Factors affecting consumption of sugar-sweetened beverages in elementary school students in Nanjing

Abstract

Surveys were conducted on sociodemographic characteristics, family, home- and school-related factors, and sugar-sweetened beverage (SSB) intake to identify factors associated with SSB consumption in children. In total, 2700 valid questionnaires were returned. Mean age was 10.4 ± 2.23 years and 49.3% were male. Multivariate logistic analysis showed that the frequency of SSB dinking by fathers and peers, the frequency of SSB purchasing at home and school, and the duration of daily TV and video watching were significantly independent factors affecting SSB intake, suggesting that interventions targeting children’s SSB intake should incorporate government policies, educational programs and parental engagement.

SUBJECTs:

• Allied Health
• Health & Society
• Public Health Policy and Practice

Keywords:

• Nutrition
• sugar-sweetened beverage
• consumption
• childhood disease
• TV advertisement

Reviewing Editor:

• Escudero-Gilete M. Luisa, Universidad de Sevilla, Spain

Introduction

Sugar-sweetened beverage (SSB) is defined as any consumable non-alcoholic water-based beverages with added sugar, including carbonated drinks, fruit and vegetable juices, functional drinks, tea drinks, milk drinks, vegetable drinks, and coffee drinks. The World Health Organization recommends that the intake of ‘free sugars’ is less than 10% of the total energy intake. It states that consuming SSB increases overall energy intake, potentially leading to weight gain and an increased risk of non-communicable disease (WHO, 2015). In addition, massive epidemiological and evidence-based studies have shown that children and adolescents who consume too many SSB will not only reduce the amount of water and milk consumption, but also develop bad dietary habits, leading to an increased risk of developing health problems, such as weight gain and obesity (Nguyen et al., 2023; Grimes et al., 2021), type 2 diabetes mellitus (T2DM) (Rousham et al., 2022; Livesey et al., 2019), tooth decay (Malik et al., 2010; Sheludiakova et al., 2012), and cardiovascular disease (Cozma et al., 2012; Zeraattalab-Motlagh et al., 2021; Huang et al., 2017).

Various measures and policies have been implemented to reduce SSB consumption, such as taxes by governments and public campaigns (WHO, 2015; Backholer et al., 2017). In China, various non-mandatory control measures and policies are in place to monitor obesity; physical exercise has been suggested to reduce the consumption of SSB, and warning signs are posted on school campuses to address the damage caused by excessive consumption of SSB to children (Xin et al., 2021; Fund UNC, 2018). Some local governments have introduced legislations to ban the in-campus sale of snack foods and SSB in elementary and middle schools in Anhui and Shanghai.

Despite these efforts, the incidence of obesity in China increased rapidly between 1998 and 2018, and the daily intake of SSB doubled from 329 to 715 ml (Jing et al., 2018; Guo et al., 2021). The increasing prevalence of obesity and non-communicable diseases results from multiple factors, including dietary and eating habits, increased intake of cooking oils, reduced physical activity, sedentary activities such as TV watching and consumption of SSB (Yu et al., 2016), particularly in children (Hafekost et al., 2011; Bonatti & Abbondandolo, 1989), depending on regional eco-social conditions and the age of the child (Si et al., 2019; Park et al., 2015).

SSB sales increased rapidly in the last two decades from 43.4 liters per person in 2001 to 65.3 liters per person in 2014 (Mendez Lopez et al., 2017). Although a sharp increase in SSB sales has been reported in China (Popkin & Hawkes, 2016), not much data on SSB consumption among school students, particularly elementary school students, are available (Cai et al., 2018). Elementary school children are at a crucial stage of growth and development. Nutrition education at this stage can potentially increase their recognition of unhealthy diets and reduce their consumption, thus reducing the incidence of related diseases (Yu et al., 2020).

With rapid economic development and diversified sociodemographic situations in China, it is necessary to have a better understanding of SSB intake by elementary students. This will help plan and develop effective strategies and interventions to reduce SSB consumption. However, data regarding SSB consumption by elementary students from large survey are not relatively scattered. Present study was conducted to survey the current SSB consumption situation and to analyze the factors affecting the SSB intake in students attending elementary schools in Nanjing, China. The findings will provide insight to manage SSB consumption in school students for heathy development.

