Does Active Commuting to School Improve Chinese School-Age Children’s Health-Related Quality of Life

Abstract

Background Active commuting to school of Chinese children has been decreasing thanks to China’s rapid urbanization which has led to the transformation of life style that increases risk for physical inactivity, overweight, and obesity. Physical activity level has been consistently found a positive impact on health-related quality of life (HR-QOL) of adults. Previous studies have found health benefits of physical activity and active commuting to school on improving depressive symptoms for children. Yet, limited studies have investigated the association between physical activity or active commuting to school and HR-QOL of children. This paper aims to fill the gap by investigating 696 Chinese school-age children from 32 elementary schools in Shanghai, China. Methods We sampled 32 public elementary schools that were evenly chosen from four strata of residential building density, located in 16 districts of Shanghai, China. Trained college student research assistants went to the each sampled school in the afternoon of non-raining school days when school was over to conduct surveys between May 2015 and April 2016. A modified Chinese version of the Children's Leisure Activities Study Survey (CLASS-C) by parents, which was validated in China, was used to record children’s physical activities including travel modes to school, and frequency and duration of leisure-time physical activities, as well as individual and household characteristics. School-age children’s health related quality of life was measured using the Chinese translated Child Health Utility instrument (CHU9D-CHN) which consists of 9 items each with a 5-level response category, an easy and quick survey for children to complete. The UK adult general population standard gamble scoring algorithm was used to compute CHU9D-CHN unity score. Multivariate linear regression models were developed to investigate the associations of active commuting to school and HR-QOL of Chinese school-age children. Results There were 899 CLASS-C parent surveys and 810 CHU9D-CHN children surveys collected, and 696 records aged between 6 and 13 years old with completed CLASS-C parent surveys and CHU9D-CHN children surveys. Among those completed records, 53.2% were girls, 36.1% walked to school, 5.6% biked to school, and only 8.3% met the health recommendation of 60 min/day of moderate-to-vigorous physical activity for children. Controlling for children’s age, sex, and time spending at school, and household monthly income level, both walking and cycling to school were significantly positively associated with children’s HR-QOL. Conclusions Active commuting to school is correlated with better HR-QOL of Chinese school-age children.