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© Journal of Comparative Family Studies Volume 51 Number 1, 2020
10.3138/jcfs.51.1.005
Abstract: Since the implementation of the One-Child Police in China in 1979, great
concern has been raised about the physical and psychological development of
“only-children.” Some researchers believe that only-children may have diculty
with social skills, which include communication ability, because they would
lack early sibling interactions. The aim of the present study was to explore the
communication ability of only-children compared to children raised with siblings.
We administered the self-developed Interpersonal Communication Ability
Assessment Scale, which had been previously validated and rened, to 1,376
medical students in China. Results showed that when considering communication
ability on its own, there were slight dierences found between only-children and
non-only-children. However, this dierence was no longer signicant when other
independent variables were included in a hierarchical linear regression. This might
be due to the fact that only-children have more highly educated parents, with
more high-status careers, and greater family income that might provide greater
social and educational opportunities, which might then increase communication
abilities.
Keywords: only-children, communication ability, communication skills,
medical students
Résumé : Dupuis la mise en place de la politique de l’enfant unique en Chine en
1979, une grande inquiétude a été exprimée concernant le développement physique
et psychologique des enfants uniques. Certains chercheurs croient que les enfants
uniques peuvent avoir des dicultés avec les compétences sociales, y compris les
compétences en communication, parce qu'ils manqueraient d'interactions précoces
entre frères et sœurs. Le but de cette étude était d'explorer les compétences de
communication des enfants uniques par rapport aux enfants élevés avec des frères
Do Only-Children Communicate
Better Than Non-Only Children?1
A Study of Medical Students in China
Wei Wang*, Jie Zhang†, Dwight A. Hennessy‡ and
Wenqiang Yin§
* Weifang Medical University, School of Public Health and Management, 7166 Baotongxi Street, Weifang City,
261053, Shandong Province, China (wang_w2006@126.com).
† Correspondence should be directed to Jie Zhang, Department of Sociology, State University of New York
College at Bualo, 1300 Elmwood Avenue, Bualo, New York 14222, USA (zhangj@bualostate.edu).
‡ State University of New York Bualo State, Department of Psychology, 1300 Elmwood Ave., Bualo NY,
14222, USA (HENNESDA@bualostate.edu).
§ Weifang Medical University, School of Public Health and Management, 7166 Baotongxi Street, Weifang City,
261053, Shandong Province, China (yinwq@wfmc.edu.cn).
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et des sœurs. Nous avons administré l'Echelle d'Evaluation des Compétences
en Communication Interpersonnelle, qui était précédemment validée et anée
à 1 376 étudiants en médecine en Chine. Les résultats ont montré que lorsque
nous avons considéré la capacité de communication de façon isolé, il y avait de
légères diérences entre les enfants uniques et les enfants élevés avec des frères
et des sœurs. Cependant, cette diérence n'était plus signicative lorsque d'autres
variables indépendants étaient incluses dans une régression linéaire hiérarchique.
Cela pourrait être à cause du fait que les parents des enfants uniques ont fait des
études supérieures, avec une carrière plus élevée et un revenu familial plus élevé,
ce qui pourrait orir de plus grandes opportunités sociales et éducatives, ce qui
pourrait alors augmenter leurs capacités de communication.
Mots-clés : enfants uniques, capacité de communication, compétences en
communication, étudiants en médecine
Introduction
In order to control rapid population growth in China, the Chinese government
implemented its “One-Child” Policy (OCP) in 1979 which remained in eect
for more than 35 years. As a result of this birth control policy, the number of
only-child homes grew rapidly. e average family size dwindled from 4.54 people
in 1980 to 3.36 people in 2000 (Festini and de Martino, 2004), and plummeted
to 2.54 by 2016 when the one-child policy was ocially abolished. According to
Wang (2013), the number of only-children homes reached 145 million in 2010
and an estimated 176 million in 2015.
For several decades, there has been great concern over the well-being of these
only-children among parents, educators, sociologists, physicians, psychologists,
economists and policy makers. Primarily, interest in the impact of the OCP has
been in the areas of intellectual/educational outcomes, psychological well-being
(including personality and character development), and physical health/
development.
For instance, a noted advantage to the OCP has been the potential for
increased intellectual growth and educational opportunities (Lin, 2019). Parents
in China have typically put more emphasis on the education of their only-child
to ensure that they are more socially and economically competitive in the future,
and as such, educational institutions have ourished across China by putting for-
ward miscellaneous programs to attract eager parents with the promise of optimal
educational experiences and the greatest chance of future success for their child
(Xue and Li, 2016). e extra attention and exclusive focus of resources has been
suggested to account for the general increased academic success of only-children
(Lin, 2019; Qin, Zhuang, and Yang, 2017; Tan, Gupta, and Wilgus, 2019). is
has also generally led to greater expectations on the only-child as well and, as a
result, recent studies (Lao and Dong, 2019; Liu, Lin, and Chen, 2009) have shown
that only-children were more likely to achieve better academic performance than
non-only children.
It has also been noted that parents of only-children typically have higher lev-
els of education themselves which may account for higher academic achievement
of the child, due to the enriched intellectual environment and focus on higher
86 Do Only-Children Communicate Better Than Non-Only Children?
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level learning (Wei, Wu, Lv et al., 2016). However, the academic advantage of
only-children has been found to be true even when controlling for the education
level of the parents (Blake, 1989; Falbo and Polit, 1986). According to Falbo and
Polit (1986) this advantage is largely due to the nature of the parent-child rela-
tionship. In China, this may be facilitated by the fact that the only-child is held
in high regard and given special favor in the home. It is conceivable that this in
turn may potentially foster higher self-esteem, as well as increased bonding and
intimate interactions with parents.