Materials and methods

Subjects

Students attending grades 4 to 6 elementary schools in Nanjing were randomly selected to participate in the study. Students were included if they were willing to participate in the survey and able to complete the questionnaire with the assistance of their parents. The assistance was only to help classifying the drinks to avoid possible miscounting of non-SSB into SSB. Students were excluded if they had diabetes, chronic digestive tract diseases, or other chronic diseases. Informed consent was obtained from the guardians of the students, and the study was approved by the Ethics Review Committee of Nanjing Xiaozhuang University.

Survey methods

A questionnaire initially designed by Grimm et al. (2004) and modified by the investigators was electronically distributed to the selected students. The questionnaire contained three parts: 1) demographic characteristics such as school name, grade, gender and age of student, parents’ education level, and family annual income; 2) weekly SSB intake including type, name, and size of any consumed carbonated drinks, fruit and vegetable juice, sports drinks, tea drinks, milk-tea drinks, and lactobacillus drinks; 3) amount of time watching television/video, parental SSB consumption (often, sometimes, seldom, or never), peer SSB consumption (often, sometimes, seldom, or never), availability in home and in school (often, sometimes, seldom, or never), and sweet taste preferences (very like, like, dislike, or very dislike). The completed questionnaires were submitted electronically via computers or mobile phones. All returned questionnaires were manually checked for their completion, accuracy, and authenticity. Incompletely or irregularly answered questionnaires were excluded from analysis.

Statistical analysis

SPSS17 software was used for statistical analysis. The measurement data are presented as means ± standard deviation (SD) and compared using the t-test; category data are expressed as percentages and compared using x² test. If the outcome variables were ordinal variables, they were compared using the Kruskal-Wallis H rank sum test. To determine which factors were independently associated with SSB consumption, those that were statistically significant in the bivariate logistic regression analyses were included in a multivariate model. Statistical significance was set at p value < 0.05.

Results

Characteristics of the survey

A total of 5159 questionnaires were issued and 3789 questionnaires were returned. The recovery rate was 73.4%. 1089 questionnaires were removed from the returned questionnaires due to incomplete answers (76.3%) and other mistakes or irregularities (23.7%), resulting in 2700 valid questionnaires. The effective rate was 71.3%. There were 1330 male and 1369 female students, with an average age of 10.4 ± 2.23 years. The majority of the students were aged between 8 and 12 years, and very few were older than 13 years (0.7%). The percentages of male and female students were not significantly different (49.3% vs. 50.7%, p > 0.05), while the ages between the grades were significantly different. The students were evenly distributed in the 4–6^th grades (Table 1).

Table 1. Demographic characteristics of participants.

Characteristics
Gender, n (%)	Male	1330 (49.26)
	Female	1370 (50.74)
Age, n (%)	9	537 (19.89)
	10	871 (32.26)
	11	890 (32.96)
	12	384 (14.22)
	13–14	18 (0.67)
Average age, year		10. 4
Grade, n (%)	4	900 (33.33)
	5	865 (32.04)
	6	935 (34.62)

SSB consumption

Statistical analysis showed that on a weekly basis, 69.3% of the students drank less than one bottle, 28.0% drank one to three bottles, and 2.8% drank more than three bottles of SSB (Table 2). Among the demographic characteristics, only sex (H = 4.78) was found to be associated with SSB consumption, with male students drinking more SSB than female students. However, SSB consumption was not significantly different between grades, ages, parents’ education levels, and annual family income (Table 2).

Table 2. Consumption of sugar-sweetened beverages in students attending primary schools in Nanjing, China.

		Weekly SSB intake (bottle)
		< 1		1–3		> 3
Variable	Group	No	%	No	%	No	%	H value	p-value
Gender
	Male	897	67.4	396	29.8	37	2.8	4.78	< 0.05
	Female	975	71.2	357	26.1	38	2.8
Grade	4	633	70.3	228	25.3	39	4.3	0.56	0.45
	5	603	69.7	201	23.2	61	7.1
	6	639	68.4	261	27.9	35	3.7
Age	9	372	69.3	114	21.2	51	9.5	1.22	0.12
	10	609	69.9	216	24.8	46	5.3
	11	630	70.8	216	24.3	44	4.9
	12	261	68.0	108	28.1	15	3.9
	13–14	9	50.0	6	33.3	3	16.7
Father’s education
	Elementary school or below	534	70.6	201	26.6	21	2.8	2.14	0.06
	Middle school	398	71.1	211	26.5	21	2.1
	High school	384	72.2	138	25.9	10	1.9
	College	336	75.3	102	22.9	8	1.8
	Bachelor or above	246	75.7	78	24.0	1	0.3
Mother’s education
	Elementary school or below	522	71.0	201	27.3	21	2.8	1.11	0.12
	Middle school	501	65.2	246	32.0	21	2.7
	High school	354	64.8	162	29.7	30	5.5
	College	255	72.6	84	23.9	12	3.4
	Bachelor or above	222	74.0	60	20.0	18	6.0
Family annual income (k US$)
	<20	873	70.1	330	26.5	42	3.4	1.25	0.11
	20–30	738	65.8	330	29.4	54	4.8
	30–40	156	68.4	54	23.7	18	7.9
	>40	81	77.1	18	17.1	6	5.7

