How Is Caring for Grandchildren Associated with Grandparents’ Health: The Mediating Effect of Internet Use

doi:10.21203/rs.3.rs-2075673/v1

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Research Article

How Is Caring for Grandchildren Associated with Grandparents’ Health: The Mediating Effect of Internet Use

https://doi.org/10.21203/rs.3.rs-2075673/v1

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Background: Prior studies showed mixed results of the association between grandchild care and grandparents’ health. This research focused on the mechanisms behind the above link by studying how internet use served as a mediator through which grandchild care impacted grandparents' health. The study aimed to draw health implications to improve health of grandparents who offer intergenerational care.

Methods: Using a sample of 16,829 grandparents aged 50 through 80 from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS), the study relied on the KHB method to conduct the analysis. Grandparental health were measured by self-rated health, IADL, life satisfaction and depression.

Results: Overall, grandchild care had a positive effect on grandparental health. Those who engaged in grandchild care were more likely to use internet. Internet use mediated the ways in which grandchild care impacted grandparents' health. It generally promoted the positive influence of intergenerational caregiving on grandparental health. The mediating effects of watching videos and chatting through internet were most pronounced among urban grandmothers. The mediating effects of watching news were most noticeable among both urban grandmothers and grandfathers.

Conclusions: These findings implied that promoting internet usage may be an effective way reducing the negative impact of intergenerational caregiving on grandparents' depression. It could also increase the positive effect of caregiving on grandparents' SRH and functional independence. The study also underscored the importance of taking rural-urban context and gender role into consideration when studying intergenerational caregiving and Chinese grandparents' health.

Internet use

grandparental childcare

health

China Health and Retirement Longitudinal Study (CHARLS)

mediating effect

KHB method

Grandparents have been found to play a vital role in caring for grandchildren, especially in traditional Asian societies where highly value multigenerational co-residence as an ideal living arrangement. Such a living arrangement pattern is considered as a form which promotes filial piety and collective family interests [1]. Multigenerational co-residence also makes the involvement of grandchild care be on a daily basis without stating a custodial responsibility [2, 3]. In recent years, with a rising trend of female labor force participation and an increasing divorce rate, grandparents’ involvement in childbearing becomes even more important. Consequently, considerable research attention has been given to studies of grandparental childcare and its impacts on grandparents' mental and physical health. Mixed results have been found with showing a positive, negative, U-shape or non-significant impact of grand parenting on grandparental health outcomes (see detailed discussion in the theoretical background section). Although some studies have attempted to explore the mechanisms that can possibly explain the ways in which caring for grandchildren links to grandparents' health status, prior literature has hardly examined the mediating effect of internet use in such a linkage. This study tried to fill the voids by relying on the Karison, Holm and Breen (KHB) method to analyze data taken from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS).

When examining the mediating effect, this study also concerned gender as well as rural-urban differences. This is because previous research highlighted significant gender differences in China’s traditional family norms in terms of domestic life and caregiving practice [4, 5]. Studies reported that grandmothers spent a comparable amount of time in childcare, which was three times as much time as grandfathers spent in childcare [6]. When caring for grandchildren, Chinese grandmothers tended to fulfill intensive responsibilities, such as feeding, bathing, and dressing whereas grandfathers usually served as fun-seeker, playmate, and companion [7]. Grandfathers may also experience social stigma if they are heavily involved grandparenting since traditional norms do not encourage males to be heavily engaged in childcare. Previous literature reported worse psychological health among grandmothers than grandmothers [8]. Besides the gender differences documented in literature studying Chinese sample, studies based on Western countries also showed significant gender differentials. A piece studying the European sample found a positive association between grandchild care and grandmothers' physical health but such an association was not found among grandfathers [9]. Researchers reported more depressive symptoms for grandmothers than for grandfathers [10, 11]. When the reducing depression effect of social media (such as using internet) was taken into consideration, studies found that it was more apparent among older women than among older men [12].

The family caregiving norms have also been found to vary in rural and urban China due to drastically uneven development levels in both settings [13]. The rural-urban differences in multiple domains, including social resources, family norms, cultural tradition, living standards, individual health disparities et al., have been repeatedly documented in abundant literature [14–18]. Although traditional family norms and cultural values have been largely weakened in recent decades by China's rapid urbanization and dramatic social changes, less changes have occurred in rural areas as compared to urban settings [19]. In addition, with a large number of rural residents moving to cities to seek job opportunities, rural Chinese grandparents are more likely than their urban peers to become custodial caregivers in skipped-generation households. Rural grandparents are also more financially dependent on their adult children and consider grandchild care as a reciprocal form of intergenerational exchange [20]. As a result, rural grandparents' psychological well-being tends to be more impacted by both financial security and grandchild caregiving. Additionally, the one-child policy was more strictly implemented in urban than in rural China. Urban grandparents tend to enjoy nurturing the only grandchild in family when rural grandparents are struggling to care multiple grandchildren. These differences are likely to cause grandparental health disparities due to giving care to grandchildren.

Under such a proceeding, this paper aimed to investigate whether the mediating effects of internet use in the linkage of grandparent caregiving and grandparental health vary among grandmothers and grandfathers and by their rural-urban residence. This study contributed to the existing literature in several ways. First, the paper systematically investigated the mediating effects, particularly internet use, as well as gender and rural-urban differences, which has been rarely seen in previous literature. Second, unlike most prior analyses of Chinese grand parenting that relied on regional, non-representative samples, this study estimated publicly available data from a nationally representative longitudinal survey, which yielded more generalizable and replicable findings. Third, when measuring health outcomes, unlike many previous analyses that restricted to grandparents’ psychological well-being, this study examined health in a more comprehensive manner by also including physical health measures, i.e., self-reported health status and functional limitations. Below we discuss the theoretical background that guided this empirical work.

Theoretical Basis

Grandchild Care and Grandparental Health

Previous studies have provided evidence linking grandchild care to grandparental health. Some studies reported a negative impact of extensive and custodial grand parenting on grandparents' health. This is because grand parenting is time consuming and is physically and psychologically demanding for grandparents. It is generally associated with a decrease in time available for hanging out with friends and doing recreational activities. Lacking of privacy, social engagement and leisure time has led to heightened isolation and depression [21], which brought consequently negative effects on grandparents' health [22]. The stress of caregiving could also cause or exacerbate poor health behaviors, such as smoking [23]. Further, custodial grandmothers have been found to be more likely economically disadvantaged. Having inadequate financial resources for raising grandchildren and lacking of social support were associated with elevated levels of psychological distress [24]. Some grandparents may have given up employment to raise grandchildren. Job and income loss increased their economic vulnerability and stress [25]. Custodial grandmothers were reported to have increased psychological distress as well due to child behavior problems [26].