It should be noted though, that there are some limits to this academic
advantage among only-children. For example, Poston and Falbo (1990) examined
1,460 schoolchildren, in addition to their parents and teachers, in the urban and
rural areas of Changchun, China, in 1987. ey found that those without siblings
had higher academic scores than those with siblings, but these advantages were
found only among urban children. In a further study by Falbo and Poston (1993)
who selected a total sample of 4,000 school children from four provinces in China,
they found that the academic advantage for only-children occurred in only 3 of
the 4 provincial samples, and that only-children were stronger only in verbal tests.
Further, Jiao, Ji, and Jing (1996) examined 142 rst-grade and 188 h-grade
children in the Beijing area and determined that only-children showed superior
cognitive abilities compared to those with siblings only at the rst grade level.
However, one caveat may be that the h graders in that sample would have been
born prior to the OCP implementation, and dierences in attitudes and treat-
ment of only-children may not have been the same as the policy progressed over
time. Moreover, when only-children were compared to rstborns, no dierences
were found once appropriate background controls were introduced. In a similar
respect, Chen and Liu (2014) found that there were no dierences in self-reported
grades between only-children and rstborns who have younger siblings. is sug-
gests that a birth order eect may account for the academic advantage, where
rst born children have the benet of exclusive attention and expectations from
parents for a given period of time, again conrming that it might be the nature of
the child-parent relationship that accounts for these dierences.
Other concerns have been raised regarding the potential social, psychological,
and physical well-being of only-children stemming from this OCP in China. One
potential issue is based on what the popular media has termed a “little emperor
generation” (Keating, 2013), where the only-child has become the excessive focus
of the entire family, including parents and grandparents, resulting in extraordinary
and extreme privilege. e concern has been that these only-children will develop
excessive levels of esteem and ultimately undesirable personality traits like self-
ishness, aggressiveness, or arrogance because they do not have to share familial
resources or compete for parental attention (Hall, 1987; Jiao, Ji, and Jing, 1986;
Meredith, Abbott, and Zhu, 1989; Yang, Hou, Wei et al., 2017).
In contrast, though, this exclusive familial focus may actually lead to some
functional outcomes as well. For example, research has found that only-children
were reported to have lower levels of fear, anxiety, and depression compared to
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non-only-children as children and adults (Falbo and Hooper, 2015; Liu, Lin, and
Chen, 2010; Wang, Du, Liu et al., 2002; Yang, omas, Dong et al., 1995). In
addition, Lin, Fong, and Wang (2017) argued that, while only-children were more
inclined to adopt a self-oriented learning style, which would place them at risk
of decreased self-condence under periods of lost control during the learning
process in school, the increased perception of help availability from the exclusive
family access also led to increased learning condence. ey also noted that the
nature of the interactions between only-children and their peers changes as they
mature, potentially leading to increased condence, which may account for some
contradictions such as increased cooperativeness with peers in their college sam-
ple despite the appearance of self-centeredness. is may also explain the fact that,
despite the existence of some dierences between only and non-only-children
in certain aspects of life, such as character quality and self-centeredness, there
are simultaneously other areas where no dierences are found, particularly as
they emerge into adulthood, such as anger control, self-ecacy, and cooperation
(Guo, Zhang, and Zhang, 2015; Kadoya, Khan, and Sano, 2018; Rodrigues and
Abhyankar, 2012).
It should be noted, however, that in many studies comparing only and
non-only-children in China, the non-only-children groups are typically dispro-
portionately selected from rural areas and among lower income families with
low social status (Huang, 2009). is is important because such factors might
alternatively account for dierences in these studies due to the excessive levels
of psychological diculties stemming from lower resources and opportuni-
ties, elevated competition and pressure, and decreased levels of social/familial
respect found among rural communities in comparison to urban environments.
Nonetheless, the existing research is clear that the only-child environment does
have the potential to impact social and psychological factors, although the exact
nature is not always clear.
Another area of concern, and one that has not received a great deal of research
attention to this point, is the potential impact of the OPC on the development of
communication. Normally, communication is considered to be a
process in which
people exchange information, ideas, feelings, and facts through the use of verbal
or nonverbal signals across various contexts, cultures, environments and media
so that they can gain consensus or understanding among each other (Jha and
Malik, 2018; Weaver and Hybels, 2007). It has been shown that communication is
essential for success among young adults, particularly as they enter the workforce
(Katz and Kahn, 1966; Phillips, 1998, 1999; Redding, 1972; Sarpparaje, 2016;
Weaver & Hybels, 2007). Netzley (1999), for example, argued that in order for
employees in business to succeed, they not only need technological knowledge,
but also the ability to cooperate and communicate eectively. Similarly, based
on a study by the National Association of Colleges and Employers, good com-
munication ability was considered the top “must have” quality among potential
job candidates (Hull, 2017). So in this respect, if the family emphasis in Chinese
only-children homes is to help the child develop the intellectual and educational
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background to excel in their future careers, the question is whether this has also
translated to benets in communication ability.