Bivariate analysis of SSB consumption

To further analyze the factors affecting SSB consumption, home- and school-related factors were assessed for their relationship with SSB intake. Bivariate analysis showed that the frequency of SSB dinking by parents and peers, the frequency of SSB purchasing at home and school, preference for sweet taste, and length of daily TV and video watching were significantly related to SSB intake (p < 0.01; Table 3).

Table 3. Univariate analysis of factors affecting consumption of sugar-sweetened beverages in students attending primary schools in Nanjing, China.

		Weekly SSB consumption (bottle)
		< 1		1–3		> 3
Variable		n	%	n	%	n	%	H value	p-value
Father intake	Often	48	43.2%	48	43.2%	15	13.5%	22.23	< 0.01
	Sometime	273	55.8%	189	38.7%	27	5.5%
	Seldom	648	63.3%	339	33.1%	36	3.5%
	Never	843	78.3%	177	16.4%	57	5.3%
Mother intake	Often	9	33.3%	12	44.4%	6	22.2%	21.12	< 0.01
	Sometime	162	48.2%	138	41.1%	36	10.7%
	Seldom	687	60.6%	405	35.7%	42	3.7%
	Never	972	80.8%	192	16.0%	39	3.2%
Peer intake	Often	28	32.6%	28	32.6%	30	34.9%	18.16	< 0.01
	Sometime	250	37.7%	342	51.6%	71	10.7%
	Seldom	880	67.2%	360	27.5%	70	5.3%
	Never	470	73.3%	128	20.0%	43	6.7%
Purchase in school	Often	3	6.3%	24	50.0%	21	43.8%	68.44	< 0.01
	Sometime	33	15.5%	156	73.2%	24	11.3%
	Seldom	504	62.9%	264	33.0%	33	4.1%
	Never	1305	79.7%	273	16.7%	60	3.7%
Available in home	Often	6	7.4%	39	48.1%	36	44.4%	58.22	< 0.01
	Sometime	123	32.3%	234	61.4%	24	6.3%
	Seldom	690	68.9%	243	24.3%	69	6.9%
	Never	1167	94.4%	60	4.9%	9	0.7%
Sweet taste	Strongly like	108	43.9%	87	35.4%	51	20.7%	12.56	< 0.01
	Like	428	57.3%	270	36.1%	49	6.6%
	Dislike	780	59.4%	480	36.5%	54	4.1%
	Strongly dislike	330	84.0%	43	10.9%	20	5.1%
Daily TV/Video	≥ 2 h	234	48.8%	165	34.4%	81	16.9%	24.12	< 0.01
	1–2 h	660	62.3%	360	34.0%	39	3.7%
	< 1 h	870	74.9%	273	23.5%	18	1.6%

Multivariate logistic regression analysis

To further determine the independent factors affecting SSB intake, ordinal logistic regression analysis was performed using weekly SSB intake as the dependent variable and variables that were significant in the bivariate analysis as independent variables. The dependent variables were assigned values of 1, 2, and 3 if the weekly SSB intake was < 1, between 1 and 3, and > 3 bottles, respectively. The results showed that the frequency of SSB dinking by fathers and peers, the frequency of SSB purchasing at home and school, and the length of daily TV and video watching were significant independent factors affecting SSB intake (p < 0.01; Table 4).

Table 4. Ordinal logistic regression analysis of factors affecting consumption of sugar-sweetened beverages in students attending primary schools in Nanjing, China.