Other studies, in contrast, claimed a positive effect of grandchild care on grandparents' health for a number of reasons. For instance, it has made grandparents stay active and has prevented elders from deteriorating at older ages [27]. Grandparents thus reported better self-rated health [28] and fewer functional health limitations (Guo et al., 2008). Meanwhile, grand parenting have enhanced grandparents' self-esteem, self-worth as well as family cohesion [9, 29]. Giving care of grandchildren could also stimulate the brain, which was helpful in maintaining good cognitive skills [30]. Grandchildren could be great emotional resources for grandparents, which led to reduced depressive symptoms [31] and greater life satisfaction [28, 32]. Caring for a grandchild may have resulted in a more active lifestyle, healthier meals, or a reduction in smoking [23]. Grandparents may have received beneficial consequences in terms of physical and mental health from their altruistic behaviors of giving grandchild care [33]. Caregiving to grandchildren was also found to be able to reduce grandparents' mortality rate [34]. The intergenerational time-for-money exchange theory also supported a positive association between the amount of grandchild care provided by grandparents and the amount of remittance received from their migrant adult children. Such a reciprocal exchange improved grandparents' living standard and health care, which in turn benefited their physical health, reduced depressive symptoms and improved level of life satisfaction [35].

Still others showed no significant association or a nonlinear relationship between grand parenting and grandparental health. For example, Arpino & Bordone (2014) found that except for verbal frequency, providing child care did not show statistically significant effect on other domains of grandparents' cognitive function. Hughes and colleagues (2007) suggested that the health disadvantages among grandparent caregivers arose from grandparents’ prior characteristics, not as a consequence of providing care [36]. Through analyzing longitudinal survey data of Japan, Oshio's (2022) study suggested that caring for grandchildren did not have either a beneficial or detrimental effect on grandparents’ health [37]. Other scholars supported a non-linear relationship between giving care to grandchildren and grandparents' health. For instance, Glaser and colleagues (2014) claimed that non-intensive levels of caregiving were most likely to be associated with better health. Whereas both grandparents who provided custodial childcare and grandparents who did not provide any grandchild care were likely to report poor health [38]. Similarly, when the level care was considered, Hughes and colleagues (2007) found that grandparents who provided primary care in skipped-generation households reported depression and worse health; whereas grandparents who offered supplementary care tended to report better health outcomes [36]. Coall and Hertwi's (2011) research further supported a nonlinear relationship by showing the amount of child care was positively associated with grandparents' well-being, nevertheless, when grandparental care reached the highest level of investment (e.g. custodial care), then caregiving was detrimental to grandparents' health [33].

The inconsistent findings on the prevision of caring by grandparents shown in the existing literature can largely be explained by the following: (1) methodological issues; (2) different social-cultural background, and (3) the studying subjects. In short, if the studied grandparents were primary caregivers and the amount of time grandparents spent on caregiving affected the research results. Primary caregivers tended to be more involved in child care, and they were more likely to report negative health outcomes.

Internet Use And Individual Health

Over the past two decades, internet use became an important tool for health campaigns, social activities and leisure time resources for adults [39]. Prior literature has showed a strong link between internet use and individual health. Some studies supported a positive influence of internet use on health by arguing that internet use may promote individual health by helping individuals' decision-making and self-care [40] since using internet may influence how individuals perceive or rate their health, improve interactions with health professionals [41] or offer online social support including health related information [42]. Internet use was also found beneficial in reducing loneliness [43–45] and enhancing life satisfaction, physical health, and quality of life [46]. Meanwhile, internet use created new personal friendships, new forms of contacts with family and friends, and maintaining social involvement. Online networks built by internet use was also shown to improve digital socializing and provide adults with various forms of entertainment [47, 48]. A study of Taiwan sample showed that internet use promoted healthy life styles [49]. By studying the Chinese sample, Yang and associates (2021) claimed that although using internet for learn, work, and commercial activity did not significantly alleviate one's depressive symptoms, but using internet for social contact and entertainment showed significant effect decreasing depression [12]. Studies on adolescents reported that online peer communication can facilitate self-disclosure and create a sense of belonging, which eventually supported individual identity development [50]. Receiving positive peer feedback on Facebook profiles was found to enhance adolescents’ self-esteem and well-being [51]. Using social media, including internet, made teens to feel closer to friends, more informed, and connected to family.

Another group of work, however, suggested a negative association between internet use and individual health. Scholars argued that overload or exaggerated online information may generate confusion due to anxieties and unrealistic expectations. Lower satisfaction with one’s subjective wellbeing may also occur for various reasons depending upon how online information was used and by whom [52–54]. It was documented that internet use was significantly associated with decreased time spent with friends and lower level of local social networking, which increased loneliness and lower quality of life [55]. In addition, internet use decreased in-person and face-to-face social activities, which resulted in a lack of personal contacts [47]. Heavier Facebook users were found to be more likely to believe other people were happier and had better lives [56]. Such kind of comparing behavior would possibly bring psychological loss and relative deprivation, which reduced people’s life satisfaction. It was argued that passive use of social media may cause depressive mood, it also had negative effects on well-being, sense of belonging and life satisfaction [57, 58]. This is because spending a lot of time on weak ties in the network would reduce time spent on strong ties, which destroyed real relationships and negatively impacted life satisfaction. Studies conducted with adolescents demonstrated that an increase in using social media or severe use of social media was related with depression, anxiety and stress [59–61].

