Green schoolyards as havens from stress and resources for resilience in childhood and adolescence

Association between neighborhood greenspace and child protective services involvement

BACKGROUND

Child maltreatment and child protective service (CPS) involvement negatively impacts families, and disproportionately impact families of color. Urban neighborhood greenspace is associated with improved mental health and decreased community violence, however correlations between greenspace and CPS involvement have not been evaluated.

OBJECTIVE

To examine the association between greenspace and CPS involvement.

METHODS

This is a secondary analysis of City of Philadelphia CPS report data from 2008 to 2018. Logistic regression was used to determine associations between greenspace and 3 CPS outcomes (substantiated reports, cases accepted for CPS services, and foster care placements) at the census block level, adjusting for sociodemographic information and area deprivation index, a composite measure combining education, employment, housing, and poverty characteristics at the census block group level. 13,336 census blocks were included, which had key exposure, covariate, and outcome data, and had a child population of at least 1.

RESULTS

66,043 CPS reports were included. In the adjusted model, compared to blocks with >30 % greenspace, blocks with <10 % greenspace had 1.52 times the odds of a substantiated report (95 % CI 1.30-1.76, p < 0.001) and 1.52 times the odds of a case accepted for CPS services (95 % CI 1.30-1.77, p < 0.001). Blocks with less greenspace had increased odds of foster care placement than blocks with >30 % greenspace, however the correlation was less strong.

CONCLUSION

Increased density of neighborhood greenspace is associated with decreased risk of substantiated child maltreatment and cases accepted for CPS services, suggesting that greenspace may confer protection against CPS involvement.

Community environmental healing benefits: A systematic review comparing intervening variables, environments, and outcomes

As the smallest spatial unit in the city, the community should be an important space for healing the urban population. This paper presents a systematic review summarizing studies on community healing environments. The study identified 75 publications. The research findings are as follows: the main intervening variables include restorativeness, emotions and mood, stress, and well-being. Little attention has been paid to the intervening variables including social support, environmental preferences and satisfaction, place attachment, behavior types that respond to personal will, self-fulfillment, and the spirit of personal culture. The various types of natural environments in communities have been given focused attention for a long time. However, the superiority of the natural environment should not be a reason to underestimate the healing benefits of community spaces. The mechanisms by which environmental characteristics are transformed into positive individual influences through intervening variables should be explored.

'Ask a hundred people, you get a hundred definitions': A comparison of lay and expert understanding of stress and its associations with health

The understanding an individual holds about stress can influence their appraisal of it and have implications for subsequent health, yet knowledge of such understanding is scarce. This study explored discrepancies between lay and expert understanding of stress and links made between stress and health. Twenty-six lay members of the local community aged 18-62 years, and seven expert stress researchers, participated in individual semi-structured interviews. Thematic analysis of the two datasets was conducted separately, then findings compared to identify similarities and differences between lay and scientific understanding. Whilst many similarities were identified, we found three important discrepancies: (i) Lay participants demonstrated a strong awareness of the indirect effects of stress on health via health behaviours; (ii) compared to experts, lay participants showed less awareness of a direct path between stress and physical health; (iii) lay participants showed less understanding of social determinants of stress and collective measures for stress management that went beyond individual responsibility. Discrepancies identified serve to highlight potential misunderstandings in lay conceptualisation of stress and its links with health. These findings have potential to facilitate the work of practitioners who serve as intermediaries to translate scientific knowledge into therapeutic benefit, through improved awareness and communication surrounding stress understanding.

"It Helps Make the Fuzzy Go Away": Autistic Adults' Perspectives on Nature's Relationship with Well-being Through the Life Course

Background

While previous work highlights the links between nature and various positive well-being-related outcomes, the experiences of autistic people in nature have received limited empirical research. Our study aimed at gathering autistic adults' perspectives on the relationship between nature and well-being in both childhood and adulthood.

Methods

We used an online survey to capture the views of 127 autistic adults across the United Kingdom. Using reflexive thematic analysis, we analyzed responses to three questions focused on nature experiences in childhood and adulthood and how the participants felt that nature was (or was not) related to well-being. Guided by self-determination theory, we used both inductive and deductive analysis.

Results

We developed three main themes to reflect the nature experiences of autistic adults: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. Compared with many other contexts, nature provides a non-judgmental space through which (in both childhood and adulthood) many, but not all, autistic individuals can meet individual needs and experience autonomy, relatedness, and competence.

Conclusion

This analysis of how autistic adults in the United Kingdom utilize nature to support well-being has implications for how nature can be used in social prescribing as well as in ensuring that existing outdoor spaces, organizations, and activities are supportive of autistic people.

Investigating the Conceptual Model of Child-Nature Interaction in Architectural Spaces Using Grounded Theory

OBJECTIVES

To explore factors affecting the quality of child-nature interaction (CNI) based on the views and desires of children themselves and to offer solutions and strategies to provide this kind of spaces.

BACKGROUND

CNI is one of the most important needs of children which causes very profound effects on the psyche of children from different aspects. Space and context that have the ability and characteristics to provide opportunities to establish this interaction have an important role in the cognitive and social development of children.

METHODS

The qualitative data were collected by draw-and-write technique from a study of 119 children aged 2-6 years from five nursery schools located in the city of Hamedan, Iran. Then, the qualitative data were coded based on the grounded theory using three main steps of open, axial, and selective coding and a conceptual model of CNI is provided by the MAXQDA software.

RESULTS

The conceptual model developed from CNI consisted of seven core categories: "intertwining with nature," "objective natural elements," "nature conservation," "colors," "exaggerated plant perceptions," "path perceptions," and "nature-home similarity."

CONCLUSIONS

To reach an optimal CNI within architectural spaces, thus children should have a sense of belonging to nature, be engaged in it, and protect surrounding natural elements. It is of utmost importance to reflect on some points, such as colors, familiar signs, scales, natural elements, the boundary between natural environments and interior spaces, and natural element circulation and placement in designing and planning spaces made specifically for children.

Outdoor Time in Childhood: A Mixed Methods Approach to Identify Barriers and Opportunities for Intervention in a Racially and Ethnically Mixed Population

A growing body of literature suggests that outdoor time is beneficial for physical and mental health in childhood. Profound disparities exist in access to outdoor spaces (and the health benefits thereof) for children in communities of color. The objectives of this research were to: (1) identify challenges and solutions to outdoor time for children; (2) assess the importance of outdoor time for children; and (3) evaluate results stratified by race/ethnicity. Using a convergent mixed methods approach, we conducted a thematic analysis from 14 focus groups (n = 50) with outdoor educators, parents with children attending outdoor preschools, and community members with children. In addition, 49 participants completed a survey to identify challenges and solutions, perceived importance, and culturally relevant perspectives of outdoor time. The main challenges identified for outdoor time were safety concerns, inclement weather, lack of access to outdoor spaces, and parent work schedules. The primary proposed solution was integrating outdoor time into the school day. Nearly all participants, independent of racial identity, reported that outdoor time improved physical and mental health. Overall outdoor time was lower in participants from communities of color (~8 h/week) compared to their White counterparts (~10 h/week). While 50% of people of color (POC) reported that outdoor time was an important cultural value, only 18% reported that people in their respective culture spent time outside. This work contributes to accumulating knowledge that unique barriers to outdoor time exist for communities of color, and the children that live, learn, and play in these communities. Increasing outdoor time in school settings offers a potential solution to reduce identified barriers and to promote health equity in childhood.

