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The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China
Last registered on December 18, 2016

Pre-Trial

Trial Information
General Information
Title
The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China
RCT ID
AEARCTR-0001138
Initial registration date
December 18, 2016
Last updated
December 18, 2016 9:23 PM EST
Location(s)
Region
Primary Investigator
Affiliation
Stanford Medical School
Other Primary Investigator(s)
PI Affiliation
Center for Chinese Agricultural Policy, Chinese Academy of Sciences, 100101 Beijing, China
PI Affiliation
Northwest Socioeconomic Development Resource Center, Xibei University, 710127 Xi’an, China
PI Affiliation
Center for Chinese Agricultural Policy, Chinese Academy of Sciences, 100101 Beijing, China
PI Affiliation
Economic and Management School, Ningxia University, 750002 Ningxia, China
PI Affiliation
Freeman Spogli Institute, Stanford University, Stanford, CA, USA
PI Affiliation
Freeman Spogli Institute, Stanford University, Stanford, CA, USA
Additional Trial Information
Status
Completed
Start date
2008-10-01
End date
2011-06-30
Secondary IDs
Abstract
This article studies whether or not health education programs targeting childhood anemia are sufficient for changing health behavior and nutrition in rural China. We conducted three different randomized-controlled trials of single and multiple face-to-face education sessions with parents and distributed written health education materials—and compare our results with a simple vitamin distribution program. Across all three studies, we find little evidence of changes in blood hemoglobin concentration or anemia status. In contrast, in our two studies that also examined a multivitamin supplementation intervention, we find meaningful reductions in anemia
External Link(s)
Registration Citation
Citation
Luo, Renfu et al. 2016. "The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China." AEA RCT Registry. December 18. https://doi.org/10.1257/rct.1138-1.0.
Former Citation
Luo, Renfu et al. 2016. "The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China." AEA RCT Registry. December 18. https://www.socialscienceregistry.org/trials/1138/history/12619.
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Experimental Details
Interventions
Intervention(s)
Three separate experiments were conducted in Shaanxi and Ningxia districts to test the effectiveness of information, and nutritional supplements vis-a-vis controls. Entire schools were assigned to treatment or control groups. Fourth grade students in sample schools were tested for anemia and then subjected to the following interventions:
Experiment 1:
Information treatment: parents are mailed general information on anemia, their child's anemia status, and ways to address anemia like including more iron-rich foods in their child's diet or giving their child an iron supplement.
Supplement treatment: teachers were instructed to give each student a daily multivitamin supplement containing iron.
Experiment 2:
Information treatment: similar to experiment 1, except messaging to parents is more intense. The school invited parents to an information session in which a trained health professional shared information on anemia, its cognitive and physiological consequences, and strategies to address it. The recommended strategies were the same as in Experiment 1. The health professional also distributed printed material on anemia: pamphlets to parents and posters to teachers.
Supplement treatment: same as experiment 1.
Experiment 3:
Information treatment: Parents invited to two information sessions at school.
Supplement treatment: None. Only information treatment and control.
Intervention Start Date
2008-10-01
Intervention End Date
2011-06-30
Primary Outcomes
Primary Outcomes (end points)
Student hemoglobin level
Primary Outcomes (explanation)
Hemoglobin levels were measured onsite using a HemoCue Hb 201þ diagnostic machine. Ten percent of all sampled students were retested; if the second measure differed from the original one by more than 0.3 g/dl among three or more students, all sample students in that school were retested. Because students in our sample were aged 8–11 years, the WHO recommended anemia threshold of ‘11.5 g/dl and below for children aged 5–11 years’ was adopted.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
First, a list of all counties in was obtained for the study regions, namely Shaanxi Province or Ningxia Autonomous Region. Second, study counties were randomly selected from those meeting the official criteria for impoverished counties. Third, a list of all primary schools in sample counties was created using official records. Fourth, researchers used official records and their own canvass survey to identify all schools with the following characteristics: (i) six grades (i.e., 'complete' primary schools, or wanxiao), (ii) boarding facilities, and (iii) 400 or more students. Fifth, primary schools were randomly selected from these sampling frames. Finally, only fourth grade students in sample schools were randomly selected for inclusion in the studies.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Three levels of randomization in order of county, primary schools, and fourth grade students.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
176 schools:
Experiment 1: Control (30), Information(12), Supplementation(24);
Experiment 1: Control (30), Information(15), Supplementation(25);
Experiment 1: Control (25), Information(25)
Sample size: planned number of observations
6,491 students
Sample size (or number of clusters) by treatment arms
Experiment 1: Control (1686), Information(675), Supplementation(1470);
Experiment 1: Control (798), Information(439), Supplementation(417);
Experiment 1: Control (541), Information(475)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Stanford University Institutional Review Board
IRB Approval Date
Details not available
IRB Approval Number
Details not available
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
June 30, 2011, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
June 30, 2011, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
6,169 students
Final Sample Size (or Number of Clusters) by Treatment Arms
Control: 2,879 Information: 1,487 Supplement: 1803
Data Publication
Data Publication
Is public data available?
No

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Program Files
Program Files
No
Reports and Papers
Preliminary Reports
Relevant Papers
Abstract
THE LIMITS OF HEALTH AND NUTRITION EDUCATION: EVIDENCE FROM THREE RANDOMIZED-CONTROLLED TRIALS IN RURAL CHINA

This article studies whether or not health education programs targeting childhood anemia are sufficient for changing health behavior and nutrition in rural China. We conducted three different randomized-controlled trials of single and multiple face-to-face education sessions with parents and distributed written health education materials—and compare our results with a simple vitamin distribution program. Across all three studies, we find little evidence of changes in blood hemoglobin concentration or anemia status. In contrast, in our two studies that also examined a multivitamin supplementation intervention, we find meaningful reductions in anemia.
Citation
Luo, Renfu, Yaojiang Shi, Linxiu Zhang, Huiping Zhang, Grant Miller, Alexis Medina, and Scott Rozelle. 2012. “The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China.”CESifo Economic Studies 58(2): 385-404.