As to internet use among seniors, a majority of studies suggested that seniors benefited from using internet and smart phones in three domains: psychological, physical and practical. In the psychological sphere, internet and smart phone use helped older users staying connected with others [62], which allowed seniors to remain active and achieve a sense of security [63]. Using internet made seniors more connected to others, therefore, benefited their cognitive function [64]. Internet and smart phone use also provided new forms of leisure and entertainment, which was a way of mental exercise that benefited seniors’ cognitive function and subjective well-being [65]. Regarding physical health, studies found internet and smart phone usage helped seniors for health maintenance and chronic disease self-management, communication with professionals, health status monitoring, and receiving health promotion interventions [66, 67]. A study on the Chinese sample from Jiangxi province provided empirical evidence that smart phone use had a significantly positive influence on elders' self-rated health [68]. The practical advantages of using internet and smart phones have been documented such as supporting of daily life activities by functioning as navigators and memory aids, which preserved seniors’ independence and improved their quality of life [65]. A study on the European sample showed that older people who used the internet tended to report better health status [69]. Through analyzing the Chinese General Social Survey (CGSS) data, Wang and colleagues (2020) found that internet use significantly affected physical and mental health of the Chinese elderly [70]. Using data from the same survey conducted in 2017, Zhang and colleagues (2021) suggested that internet use was significantly associated with better mental health status for Chinese elders, mediated by higher physical exercise frequency [71]. Still using the 2017 CGSS data, Han and Zhao (2021) found that using internet improved seniors' health in multiple dimensions. Information, leisure, and social preferences were found to be important mediating factors through which internet use promoted elderly physical, mental, and social health [72]. Drawing sample from the China Family Panel Studies (CFPS), scholars further indicated that although internet use did not improve the elders' life satisfaction, it significantly reduced their depression level [73]. Similarly, by analyzing data from CFPS conducted in 2016, it was found that internet played a significantly positive role in promoting cognitive health of middle-aged and elderly people. Such an effect varied by educational attainments, but not by gender or rural-urban residence [74]. An analysis based on examining Shanghai elders showed that frequent using internet substantially lowered the odds of seniors having mental health problems [75]. on the other side of the globe, scholars found a similar results. For instance, Khalaila and Vitman-Schorr (2018) studied 502 respondents aged 50 and older from a survey conducted in 2016 in Israel and found that internet use was positively associated with quality of life. Such a relationship was mediated by loneliness, and moderated by the time the elderly spent with family members [76].

A few studies, in contrast, showed a negative effect of internet use on elders' health. For example, by studying sample from the 2017 Chinese General Social Survey (CGSS), Yang and colleagues (2021) showed that internet use was significantly and negatively associated with life satisfaction level of Chinese elders, especially among those who were male, young old, poor, rural and relatively healthy. Perceptions of social justice mediated the way in which internet use was affected elders' life satisfaction [77].

Mediators In The Relationship Of Caring For Grandchildren And Grandparents' Health

Besides discussing the direct effect of grandparental childcare on grandparents' health, previous analyses have also attempted to explore the mechanisms explaining the ways in which giving care to grandchildren shaped grandparents' health status. To illustrate, through examining Chinese sample from the CHARLS data, it was found that participating in social activities, having limited sleeping time and good intergenerational relations were mediating factors which had either positive or negative indirect effects on grandparental health [78]. By studying sample from Hebei province in China, scholars further pointed out that family cohesion served as a mediator in the relationship between grandparental caregiving frequency and grandparents' level of life satisfaction. Better family cohesion reduced the negative influence of grandparenting on grandparents' level of life satisfaction [79]. Using data from the 2014 baseline survey of the China Longitudinal Ageing Social Survey (CLASS), Tang and colleagues (2020) found that the association between grandchild care and depressive symptoms was fully mediated by social networks. Grandparents who took care of grandchildren tended to have larger social networks, and giving care to grandchildren could reduce depressive symptoms through having a larger social networks [80].

The studies reviewed above provided theoretical background that grandparenting affected grandparental health. Nonetheless, these analyses have rarely paid attention to internet use in the association between grandparenting and grandparental health. Most research treated social networks and intergenerational relations as mediating factors in the above association. Little is known about how internet use can buffer against grandparent caregivers’ stress or negative health outcomes. With internet use becoming more popular and a considerable amount of seniors accessing to the internet, internet has played irreplaceable role in people's daily life. As previous literature showed, internet use benefited elders' health in multiple dimensions. Under such a proceeding, empirical evidence is warranted to elucidate whether and how using internet helps grandparent caregivers to achieve better health status. Thus, this study aimed to investigate the effect of caregiving on grandparents' physical and mental health outcomes, specifically the mediating effects of internet use in such a linkage. By taking gender and rural-urban differences into consideration, the findings clarified the role of internet use in protecting against caregiving stress and negative influence among male and female grandparents in rural and urban settings. The findings advanced our understanding of health advantages of internet use among grandparent caregivers.

Data

Data were drawn from the 2018 survey of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 and older and their spouses. The CHARLS was conducted by the China Centre for Economic Research of Peking University. Detailed information on demographic characteristics, social and economic conditions, and health and health-related behaviors was collected based on face-to-face interviews in respondents’ homes. Using a multi-stage probability-proportional-to-size technique, participants were randomly sampled by regions and then by urban districts or rural counties and per capita GDP. In total, CHARLS sampled residents from 150 counties across 28 provinces in China.

This study focused on individuals aged 50 through 80 who were grandparents and who provided care to their grandchildren. We initially wanted to include sample from the 2015 CHARLS survey and draw information from the 2015 survey for the independent and mediating variables to predict the 2018 individual health outcome. By doing so, we should be able to better capture the influence of grandparenting on grandparental health. Unfortunately, the 2015 survey did not contain information on internet use, which prevented us from obtaining information for mediating variables. Since the main focus of the study was to explore the mediating effects, we had to exclude the 2015 survey and used the 2018 survey only. As a result, 16,829 respondents (8,060 males and 8,769 females) aged 50 to 80 taken from the 2018 CHARLS survey were included in our analysis. Among them, 12,080 were rural and the rest 4,769 were urban.

Variables

In terms of the variables applied in the analysis, the dependent variables were mental and physical health of grandparents. Mental health was measured by two continuous variables: life satisfaction and depressive symptoms, both of which have been used as validate measures of psychological well-being in the literature [8]. Life satisfaction variable was obtained from the survey question: “Please think about your life-as-a-whole. How satisfied are you with it?” A 5-point coding scale was applied for the responses ranging from 1 ("not at all satisfied”) to 5 (“completely satisfied”). Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), which has been repeatedly used in prior literature as a measure of depression [14, 81]. The depressive symptoms were captured by 10 questions asking if the respondent: 1) was bothered by things, 2) had trouble keeping mind on what he/she was doing, 3) felt depressed, 4) felt everything he/she did was an effort, 5) felt hopeful about the future, 6) felt fearful, 7) felt that sleep was restless, 8) was happy, 9) felt lonely, and 10) could not get "going". The depression symptom measure used in this research was obtained by summing the CESD-10 scores, which ranged from 0 to 40, with higher values indicating more depressive symptoms.