The health perception of urban green spaces and its emotional impact on young adults: an empirical study from three cities in China

Introduction

Exposure to green space can bring many benefits to physical and mental health, but in China, the attractiveness of green space to youth groups seems to be not significant. The question of how to encourage young people to go out of the house to better perceive green space, enjoy nature, and promote physical and mental health is on our minds.

Methods

This study combines young people's green space perception, green space use, and purpose of visit to explore its impact on the emotional health of youth groups, combined with the PANAS psychological data scale, an online questionnaire survey of 426 residents (18-35  years old) in three Chinese cities, and was used to construct a multiple regression model and AMOS structural equations.

Results and discussion

The results of the study showed that, firstly, environmental attractiveness, environmental odor, and number of facilities were the key factors influencing adolescents' landscape perception evaluation, while activity space, environmental odor, and environmental attractiveness had a greater impact on adolescents' emotional well-being. Second, among adolescents' visit purposes, socializing and fitness were more likely to help them generate positive emotions while resting and viewing activities were effective in helping them alleviate negative emotions. In addition, in terms of usage, residents who took public transportation as well as those who arrived on foot were the most emotionally healthy. The findings of this paper provide insights for public policymakers, urban planners, and landscape architects to better encourage youth participation in green spaces when they are installed.

Influences of High School Physical Learning Environments on Students' Anxiety in China

BACKGROUND

High school students are at an increased risk of developing generalized anxiety disorder (GAD) due to significant pressure to achieve academic success.

AIM

Although it is known that a school's physical learning environment can influence students' GAD, there is limited research examining this relationship. To fill this knowledge gap, a cross-sectional study was conducted among 230 students from two high schools in China.

METHODS

A survey questionnaire captured students' GAD self-evaluations (dependent variables), perceptions/preferences of their school physical environment (independent variables), and social and personal conditions (confounding variables). Bivariate analysis showed that students' GAD scores were associated with multiple factors related to the learning environment, physical activities, and personal characteristics. The multivariate analysis examined the relationship between GAD scores and physical learning environment variables while controlling for confounding variables.

RESULTS

The results indicated that adequate lighting (B = -0.154, p = .029) and perceived effectiveness of using self-service cafeterias in reducing anxiety (B = -0.138, p = .044) were significantly associated with GAD scores.

CONCLUSIONS

These findings provide evidence for the importance of designing high schools with students' mental health in mind. Specifically, school administrators and designers should consider how to improve the physical learning environment by incorporating natural light, a self-service cafeteria, and spaces for physical activities to promote students' mental well-being.

The effects of green space on college students' mood

Objective: Less attention has been given to how green space can impact college students' moods. This study aimed to examine whether university students exposed to outdoor and indoor green space-natural and artificial would experience a change in moods compared to students not exposed to green space. Method: Seventy-nine participants were randomly assigned to four different conditions: office without greenery, office with posters of nature, office with green plants, and outside in a garden. The Brunel Mood Scale was used to assess participants' moods before and after spending time in their assigned setting. Results: Results indicated that all participants experienced a decline in tension and fatigue regardless of their assigned setting, yet the decline was less pronounced among participants in the office without greenery. Conclusion: Study findings highlight indoor green space is also conducive to positive moods. Thus, in addition to protecting outside greenery, universities may invest in indoor greenery (e.g., indoor plants, posters/artwork featuring nature) that can be placed in classrooms, libraries, dormitories, and other spaces frequented by students.

The School Environment and Physical and Social-Emotional Well-Being: Implications for Students and School Employees

BACKGROUND

The school environment, consisting of the physical environment and social-emotional climate (SEC), plays a crucial role in both student and employee health; however, there is a lack of recent literature synthesizing school environment interventions in K-12 settings. We describe updated evidence about school environment interventions to support K-12 student and employee health in the United States.

METHODS

A 2-phase search included a review of reviews (2010-2018), followed by a search for individual articles (2010-2020) that targeted school physical environment and/or SEC to address physical activity (PA) and/or nutrition. We also investigated how nutrition and PA interventions with an SEC component improves social-emotional and/or mental health outcomes. Because research on dietary and PA behaviors for school employees is limited; we included studies on other worksites (eg, hospitals and offices) to provide insight for school employees.

FINDINGS

We identified 40 articles describing 40 unique studies and 45 interventions and grouped them by intervention type. Physical environment interventions demonstrated significant and positive nutrition and PA behavioral outcomes for students; outcomes among employees were mixed. Interventions with SEC components reported improvements in some mental health outcomes.

IMPLICATIONS

The school environment can affect dietary and PA behaviors as well as mental health for students and employees.

CONCLUSIONS

Establishing healthy school environments can support student and employee PA, dietary behaviors, and mental health.

What can drawings tell us about children's perceptions of nature?

The growing disconnect between children and nature has led to concerns around the loss of ecological knowledge and reduced nature connection. Understanding children's perceptions of nature is vital for engaging them with local wildlife and mitigating this growing disconnect. This study investigated children's perceptions of nature by analysing 401 drawings made by children (aged 7-11) of their local green spaces, collected from 12 different English schools, including state-funded and privately funded. We assessed which animal and plant groups were drawn the most and least often, quantified each drawing's species richness and community composition, and identified all terms used in the drawings to the highest taxonomic resolution possible. The most commonly drawn groups were mammals (80.5% of drawings) and birds (68.6% of drawings), while herpetofauna were the least commonly drawn (15.7% of drawings). Despite not explicitly being asked about plants, 91.3% of drawings contained a plant. Taxonomic resolution was highest for mammals and birds, with 90% of domestic mammals and 69.6% of garden birds identifiable to species, compared to 18.5% of insects and 14.3% of herpetofauna. No invertebrates other than insects were identifiable to species. Within plants, trees and crops were the most identifiable to species, at 52.6% and 25% of terms respectively. Drawings from state-school children had higher plant richness than those from private-school children. Animal community composition differed between school funding types, with more types of garden birds drawn by private-school than state-school children, and more types of invertebrates drawn by state-school than private-school children. Our findings indicate that children's perceptions of local wildlife are focused on mammals and birds. While plants feature prominently, plant knowledge is less specific than animal knowledge. We suggest that this skew in children's ecological awareness be addressed through better integration of ecology within national curricula and more funding for green space within schools.

Nursing Strategies to Help Children Cope with Eco-Anxiety

ABSTRACT

The threat of climate change is causing collective fear and worry among individuals and communities worldwide. Children may be among those who are most affected. As global temperatures continue to rise and subsequent natural disasters occur with more intensity, children are taking notice and, as a result, experiencing what experts are calling "eco-anxiety." Eco-anxiety, a term used to describe the negative emotions associated with climate change, is becoming more prevalent in children as they witness these extreme weather events and hear future dire scenarios laid out by scientists. Children are becoming acutely aware that their governments are not doing enough to protect them or their future, resulting in a distress that could be reduced if world governments became more committed to the fight to protect the planet from climate change. In the interim, there are nursing strategies to help children cope with their overwhelming sense of doom. By having their concerns validated, implementing strategies to feel more connected to the natural world, and becoming more empowered to take action to protect the planet, children can begin to feel more optimistic and confident about their futures.