ere have been numerous studies attempting to link communication with
success at obtaining or succeeding in particular occupational roles. ese studies
have ranged from the evaluation of graduate business students’ perceptions of
their communication competencies at the onset of a required managerial com-
munication course in relation to their self-ratings at the conclusion of the course
(Hill, Mehta, and Hynes, 2014), to the eectiveness of a job search and interview
skills workshop for graduate students in audiology and speech-language pathol-
ogy (Ward, Leuty, and Corie, 2016). ey have included varied topics such as the
development and validation of the Science, Technology, Engineering, and Math
Interpersonal Communication Skills Assessment Battery (STEMICSAB) for
women doctoral students in engineering, mathematics, computer sciences, and
the physical sciences (Wilkins, Bernstein, and Bekki, 2015), and the evaluation of
communication skills among medical students and physicians from a variety of
dierent medical specialties (Gude, Finset, Anvik et al., 2017; Han, Joekesc, Elwyn
et al., 2014; Liew, Dutta, Sidhu et al., 2014; Maraccini, Houmanfar, Kemmelmeier
et al., 2018; Modi, Anshu, Gupta et al., 2016; Shafakhah, Zarshenas, Sharif et al.,
2015). However, what seems to be lacking is an attempt to understand how com-
munication ability might dier between only-children and non-only-children.
ere are more than 200 million only-children in China (Yi, 2013) whose ability
to communicate with others is an issue worth addressing.
Furthermore, it should also be noted that previous studies on the impact of
the OCP have focused mainly on elementary and middle school children, with
a few notable exceptions (Kadoya et al., 2018; Lin et al., 2017; Wang, Du, et al.,
2002; Yang et al., 2017) which have examined adult only-children. erefore,
the present study was designed to examine potential dierences between only
and non-only-children as young adults. In particular, the focus was on medical
students due to the fact that China has seen a sharp rise in medical demand in
recent years which has been met by a rapid increase in the number of physicians
(National Health Commission of the People's Republic of China, 2019). Within
the medical system, physicians are required to communicate with a number of
dierent individuals on a variety of levels, including other doctors and nurses
to share health information to impact outcomes and treatment, with patients
to understand symptoms and to pass on relevant medical information at a level
they might understand, with families of patients to pass on support or to share
information during medical procedures at times when patients are unable, and
with the hospital administration to communicate about systematic aspects like
patient payments or employment issues. In this respect, ecient communication
is essential for eective medical practice (Guetterman, Sakakibara, Baireddy et
al., 2019; Zhang, Jiang, Sun et al., 2018), whereas poor communication can lead
to disadvantageous consequences, medical error, physician-patient conict, and
declined doctor-patient satisfaction (Carter, Ward, Wexler et al., 2018; Curry,
Spatz, Cherlin et al., 2011; Kemp, Santana, Southern et al., 2016). In China, lack
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of communication with patients is considered to be responsible for the bulk of
conicts between medical providers and the users of the medical system (Huang,
Huang, and Hu, 2011; Yin, 2003; Yu, Wang, and Sun, 2018). Evidence currently
notes that physicians in China do not appear to be considered good at communi-
cating with others (Liu, Rohrer, and Luo, 2015; Wu, Gao, and Fan, 2007). In this
respect, as future physicians, the communication of medical students might have
impact on good physician-patient relations, as well as eective medical treat-
ment/outcomes, as they commence their medical practice and career.
erefore, the aim of the present study was to understand if there are dier-
ences in only-children’s socio-demographic makeup, and if there are dierences in
their communication ability aer controlling for social and demographic factors
among young adult medical students in China. It was hypothesized that: (1) basic
demographic and social factors like gender, birthplace and family atmosphere,
father’s and mother’s education, father’s and mother’s occupation, and family
economics will dier between only and non-only-children and (2)only-children
will show greater communication ability than non-only-children.
Method
Sample and Data Collection Procedures
In order to examine potential dierences between only-children and non-only-
children in communication ability, a cross-sectional survey was conducted in
May, 2012 and December, 2013 among a convenience sample of three medical
universities in Shandong province, China. All participants were undergraduates
who enrolled directly into university from high school. Of the three universities,
one was aliated with the Ministry of Education in China, the other two were
aliated with the Shandong Provincial Department of Education.
Administrative approvals were obtained from all three universities before
survey implementation. All participation was voluntary and all information
was kept private and condential. Written informed consent was obtained
prior to participation. Approximately 5% of all students were randomly chosen
from within each of the ve grade levels. erefore, there were a total of 1,600
respondents who were recruited with 1,460 (91.25%) returning the questionnaire
battery. From these, 84 were excluded due to missing data, leaving 1,376 (86.0%
of the total recruited and 94.25% of the total returned) completed questionnaires
in the nal analyses.
Design and Materials
A cross-sectional design and quantitative method were used. In terms of ma-
terials, this study involved two self-developed questionnaires. e rst was
a self-reported measure of basic socio-demographic information, including
Gender, Birthplace (city/rural area), Year in School (ve year options based on
timing to complete medical undergraduate training), Family Structure (sin-
gle family, nuclear family, extended family), Father’s and Mother’s Education
Degree (Bachelor’s and above, junior college, technician training school, high
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school and below), Father’s and Mother’s Occupation (head of state organization
or enterprise, technology professional/clerk, military, worker/farmer), Family
Atmosphere (1–5 scale representing extremely hostile to extremely harmoni-
ous), and Family Economic Condition (1–5 scale representing extremely poor
to extremely wealthy).
e second questionnaire (Interpersonal Communication Ability As-
sessment Scale – ICAAS) was a self-reported tool designed to measure
communication abilities, and was developed through pilot work prior to the
implementation of this study by members of the current research study (Wan g
and Yin, 2015). Beginning with a review of communication literature (Baney,
2004; Barker, 2006; Chen and Miao, 2007; Gallagher, Hartung, Gerzina et al.,
2005; Humphris and Kaney, 2001; Liu, 2005; Pearce, 1994; Team FME, 2013;
Wang, 2013; Weaver and Hybels, 2007), the initial development of questionnaire
items followed a grounded theory approach to establish baseline dimensions of
key communication abilities. Specically, key identiers of communication abil-
ities among young adults and ultimately potential survey items were generated
through qualitative surveys and focus groups made up of individuals such as
researchers and professors with expertise in the areas of communication, psy-
chology, and sociology, as well as those with experience in social science method-
ology, health statistics, and communication theory and practice. e initial list of
41 items was then presented to a pilot group of 600 medical students (228males
and 372 females) that were recruited from Weifang Medical University. ese
students were asked to rate how much they agreed that each item applied to
them using a 5-point Likert scales (1 = strongly disagree to 5 = strongly agree).
