participants toward selecting lighter work clothes and boosted commitment to lighter clothing. Outcomes related to the use of PCDs were not affected by any of the norm conditions. These mixed findings present a cautionary tale for designing social norm interventions in office spaces and highlight the boundaries of their effectiveness in energy-saving behaviors.
This article offers an explanation for gendered patterns of work in emerging Chinese cotton spinning mills during the early twentieth century from the perspective of household labour allocation. Female workers were rarely employed in mills in the north of the country, but the Yangtze Delta showed a much higher proportion of female factory labour. Whereas many authors have explained women’s participation from the viewpoint of patriarchal culture, or physiological differences, this article brings to the fore another, largely neglected but important, explanatory factor for differences in labour allocation in modern factories during early industrialization: the development of handicraft textile production in sending regions. In districts where household cotton textile production persisted, fewer women supplied their labour to the urban factories. Landholding size, real wages, and local agricultural-industrial structures contributed to variations in the living strategies of rural households, affecting the deployment of female family members. Our argument is supported by analyses of gender wage ratios and rural–urban income disparities in different parts of China in order to expose the opportunity structures under which households decided to supply their labour to modern textile factories.
How does China use development finance to gain influence in international organizations? Leveraging the exogenous rotation of ASEAN and African Union Chairmanship, I estimate the effect of regional leadership on Chinese commitments. Results suggest that Chinese projects are politically motivated only when the lending and recipient entities are linked to the Chinese and host governments. Governments that assume the Chair received seven times more commitments from Chinese government agencies relative to non-Chair years, a $90 million increase for the average project. By contrast, there is no evidence to suggest that Chinese banks act as agents of Beijing. Moreover, I find a consistent null relationship between temporary UN Security Council status and Chinese finance, unlike established findings about Western donors, suggesting that China is deliberately seeking regional influence. These results underscore the importance of considering the specific actors involved in China’s economic statecraft.
When the world’s leading human rights advocates violate international norms, how does this affect support for those norms around the world? Rather than diffusing norm breaking across borders, I argue that authoritarian states’ propaganda about liberal states’ violations may increase the salience of human rights norms in places where those norms are normally censored. Focusing on American racial discrimination, I find that the Chinese Communist Party publicizes American human rights violations on to its citizens for strategic political reasons. Through two survey experiments I show that while exposure to news about American discrimination does provide substantial propaganda benefits to the regime, it also makes Chinese respondents more supportive of minority rights and more critical of their own country’s respect for those rights. The study shows how prominent violations of international norms may be an underappreciated means of strengthening global public support for those norms.
In the era of digital economy, business operators often collect and utilize information such as consumers’ browsing history and past purchases to build user profiles and capture consumer needs. Based on such data, business operators would be able to provide personalized search results for their consumers. Arguably, this mode of operation is a boon to consumers and operators alike. It provides convenience and increases efficiency for the consumers, and their increased likelihood to purchase in turn generates profits and commercial returns for the business operators. In fact, the potential for personalized services is arguably one of the reasons driving the success of e-commerce.
The literature shows that social media enhances individual stakeholders’ ability to directly influence firm behaviors, paying less attention to how it enables different stakeholder groups to influence firms collectively. Drawing on the stakeholder multiplicity perspective in stakeholder theory, this study theorizes and empirically demonstrates that social media can empower lower-salience stakeholders to drive the actions of higher-salience stakeholders to influence firm behaviors. By analyzing 506 consumer crises involving foreign and local companies in China from 2000 to 2020, we find that firms take more substantial responsibility when confronted with consumers’ social-media-based collective actions than when confronted with conventional channels of consumer complaints. This heightened responsibility stems mainly from collective actions’ tendency to spur law-enforcing agencies into addressing alleged firm misdeeds, demonstrating a stakeholder multiplicity effect of social media empowerment. We also identify the institutional contingency of this effect, showing that local governments’ bureaucratic capacity positively moderates collective actions’ effect on law-enforcing actions, whereas their intervention in firms’ operational decisions negatively moderates law-enforcing actions’ effect on firms’ responsibility assumption. This study extends the understanding of social media's relationship with stakeholder influence and consolidates the stakeholder multiplicity perspective in stakeholder theory.