It's time to take a sustainable approach to health care in the face of the challenges of the 21st century

Health challenges in the 21st century have become increasingly complex and global. The recent COVID-19 pandemic has only exacerbated the many problems faced by health care systems around the world and sadly, exposed various flaws. With ageing populations, particularly in Canada, as well as unavoidable factors such as globalization and accelerating climate change, it is becoming imperative to implement a new health care approach based on intersectorality and interdisciplinarity. Furthermore, links must be forged between all the stakeholders, i.e. the researchers, the health system and its specialists, the communities and the individuals themselves. It is in this perspective, where everyone concerned must be equally involved in attaining a better quality of life, that the concepts of One Health and sustainable health must be deployed.

How ‘outdoors time’ transforms the social relationships of children in Iceland

This study explores the relationship between the time children spend outdoors with critical social and health factors. We use questionnaire data from the 2017–2018 Health Behaviour in School-aged Children (HBSC) study in Iceland, focused on children in the 6th, 8th, and 10th grades. All Icelandic schools with pupils in these classes were invited to participate. The HBSC study is based on a research collaboration dating back to 1983 and is in cooperation with the WHO Regional Office for Europe (Inchley et al., 2020 ). Every four years the study is conducted in more than 50 countries and regions across Europe and North America. Data is collected on children’s health and well-being, social environments and health behaviours. The purpose of this paper is to better understand the social and health factors that impact children in Iceland, paying attention to the diversity of this social group, and how these factors relate to their outdoor behaviour. Our analysis focuses on children’s time spent outdoors on weekdays in relation to their parents, general health, leisure, and friendship. The findings reveal a complex picture of children’s outdoor lives. The results show that a great majority of children spend time outside mostly with friends and that children with poor relationships with other children spend considerably less time outside. Children’s outdoor lives emerge as a social activity that strongly relates to physical and mental health. Interventions to increase time spent outside might focus on this social dimension rather than simply on the extent of outside time.

Adolescents' Out-of-School Physical Activity Levels and Well-Being during the COVID-19 Restrictions in Greece: A Longitudinal Study

The present study aimed to identify the impact of social distancing measures on adolescents' physical activity (PA) levels and well-being during the implementation of COVID-19 restrictive measures. There were 438 participants (207 boys and 231 girls), aged 12 to 15 years old (M = 13.5, SD = 0.55). They completed online questionnaires on well-being and PA in three waves (December 2020, February 2021, and June 2021). Correlation analyses were conducted to examine the relationship between well-being and PA variables in the three measurements. Additionally, separate three-way repeated-measures ANOVAs were conducted to capture possible differences in students' moderate to vigorous physical activity (MVPA) levels, life satisfaction, and subjective vitality among the three measurements due to gender, age, and interaction between gender and age. A significant relation emerged between the MVPA variables and well-being. In all measurements, adolescents' PA levels did not meet the World Health Organization (WHO) recommendations of at least 60 min per day in MVPA. Students' MVPA levels, life satisfaction, and subjective vitality were significantly higher in the third measurement compared to the first and second ones. Moreover, significant differences emerged in life satisfaction and subjective vitality between boys and girls in the first and third measurements, respectively. The COVID-19 restrictions appeared to negatively influence adolescents' PA and well-being. Policymakers aimed at facilitating adolescents' well-being in a similar situation in the future should not adopt measures restricting the participation of adolescents in PA.

School Children's Physical Activity and Preferred Activities during Outdoor Recess in Estonia: Using Accelerometers, Recess Observation, and Schoolyard Mapping

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess PA in two urban and two rural primary schools in Estonia. Schoolyards were described with the geographical mapping method, children's activities during outdoor recess were registered by using observations, and PA levels were measured with accelerometers. Students from grades two to six (8-13-year-olds) were included in the study. All observed schoolyards had different spaces including various ball game areas, climbing facilities, and slacklines. The natural environment dominated in the rural schools, and artificial surfaces dominated in the urban schools. Boys in the study tended to enjoy more sport-related activities, whereas girls preferred more social and less active activities. Students participating in outdoor recess spent about twice as much time (20.4%) on moderate-to-vigorous PA (MVPA) compared to indoor recess (9.5%), although boys were more active than girls (22.9% vs. 17.3%). All schoolyards afforded more MVPA during outdoor recess compared to indoor recess, whereas schoolyards with more space per child and natural environment elements generated more varied PA and higher MVPA. These findings confirm the importance of schoolyard design and quality for the variety and intensity of students' PA during outdoor recess.

Enjoyed by Jack but Endured by Jill: An Exploratory Case Study Examining Differences in Adolescent Design Preferences and Perceived Impacts of a Secondary Schoolyard

The school grounds provide students opportunities for respite, relaxation and relief from daily stresses during breaks in the school day. However, it is unclear whether secondary schoolyard designs adequately support the diverse and evolving needs of adolescents, particularly at a time when they are experiencing rapid emotional and physical developmental change. To investigate this, quantitative methods were used to explore differences in perceptions of schoolyard attractiveness and restorative quality based on student gender and year level. A school-wide survey was administered to approximately 284 students in years 7 to 10 at a secondary school in Canberra, Australia. Results indicate significant declines in student perceptions of schoolyard attractiveness and restorative quality. Higher ratings of schoolyard likeability, accessibility, personal connection and restorative quality of 'being away' were associated with male students across all year levels. Further work is needed to explore how schoolyard environments can better support the design preferences and well-being needs of older and female students. Such information would help planners, designers and land managers develop schoolyard designs that are more equitable in their benefits to secondary school students of different genders and year levels.

Kindergarten Affordances for Physical Activity and Preschoolers' Motor and Social-Emotional Competence

This study examined the relationship between the quality of the kindergarten physical and social environment to promote physical activity (PA) and preschoolers' motor and social-emotional competence. Two Portuguese kindergartens (Gondomar city) were selected from a pool of seventeen with an assessment of kindergarten PA best practices (one with high PA practices, the other with low). Thirty-six children (M = 4.42; SD = 1.00 years) without neuromotor disorders participated in this study. Motor and social-emotional competence were assessed with standardized motor skills tasks and parent report of child behaviors. Children from the kindergarten with higher compliance with PA best practices showed significantly better motor competence. No statistically significant differences were found for social-emotional competence scores. These findings emphasize the critical importance of kindergarten in promoting preschoolers' motor competence by assuring a physical and social environment that enhances their PA practice. This is a particularly relevant concern for directors and teachers during the post-pandemic period, given the developmental delays and decreases in physical activity preschool children experienced across the pandemic period.

The wellbeing of adolescents and the role of greenness: A cross-sectional study among Italian students

Introduction

Adolescence is a critical period of life, and the level of wellbeing acquired during this stage might have an influence on health status in adulthood. The wellbeing of adolescents is associated with both biological and environmental determinants. To date, few studies have evaluated the effect of exposure to urban green spaces (i.e., greenness) on adolescents' wellbeing. Therefore, the aim of this study is to assess the association between exposure to greenness and the wellbeing of adolescents, accounting for the level of urbanization surrounding schools.