Variable		β	Sx	Wald X2	p-Value	OR (95% CI)
Gender	Male	−0.08	0.16	0.07	0.76	0.97 (0.72–1.33)
Father intake	Often	−0.22	0.24	0.65	0.34	0.57 (0.32–0.81)
	Sometime	0.24	0.28	1.65	0.15	1.33 (0.92–1.67)
	Seldom	0.52	0.24	6.22	0.034	1.88 (1.52–2.21)
	Never	0.68	0.49	7.89	0.01	1.95 (1.62–2.44)
Mother intake	Often	0.08	0.19	0.27	0.76	0.97 (0.72–1.33)
	Sometime	0.22	0.24	0.65	0.35	0.52 (0.30–0.71)
	Seldom	0.18	0.58	0.47	0.15	0.33 (0.12–0.47)
	Never	0.52	0.24	0.87	0.11	0.90 (0.64–1.21)
Peer intake	Often	1.08	0.49	5.27	0.02	3.91 (2.72–4.66)
	Sometime	0.26	0.24	1.33	0.17	1.52 (0.81–1.91)
	Seldom	0.08	0.28	0.47	0.15	0.33 (0.11–0.48)
	Never	0.12	0.44	0.17	0.11	0.88 (0.61–1.11)
Purchase in school	Often	2.34	0.67	11.21	< 0.01	9.57 (8.52–12.11)
	Sometime	1.66	0.33	18.32	< 0.01	4.44 (3.12–6.17)
	Seldom	0.55	0.23	7.88	< 0.01	3.57 (2.55–4.82)
	Never	0.12	0.16	6.36	< 0.01	1.57 (0.92–2.19)
Available in home	Often	2.34	0.78	22.11	< 0.01	16.33 (13.12–18.01)
	Sometime	1.55	0.65	24.21	< 0.01	8.51 (6.57–9.91)
	Seldom	0.12	0.24	0.76	0.14	1.17 (0.62–1.99)
	Never	0.06	0.1	0.22	0.41	0.57 (0.42–0.88)
Sweet taste	Strongly like	0.56	0.45	1.02	0.31	1.33(0.82–2.01)
	Like	−0.35	0.24	1.22	0.24	1.17 (0.82–1.46)
	Dislike	−0.11	0.33	0.78	0.67	0.52 (0.32–0.88)
	Strongly dislike	−0.05	0.24	0.12	0.32	0.34 (0.12–0.76)
Daily TV/Video	≥ 2 h	0.82	0.24	16.11	< 0.01	2.88 (1.52–3.51)
	1–2 h	0.76	0.2	14.22	< 0.01	1.97 (1.23–2.61)
	< 1 h	0.55	0.21	8.21	< 0.01	1.59 (0.98–2.14)

Discussion

Although it is recommended that children and adolescents should not drink or drink less SSB (Chinese Nutritional Society, 2016), our survey indicated that about 30% of grade 4 to 6 students drink more than one bottle (230 mL) of SSB per week, irrespective of age, gender, grade, parent education, and family income. Parental and peer SSB consumption, availability of SSB at home and school, and daily TV and video watching are significantly associated with SSB consumption. This cross-section study is a relatively large-scale survey conducted on elementary students in a city representing average social-economic status of China.

Nanjing was selected as a study site because of its representativeness to Chinese city. With a population of 8.5 million and area of 2,543.26 square kilometers, it is the capital of China’s eastern Jiangsu province. Situated in the lower reaches of the Yangtze River, roughly 300 km west from Shanghai with a per capita gross domestic product (GDP) of $27500 (2022). Nanjing is one of the highly-developed cities with strong industrial economic strength, accounting for about 1% of the country total gross industrial capability. There are 346 elementary schools with over 270000 students. Health check-ups are organized by the school authority for every student once a year and are conducted by licensed doctors. The check-ups results are recorded in government-issued health-information cards issued to students. Students are checked for overall health conditions and conditions that mostly affect students such as overweight, obesity, malnutrition, abnormal spinal curvature, poor vision, dental caries and diabetes.

Compared with other countries, Chinese children consumed relatively fewer SSB 10 to 15 years ago, but their consumption has increased rapidly, as reported by Euromonitor Passport International (Singh et al., 2015; Brand-Miller & Barclay, 2017). Among the demographic characteristics, only gender (H = 7.56) was found to affect SSB consumption, female students consumed fewer SSB than the male students surveyed. This is consistent with previous findings and might be attributed to the possibility that girls pay more attention to their body shape to avoid high-energy foods and beverages (Gui et al., 2017; Feng et al., 2019), although in an early study, no sex difference was found in SSB consumption (Guo et al., 2021). Home income was previously found to be positively associated with SSB consumption, especially in the highest consumption group (>2 times a week) (Guo et al., 2021). However, in the present study, we found that home income between 20 and 40 k/year does not impact SSB consumption. This is probably because SSB is relatively cheap, the differences in income among children’s families do not have substantially impact on the purchase of SSB. We also found that parents’ education level did not influence SSB consumption. This is again different from previous results showing that fathers’ and mothers’ low education levels are associated with children’s higher SSB consumption (Guo et al., 2021).