Physical health was captured by self-rated overall health and difficulty in instrumental activities of daily living (IADLs). The IADLs included managing money, taking medications, grocery shopping, preparing meals, making phone calls and cleaning house. If the respondent had no difficulty with the above six activities, then he or she was coded as "1", "2" if had some difficulty but could still made it, "3" had difficulty and needed help, and "4" could not complete the above activities. Consequently, the IADL score ranged from 6 to 24. The self-rated health (SRH) score ranged from 1 to 5 with "1" representing "very poor health" and "5" representing "excellent health". Both variables were continuous with higher scores indicating a greater difficulty in instrumental activities of daily living and a better self-rated health condition, respectively.

There were two key independent variables capturing grandparental childcare. One was grandparents’ self-reported grandchild caregiving in the past year. If those who reported giving care to one or more grandchildren, then the respondent was coded as "1" and "0" if otherwise. The other independent variable asked that during the past year, one average, number of hours the respondent or his/her spouse took care of grandchild(ren) per day, which was coded as a continuous variable.

The mediating variables were taken from three survey questions in CHARLS, which asked the respondent's internet usage. The three questions asked if the respondent used internet to chat, watch videos, or watch news, respectively. The three mediating variables were coded as dichotomous ones with "1" indicating "yes" and "0" if otherwise.

The control variables included age, educational attainment, annual household per capita income, number of adult children, having weekly contact with adult children (1 = yes, 0 = no). Annual household per capita income was generated from annual household income which was summarized from self-reported multiple income sources (e.g., salary and wage, capital income, pension, government transfer, and other unspecified sources) and divided by number of household members.

Statistical Methods

The analyses began with descriptive results that provided initial insights into the descriptive information of all variables included in the research (see Table 1). The study then applied the KHB method, a recently developed mediation approach, to determine the extent to which the selected mediating variables explained the total effect of grandparent caregiving on grandparental health. The KHB method provided an unbiased decomposition of total effects into direct and indirect effects for nonlinear probability models [82, 83]. It allowed for the comparison of odds by subtracting residuals of the variables that were subsequently added in the original equation. The estimates of these models were more robust than standard logit models [84]. The KHB method was chosen also because the mediating variables in this research were dichotomous, structural equation models only fit for continuous variables.

Table 1

Descriptive Statistics of Variables: Chinese Grandparents Aged 50–80 (%)
Variables	All	Cared for at Least 1 grandchild Past Year	Did not Care for Grandchildren Past Year
Dependent Variables
Mental health
CESD score(mean)**	18.23	18.18	18.28
Life satisfaction**
Completely satisfied	4.99	4.91	5.05
Very satisfied	28.81	29.37	28.34
Somewhat satisfied	54.68	55.17	54.27
Not very satisfied	8.42	7.81	8.92
Not at all satisfied	3.11	2.74	3.41
Physical health
IADL(mean)***	7.22	7.03	7.39
Self-rated health
Very good	12.49	12.17	12.76
Good	12.89	12.65	13.08
Fair	49.25	50.67	48.07
Poor	19.63	19.24	19.95
Very poor	5.75	5.27	6.14
Independent Variables
Number of hours cared for grandchild(ren)/day (mean)	-	6.69	-
Mediating Variables
If used internet to chat***
Yes	9.38	10.19	8.38
No	90.62	89.81	91.62
If used internet to watch news***
Yes	11.38	12.53	9.96
No	88.62	87.47	90.04
If used internet to watch videos***
Yes	9.26	10.00	8.35
No	90.74	90.00	91.65
Control Variables
Age(mean)	63.99	64.02	63.96
Sex**
Male	47.89	47.13	48.51
Female	52.11	52.87	51.49
Residence
Urban	28.22	28.70	27.83
Rural	71.78	71.30	72.17
Educational attainment
Illiterate	22.69	19.29	19.40
Elementary school	42.81	43.51	44.07
Middle and high school	32.33	35.94	33.88
College and above	2.17	1.26	2.65
If lived with spouse
Yes	81.36	83.87	79.32
No	18.64	16.13	20.68
Household per capita income(mean)	5,055.73	3,608.13	6,498.21
If received pension
Yes	86.46	87.50	85.63
No	13.54	12.50	14.37
Number of chronic diseases(mean)	0.71	0.71	0.72
N	16,829	7,541	9,288
Source: 2018China Health and Retirement Longitudinal Study (CHARLS). Note: * p < 0.05; p < 0.01; * p < 0.001 represent significance levels when conducting Chi-square or T-tests to check sample differences between those who cared for grandchildren and those who didn't.

The total effect represented the impact of caring for grandchildren on grandparental health without including mediating variables as controls. The direct effect was obtained by using a full model with mediators, and indicated the (remaining) effect of caring for grandchildren on grandparental health (unexplained part). The indirect effects represent the parts of the total effect that ran through the different mediating variables. The analyses were performed by using a user-written KHB module for Stata [83]. In this study, age, education and other control variables were covariates with impact on mediators and outcomes. Since we were interested in exploring the rural-urban as well as gender differences, sample in our study were divided into four subgroups and all the models were fitted to each of the four group subsample (urban men, rural men, urban women, and rural women). The Chi-square tests and T-tests were applied to test whether the between group differences were statistically significantly different for dichotomous and continuous variables, respectively. The potential mechanisms linking grandparental child care to grandparents' health outcomes were presented in Fig. 1.

[Figure 1 about here]

Descriptive Statistics

Table 1 summarized the descriptive information of the variables applied in the analysis. The average depressive symptom scores for respondents who had and who had not grandchild caregiving experience during the past year were 18.18 and 18.28, respectively. The group difference was statistically significant, indicating that the mental health outcome for grandparents with grandchild caregiving experience was significantly better than that of their counterparts with no such experience. The majority of the respondents reported very satisfied or somewhat satisfied with their life. Higher percentages of respondents who did not care for grandchildren reported "not very satisfied" or "not at all satisfied" with life. Such a difference was statistically significant, which again showed that giving care to grandchildren improved grandparents' life satisfaction. The mean IADL score for those who did not care for grandchildren was higher than that who cared for grandchildren (7.39 vs. 7.03), with a p value lower than .01 when performing a t-test. The majority of the respondents rated their health as "fair". The average number of hours cared for grandchildren per day was 6.69.

Grandparents who cared for grandchildren during the past year tended to report higher percentages of internet use for all three mediating variables than their counterparts with no grandchild caregiving experience. Specifically, 10.2%, 12.5% and 10.0% of the grandparents who cared for grandchildren reported used internet to chat, to watch news and to watch videos, respectively. And the corresponding percentages for non-caregivers were 8.4%, 10.0% and 9.4%, respectively. The Chi-square test showed a statistically significant difference between these two subgroups.