Methods

In the frame of the 2018 Italian Health Behaviour in School-aged Children (HBSC), we analyzed cross-sectional data from the Piedmont Region. Exposure to greenness was quantified by the Normalized Difference Vegetation Index (NDVI). Schools were geocoded, and a fixed buffer (radius 1,500 m) centered on each school was then built to enable average NDVI calculations. Adolescents' wellbeing was assessed by self-reported psychological, somatic, and psychosomatic health complaints as follows. Respondents were asked how often, in the last 6 months, they had experienced: (a) headache, (b) stomachache, (c) backache, (d) dizziness, (e) feeling low, (f) irritability or bad temper, (g) feeling nervous, and (h) difficulties getting to sleep using the HBSC Symptom Checklist (HBSC-SCL), an eight-item tool. Multivariable, multilevel logistic regression models tested the association between exposure to NDVI and psychosomatic, somatic, and psychological health complaints, one at a time, using schools as a random intercept.

Results

In total, 2065 subjects (47.6% girls) aged 11 (48.4%) and 13 (51.6%) years were involved. Greenness was found to be inversely associated with reported psychosomatic (OR 0.72, 95% CI: 0.53-0.98) and psychological health complaints (OR 0.67, 95% CI: 0.49-0.92) in boys only, adjusting for age, urbanization level, and socioeconomic status, and stratifying by gender.

Discussion

Our results support the implementation of future policies for urban environmental design supporting the increase of green spaces, as suggested by the United Nations Sustainable Development Goals. Further studies are needed to confirm our findings.

Effects of Greenness on Myopia Risk and School-Level Myopia Prevalence Among High School-Aged Adolescents: Cross-sectional Study

BACKGROUND

Myopia is a serious public health issue. High school-aged adolescents in Beijing have an alarming prevalence of myopia. Therefore, determining myopia protective factors is essential. Green space has a certain association with myopia protective factors that can protect against myopia.

OBJECTIVE

This study aims to examine the effects of green space around schools on individual myopia risk in high school-aged adolescents and the school-level myopia prevalence.

METHODS

Green space was measured using the normalized difference vegetation index (NDVI). A total of 13,380 samples of 51 high schools were selected from a 2021 Beijing Municipal Health Commission survey. Adolescent myopia was defined as a spherical equivalent of ≤-1.00 diopters in the worse eye. Generalized linear mixed models with a binomial error structure were used to analyze the effects of the NDVI on personal myopia risk and adjust them by other factors, such as demographics, exposure time, and outdoor exercise. The effects of the NDVI on school-level myopia prevalence with adjusted demographics and the relative position factors of trees were analyzed through quasibinomial regression.

RESULTS

The overall prevalence of myopia was 80.61% (10,785/13,380, 95% CI 79.93%-81.27%). Although with a 0.1 increase in the 500 and 1000 m buffer NDVIs adjusted by demographic and other factors, the high school-aged personal myopia risk significantly dropped by 16% (odds ratio [OR] 0.84, 95% CI 0.73-0.97) and 12% (OR 0.88, 95% CI 0.79-0.99), respectively. However, only the adjusted 500 m buffer NDVI (by demographics and the position of trees) with a 0.1 increase significantly reduced the school-level myopia prevalence by 15% (OR 0.85, 95% CI 0.74-0.98). Subgroup analysis showed that the adjusted effects of the 500 m buffer NDVI are significant in schoolgirls (OR 0.82, 95% CI 0.72-0.93), juniors (OR 0.82, 95% CI 0.72-0.94), the Han nationality (OR 0.84, 95% CI 0.72-0.97), 1-year exposure (OR 0.84, 95% CI 0.71-0.99) and 3-year exposure (OR 0.78, 95% CI 0.65-0.94).

CONCLUSIONS

The greenness of a 500 m buffer around schools is associated with a lower personal myopia risk among adolescents and a lower prevalence of myopia in schools. With regard to prevention and control activities, green space within a 500 m buffer around schools is suggested as an independent protective factor for adolescent myopia.

Restorative effect of audio and visual elements in urban waterfront spaces

Introduction

Urban waterfront spaces are often composed of built infrastructures and nature elements. Though citizens could take advantage of these public spaces to relax from daily work, its restorative potential has not been paid enough attention. In this study, the restorative effect and mechanism of different audio and visual elements in urban waterfront spaces was systematically studied.

Methods

At the first stage, restorative potential of waterfront spaces was investigated and different elements with restorative effects were identified through an on-site survey, in which visual and auditory forms of environmental-nature, animal-nature, on-water human activities and on-shore human activities were identified. At the second stage, a series of laboratory experiments were conducted to explore the restorative function of the audio and visual elements.

Results and discussion

It is found that the degree of artificiality of waterfront space was a crucial factor influencing the restoration level of the space, and higher artificiality level of waterfront space resulted in lower level of perceived restoration. However it was available by adding visual and audio elements to the scene to facilitate the restorative effect in waterfront spaces with high-level artificiality. The effects of adding visual and auditory elements on psychophysiological restoration were explored, and elements that should be recommended and restrained were discussed.

Prospects

These findings would provide applicable suggestions for future design and rebuilding of urban waterfront spaces.

Research on the psychologically restorative effects of campus common spaces from the perspective of health

Contemporary college students are suffering from increasingly serious psychological health problems, such as attention fatigue, psychological stress and negative emotions. A growing body of evidence has revealed that restorative environment design is conducive to psychological health. As the main choice of venue for students' daily activities, campus common spaces are supposed to be restorative to some extent. Given the above, the author studied 22 common spaces in the South China University of Technology (SCUT) Wushan Campus from the perspective of college students' behavioral patterns based on theories pertaining to restorative environments, then constructed a structural equation model (SEM) analyzing the psychologically restorative effects exerted by the characteristics of campus common spaces upon college students through a scale design and questionnaire survey. With the analysis of 478 valid questionnaires, the research found that the characteristics of campus common spaces with psychologically restorative effects mainly comprise the architectural environment, landscape environment, rest facilities and activity facilities. Among them, the characteristics of activity facilities and the landscape environment have the greatest impact on psychologically restorative effects, accounting for 33 and 30% of the total effects, respectively; they are followed by those of the architectural environment, which accounts for 21% of the total effects; those of the rest facilities have the least impact, accounting for 16% of the total effects. The research also found that the characteristics of campus common spaces can both directly influence college students' psychological recovery and produce psychologically restorative effects mediated by college students' behavioral patterns. The mediation effect of college students' behavioral patterns accounts for approximately 41% of the total effect of psychological restoration, in which the psychologically restorative effect of dynamic exercise behaviors is 2.5 times that of static leisure behaviors. The research reveals how the characteristics of campus common spaces promote the psychological restoration of college students, and it provides inspiration for healthy environment design in campus common spaces.

Vegetation and vehicle emissions around primary schools across urban Australia: associations with academic performance

BACKGROUND

Evolving evidence suggests that vegetation surrounding schools is beneficial to children's academic performance, however vehicle emissions are adversely related. Little is known about concurrent impacts of vegetation and vehicle emissions on academic performance. This study examined associations of vegetation and vehicle emissions near urban Australian primary schools with children's academic performance.

METHODS

Vegetation within schoolyards and Euclidean buffers (100, 300 and 1000 m) was assessed using the Normalized Difference Vegetation Index (NDVI). Weighted road density (WRD) was computed for each buffer as a vehicle emissions proxy. Cross-sectional associations and mediating pathways between vegetation and vehicle emissions and standardized average academic scores in Literacy (Reading, Writing, Language Conventions) and Mathematics for Grades 3 and 5 attending 3745 primary schools in urban areas (population ≥10,000) of Australia in 2018 were assessed using generalised linear models adjusted for school socio-educational status.

