Family Structure and Child Malnutrition in China: Three Essays

Thumbnail Image





James, Sherman A
Merli, M. Giovanna

Journal Title

Journal ISSN

Volume Title

Repository Usage Stats



Over the past three decades, the phenomenon of children's health in China has been marked by a co-existence of overweight and underweight. 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 proximately affect child malnutrition in China. Using data drawn from 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 together with the drastically increasing income inequality has created an ever-increasing 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. Although the fertility level has been lowered by One Child Policy, resource dilution effect still affects girls' nutrition status, 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 relationship that facilitates effective communication and promotes healthy lifestyle formation.






He, Wei (2013). Family Structure and Child Malnutrition in China: Three Essays. Dissertation, Duke University. Retrieved from


Dukes student scholarship is made available to the public using a Creative Commons Attribution / Non-commercial / No derivative (CC-BY-NC-ND) license.