Of the 557 questionnaires returned, 502 (90.1%) were completed suciently for
further analysis.
In order to improve item and test quality, item analysis was performed to
evaluate the performance of individual items (observed variables) and of the
scale as a whole. Critical Ratio analysis was conducted, through which it was
determined that a score of 129 signied the lower 27% of scores, and 154 identi-
ed the highest 27% of scores (Wu, 2010). Accordingly, the low and high Critical
Ratios were set at 127 and 154 respectively and an Independent samples t-test (p<
0.05) showed that dierences between low score and high score items were sig-
nicant, which meant individual items performed well. Subsequently, Principal
Component Analysis was applied to test the validity of ICAAS. e initial
scale provided a good t to the data (KMO = 0.97, Bartlett's Test of
Sphericity:
Χ2 = 34,205.928, p < 0.001) which indicated that Factor Analysis could be used to
purify the initial assessment scale. erefore, using Factor Analysis, 8 items were
eliminated whose factor loadings were below 0.50 which indicated that those
observed variables had weak associations with latent variables.
e resulting ICAAS revision included 33 items across 5 factors as shown
in Table 1. e 5 dimensions were labeled as follows: Factor 1: Communication
Inclination with Friends (11 items; loadings:0.509 to 0.758), which represents
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Table 1: Rotated component matrix for the ICAAS
Items
Factors
1 2 3 4 5
Communication intent 0.758 0.202 0.247 0.219 0.039
Heart-to-heart talk with friends 0.755 0.148 0.136 0.183 0.184
Enjoy sharing with friends 0.738 0.195 0.260 0.169 0.053
Tell about your own suerings 0.630 0.096 0.053 0.140 0.326
Perceptive towards friend’s emotions 0.619 0.264 0.238 0.160 0.293
Good listener 0.583 0.272 0.457 0.057 −0.041
Getting along with everyone 0.545 0.253 0.317 0.411 −0.122
Attentive to others’ feelings 0.543 0.361 0.422 0.024 0.064
Take the initiative to reconcile with
friends
0.525 0.115 0.187 0.209 .0331
Put yourself in the another person's
shoes
0.518 0.351 0.308 −0.045 0.309
Empathetic in others’ experiences 0.509 0.432 0.297 −0.066 0.321
Decide what other’s need 0.137 0.771 0.127 0.127 0.183
Figure out what’s going on 0.075 0.735 0.173 0.103 0.229
Empathetic to others’ feelings 0.309 0.717 0.253 0.108 −0.024
Judge a person’s character 0.189 0.673 0.300 0.125 0.016
Know how to help others 0.221 0.670 0.103 0.283 0.171
Adopt communication ways according
to a person’s social status
0.254 0.558 0.334 0.273 0.190
Adopt communication ways according
to environment
0.323 0.530 0.271 0.334 0.218
Clear about communication situation 0.258 0.525 0.323 0.264 0.218
Eectively communicate with the help
of environment
0.267 0.518 0.345 0.254 0.204
Using body language 0.233 0.175 0.737 0.217 0.155
Using eye expression 0.200 0.232 0.719 0.181 0.180
Using eye contact 0.180 0.248 0.694 0.152 0.179
Using facial expression 0.342 0.233 0.636 0.160 0.160
Explaining yourself clearly 0.292 0.285 0.585 0.215 0.188
(Continued)
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Items
Factors
1 2 3 4 5
Clear verbal symbols 0.260 0.301 0.573 0.266 0.115
Participating in social activities 0.129 0.115 0.220 0.683 0.323
Good at organizing activities 0.022 0.210 0.241 0.647 0.282
Good at hosting 0.304 0.262 0.137 0.639 0.100
Getting along with older people 0.337 0.253 0.206 0.526 0.000
Talking to strangers like friends 0.169 0.183 0.110 0.200 0.776
Initiating a talk with strangers 0.175 0.179 0.182 0.166 0.733
Expressing yourself clearly with
strangers
0.219 0.249 0.350 0.166 0.581
Table 1: Continued
a preference for sharing and communicating thoughts/feelings with friends;
Factor2: Perception of the Communication Environment (9 items; loadings:0.518
to 0.771), which identies a person’s ability to think about potential communi-
cation situations and develop communication skills or strategy based on specic
situational or contextual elements like culture, language, and communication
location; Factor 3: Communication Skills (6 items; loadings:0.573 to 0.737),
which represents the ability to eectively present and understand communi-
cation verbally and non-verbally; Factor 4: Self-Evaluation (4 items; loadings:
0.526 to 0.683), which includes items that focus on how an individual evaluates
their own communication ability; Factor 5: Communication Inclination with
Strangers (4 items; loadings:0.581 to 0.776), which represents a preference for
sharing and communicating thought/feelings with strangers. Table 2 shows good
internal reliability (ranging from 0.782 to 0.914) which supports its use in the
current study to measure communication ability.