The average age for studied respondents was 64 years old. The caregiver subgroup contained a lower percentage of males as compared to the non-caregiver subgroup (47.1% vs. 48.5%). Such a difference was statistically significant. Most respondents had low educational attainments. The average annual household per capita income was 5,055.7RMB (about 802 USD), with urban grandparents' per capita annual income doubled that of rural grandparents. About 81.4% of the sample lived with a spouse and such a percentage was slightly higher for the subgroup with grandchild caregiving experience (83.9% vs. 79.3%). Over 86.0% of the respondents claimed they were pension receivers. The average number of chronic diseases reported by the respondents was below 1, indicating a fairly good health condition of the studied sample.

[Table 1 about here]

Since the study was interested in exploring the urban-rural as well as gender differences, the respondents who cared for grandchildren in the past year were further classified into four subsamples (urban men, rural men, urban women, and rural women) and the descriptive information was presented in Table 2. Disparities were shown in both mental and physical health outcomes among four subgroups. For instance, the average depressive symptom score was highest for rural grandmothers (19.6), followed urban grandmothers (17.7), rural grandfathers (17.6) and urban grandfathers (16.2). In general, the percentage of respondents who reported "not very satisfied" and "not at all satisfied" were higher among rural grandparents (especially grandmothers) as compared to their urban counterparts. As to physical health conditions, disparities in daily activity functional limitations were smaller. On average, urban grandfathers appeared to be the healthiest whereas rural grandmothers experienced the highest level of disability. Regarding SRH, higher percentages of urban grandparents tended to rate their health as "very good" or "good" than rural grandparents. Rural grandmothers were the group that had the highest percentages of respondents who rated their health as "poor" or "very poor" (24.9% and 6.1%).

Table 2

Descriptive Statistics of Variables for Four Subgroups: Chinese Grandparents Who Cared for Grandchildren in Past Year, Aged 50–80 (%)
Variables	Grandfathers				Grandmothers
Variables	Urban		Rural		Urban	Rural
Dependent Variables
Mental health
CESD score (mean)	16.19		17.55		17.65	19.62
Life satisfaction
Completely satisfied	5.55		4.58		4.70	5.07
Very satisfied	25.72		29.49		28.94	30.67
Somewhat satisfied	61.58		56.75		57.79	50.55
Not very satisfied	5.34		7.39		6.36	9.59
Not at all satisfied	1.81		1.78		2.21	4.12
Physical health
IADL(mean)	6.57		6.92		6.77	7.39
Self-rated health
Very good	13.22		13.45		11.36	11.01
Good	18.87		12.34		14.56	10.06
Fair	48.89		50.41		55.49	49.26
Poor	14.29		18.22		14.74	23.61
Very poor	3.73		5.59		3.85	6.07
Independent Variables
Number of hours cared for grandchild(ren)/day (mean)	6.42		6.66		6.21	6.60
Mediating Variables
If used internet to chat
Yes	13.74		6.69		15.71	5.01
No	86.26		93.31		84.29	94.99
If used internet to watch news
Yes	22.73		9.21		15.45	3.84
No	77.27		90.79		84.55	96.16
If used internet to watch videos
Yes	16.60		7.32		14.24	3.95
No	83.40		92.68		86.76	96.05
Control Variables
Age(mean)	65.25		64.43		64.25	63.13
Educational attainment
Illiterate	2.96		9.32		16.41	35.24
Elementary school	32.91		48.66		35.77	45.82
Middle and high school	35.08		29.46		29.08	15.52
College and above	29.05		12.55		18.75	3.42
If lived with spouse
Yes	86.07		89.18		77.08	81.09
No	13.93		10.82		22.92	18.91
Household per capita income(mean)	6331.25		3404.75		4765.46	2243.52
If received pension
Yes	89.53		87.88		86.72	86.74
No	10.47		12.12		13.28	13.26
Number of chronic diseases(mean)	0.82		0.66		0.77	0.69
N	1,012	2,542		1,152			2,835
Source: 2018 China Health and Retirement Longitudinal Study (CHARLS).

Differentials were also observed in terms of internet usage. Around 15.0% of urban grandfathers and 15.0% of grandmothers reported using internet to chat and watch videos. About 22.7% of urban grandfathers and 15.5% of urban grandmothers used internet to watch news, respectively. In contrast, the percentage of rural grandparents who used internet to chat, watch news and watch videos ranged between 6.7–9.2%. Such percentages were even lower for rural grandmothers. The average age ranged between roughly 63.1 and 65.2 years old. Both rural-urban gaps and gender differences were evident in socioeconomic status. About 64.1% of urban grandfathers completed secondary education (middle school or above), which was more than three times as high as that for rural grandmothers (18.9%). The average annual household per capita income was 6,331.2 and 4,765.5 RMB for urban grandfathers and grandmothers, respectively, which doubled the corresponding values for their rural counterparts. Rural grandmothers and urban grandfathers reported the lowest and highest average numbers of chronic diseases, respectively (0.7 vs. 0.8). Over 86.0% of rural and urban grandparents received pension with minor differences. Percent of grandfathers living with spouses were much higher than grandmothers with little rural-urban differences.

[Table 2 about here]

Regression Results

The next steps of the analysis was to detect: 1) whether the total effects of key grandchild caregiving variables, i.e. grandchild caregiving experience and number of hours cared for grandchild per day, on the respondent's health outcomes were significant (see results of Model 1 in Tables 3 and 4); 2) whether the effects of grandchild caregiving acted through a given set of internet use mediators, which were the indirect impacts. When adding mediators in Model 2, if the values or the significance levels the regression coefficients presented in Model 1 changed, then it indicated the indirect effects existed (see results in Tables 3 & 4); 3) whether the ways in which grandchild caregiving impacted grandparents' health were unexplained by these mediators (direct impact).