RESULTS

Significant positive associations were found between vegetation and Reading in Grades 3 and 5, Mathematics in Grade 3 (all buffers), Writing in Grade 3 (100 and 300 m), and Language Conventions in Grades 3 and 5 (most buffers). Increased vehicle emissions were negatively associated with Reading and Mathematics in Grades 3 and 5 (most buffers), and Language Conventions in Grade 3 (300 and 1000 m) and Grade 5 (100-1000 m). Within 300 m, vehicle emissions partially mediated associations between vegetation with Mathematics in Grade 3 (proportion mediated, 21%), Reading and Language Conventions in Grade 5 (15%, 37% respectively).

CONCLUSIONS

Our findings contribute to growing evidence that vegetation around primary schools is associated with higher achievement in Literacy and Mathematics, with partial mediation by vehicle emissions. Future studies should conduct on-site measurement of vehicle emissions and audit vegetation around schools to confirm findings and inform urban/school planners and school leaders on designing and modifying school environments to support learning.

A Novel Data-Driven Approach to Examine Children's Movements and Social Behaviour in Schoolyard Environments

(1) Many children in schoolyards are excluded from social interactions with peers on a daily basis. For these excluded children, schoolyard environments often contain features that hinder, rather than facilitate, their participation. These features may include lack of appropriate play equipment, overcrowded areas, or insufficient supervision. These can generate negative situations, especially for children with special needs-such as attention deficit or autism-which includes 10% of children worldwide. All children need to be able to participate in their social environment in order to engage in social learning and development. For children living with a condition that limits access to social learning, barriers to schoolyard participation can further inhibit this. Given that much physical development also occurs as a result of schoolyard play, excluded children may also be at risk for reduced physical development. (2) However, empirically examining schoolyard environments in order to understand existing obstacles to participation requires huge amounts of detailed, precise information about play behaviour, movement, and social interactions of children in a given environment from different layers around the child (physical, social, and cultural). Recruiting this information has typically been exceedingly difficult and too expensive. In this preliminary study, we present a novel sensor data-driven approach for gathering information on social interactions and apply it, in light of schoolyard affordances and individual effectivities, to examine to what extent the schoolyard environment affects children's movements and social behaviours. We collected and analysed sensor data from 150 children (aged 5-15 years) at two primary special education schools in the Netherlands using a global positioning system tracker, proximity tags, and Multi-Motion Receivers to measure locations, face-to-face interactions, and activities. Results show strong potential for this data-driven approach to examine the triad of physical, social, and cultural affordances in schoolyards. (3) First, we found strong potential in using our sensor data-driven approach for collecting data from individuals and their interactions with the schoolyard environment. Second, using this approach, we identified and discussed three schoolyard affordances (physical, social, and cultural) in our sample data. Third, we discussed factors that significantly impact children's movement and social behaviours in schoolyards: schoolyard capacity, social use of space, and individual differences. Better knowledge on the impact of these factors could help identify limitations in existing schoolyard designs and inform school officials, policymakers, supervisory authorities, and designers about current problems and practical solutions. This data-driven approach could play a crucial role in collecting information that will help identify factors involved in children's effective movements and social behaviour.

The factors associated with under-five mortality in Ethiopia

Background

Under-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia.

Subject and method

Community-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05.

Results

A total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137–4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257–4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128–0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252–2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257–4.539, P = .008).

Conclusion

This study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

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The global number of under-five mortality remains high including in Ethiopia.

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The prevalence of under-five mortality was 5.9% of live children in Ethiopia.

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Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been found to be statistically significant factors of under-five mortality in Ethiopia.

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The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving.

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The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

A scoping review of interventions using occupation to improve mental health or mental wellbeing in adolescent populations

Introduction

Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds.

Aim

The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents’ and young people’s mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research.

Method

An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool.

Results

Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified.

Conclusions

Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area.

Green schoolyard renovations in low-income urban neighborhoods: Benefits to students, schools, and the surrounding community

Green schoolyards may buffer against the effects of urbanization through increasing access to nature and its benefits. The present study was a community-academic partnership that examined the effects of green schoolyard renovations on utilization, physical activity (PA), and social interactions as well as perceptions of safety, neighborhood climate, and social cohesion among those living in low-income, urban neighborhoods. Utilizing behavioral mapping techniques and multi-informant surveys (i.e., caregivers, teachers, and community members), changes from pre- to postrenovation were assessed at two low-income, urban schools. Behavioral mapping results demonstrated increases in utilization and prosocial interactions among youth from pre- to postrenovation. Levels of moderate-to-vigorous PA also increased from pre- to postrenovation at one school. Survey data from community stakeholders revealed improvements in the perception of schoolyard safety and school-community relationships as well as reductions in bullying postrenovation. Green schoolyards may offer a safe space for children and adults to engage in social, outdoor activities, particularly in low-income, urban neighborhoods.

Effect of Forest Users' Stress on Perceived Restorativeness, Forest Recreation Motivation, and Mental Well-Being during COVID-19 Pandemic

Even though the COVID-19 pandemic has discouraged travel and people’s movements, the number of visitors to forests near cities which are easily accessible by private vehicle is increasing in Korea. This study aims to investigate the relationship between stress, perceived restorativeness, forest recreation motivation, and the mental well-being of forest users. A survey of forest users was conducted at three recreational forests near Seoul in the summer of 2020. A total of 1196 forest users (613 males and 583 females) participated in the study. As a result of the data analysis, it was found that stress had a negative correlation with perceived restorativeness, forest recreation motivation, and mental well-being; perceived restorativeness had a positive correlation with mental well-being, and forest recreation motivation had a positive correlation with mental well-being. For the relationship between stress and mental well-being, the fitness index that was mediated by the perceived restorativeness and the forest recreation motivation found that the model was statistically suitable. Through this study, a research model was derived that, if the stress of forest users is reduced, direct or indirect effects on perceived restorativeness, forest recreation motivation, and mental well-being are increased. Further, a multi-group analysis found that the effect of perceived restorativeness and forest recreation motivation on the mental well-being of the male group was higher than the effect on the female group. Using this research model to find ways to promote health in forests can be utilized for forest management or forest healing.

A Literature Review on Facade Greening: How Research Findings May Be Used to Promote Sustainability and Climate Literacy in School

The promotion of Climate Literacy is a central concern of our time. To achieve this ability, one can draw on different content areas. One possible area is Nature-Based Solutions (NBS), such as Vertical Greening Systems (VGS), and their effectiveness in mitigating climate change. However, VGS is not yet an established topic in environmental education, even if the pro-environmental effectiveness of VGS has been proven from a scientific point of view and this topic is close to everyday life. To facilitate the transfer of knowledge from research to school, this paper presents an example of a possible procedure. This procedure starts with a narrative review of the scientific literature on VGS. Then, the main results of this review are related to the Sustainable Development Goals, Climate Literacy, and general educational goals to capture its educational relevance. Finally, a flow chart for a teaching sequence is developed, with the phase sequence derived from the performed narrative review. Thus, a parallelism between the structure of a scientific review and an action-oriented environmental education becomes visible. To what extent this parallelization may be generalized, and whether teaching based on it is effective, will have to be tested.