Table 2: Reliability levels of the ICAAS factors
Factors Items Cronbach's Alpha
Communication Inclination with Friends 11 0.914
Perception of the Communication Environment 9 0.901
Communication Skills 6 0.886
Self-Evaluation 4 0.724
Communication Inclination with Strangers 3 0.782
Total 33 0.962
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Statistical Analyses
Descriptive statistics, chi-square analysis, and logistic regression were employed
to describe and compare the demographic characteristics. T-tests were used to
compare dierences in communication ability on ve factors between only and
non-only-children. One-way ANOVA was applied to describe and compare
communication mean scores across demographic variables. Finally, a hierarchical
linear regression was conducted in order to explore the impact of onlyvs. non-
only child status on communication ability, aer controlling for demographic
and social factors.
Results
Characteristics of Only-Children Respondents
A total of 1,376 undergraduate medical students were included from rst year
to h year in three medical universities in Shandong Province; only-children
accounted for 40.9% of this sample. e frequencies of each response option
to each of the socio-demographic factors can be found in Table 3. Chi-square
was conducted to examine potential dierences between only-children and
non-only-children in terms of the frequency of social-demographic charac-
teristics, including gender, birthplace, year in school, family structure, parents’
education and occupation, family atmosphere, and family economic condi-
tion. Outcomes showed that all but family structure were statistically signif-
icant (seeTable 3). In this sample, only-children were more likely to be males
(53.6%), live in cities (73.4%), have parents with the highest level of education
(82.0% for father, 86.9% for mother), have parents with occupations as head of
state organizations (72.8% for father, 82.7% for mother), to have higher family
income (72.7%), and less likely to report a somewhat (34.2%) or extremely
(46.6%) harmonious family atmosphere. Further, the average score for the
family atmosphere variable was 4.54 (SD = 0.70) for only children and 4.37
(SD = 0.7565) for non-only-children (where higher scores indicated greater
levels of family harmony rather than hostility) (t =4.565, p < 0.001). e aver-
age rating of family economic standing was 3.38 (SD = 0.74) for only children
and 2.95 (SD = 0.67) for non-only-children (where higher scores indicated
greater wealth) (t = 11.65, p < 0.001). e discrepancy between the number of
only-children and non-only-children in terms of year in school was greater in
the later years.
Logistic Regression was used to explore the demographic makeup among
the only-children group (see Table 4). e only-children group was 4.38 times
more likely to be males than females and 4.65 times more likely to live in urban
rather than rural areas. ey were also 1.32 more likely to have parents with
higher education, as well as 3.03 times more likely to have mothers with head
of state/entrepreneur careers and 1.78 times more likely to have mothers with
technology/clerk careers. Finally, they were 10.26 times more likely to live in
extremely wealthy families.
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Table 3: Demographic characteristics of only-children and non-only-children
(N = 1,376)
Demographic
characteristics Total Only-child
Non-only-
child Χ2p
n f (%) f (%)
Gender Male 524 281 (53.63) 243 (46.37) 56.55 < 0.001*
Female 852 282 (33.10) 570 (66.90)
Birthplace City 507 372 (73.37) 135 (26.63) 349.84 < 0.001*
Rural area 869 191 (21.98) 678 (78.02)
Year in
school
Freshman 298 130 (43.62) 168 (56.38) 12.54 < 0.001*
Sophomore 263 123 (46.77) 140 (53.23)
Junior 269 117 (43.49) 152 (56.51)
Senior 247 85 (34.41) 162 (65.59)
Graduate 299 108 (36.12) 191 (63.88)
Family
structure
Single parent 56 27 (48.21) 29 (51.79) 6.18 0.103
Nuclear family 1228 508 (41.37) 720 (58.63)
Extended
family
74 21 (28.38) 53 (71.62)
Others 18 7 (38.89) 11 (61.11)
Father's
education
Bachelor's and
above
924 230 (24.89) 694 (75.11) 321.92 < 0.001*
Junior college 73 42 (57.53) 31 (42.47)
Technician
training school
140 95 (67.86) 45 (32.14)
High school
and below
239 196 (82.01) 43 (17.99)
Father's
occupation
Head of state
organization/
enterprise
254 185 (72.83) 69 (27.17) 248.99 < 0.001*
Technology
professional/
clerk
348 192 (55.17) 156 (44.83)
Military and
others
485 101 (20.82) 384 (79.18)
Worker/farmer 289 85 (29.41) 204 (70.59)
(Continued)
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Demographic
characteristics Total Only-child
Non-only-
child Χ2p
Mother's
education
Bachelor's and
above
1038 291 (28.03) 747 (71.97) 302.51 < 0.001*
Junior college 69 49 (71.01) 20 (28.99)
Technician
training school
109 84 (77.06) 25 (22.94)
High school
and below
160 139 (86.88) 21 (13.13)
Mother's
occupation
Head of state
organization/
enterprise
162 134 (82.72) 28 (17.28) 299.41 < 0.001*
Technology
professional/
clerk
347 210 (60.52) 137 (39.48)
Military and
others
502 109 (21.71) 393 (78.29)
Worker/farmer 365 110 (30.14) 255 (69.86)
Family
atmosphere
Extremely
hostile
95 (57.66) 4 (42.34) 29.95 < 0.001*
Somewhat
hostile
13 3 (22.24) 10 (77.76)
Neither hostile
nor harmonious
115 35 (30.52) 80 (69.48)
Somewhat
harmonious
462 158 (34.23) 304 (65.77)
Extremely
harmonious
