Research documents a positive link between access to nature and children's health-related quality of life (HRQOL). An assessment of a child's HRQOL provides more detail than a general quality of life assessment, in that an HRQOL assessment addresses physical, emotional, social, and school functioning. What has not been well addressed in the literature is how geographical context might influence the relationship between children's access to natural environments and their HRQOL. This study was designed to address this gap.
Data for this study was based on 851 children (age 8-14) living in different regions (rural, urban, and suburban) of Ontario, Canada. The data allowed the researchers to examine how intrapersonal, interpersonal, and physical environmental factors can influence the relationship between children's access to nature and their HRQOL based on the geographical context in which they live. The Pediatric Quality of Life Inventory (PedsQL) was used to measure the children's HRQOL. The PedsQL is a self-report measure addressing a child's physical, emotional, social, and school-related functioning. Demographic surveys completed by the children and their parents provided information relating to intrapersonal and interpersonal factors. Information provided through these surveys included age, gender, visible minority status, and family situation (single parent household, the presence of siblings, parental education status, parental employment status, and household income). Geographic information system (GPS) measures provided information about the physical environment around each child's home location. This data was used to compute an estimate of each child's access to nature. Data analysis explored the relationship between children's HRQOL and their access to nature in urban, suburban and rural environments.
Results showed that neither intrapersonal nor interpersonal factors were significantly associated with total HRQOL scores. What was significant were associations between characteristics of the natural environment -- including the amount of greenness -- and HRQOL scores for children living in urban/suburban environments. However, findings were mixed in terms of positive and negative associations between access to nature measures and HRQOL scores and few were significant enough to be considered important for daily functioning (referred to as "clinical significance"). For rural children, natural environment variables were only significant in the area of social functioning. Overall, this research indicates that the relationship between access to nature and children's HRQOL is influenced by where the children live -- that is, in rural, urban or suburban environments. The level of urbanicity, however, was not a significant predictor of HRQOL.
The researchers refer to their findings as being “somewhat inconclusive” and call attention to the fact that children's access to nature may not adequately reflect their actual interactions with nature. Yet, policy makers and practitioners are urged to consider -- not only the intrapersonal, interpersonal, and physical environmental variables that contribute to a child's well-being -- but also where a child lives and how this might impact their overall well-being. Further research should consider exposure to and engagement with nature – rather than just access to nature – in examining what it takes in terms of dose and duration to more effectively promote children's HRQOL through interactions with nature.
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