Elevating the Role of the Outdoor Environment for Adolescent Wellbeing in Everyday Life

In light of concerns about adolescent mental health, there is a need to identify and examine potential pathways to wellbeing in their daily lives. Outdoor environments can offer multiple pathways to wellbeing through opportunities for restoration, physical activity and socialising. However, urbanisation and new lifestyles revolving around the home and the internet are changing young people's access, use and relationship to the outdoor environment. The authors point out how the research related to adolescents' outdoor environments is generally not treated with the same level of importance or as comprehensively as that for younger children. The aim of this paper is to pave the way for research and planning initiatives on everyday outdoor environments promoting the wellbeing of adolescents and the authors suggest ways in which perspectives from developmental psychology might inform the study of adolescents' outdoor environments. The paper concludes by calling for an elevated focus on the role of outdoor environments in adolescents' everyday lives as a source of wellbeing and more research that makes clear the specific attributes, activities and experiences related to places outdoors which make adolescents feel good.

What is the impact of structural and cultural factors and interventions within educational settings on promoting positive mental health and preventing poor mental health: a systematic review

Mental health (MH) difficulties are on the increase among children and young people (CYP). Evidence has shown that educational settings contain both risk and protective factors for MH. This review investigated which structural and cultural factors and interventions within educational settings promote positive MH and prevent poor MH in 4–18 year olds. Searches were conducted in PsychINFO, Embase, ERIC, ASSIA and British Education Index, and reference lists from key studies and relevant systematic reviews were hand-searched. Intervention, cohort, and qualitative studies were included. Of the 62 included papers, 36 examined cultural factors (30 social/relational and six value-related) while 12 studies examined structural factors (eight organisational and four physical) and 14 studies examined multiple factors. There was strong evidence for the impact of positive classroom management techniques, access to physical activity, and peer mentoring on student MH. Studies examining the impact of positive school culture, teacher training in MH and parent involvement in school MH activities also found predominantly positive results for student MH, albeit the evidence was of lower quality or from a low number of studies. Few studies explicitly examined the impact of interventions on MH inequalities; those that did indicated limited if any reduction to inequalities. A very small number of studies suggested that interventions targeting those at risk of poor MH due to socioeconomic factors could successfully improve wellbeing and reduce depression, anxiety and behavioural problems. Studies exploring the effect of management and leadership strategies within schools, policies, and aspects of the physical environment other than green space were scarce or absent in the literature. This review highlights the need to consider the ways in which educational settings are organised, the culture that is created and the physical space in order to improve the MH of CYP.

A Systematic Review of Arts-Based Interventions Delivered to Children and Young People in Nature or Outdoor Spaces: Impact on Nature Connectedness, Health and Wellbeing

Background

The time that children and young people spend in nature and outdoor spaces has decreased significantly over the past 30 years. This was exacerbated with a further 60% decline post-COVID-19. Research demonstrating that natural environments have a positive impact on health and wellbeing has led to prescription of nature-based health interventions and green prescribing, although evidence for its use is predominantly limited to adults. Growing evidence also shows the impact of arts on all aspects of health and wellbeing. However, what has received scant attention in literature is the interconnection between the two: arts and nature.

Aims

This review synthesizes the literature surrounding the interconnectedness between arts and nature, and their impact on the health and wellbeing of children and young people.

Methods

Eight major electronic databases were systematically searched, while hand-searching included 20 journals, six books, and contact with experts. The review was conducted using the Cochrane handbook for systematic reviews, PRISMA guidelines and TIDieR template. All stages were conducted independently by two researchers and the protocol was published on PROSPERO (Registration no.: CRD42021286574).

Results

Although 9,314 records were identified, only 11 records were included as most studies focused either on arts or nature, but not both. Studies were conducted in United Kingdom, United States, Ireland, Australia, and Hong Kong, in a range of spaces such as forests, woodlands, beaches, parks, fields, gardens, and school playgrounds. The review encompasses data from 602 participants in total.

Discussion

Arts-in-nature offered an inclusive medium to engage all children and young people, especially those who might otherwise remain disinterested about environmental issues and disengaged with educational programs. Further, arts-in-nature provided stimuli to increase nature connectivity, understand environmental issues and explore ways to prevent environmental disasters. This led to higher environmental awareness and pro-environmental behaviors, and potential decrease in eco-anxiety.

Conclusion

Although the quality of qualitative studies was high, the quality of quantitative studies was low or unclear, thus quantitative evidence is still at its infancy. Implications for research, policy, and practice are discussed, such as methods and activities to strengthen future interventions. Scaling-up existing interventions may lead to wider recognition and inclusion of arts-in-nature in future health guidelines, including green prescribing.

Natural and built environments and blood pressure of Alpine schoolchildren

BACKGROUND

Early life environments may influence children's blood pressure (BP), but evidence on the combined effects of natural and built environment exposures is scarce. The present study investigates the associations of natural and built environment indicators, traffic noise, and air pollution with BP in children living in Alpine valleys.

METHODS

In 2004/2005, 1251 school children (8-12 years old) were sampled for a cross-sectional survey in several Austrian and Italian mountain valleys. Children's mothers completed a questionnaire. The outcomes of interest were systolic and diastolic BP measured with a calibrated oscillometric device. Indicators of land cover assigned to the residential and school coordinates within 100 and 1000 m included normalized difference vegetation index (NDVI), tree canopy cover, and a broader naturalness indicator titled distance to nature (D2N). The presence of a home garden was also measured via self-report. Imperviousness density served as a proxy for the built environment. Residential air pollution (NO₂) and noise (L_den) from traffic were calculated using bespoke modeling. NO₂, L_den, physical activity, and body mass index (BMI) were treated as mediating pathways.

RESULTS

Higher NDVI and tree cover levels in residential and school surroundings and home gardens were consistently associated with lower BP. The built environment was associated with higher BP. Counterintuitive inverse associations between NO₂ and L_den and BP were also found. Structural equation modeling showed that higher levels of greenspace and presence of a home garden were weakly associated with more outdoor play spaces, and in turn with lower BMI, and ultimately with lower BP.

CONCLUSIONS

Exposure to natural environments may help maintain normal BP in children, while built environment may increase children's BP. Outdoor play and less adiposity in greener areas may mediate some of these associations. Evidence on air pollution and noise remains controversial and difficult to explain.

Early life exposure to greenness and executive function and behavior: An application of inverse probability weighting of marginal structural models

Increasingly, studies suggest benefits of natural environments or greenness on children's health. However, little is known about cumulative exposure or windows of susceptibility to greenness exposure. Using inverse probability weighting of marginal structural models (IPW/MSM), we estimated effects of greenness exposure from birth through adolescence on executive function and behavior. We analyzed data of 908 children from Project Viva enrolled at birth in 1999-2002 and followed up until early adolescence. In mid-childhood (median 7.7 years) and early adolescence (13.1 years), executive function and behavior were assessed using the Behavior Rating Inventory of Executive Function and the Strengths and Difficulties Questionnaire (SDQ). Greenness was measured at birth, early childhood, mid-childhood, and early adolescence, using the Normalized Difference Vegetation Index. We used inverse probability weighting of marginal structural models to estimate effects of interventions that ensure maximum greenness exposure versus minimum through all intervals; and that ensure maximum greenness only in early childhood (vs. minimum through all intervals). Results of the effects of "maximum (vs. minimum) greenness at all timepoints" did not suggest associations with mid-childhood outcomes. Estimates of "maximum greenness only in early childhood (vs. minimum)" suggested a beneficial association with mid-childhood SDQ (-3.21, 99 %CI: -6.71,0.29 mother-rated; -4.02, 99 %CI: -7.87,-0.17 teacher-rated). No associations were observed with early adolescent outcomes. Our results for "persistent" maximum greenness exposure on behavior, were not conclusive with confidence intervals containing the null. The results for maximum greenness "only in early childhood" may shed light on sensitive periods of greenness exposure for behavior regulation.