Table 3

OLS Regression Analysis of Grandparental Childcare on Grandparents' Health Outcomes: Chinese Grandparents Aged 50–80 (%)
Variables	Self-Rated Health		IADL		Depression		Life Satisfaction
Variables	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2
Independent Variable
If Care for grandchild(ren)	0.03⁺ (0.02)	0.02⁺ (0.02)	-0.42^*** (0.47)	-0.32^*** (0.47)	-0.20⁺ (0.11)	-0.18⁺ (0.11)	0.03^** (0.01)	0.03^** (0.01)
Control Variables
Age	-0.01^*** (0.00)	-0.01^*** (0.00)	0.07^*** (0.00)	0.06^*** (0.00)	-0.01 (0.01)	-0.02^* (0.01)	0.01^*** (0.01)	0.01^*** (0.01)
Sex	0.11^*** (0.02)	0.11^*** (0.02)	-0.38^*** (0.05)	-0.38^*** (0.05)	-1.66^*** (0.11)	-1.64^*** (0.11)	0.05^*** (0.01)	0.05^*** (0.01)
Urban residence	0.06^*** (0.02)	0.05^* (0.02)	-0.28^*** (0.06)	-0.25^*** (0.06)	-1.11^*** (0.13)	-1.00^*** (0.13)	0.03 (0.02)	0.03 (0.02)
Educational attainment	0.15^*** (0.02)	0.13^*** (0.02)	-0.39^*** (0.05)	-0.35^*** (0.05)	-1.16^*** (0.12)	-1.02^*** (0.12)	-0.02 (0.01)	-0.02 (0.01)
If lived with spouse	0.06^** (0.02)	0.06^** (0.02)	-0.08 (0.06)	-0.09 (0.06)	-1.33^*** (0.14)	-1.33^*** (0.14)	0.12^*** (0.02)	0.12^*** (0.02)
Annual household per capita income	0.07^*** (0.01)	0.06^*** (0.01)	-0.19^*** (0.02)	-0.19^*** (0.02)	-0.39^*** (0.04)	-0.37^*** (0.04)	0.02^*** (0.00)	0.02^*** (0.00)
If received pension	-0.06^* (0.03)	-0.06^* (0.03)	-0.08 (0.07)	-0.07 (0.07)	0.06 (0.17)	0.08 (0.17)	0.04^* (0.02)	0.04^* (0.02)
# of chronic diseases	-0.25^*** (0.01)	-0.25^*** (0.01)	0.36^*** (0.02)	0.36^*** (0.02)	0.98^*** (0.05)	0.98^*** (0.05)	0.06^*** (0.02)	0.06^*** (0.01)
Mediating Variables
Used internet to chat		0.02 (0.04)		-0.25^* (0.12)		-0.31 (0.27)		0.00 (0.03)
Used internet to watch news		0.07 (0.04)		-0.12 (0.12)		-0.81^** (0.28)		-0.01 (0.04)
Used internet to watch videos		0.11^* (0.02)		-0.10 (0.13)		0.01 (0.29)		0.01 (0.04)
Constant	2.73^*** (0.09)	2.77^*** (0.09)	5.27^*** (0.26)	5.36^*** (0.26)	24.69^*** (0.61)	24.89^*** (0.04)	3.42^*** (0.08)	3.42^*** (0.08)
N	13,483	13,483	14,214	14,214	13,337	13,337	13,420	13,420
Adjusted R²	0.12	0.13	0.11	0.11	0.10	0.11	0.02	0.02
Source: 2018 China Health and Retirement Longitudinal Study (CHARLS). Note:⁺p < 0.1, ^p < 0.05, ^p < 0.01, ^**p < 0.001. Numbers in parentheses are standard errors.

Table 4

OLS Regression Analysis of Grandparental Childcare Length on Grandparents' Health Outcomes: Chinese Grandparents Aged 50–80 (%)
Variables	Depression
Variables	Model 1	Model 2
Independent Variable
Number of hours cared for grandchild(ren)/day	0.04^**(0.01)	0.03^** (0.01)
Control Variables
Age	-0.03^* (0.01)	-0.03^**(0.01)
Sex	-1.41^*** (0.17)	-1.39^*** (0.17)
Urban residence	-1.02^*** (0.19)	-0.92^*** (0.19)
Educational attainment	-1.10^*** (0.17)	-0.95^*** (0.18)
If lived with spouse	-0.92^*** (0.22)	-0.93^*** (0.22)
Annual household per capita income	-0.43^*** (0.05)	-0.37^*** (0.04)
If received pension	-0.08 (0.26)	-0.04 (0.26)
# of chronic diseases	0.81^*** (0.08)	0.82^*** (0.08)
Mediating Variables
Used internet to chat		-0.52 (0.42)
Used internet to watch news		-0.84^**(0.44)
Used internet to watch videos		-0.04 (0.45)
Constant	25.48^*** (0.97)	24.89^*** (0.04)
N	5,808	5,808
Adjusted R²	0.08	0.09
Source: 2018 China Health and Retirement Longitudinal Study (CHARLS). Note:⁺p < 0.1, ^p < 0.05, ^p < 0.01, ^**p < 0.001. Numbers in parentheses are standard errors.

We first conducted a series of analyses to make sure that prerequisite requirements for applying the KHB method were met, i.e., the effects of independent variables on dependent variables, the effects of independent variables on mediating variables, and the effects of mediating variables on dependent variables were statistically significant. Since the three mediating variables were dichotomous variables, we conducted logistic regression to determine if the two main independent variables had significant effects on the mediating variables. The results showed significantly positive effects of two main independent variables on all three mediating variables. Considering the dependent variables were all coded as continuous variables, we further performed OLS regression analyses to investigate the effects of independent as well as mediating covariates on dependent variables. The results showed that the number of hours taking care of grandchildren had significantly positive effect on grandparents' depressive level; and the impact of giving care to grandchildren on grandparents' depression and life satisfaction also showed significantly positive effects (results were not shown here but are available upon request). Such findings suggested that independent variables influenced the respondent's health outcomes in a significant manner. We then constructed regression models in Table 3 and Table 4 to test whether mediating effects existed when using grandchild caregiving and length of grandchild caregiving to predict grandparents' health outcomes, respectively. If the regression coefficients in Model 1 changed in either values or significance levels when adding mediating variables in Model 2, then it indicated the mediating effects of internet use existed.

As Table 3 showed, when including mediating variables in Model 2, the regression coefficient for grandchild care predicting SRH reduced from .03 in Model 1 to .02 in Model 2, suggesting a significant effect of mediating variables when linking grandchild care to grandparents' SRH. The regression coefficient for grandchild care predicting IADL changed from − .42 in Model 1 to − .32 in Model 2, which also suggested significant mediating effects of internet use variables. Similarly, the regression coefficient for grandchild care decreased from − .20 in Model 1 to − .18 in Model 2,evidencing significant mediating effects of internet use covariates. But the mediating effects were not shown when predicting life satisfaction. Table 4 showed when including mediating variables to analyze grandparents' health, the logistic regression coefficient for hours of giving grandchild care were .04 and .03 in Models 1 and 2, respectively. Such findings implied significant mediating effects. By performing the above analyses, we identified the pathways that mediating variables played a significant role. The next step of the study was to use the KHB method to detect total, direct and indirect effects to further explain what exact roles the internet use variables played in this study.