778 362 (46.55) 416 (53.45)
Family
economic
condition
Extremely
wealthy
21 5 (23.50) 16 (76.50) 34.31 <0.001*
Somewhat
wealthy
176 34 (19.32) 142 (80.68)
Neither poor
nor wealthy
839 304 (36.22) 535 (63.78)
Somewhat poor 287 182 (63.37) 105 (36.63)
Extremely poor 52 38 (72.77) 14 (27.23)
* Signicant at p < 0.05
Table 3: Continued
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Table 4: Logicstic regression comparison between demographic among
only-children
Dependent
variables Independent variables OR (95% CI) p
Gender Male 4.38 (3.22–5.96) < 0.001*
Female 1
Birthplace City 4.65 (3.26–6.62) < 0.001*
Rural area 1
Father's
education
Bachelor's degree and above 2.55 (1.46–4.54) 0.008*
Junior college 2.48 (1.50–4.10) 0.001*
Technician training school 2.50 (1.37–4.47) 0.003*
High school and below 1
Mother's
education
Bachelor's degree and above 2.24 (1.10–4.55) 0.026*
Junior college 2.15 (1.14–4.05) 0.018*
Technician training school 1.32 (0.67–2.61) 0.420
High school and below 1
Mother’s
occupation
Head of state organization/
enterprise
3.30 (1.75–6.22) < 0.001*
Technology professional/clerk 1.78 (1.17–2.70) 0.007*
Military and others 1.04 (0.72–1.51) 0.829
Worker/farmer 1
Family
economic
condition
Extremely wealthy 10.26 (2.2–48.24) 0.003*
Somewhat wealthy 3.64 (0.91–14.67) 0.069
Neither poor nor wealthy 2.82 (0.72–11.07) 0.137
Somewhat poor 2.50 (0.60–10.39) 0.208
Extremely poor 1
* Signicant at p < 0.05
Evaluation of Only-Children’s Communication Ability
An Independent Sample T-test was conducted to examine potential dierences
in the mean scores on the ve communication ability factors between only and
non-only-children (see Table 5). e results showed that only-children scored
signicantly higher in all ve dimensions individually and on the total score.
A series of one-way ANOVAs were conducted in order to determine if
communication ability diered across the main variables in the study, including
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only-child status and socio-demographic factors (see Table 6). Results showed
that communication ability was slightly higher for only-children 3.49 (SD = 0.67)
than for non-only-children 3.29 (SD = 0.67) (F = 15.45, p < 0.001). With the
exception of gender, all socio-demographic variables showed dierences in mean
communication ability scores. Specically, participants from cities, whose father
and mother achieved a bachelor’s degree or above, whose parents were heads of
state-run organizations, who reported a more harmonious family atmosphere,
and those from homes with higher economic levels all reported greater com-
munication skills. While providing useful information on factors that impact
communication ability in young adult medical students, these outcomes also sup-
port treating socio-demographic variables as controls in examining the impact of
only vs. non-only child status on communication ability.
In order to determine if the overall mean of communication ability dif-
fered between only and non-only-children, a hierarchical linear regression was
conducted entering gender (personal variable) on the rst step, birthplace and
family atmosphere (family factors) on the second step, both parents’ education,
occupation and family economics (nancial related items) on the third step, and
only vs non-only-children on the last step (see Table 7). Results revealed that
unlike the results of single factor analyses (t-test and one-way ANOVA), only
father’s education degree was signicantly related to elevated communication
Table 5: Comparison of mean communication ability scores between only and
non-only-children
Independent
variables
Only-
children N Mean SD
Mean
dierence t p
Self-evaluation Yes 563 3.41 0.75 0.17 4.27 P < 0.01*
No 823 3.24 0.73
Perception of the
context
Yes 563 3.56 0.71 0.15 3.68 P < 0.01*
No 813 3.41 0.66
Verbal and
nonverbal symbols
Yes 563 3.56 0.75 0.12 3.12 p < 0.01*
No 813 3.44 0.68
Communication
inclination with
friends
Yes 563 3.77 0.71 0.09 2.22 p < 0.01*
No 813 3.68 0.69
Communication
with strangers
Yes 563 3.32 0.80 0.13 2.99 p < 0.01*
No 813 3.19 0.79
Total mean scores Yes 563 3.52 0.62 0.13 3.94 p < 0.01*
No 813 3.39 0.59
* Signicant at p < 0.05
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Table 6: One-Way ANOVA model for socio-demographic factors in predicting
mean communication ability scores
Mean ± SD 95% CI F p
Only-child Yes 3.49 ± 0.67 3.19–3.48 15.450 < 0.001*
No 3.29 ± 0.67 3.25–3.52
Gender Male 3.27 ± 0.74 3.18–3.46 0.007 0.934
Female 3.27 ± 0.62 3.26–3.54
Birthplace City 3.37 ± 0.65 3.25–3.53 18.501 < 0.001*
Rural area 3.21 ± 0.68 3.18–3.47
Father's
education
High school and below 3.22 ± 0.67 3.18–3.26 8.927 < 0.001*
Technician training
school
3.19 ± 0.52 3.04–3.35
Junior college 3.29 ± 0.73 3.18–3.41
Bachelor’s degree and
above
3.47 ± 0.66 3.38–3.55
Father’s
occupation
Head of state
organization or
enterprise
3.39 ± 0.72 3.31–3.48 4.497 0.004*
Technology
professional or clerk
3.29 ± 0.67 3.22–3.37
Famers or workers 3.22 ± 0.61 3.17–3.29
Other 3.21 ± 0.71 3.18–3.51
Mother's
education
High school and below 3.22 ± 0.66 3.18–3.26 10.316 < 0.001*
Technician training
school
3.23 ± 0.61 3.08–3.39
Junior college 3.36 ± 0.77 3.23–3.48
Bachelor’s degree and
above
3.53 ± 0.68 3.42–3.63
Mother's
occupation
Head of state
organization or
enterprise
3.41 ± 0.73 3.31–3.52 4.557 0.003*
Technology
professional or clerk