Is vegetation cover in key behaviour settings important for early childhood socioemotional function? A preregistered, cross-sectional study

The environmental influences on early childhood development are understudied. The association between vegetation cover (i.e., trees, shrubs, grassed areas) in four key behaviour settings and socioemotional functioning was investigated in 1196 young children (2-5 years). Emotional difficulties were inversely associated with vegetation cover in the home yard (OR: 0.81 [0.69-0.96]) and neighbourhood (OR: 0.79 [0.67-0.94]), but not in early childhood education and care (ECEC) centre outdoor areas or the ECEC neighbourhood. The higher odds of emotional difficulties associated with lower levels of maternal education was reduced with higher percentages of home yard vegetation cover. There was no evidence of mediation of the relationship between emotional difficulties and vegetation cover by time spent playing outside the home, day or nighttime sleep duration, or physical activity. We found no associations between vegetation cover and conduct, hyperactivity and inattention, peer difficulties, or prosocial behaviours. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=J3HeEiIjVZc.

Connection to Nature Boosts Adolescents’ Mental Well-Being during the COVID-19 Pandemic

Growing evidence suggests that connection to nature may be linked to mental health and well-being. Behavioral changes brought about by the COVID-19 pandemic could negatively affect adolescents’ connection to nature, subsequently impacting health and well-being. We explored the relationship between connection to nature and well-being before and during the pandemic through a nationally representative survey of adolescents across the United States (n = 624) between April and June 2020. Survey items focused on connection to nature, mental well-being, and participation in outdoor activities before and during the pandemic. Paired-sample t-tests revealed declines in connection to nature, mental well-being, and participation in outdoor activities during the pandemic. Multiple linear regression analyses examining connection to nature’s mediating role between outdoor activity participation and mental well-being indicated that connection to nature fueled higher levels of mental well-being at both time intervals. Z scores comparing connection to nature’s mediating role between outdoor activity participation and mental well-being between time intervals indicate that during the pandemic, the direct effect of outdoor activities on mental well-being increased, generating a greater impact than before the pandemic. This study illustrates how the health and well-being benefits associated with adolescents’ outdoor activities are reinforced when those activities also foster a stronger connection to nature.

Comparing the Impact of Nature, Blended, and Traditional Preschools on Children's Resilience: Some Nature May Be Better Than None

This study examined the effect of nature preschools on the development of key protective factors associated with psychological resilience. The Deveraux Early Childhood Assessment for Preschoolers, Second Edition (DECA-P2), was used to assess the growth in the protective factors of initiative, self-regulation, and attachment in 87 children who attended nature, blended, and traditional preschool classes within the same school district. Study results suggest that nature preschool participation was important in the context of initiative. Blended classes, where some nature-based practices were incorporated into traditional preschool classes, were sufficient in the sense of being more impactful than traditional classes on self-regulation, attachment, and the total protective factors overall. Implications are discussed within the context of the limitations of the study.

Schoolyard Affordances for Physical Activity: A Pilot Study in 6 Nordic–Baltic Countries

Environmental settings influence children’s and adolescents’ physical activity (PA) in neighborhoods and schoolyards. This study aimed to explore the main characteristics of schoolyards in six Nordic–Baltic countries, to document how those facilities provide affordances for PA in 7–18 year–old schoolchildren, and how the schoolyard meets children’s preferences. One schoolyard was studied in each included country: Iceland, Norway, Finland, Lithuania, Latvia, and Estonia. The affordances, facilities, and equipment for PA in schoolyards were identified through orthophoto maps and standard registration forms. Children’s preferences were collected through group interviews at each participating school. A common design of schoolyards across countries indicated mostly flat topography with sparse vegetation and green areas dominated by large traditional sport arenas such as a football field, areas suitable for ball games, and track and field activities. Green spaces and varied topography were more prominent in Nordic countries. Across nationalities, the responses from pupils regarding the schoolyard were similar: they liked it though they wished for more variety of activities to do during recess. National regulations/recommendations for schoolyard design differed across the countries, being more restricted to sport fields and sport-related activities in Latvia and Lithuania, while in Nordic countries, the recommendations focused more on versatile schoolyard design.

Associations of physical activity and sedentary behaviors with child mental well-being during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic resulted in public health and policy measures to reduce in-person contact and the transmission of the virus. These measures impacted daily life and mental well-being (MWB). The aims of this study were to explore the MWB impacts of COVID-19 on children and assess the associations among perceived changes in physical activity (PA) and sedentary behaviors (SB), with perceived MWB changes, using a mixed-methods approach.

METHODS

A convergent parallel mixed-methods design consisting of an online survey with a convenience sample and interviews was conducted from May through July 2020 with parents/caregivers of kindergarten through 5th graders in the St. Louis region. Survey domains assessed included child MWB, PA, and SB. Interviews were recorded, transcribed, and qualitatively analyzed using a code book developed to elicit themes. Survey data was analyzed with chi-squared tests and logistic regressions. The dependent variable was perceived change in child MWB due to the impact of COVID-19. Independent variables included perceived changes in PA, SB, and child concerns about COVID-19.

RESULTS

Sample size consisted of 144 surveys and 16 interviews. Most parents reported a perceived decrease in child MWB (74%), a decrease in child PA (61%), and an increase in child SB (91%). Discontentment with stay-at-home orders and concern about COVID-19 were associated with a perceived decrease in MWB. Children whose PA decreased were 53% less likely to have the same or better MWB (OR 0.47) and children whose outside PA decreased were 72% less likely to have the same or better MWB (OR 0.28). Common qualitative themes included difficulty in adjusting to COVID-19 restrictions due to school closures and lack of socializing, child concerns about family getting sick, and PA benefits for improving MWB.

CONCLUSIONS

Based on parent perceptions, MWB decreased with COVID-19. Maintained or increased child PA improved the chances MWB would remain the same or improve. Parent interviews provide context to these findings by showing how COVID-19 impacted MWB and the associations between PA and MWB. Understanding protective factors for child MWB during COVID-19 is important to offset negative long-term health outcomes from this ongoing pandemic.

Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond

The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.

Associations of traffic-related air pollution and greenery with academic outcomes among primary schoolchildren

BACKGROUND

There is preliminary evidence that greenery/greenspace around schools may be positively associated with children's cognitive development and academic outcomes, whereas traffic-related air pollution (TRAP) may have a detrimental effect. Few studies have examined pathways between both exposures and academic outcomes. This study aimed to assess associations between greenery, road traffic density (a proxy for TRAP) surrounding primary (elementary) schools, and academic achievement of primary schoolchildren in Melbourne, Australia.