In the digital age, “commercial sharenting” refers to parents excessively sharing their children’s images and data on social media for profit. Initially motivated by parental pride, this practice is now driven by child-to-child marketing, where young influencers shape their peers’ consumption habits. While regulations protect child influencers’ privacy, a significant gap remains regarding the rights of child viewers. We argue that commercial sharenting threatens children’s right to health under Article 24(1) of the UNCRC, potentially leading to harmful consumer behaviors and identity confusion. In response, China has adopted a fragmented regulatory approach to platform liability. This article advocates for a comprehensive legal framework incorporating content filtering, moderation, and reviewal to regulate commercial sharenting and safeguard children’s rights and interests in China.
The proliferating Sino-US peer competition is increasingly impacting Latin American states and triggering uncertainty. As China’s expanding influence in the region challenges longstanding US supremacy in the western hemisphere and reshapes the strategic calculus for regional states, hedging behaviour becomes increasingly opportune. This most notably includes Brazil, the largest state in Latin America both politically and economically, whose hedging behaviour oscillated between governments, a characteristic normally associated with states facing higher systemic pressures. As such, how does the Sino-US peer competition impact Brazil’s hedging strategy? And why do coping behaviours differ on various indices between different administrations, from Lula to Bolsonaro? Findings suggest that depending on whether the incumbent government was left- or right-wing, Brazil’s hedge was recalibrated as either pro- or anti-US regional supremacy.
The 2018/2019 trade conflict between the United States and China impacted a broad array of agricultural products, including soybeans. Previous trade studies using gravity models fail to account for trends and complex seasonal patterns observed in the data. This study uses a machine learning (ML) approach to estimate losses in soybean export value and volume from the trade war. We find that models using ML techniques outperform traditional models and estimate losses in the value of soybean exports of $10.16 billion/year. The ML models fit the complex export trade data series well, highlighting the importance of utilizing improved modeling approaches.
Weight misperception has been reported as a common problem in high-income countries, but there is a paucity of high-quality empirical evidence in low- and middle-income countries, especially among children and adolescents. This study estimates the prevalence of weight misperception and investigates changes over time among children and adolescents in China, as well as identifies factors that may affect this weight misperception.
Design:
The China Health and Nutrition Survey, which is a repeated, representative cross-sectional study employing multistage random cluster processes.
Setting:
A Chinese national survey across fifteen provinces and municipal cities.
Participants:
Data from children and adolescents aged 6–16 years from six consecutive waves between 2000 and 2015 were included.
Results:
The final sample totalled 7110 children and adolescents. The overall prevalence of weight misperception was largely stable between 2000 and 2015 (range: 34·1–37·3 %). Sex and age groups were associated with weight misperception, with boys and younger participants more likely to misperceive their weight status. In addition, dieting and being physically active or inactive were associated with increased rates of weight misperception.
Conclusions:
Weight misperception is common among youth in China and is unequally shared with several subpopulations at increased risk. Researchers and health promoters are called to recognise weight misperception when addressing overweight and obesity countermeasures, and more tailored public health initiatives are warranted to more effectively reach those with weight misperceptions.
Although fertility is typically regarded as a unitary family decision, a meaningful degree of disagreement in fertility willingness exists within households, especially for having two or more children. As China transitioned from a one-child to multiple-child policy, understanding how such disagreement affects fertility decisions is crucial. Using household data from the 2016 China Labor-force Dynamic Survey, we analyze fertility willingness in married couples. We find that over 10% of families disagree on having two or more children. Disagreement negatively impacts plans to have more children: only the husband wanting two children significantly reduces fertility plans compared to mutual agreement, while only the wife wanting two children does not suppress the plan. This is consistent with the wife's veto power in fertility decisions. Heterogeneity analyses reveal that more equal gender role and higher bargaining power contribute to the wife's veto power, offering insights into the mechanism of intra-household fertility decisions.