3.32 ± 0.66 3.25–3.39
Famers or workers 3.27 ± 0.62 3.16–3.29
Other 3.21 ± 0.69 3.15–3.29
(Continued)
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Mean ± SD 95% CI F p
Family
atmosphere
Extremely hostile 3.04 ± 1.17 2.65–3.43 12.575 < 0.001*
Somewhat hostile 2.96 ± 0.63 2.65–3.28
Neither hostile nor
harmonious
3.39 ± 0.59 3.28–3.50
Somewhat harmonious 3.41 ± 0.55 3.36–3.47
Extremely harmonious 3.60 ± 0.62 3.56–3.65
Family
economic
condition
Extremely poor 3.62 ± 1.12 3.36–3.88 3.485 0.008*
Somewhat poor 3.46 ± 0.54 3.37–3.55
Neither poor nor
wealthy
3.48 ± 0.56 3.43–3.52
Somewhat wealthy 3.61 ± 0.65 3.54–3.69
Extremely wealthy 3.59 ± 0.92 3.42–3.77
* Signicant at p < 0.05
(Continued)
Table 6: Continued
Table 7: Hierarchical regression model in predicting communication ability
Step Predictor
Unstandardized
Coecients
Standardized
Coecients
t p R2
B Std. Error B
1 Gender −.005 .059 −.003 −.080 .936 −.000
Constant 3.342 .037 90.655 0.000
2 Gender .001 .058 .001 .016 .987 .019
Birthplace .151 .061 .103 2.462 .014*
Family atmosphere −.041 .021 −.081 −1.931 .054
Constant 3.277 .061 53.552 0.000
3 Gender −.010 .059 −.007 −.175 .861 .040
Birthplace .122 .067 .083 1.817 .070
Family atmosphere −.039 .021 −.078 −1.876 .061
Father’s education .205 .083 .106 2.486 .013*
Mother’s education .035 .019 .089 1.843 .066
Father’s occupation .061 .065 .044 .947 .344
Mother’s occupation −.007 .028 −.012 −.262 .794
Family economics .029 .027 .046 1.105 .270
Constant 3.165 .079 39.948 .000
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Step Predictor
Unstandardized
Coecients
Standardized
Coecients
t p R2
B Std. Error B
4 Gender −.020 .060 −.014 −.340 .734 .042
Birthplace .102 .070 .070 1.463 .144
Family atmosphere −.039 .021 −.077 −1.865 .063
Father’s education .209 .083 .108 2.525 .012*
Mother’s education .030 .020 .076 1.530 .126
Father’s occupation .060 .065 .043 .924 .356
Mother’s occupation −.010 .028 −.017 −.350 .727
Family economics .029 .027 .044 1.068 .286
Only/non-only child .071 .069 .049 1.031 .303
Constant 3.150 .081 39.109 .000
* Signicant at p < 0.05
Table 7: Continued
ability. Specically, communication ability was greater among those whose father
achieved a higher-level education degree. But more importantly, contrary tothe
second hypothesis, this analysis showed that overall communication ability did
not dier between only-children and non-only-children aer controlling for
these socio-demographic factors.
Discussion
e present ndings show that there are some distinct dierences in sociodemo-
graphic factors between only-children and non-only-children that is consistent
with the implementation of the OCP in China. Specically, only-children are
more typically males, living in urban settings, with more highly educated parents
who have more upper level careers, and higher family economic levels. Demog-
raphers have indicated that a sex ratio bias, which skews towards a greater male
to female ratio, has existed for many years, especially in Asian countries (Dyson,
2012; Grech, 2015) where Confucius culture and its male preference is popular.
Further, the fact that the OCP in China is more strictly enforced in urban than in
rural areas could contribute to this imbalance. Additionally, even in rural areas,
where many couples have been permitted to have a second child when their rst
child is a girl, this male preference has led to selective sex based termination of
pregnancies—particularly for the second child—which would increase the pro-
portion of males in rural areas (Zhu, Lu, and Hesketh, 2009).
With respect to the dierences in education, employment, and economic
standing imbalance, greater education typically facilitates higher ranked
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employment with increased salaries. is is reected in the Chinese proverb “the
carp leaped through the dragon’s gate” where gaining an advanced degree is a
means for someone to achieve greater social/economic standing and status in
Chinese culture. However, these types of esteemed careers oen necessitate living
in urban areas with stricter OCP enforcement.
It is also noteworthy that the only-children were more likely than the
non-only-children to report living in harmonious homes. One explanation for
this might be that, for urban and highly-educated parents, it may be easier to
adopt more “western” parenting principles that emphasize warmth and support
rather than the more restrictive traditions of Chinese parenting (Wang and Chang,
2009), especially in the context of the OCP where time, attention, and eort do
not need to be divided between multiple children (Lu and Chang, 2013). is,
along with the fact that there is no opportunity for sibling conict in only-children
homes, may provide a greater sense of belongingness and satisfaction, leading to
greater perceptions of harmony. Alternatively, it is also oen necessary for parents
in rural communities to move to cities without their children as migrant workers
in order to provide nancial support for their family. It has been estimated that
this phenomenon has impacted nearly one in three children in rural China (Lv,
Yan, Duan et al., 2018). As a result, the absence of a parent (particularly long-
term) might lead to elevated feelings of abandonment, tension, stress, and con-
ict, which may ultimately decrease perceptions of family harmony.
