Rural-Urban Differences in Social and Emotional Protective Factors

Rural-Urban Differences in Social and Emotional Protective Factors 1024 683 Mary Bates, PhD

Efforts to improve child health and flourishing should consider communities’ unique sources of support.

Children living in rural areas experience well-documented health and health care disparities compared to those living in urban areas. Protective factors, such as social connectedness and social engagement, also vary by geography, yet their contribution to differences in child health is understudied.

In a new study, researchers from Nationwide Children’s Hospital sought to address this gap by examining protective factors’ association with child health and flourishing in rural and urban communities. They used publicly available data from the National Survey of Children’s Health between 2018 and 2021 to assess geographic differences in protective factors (including caregiver health and emotional support, child social support, family interactions, and school and neighborhood characteristics) and their relationship with child health outcomes.

“We wanted to take more of a strengths-based approach to understand differences in protective factors that we could potentially leverage in future interventions,” says Rose Hardy, PhD, a data scientist in the Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children’s and  first author of the study.

Overall, Dr. Hardy and colleagues found that more than a third of children were not flourishing, with only a slight effect of geography: An estimated 62% of rural children were flourishing compared to 66% of their urban peers.

In both rural and urban settings, protective factors at the caregiver, family and community level were associated with good child health and flourishing. In line with previous findings, the researchers noted more perceived support and more social connections in rural communities. However, both rural and urban families reported needing more emotional support.

Caregivers in rural and urban communities reported looking to different sources for support, says Kelly Kelleher, MD, a pediatrician at Nationwide Children’s and senior author of the study.

“In rural communities, family, close friends and neighbors, and places of worship were all important sources of support,” he says. “Whereas in urban communities, people relied more on services, such as mental health care professionals.”

Health systems, providers and community organizations would benefit by recognizing how families are already addressing their needs and integrating those assets into their health care plans, according to Dr. Hardy.

“I think there is a lot of focus on the adverse factors,” she says. “Those are very important to consider, but I sometimes wonder if we don’t focus enough on the positives that people bring to the table, and what they value within systems, and how they can improve their own health and wellbeing.

“We are getting a better sense of that, and I think we’re starting to understand that social connectedness and supportive relationships are really important for the health of caregivers and children.”



Hardy RY, Boch SJ, Davenport MA, Chavez LJ, Kelleher KJ. Rural-urban differences in social and emotional protective factors and their association with child health and flourishing. J Rural Health. 2023 Oct 20. doi: 10.1111/jrh.12802. Epub ahead of print.

Image credit: Adobe Stock


About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.