In Western countries, lower parental education levels are related to high SSB consumption by children because parents with higher education levels tend to be more restrictive to their children’s access to beverages (Mazarello Paes et al., 2015; Cockburn et al., 2018), while in other studies, the relationship is reversed and parents with high education levels result in increased SSB consumption by their children (Sim et al., 2019; Zahid et al., 2017; Inhulsen et al., 2017).

In the present study, different age groups had similar SSB consumption rates. This might be because the age range was relatively narrow in the study population (most students were aged 10–11 years). It is likely that this relationship might change when students are older, as shown previously, that SSB consumption is higher in high school students than in primary school students (Guo et al., 2021).

Among the independent factors that significantly influenced SSB consumption, daily TV/video viewing time positively correlated with SSB intake. This correlation can be attributed to several factors. In China, approximately 80% of TV advertising is for food and beverages (Parvanta et al., 2010) and the top food category with teen-directed marketing expenditures is SSB (Kumar et al., 2015). Children with longer TV/video watching times are more likely to be exposed to SSB advertising and are more affected by their dietary preferences, resulting in increased SSB purchase and intake (Kelly et al., 2010; Boyland et al., 2016). It has been suggested that reducing advertising that markets unhealthy foods and beverages to adolescents and minorities would help reduce the consumption of SSB (Cervi et al., 2017). In addition, nutrition-related education should be part of classroom education. This would enable students to properly identify and distinguish various SSB and non-SSB, such as lactic drinks and sugar-free drinks, for better control of SSB intake.

Our study showed that peers have a significant impact on SSB consumption. This was consistent with previous studies (Smit et al., 2016; Watts et al., 2018). The students surveyed were at ages that have less self-controlling ability and are easily affected by peers (Erwin, 1994; Rapp et al., 2019). Studies show that peer effects can subtly change non-cognitive abilities and skills such as self-control ability, health, and behavior habits, thereby influencing health outcomes such as bodyweight (Loh & Li, 2013). Misperceptions of peer SSB consumption norms are pervasive and associated with unhealthy SSB consumption behavior, possibly leading to intake of excess calories (Perkins et al., 2010). Peer education has been widely used in drug abuse prevention, AIDS prevention, sex education, and other areas of health education (Shucksmith et al., 1997; Kosterman et al., 2000) but is less applied to nutrition education (Story et al., 2002; Wang et al., 2001), although it has been demonstrated to improve students’ nutrition knowledge and help them establish good eating behaviors (Wang et al., 2001). Therefore, peer education should be implemented as a part of prevention and intervention strategies to reduce SSB consumption.

Our analysis also reveals that the availability of SSB in homes and schools affects SSB consumption. This is consistent with earlier results showing that the availability of SSB in schools and nearby neighborhoods increases SSB consumption (Godin et al., 2019). In Nanjing, food marts and grocery stories are present in almost all schools, and students are also able to walk to nearby street vendors for food, including SSB. The selective banning of food categories may help reduce SSB consumption. For example, no drinks containing caffeine were allowed from September 2018, including carbonated drinks, lactic acid bacteria beverage, vegetable juice, and fruit juice in Korea (Si, 2018) and carbonated drinks were banned in primary and middle schools in Beijing as a governmental effort to improve children’s health (Guo, 2013). Installing drinking water dispensers and encouraging reusable water bottles could also be effective in reducing SSB consumption (Zhang et al., 2021).

SSB might be purchased either directly or via parents from vendors when students are at school. The ability to purchase directly increases the accessibility to SSB and signals the permission of parents to drink SSB (Mou et al., 2020). Provision of SSB by parents would potentially transmit unhealthy eating habits and encourage the intake of SSB by students (van de Gaar et al., 2017).