With respect to the potential unique impact of only-children environ-
ments, previous research has found somewhat contradictory evidence. Some
have noted disadvantages in terms of personality, cooperation, and depression
(Falbo, Poston, Ji et al., 1989; Jiao et al., 1986; Wan, Fan, Lin et al., 1994), while
others have revealed advantages in personal traits, academic performances, and
social functioning (Wang, 1980; Wang, Wang, Du et al., 2002; Yang et al., 1995).
e main purpose of the present study was to investigate possible dierences
in communication ability between only-children and non-only-children using
a young adult sample. However, given that there were no established tools that
t this particular goal, a self-report instrument was developed specically for
this study (Wang and Yin, 2015). is Interpersonal Communication Ability
Assessment Scale (ICAAS), which identies an individual’s ability to commu-
nicate on ve dierent dimensions, showed high internal reliability and strong
item association. is multidimensional approach is important because eective
communication represents dierent things to each individual (Berlo, 1960), and
every individual will have their own areas of communication strength.
When considering communication ability on its own, dierences
emerged between only and non-only-children. However, when controlling for
socio-demographic factors, communication ability scores no longer diered
between these two groups. is would be consistent with Poston and Falbo
(1990) who argued that rstborns did not show any distinct advantages in
important developmental areas compared to children with siblings when other
contextual factors were considered as controls. is seems particularly relevant
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as development progresses towards adulthood (Lin et al., 2017). In fact, quality
parental anity could potentially explain any advantages in developmental
outcomes—including personality, intellect, and in the case of the present nd-
ings possibly communication ability—regardless of the number of children in a
home. While Ching (1982) argued that children’s social qualities (which could
extend to communication) are developed through interaction while playing with
other children, which conceptually would be more limited in the earliest years
for only-children, these ndings could be explained by parental involvement
and attention (Wei et al., 2016). Specically, parents of only-children in China
may spend more time speaking to and interacting with their child at a higher
language level. ey may be more focused on any issues that might arise and
show greater motivation to shape appropriate (or even more advanced) commu-
nication outcomes. Plus, considering the fact that they know that this will be
their only child, they may invest themselves to a greater extent in ensuring that
their child interacts with other children in their neighborhoods or schools. e
fact that the majority of only-children are raised in urban areas may also facilitate
interaction with other children. ese factors then may counteract any potential
disadvantages of not having siblings to interact with in the home.
In a related sense, another explanation for the current outcomes might be
the fact that the communication abilities were measured among adults rather
than children. It is conceivable that communication issues are present but only
at early ages. us, exposure to other children in schools and within larger and
more populated urban neighborhoods may provide opportunities to compensate
for any deciencies that existed earlier in life for only-children. Further, the fact
that the parents of only-children are more likely to have higher levels of education
and hence greater economic status, may allow them to provide an enriched envi-
ronment where the only-child receives better education and encounters enriched
social interactions which help compensate for potential communication issues
experienced at a younger age. erefore, just as Lin et al., (2017) noted separate
pathways in the development of self-ecacy among only and non-only-children,
it is possible that these two group progress towards similar levels of communica-
tion ability into adulthood through dierent pathways as well.
Limitations and Future Directions
One possible limitation to the present study was the fact that it utilized a cross
sectional design and only among young adults. As a result, it was not possible to
examine changes in communication over time and particularly at young ages.
Although the outcomes are still relevant, given that the proposed impact of an
only-child environment is present and observable among adults in China, it may
be useful in the future to make comparisons at younger ages and potentially
engage in a longitudinal design to examine possible changes in outcomes.
Another limitation is the fact that the present study used a convenience sample
narrowed within medical undergraduates which might have generated sampling
bias. For example, perhaps only those who were more condent in their commu-
nication abilities or those with actual higher communication abilities volunteered
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to participate in this study which could mask potential dierences that exist. us,
future research may benet from recruiting within a broader base of the population.
Finally, while the self-generated ICAAS does show good psychometric properties,
future research is needed to further establish the goodness of this instrument.
Value of the Outcomes
To our knowledge, this is the rst large scale examination of communication abilities
of only-children following the implementation of the OCP in China. By comparing
only-children with non-only-children cross sectionally, the hope was that the out-
comes of the present study might provide educators and policy-makers with a frame
of reference regarding only-child communication tendencies to inuence pedagogy
and shape family-planning policies. Furthermore, the self-designed ICAAS which
had good psychometric properties could be a useful instrument for researchers to
conduct similar studies. For example, since this study was carried out among med-
ical students, further research could analyze the communication ability of medical
students to explore issues related to medical education and to potentially address
the doctor-patient communication problems in China. Similarly, it may allow future
researchers to examine potential dierences in communication between only-chil-
dren and non-only-children in other regions, among those pursuing other types of
careers, within dierent generations in relation to the implementation of the OCP,
or among only-child parents planning their own families.
Conclusion
e present study demonstrated that there are socio-demographic dierences
that exist between only-children and non-only-children in post-OCP China.
However, the main purpose of the study was to determine if there were dier-
ences in communication ability between only-children and non-only children.
Results showed that when considered on its own, only-children showed slight in-
creased communication ability, but that dierence disappeared when controlling
for socio-demographic factors. is suggests that, on average, any advantage or
disadvantage in communication ability among only-children may be balanced by
factors in their environment.
Note
1. e research was supported by Shandong Provincial Department of Education:
2011GG293, China and Overseas-Study-Program of People’s Government of Shandong
Province, China.
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