Objectives: The aim of this study is to describe the prevalence and associated factors of spectacles need and ownership among multiethnic school students in rural China. Study design: School-based cross-sectional study. Methods: This school-based eye study was conducted in Yunnan province located in Southwestern China. Questionnaires were filled out by children with the help of their parents concerning demographic characteristics, spectacles usage, and myopia-related lifestyle exposures. Spectacles need was defined as participants who had an uncorrected visual acuity (VA) of less than 6/12 but could be corrected to more than 6/12 in the better-seeing eye, with myopia of less than -0.5 diopters (D), hyperopia of more than +2.0 D, or astigmatism of more than 0.75 D in both eyes. Definition of spectacles ownership was based on spectacles wearing at school on the examination day. Results: Among the 7681 students aged 5-16 years participating in this study, 7166 (93.3% of the study participants) successfully completed VA tests and questionnaires. The rate of spectacles need among children with an uncorrected VA of 6/12 or worse in either eye was 68.3% (623/912). Among the students who needed spectacles, only 18.9% owned them. Multivariate analyses revealed that spectacles ownership was significantly associated with increasing age (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.08-1.55), more time on reading and writing (OR - 1.66; 95% CI: 1.15-2.40), having myopic friend(s) (OR: 1.90; 95% CI: 1.01-3.56), self-awareness of myopia (OR: 6.67; 95% CI: 2.48-17.92), and poorer uncorrected VA (OR: 4.57; 95% CI: 2.78-7.52). Conclusions: We observed a lower rate of spectacles ownership among rural children compared with those of similar ages in urban China. These findings may have important public health implications for China and other countries regarding vision-related health resources allocation. (c) 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.