The utilization of health screening and other community health services has been a hot topic in China. Thus, this study examined the effect of health changes (self-rated health, physical health, and mental health) on older people's community health screening participation in China. We derived the data from the 2016 and 2018 waves of the Chinese Longitudinal Aging Social Survey (CLASS). This paper included 10,992 observations in two waves. We tested the causal relationship using the fixed effects model. Approximately 29.56% of the respondents participated in a health screening. Notably, after controlling for covariates, changes in mental and physical health both significantly influenced seniors' participation in health screenings (self-rated health: β = 0.188, 95% CI [−0.037, −0.413]; physical health: β = 0.078, 95% CI [0.032, −0.124]; mental health: β = 0.034, 95% CI [−0.057, −0.002]). The findings showed age, educational level, income level, and family support to be significant factors associated with community health screening participation. Additionally, we identified a partial mediating effect of mental health between self-rated health and health screening participation and a partial mediating effect of depression between physical health and health screening participation. The results highlight the important role of health changes in influencing participation and promoting health screening in China. On this basis, healthcare providers in the community may consider health changes as a screening criterion to promote health screening, guiding other health promotion and prevention programs while promoting healthy aging.

ObjectivesWelfare policy focuses on vulnerable populations, such as children with difficult family backgrounds. Education is a crucial way to reduce poverty. This study explored the relationship between children’s diet structure and academic achievement and compared these across different family backgrounds.DesignA cross-sectional study was conducted to survey the health status of children from difficult families based on a random sampling method in 2018. Survey data were collected from children and their guardians with a questionnaire. A multi-sample latent class model and an ordinal logistic model were applied for data analysis.SettingThis study was conducted in 31 provinces nationwide. Two provinces in the Central (Shandong and Jiangxi), Eastern (Hebei and Henan) and Western (Chongqing and Shanxi) regions and one province in the Northeast (Liaoning) were selected considering different stratum of economic development.ParticipantsA total of 2099 children with difficult family backgrounds and 666 children from ordinary families were surveyed.ResultsThe dietary structure of children from ordinary families was significantly better than that of children with difficult or unstable family backgrounds (χ2 =9.178, p<0.01). Children from difficult families had an intake of dairy products and fruits below dietary standards. The difference in academic achievement between children in the balanced and deprived groups was statistically significant (OR=0.640, 95% CI 0.429 to 0.955). Other determinants of the academic achievement of children in difficult families were parents’ education level (OR=1.331, 95% CI 1.162 to 1.525), family economic status (OR=0.835, 95% CI 0.748 to 0.932) and parents’ academic concern (OR=0.373, 95% CI 0.252 to 0.553).ConclusionsTo address the differences between children from difficult families and ordinary families, policymakers should develop support policies for difficult children, guide the formation of a reasonable dietary structure. Besides, enhancing family closeness and fostering family nurturing behaviours are the keys to promote the good academic development of children from difficult families.

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BackgroundFamily is an important environment for the adaptive development of children. A lack of family functions can affect the equality of children's access to health opportunities. Based on past survey data, there are many children in difficult families in China, and the life experiences of living in difficult families have had a serious negative impact on children's health. Therefore, the research on health equality in children in difficult families is particularly important. ObjectiveThe study aimed to examine the difference in the extent of family environment's influence on equal health opportunities between children from difficult families and ordinary families. MethodThe study based on data of a survey, "Health Status of Children in Difficult Families," which was conducted in 7 provinces in China in 2018. The D index was used to calculate the extent to which the family environment influenced the health opportunity equality in children from two types of families. Through conducting the Shapley decomposition based on ordered multi-class regression, the relative level of contribution of different family environment factors to the health opportunities equality in children from two types of families was examined. ResultsThe family variables included in this paper examined had a significant impact on the health opportunities of children from both families, and they had a greater impact on children's mental health. Based on the results of Shapley decomposition on different family environment factors, the family relationship had the greatest impact on the self-reported health opportunities of children from difficult families (32.02%). Living condition was the main factor that influenced the self-reported health opportunities of children from ordinary families (25.72%). In terms of mental health, family economic status was the main factor that affected the mental health opportunity equality in children from difficult families (21.22%). Family relationship was the main factor influencing the mental health opportunity equality in children from ordinary families (36.54%). In terms of cognition, family relationship was the main factor affecting health opportunity equality in children from two types of families (55.72% and 28.05%, respectively). ConclusionThere is a significant difference in the extent to which the family environment influences the health opportunity equality between children from two types of families across different health domains. Family relationship is the most important factor affecting the fairness of children's access to health opportunities in difficult families.