Parental SSB consumption may influence children because parents function as role models both positively and negatively. Therefore, parents who consume SSB are often prone to fewer restrictions regarding their children’s SSB consumption (Fisher et al., 2001). Our research demonstrated that fathers have a strong impact on children’s SSB consumption. This is consistent with conclusions from previous studies that children consume more SSB if their parents are frequent SSB consumers (Watts et al., 2018; Sim et al., 2019; Lundeen et al., 2018). However, in these studies, it was found that mothers’ SSB consumption has a stronger association with SSB consumption in children due likely to close proximity and great influence of mother to child (Guo et al., 2021). However, our study showed that mothers were less influential on children regarding SSB consumption. Since mothers may have different impact on daughters and sons, we analyzed SSB consumption relationships between mothers and daughters or sons separately. While the overall relationships are similar between mothers and children and mothers and daughters or sons at different drink frequencies from often to never, it is slightly more in favor between mother and daughter than between mother and son, where daughter’s SSB consumption was significantly (p = 0.045) affected only if mother intake frequency was seldom. This suggests that daughters are more socially close to mothers in drink behavior or preference.

Based on these findings, measures and policies may be designed to reduce SSB consumption in children, including regulating advertisements for SSB in TV, internet, and other media accessible to children, implementing tax on SSB, selective banning of SSB sales in school, and parental and children education on food/drink selection.

Limitations: This study used data from self-reported SSB consumption questionnaires and the survey was limited to selected students in Nanjing. The amount of SSB consumed by children was the best estimate, not quantitatively determined, this would generate bias in reporting the degree of SSB consumption among people. As a cross sectional study, this study does not provide dynamics of SSB consumption over time which are important for policy making targeting prospective improvement. Longitudinal studies are therefore needed to examine the changes of relationships in SSB consumptions and to establish solid causality by avoiding influence from confounding variables.

Conclusions

Our results show that children’s SSB consumption is affected by their living habits (TV/video watching), parental and peer SSB consumption, and availability. Therefore, interventions targeting children’s SSB intake should incorporate government policies, educational programs, and parental engagement.

Author contributions

DL, YY, and YY designed the study. DL, YY, MW, JC, YL, and YY collected the data and performed the analysis. DL, YY, and YY drafted the manuscript. All the authors have read and approved the final version of the manuscript.

Ethical approval

The study was approved by The Ethics Review Committee of Nanjing Xiaozhuang University. Informed written consent was obtained from the guardians of student.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported by Jiangsu University Philosophy and Social Science Research Funding Project [2021SJA0476] and National Natural Science Foundation of China [32000759].

Notes on contributors

Dan Li

Dan Li is a lecturer at Nanjing Xiaozhuang University. She graduated from China Pharmaceutical University with a bachelor’s degree and master’s degree. She received her doctoral degree in epidemiology and health statistics from the School of Public Health at Southeast University in 2020. Her research interests include child health and health policy studies of children.

Yuan Yuan

Yuan Yuan, an assistant researcher, is a doctoral student at the School of Education at Nanjing University. She has received a bachelor’s degree in primary education from Nanjing Normal University and a master’s degree in Public Administration (MPA) from Southeast University. Her research interests and directions are teacher education, child education, and child health policy research. The current research is exploring the pathways of child health improvement in primary schools in China.

Mi Wang

Mi Wang is now a lecturer at Nanjing Xiaozhuang University. She worked as a Senior Researcher at the Education University of Hong Kong. Wang received her Doctor of Education degree from the Chinese University of Hong Kong in 2022, and her Master of Education degree from the University of Massachusetts in 2017. Wang‘s research interests include educational policy studies, student well-being, and home-school collaboration. Her current research focuses on the development of elementary school students.

Jing Chen

Jing Chen is an associate professor at the Department of Education, Shanghai Normal University. She earned a Ph.D. degree in 2019. Her research interests are principles of education and educational policy. Current research is focusing on educational governance and educational equity policies.

Yanwei Li

Yanwei Li is an associate professor at Nanjing Xiaozhuang University. She earned a Bachelor of Science in 2009, a Master of Developmental and Educational Psychology in 2012, and Doctor of Biomedical Engineering in 2017 at Henan Normal University, Beijing Normal University and Southeast University respectively. She has a passion for childhood development and education. Her current research focuses on child health evaluation.

Yihan Yang

Yihan Yang is a senior engineer in Information Engineering, the head of the Regulatory Science and Policy Research Department of the Shanghai Drug and Medical Device Adverse Reaction Monitoring Center, the responsible editor of the Jounal of Shanghai Drug Regulatory Intelligence Research. She is graduated from China Pharmaceutical University with a master’s degree in 2019. Her research interests are child food and drug regulatory policies.