[Tables 3 and 4 about here]

Table 5 presented the results of running different mediation models for all respondents and the four subgroups separately. The KHB method was used to decompose the total effect of internet use variables on grandparents' health outcomes into indirect and (remaining) direct effects. The models contained all control variables, but only mediation results with significant effects were presented in the table. As to the total effect, the results showed that the total effect of caregiving experience on SRH was positive in the model that contained all respondents. This meant that giving care to grandchildren was beneficial to grandparents' SRH. It increased the SRH score by 7.0% for the model that contained all respondents. By introducing the mediating variable, using internet to watch videos, the direct effect of the caregiving variable on SRH was 0.8, suggesting using internet to watch videos increased the positive effect of grandchild caregiving on health by 1.0%. The mediating effect was found to be significant among rural grandfathers and rural grandmothers. The mediating effect seemed to be stronger among urban grandmothers, which decreased the positive effect of caregiving on urban grandmothers' SRH.

Table 5

Total, Direct, and Indirect Effects of Internet Use on Health Outcomes, Using the KHB Method: Chinese Grandparents Aged 50–80
Variables	Self-rated health			IADL			Depression
Variables	Total effect	Direct effect	Indirect effect	Total effect	Direct effect	Indirect effect	Total effect	Direct effect	Indirect effect
All Respondents
X1: Cared for grandchild (ren)
M1: Used internet to chat	-			-0.29^***	-0.30^***	0.01^*	-
M2: Used internet to watch news	-			-			-0.23^*	-0.29^**	0.06^***
M3: Used internet to watch videos	0.07^*	0.08*	-0.01⁺	-			-
X2: # of hours cared grandchild(ren) /day
M2: Used internet to watch news	-			-			0.05^***	0.04^***	0.01^*
Subgroup 1: (Urban Grandfathers)
X1: Cared for grandchild (ren)
M1: Used internet to chat	-				-		-
M2: Used internet to watch news	-			-			-0.18	-0.29	0.12^**
M3: Used internet to watch videos		-		-			-
X2: # of hours cared for grandchild (ren)/day
M2: Used internet to watch news	-			-			0.06^**	0.06^**	0.01⁺
Subgroup 2 (Rural Grandfathers)
X1: Cared for grandchild (ren)
M1: Used internet to chat	-			-0.23^**	-0.24^*	0.01⁺	-
M2: Used internet to watch news	-			-			0.08	0.13	-0.04^*
M3: Used internet to watch videos	0.04	0.05	-0.01⁺	-			-
X2: # of hours cared for grandchild (ren)/day
M2: Used internet to watch news	-			-			0.01	0.01	0.00
Subgroup 3 (Urban Grandmothers)
X1: Cared for grandchild (ren)
M1: Used internet to chat	-			-0.07	-0.10	0.03^*	-
M2: Used internet to watch news	-			-			0.45	0.31	0.14^**
M3: Used internet to watch videos	0.02	-0.01	0.03^***				-
X2: # of hours cared for grandchild (ren)/day
M2: Used internet to watch news	-			-			0.08	0.07	0.01⁺
Subgroup 4 (Rural Grandmothers)
X1: Cared for grandchild (ren)
M1: Used internet to chat	-			-0.50^***	-0.52^***	0.02^*	-
M2: Used internet to watch news	-			-			-0.92^***	-0.94^***	0.02^***
M3: Used internet to watch videos		-		-			-
X2: # of hours cared for grandchild (ren)/day		-			-			-
M2: Used internet to watch news	-			-			0.06^***	0.05^***	0.01^*
Source: 2018 China Health and Retirement Longitudinal Study (CHARLS).Note: ⁺p < 0.1, ^p < 0.05, ^p < 0.01, ^**p < 0.001.

Caring for grandchildren was found to be significantly negatively associated with grandparents' IADL difficulty scores with the total effect being − .29 in the model for all respondents. When including the mediating variable, using internet to chat, the direct effect was − .30 and the indirect effect became .01. These values indicated that using internet to chat had beneficial effect, which decreased the likelihood of grandparents having difficulties in instrumental activity of daily living by 1.0% when using grandchild caregiving experience to predict it. Except for the subgroup of urban grandfathers, such a mediating effect was significant among all other three subgroups. The mediating effect of the internet usage variable was relatively stronger for urban grandmothers as compared to other subgroups.

As to depression, the results showed that using internet to watch news tended to be a pathway variable that mediated with both caregiving variables to impact grandparents' depression level. To illustrate, in the model for all respondents, when caregiving experience mediated with the watching news variable to predict grandparents' depression, the total and direct effects were − .23 and − .29, respectively. The indirect effect of .06 implied that for those who cared for grandchild(ren), using internet to watch news further dropped grandparents' depression level by 6.0% when linked to grandparental caregiving. Similarly, when number of hours was used to predict grandparents' depression, all three effects in the model were significant with indirect effect being .01. It suggested that longer hours of grandchild care increased grandparents' depression level; internet usage offset the detrimental effect of long hours caregiving on the respondent's mental health by 1.0%. The mediating effects were found in all four subgroups with the mediating effect being strongest among urban grandmothers.

[Table 5 is about here]

This study investigated the impact of intergenerational caregiving on grandparents' health in middle and later life, paying special attention to its mechanisms. The descriptive results showed that except for SRH, grandparents who had the experience of caring for at least one grandchild reported better mental health status, higher level of life satisfaction as well as lower IADL scores. The regression analyses further demonstrated that except that longer hours of caring for grandchildren was linked to a higher level of depression, giving care to grandchildren was associated with better health outcomes among Chinese grandparents. These findings were consistent with previous studies that giving care to grandchildren was beneficial to grandparents' health [6, 20, 78].

In addition to that direct linkage, the association was also found to be mediated by internet usage. Specifically, watching videos promoted the positive impact of caregiving on grandparents' SRH. Chatting through the internet offset the negative influence of caregiving on IADL. Watching news through the internet also reduced the negative effect of caregiving on depression. These results meant that except for the life satisfaction measure of health, all three internet use variables performed as mediators to either diminish the detrimental influence or increase the positive effect of caring giving on grandparental health. Thus far, most previous analyses have focused on documenting family cohesion, intergenerational relations, social networking, participating in social activities, and sleeping time as mediating factors which had either positive or negative indirect effects on grandparents' health and level of life satisfaction [78–80]. Very few studies have considered internet use as a mediator in the above linkage. Findings of this study shed light on the mediating effect of internet use, which enriched the existing literature and theories on mechanisms explaining intergenerational caregiving on grandparents' health.

While highlighting the mediating effects of internet use, it is also interesting to discuss why the mediating effects existed. Watching videos served as a mediator promoting the beneficial effect of caregiving on grandparental health. This is probably because Chinese grandparents tended to watch videos relating to longevity and health preservation. Practicing and internalizing healthy behaviors and lifestyles learned from those videos may explain such a mediating effect. Chatting through the internet decreased the negative effect of caregiving on IADL may be because chatting on the internet could be an important way of social networking, which improved seniors' functional independence dealing with daily activities. Watching news through the internet was found to decrease the negative consequence of caregiving on depression. This is likely attributable to the fact that watching news can make grandparents feel less isolated from the society and more involved in social events. Since caregiving is time consuming and it often prevents caregivers from socializing with others, watching news could serve as a mediator diminishing caregivers' depression level caused by taking care of grandchildren. Internet use did now show a mediating effect on grandparents' life satisfaction. This finding suggested that although surfing the internet may alleviate intergenerational caregivers' mental illnesses and promote their physical health, internet use may not help improving their satisfaction towards life. This is probably attributable to the fact that when posting information on the website, people tend to upload photos, videos, stories and alike that show positive sides of life. Individuals who receive such information through the web are likely to feel that others live better than themselves, which makes them feel less satisfied with life.

Another focus of the research was to explore the rural-urban and gender differences. Findings of the study painted a complex picture of the health implications. Overall, urban grandparents showed better physical and mental health than their rural counterparts with urban grandfathers reporting best health outcomes and rural grandmothers having worst health status. As to the gender differentials, grandfathers showed better health outcomes as compared to their female counterparts in both rural and urban settings. When the KHB method was applied to explore how caregiving and internet use shaped grandparental health, variations arose among subgroups. Clearly, watching videos through internet only showed a significant mediating effect on SRH among urban grandmothers and rural grandfathers. The mediating effect of using internet to chat on IADL was significant among all other three subgroups except for the urban grandfather group. Additionally, the mediating effect of using internet to watch news on depression was significant among all subgroups with the mediating effect being strongest among urban grandmother and grandfather subgroups. It is interesting to see that for some subgroups, the effects of caregiving and mediating variables were not consistent with the whole sample group. For example, watching videos reduced the positive effect of intergenerational caregiving on urban grandmothers' SRH. Among rural grandfathers, intergenerational caregiving linked to a higher level of depression; watching news mediated with caregiving, which further increased caregivers' depression level. For urban grandmothers, although watching news mediated with caregiving to reduce the depression level of caregivers, caregiving was found to be positively associated with grandmothers' depression level. These findings implied that urban grandmothers somehow differed from other grandparents subgroups. This may be attributed to gender difference in the division of labor. Urban grandmothers provide more intensive care such as cooking, housekeeping, feeding, bathing, and dressing. Caregiving was therefore more demanding than rewarding for urban grandmothers. The urban-rural and gender differences deserve further investigation in future research. The results underscored that the health implications for grandparents who cared for grandchildren depended on their gender and rural-urban context.

The study had limitations that need to be addressed in future research. One limitation was the relatively crude measures of caregiving. Detailed measures of intensive versus non-intensive care were not applied in this study. In addition, there could be recall bias in terms of grandparents’ self-reports of caregiving activities. Future research may rely on survey data that are collected by better survey instruments to measure caregiving. Another limitation related to the causality issue. Ideally, regressions should be conducted by analyzing the baseline and follow-up data of CHARLS. But the internet use variables were only available in the most recent wave, which prevented us from taking advantage of the longitudinal nature of the dataset to detect longitudinal changes in intergenerational caregiving and grandparental health. Thus, the current data has limited capacity for adequately addressing issues of confounding or endogeneity in inferring causal relationships. Future research that covers a longer time span is warranted.

Despite these limitations, this study had important theoretical contributions as well as practical implications. Theoretically, the study contributed to the literature on mechanisms of how caring for grandchildren links to grandparental health in a non-Western context. Previous studies have rarely paid attention to internet use as a pathway explaining parental health changes due to intergenerational caregiving. Results drawn from this research indicated that internet can serve as a mediator that improves grandparents' health and reduces their depressive symptoms. Thus, findings of this study enriched existing theories on intergenerational care and grandparents' health. Practically, policy makers and health professionals may consider encouraging grandparents to access to the internet, which had beneficial effect on their health. Such findings provided valuable insights for other Asian countries as well. Further, given the urban-rural and gender differentials in internet usage, intergenerational caregiving patterns and health outcomes observed in this study, future policy designs may need to be tailored considering the heterogeneity of Chinese grandparent subpopulations.

Grandchild care had a positive effect on grandparental health. Grandparents who engaged in grandchild care were more likely to use internet. Internet use mediated the ways in which grandchild care impacted grandparents' health. It generally promoted the positive influence of intergenerational caregiving on grandparental health. Promoting internet usage may be an effective way reducing the negative impact of intergenerational caregiving on grandparents' depression. It could also increase the positive effect of caregiving on grandparents' SRH and functional independence. The study highlighted the importance of taking rural-urban context and gender role into consideration when studying intergenerational caregiving and Chinese grandparents' health.

SRH

self-rated heath.

Acknowledgements

None.

Authors’ contributions

LZ: conceptualized the article and the analysis and wrote the draft. GRX and JW: conducted the analyses and interpreted the results. AL: provided theoretical guidance.

Availability of data and materials

The data analyzed in the study is from publicly available database. Data can be downloaded from the following website: https://charls.pku.edu.cn/.

Funding

This research is supported by National Social Science Foundation of China (Grant No. 21BRK043) . It was also funded by the Fundamental Research Funds for Central Universities

(Grant No. 20ZFG84001 & Grant No. 19ZFY84001) and the Distinguished Qian Duansheng Scholar Funds at China University of Political Science and Law. The funders had no role in the design of the study, in collection, analysis and interpretation of data, and in writing the manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no conflicts of interest.

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No competing interests reported.

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How Is Caring for Grandchildren Associated with Grandparents’ Health: The Mediating Effect of Internet Use

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Abstract

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Background

Theoretical Basis

Grandchild Care and Grandparental Health

Internet Use And Individual Health

Mediators In The Relationship Of Caring For Grandchildren And Grandparents' Health

Methods

Data

Variables

Statistical Methods

Results

Descriptive Statistics

Regression Results

Discussion

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