METHODS

This cross-sectional study examined mean academic scores in Years 3 and 5 for primary schools (n = 851) in Greater Melbourne. Scores were from the 2018 'National Assessment Program - Literacy and Numeracy' (NAPLAN) in five domains: 'Reading'; 'Writing'; 'Spelling'; 'Grammar & Punctuation' and 'Numeracy'. Greenery was measured within school boundaries and surrounding Euclidean buffers (100, 300, 1000 and 2000 m) using the Normalized Difference Vegetation Index (NDVI). Measured TRAP proxies were weighted road density (WRD) within the buffers and distance to a major road. Generalised Linear Models were used to examine associations of greenery and TRAP with academic scores (adjusted for school socio-educational status), and to identify mediating pathways.

RESULTS

Greenery was positively associated with Reading scores in Year 3 (all buffers except 2000 m) and in Year 5 (all buffers), with Numeracy in Years 3 and 5 (all buffers) and with Grammar & Punctuation in Year 5 (all buffers). WRD was inversely associated with Reading scores in Year 5 (all buffers), with Numeracy in Year 3 (all buffers) and Year 5 (300 and 1000 m buffers), and with Grammar & Punctuation in Year 3 (100 and 300 m buffers) and Year 5 (all buffers). Distance to a major road was not associated with any score. TRAP partially mediated associations of greenery within 300 m with Numeracy in Year 3 and Grammar & Punctuation in Year 5, and within 2000 m for Reading in Year 5.

CONCLUSIONS

Preliminary evidence indicated that greenery around primary schools was positively associated with Reading, Numeracy and Grammar & Punctuation scores, with TRAP mediating some associations. Further research is required to improve TRAP exposure assessment around schools to verify these findings and inform town/school planners and educators regarding optimal school locations and environments for promoting learning.

Coping with post-hurricane mental distress: The role of neighborhood green space

BACKGROUND

Although increases in the prevalence of mental distress have been reported after natural disasters, less is known about the role the environment may play in mitigating posttraumatic stress disorder (PTSD) in hurricane-impacted communities.

AIM

This study aims to investigate the extent to which concentration and perceived quality of neighborhood greenness are associated with lower levels of PTSD, along with potential mechanisms through which these effects occur.

METHODS

We conducted a cross-sectional survey of individuals (N=272) from 30 Houston neighborhoods that were affected during Hurricane Harvey. Perceived quality of neighborhood green space was measured using a scale adapted from the Neighborhood Open Space (NOS) scale, and concentration of greenness was measured objectively using the normalized difference vegetation index (NDVI). Probable PTSD was measured using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and hurricane-related distress using the Impact of Event Scale (IES-R). Generalized linear mixed models were used to fit individual models. Based on the results, structural equation models were employed to test direct and indirect pathways simultaneously. Models were adjusted for neighborhood- and individual-level confounders.

RESULTS

Greater perceived quality of neighborhood green space was significantly associated with lower likelihoods of probable PTSD and hurricane-related distress. The effects of perceived green space quality on hurricane-related distress were mediated by higher levels of emotional resilience. Social cohesion, although significantly correlated with PTSD and distress, did not mediate the effect of perceived green space quality on either. Neighborhood NDVI was significantly associated with hurricane-related distress, but not with PTSD.

CONCLUSION

We conclude that living in neighborhoods with greater perceived quality of green space was associated with lower levels of post-hurricane distress, with mediation especially through the emotional resilience pathway. These findings suggest that in disaster recovery policy frameworks, more attention should be paid to the benefits of high-quality neighborhood green infrastructure.

Nature as an Ecological Asset for Positive Youth Development: Empirical Evidence From Rural Communities

Despite increasing emphasis on youth contact with nature and associated benefits, research has not examined the direct relationship between adolescents' nature-based experiences and holistic measures of positive youth development (PYD). This gap may stem from the lack of interdisciplinary work on nature and PYD. Our study integrates multiple disciplinary perspectives to explore direct associations between time in nature, connection to nature, and the five Cs of PYD (competence, connection, confidence, character, and caring) as well as the "sixth" C of contribution. From 2015 to 2016, we collected data from 587 diverse South Carolina middle school students (57% female, 40% BIPOC) between the ages of 11 and 14 (M age = 12.9) and living in predominantly low-income communities. OLS regression analyses indicated that across all youth, self-reported connection to nature was a consistent positive correlate of overall PYD and each of the individual Cs. Time in nature was associated with overall PYD and competence. Findings demonstrate significant associations between nature-based experiences and PYD and underscore the importance of ensuring that diverse youth can access and enjoy the developmental benefits of nature and nature-based recreation opportunities.

Nature’s Services and Contributions: The Relational Value of Childhood Nature Experience and the Importance of Reciprocity

People depend on functioning ecosystems to meet human needs and support well-being across the life span. This article considers the interest in ecosystem service valuation, the growing interest in the benefits of nature experience for children, and ways to bridge these perspectives. We focus on embodied childhood nature experiences: the physical and multisensory experiences that intertwine child and nature. Additionally, we highlight the reciprocal quality of nature and child experience relationship as an example of how this relationship goes beyond the instrumental and demonstrates relational value. Underlying this perspective is the belief that children need to be better represented in the perception and action of ecosystem valuation in environmental policy.

Life Course Nature Exposure and Mental Health Outcomes: A Systematic Review and Future Directions

Recently, an emerging body of literature has examined the relationships between early life nature exposure and mental health in later life; however, no critical synthesis yet exists regarding the extent and strength of these relationships. This study presents the first systematic review of studies in this growing area. Following the PRISMA framework, we searched six databases (i.e., Scopus, Web of Science, MEDLINE, Embase, PsycINFO, and CINAHL); conducted identification, screening, eligibility, and inclusion analyses; and identified a final set of 29 articles. The review set comprises primarily longitudinal studies, with several cross-sectional studies using retrospective measures of childhood nature exposure. The majority of included studies were published between 2016 and 2020 and conducted in Europe and North America. Five domains of mental health outcomes are associated with early-life nature exposure: incidence of mental disorders, psychiatric symptoms and emotions, conduct problems in children, cognitive function, and subjective well-being. The evidence lends support to an overall beneficial role of early nature exposure on mental health, although inconsistencies are reported. Taken together, the evidence does not suggest that exposure at any given life stage is more saliently associated with mental health outcomes than at others. We discuss the validity concerns and methodological remedies and offer directions for future research.

A case study exploring the 'real world' process of 'naturalizing' school playgrounds

Background: The aim of this study was to examine the lived experiences of teachers and administrators at two schools (one elementary Kindergarten-Grade 5 and one middle school, grades 6-8) following the 'naturalizing' of a portion of their schoolyard. Methods: A qualitative case study design was used. Focus groups and interviews allowed participants to express their rationale, identify implementation facilitators and barriers and critical processes/steps for realizing their naturalization goals. Researcher questions explored (1) factors which led to naturalizing the schoolyard, (2) key planning and process steps (3) challenges and successes experienced, and, (4) lessons learned. Findings: Six themes were identified as rationale for naturalizing including: re-integration of outdoor play into children's daily lives, pro-active mental health, opportunity for inclusion, nature as a positive space for learning, it fit with our values and principles, we had a need. Implementation was facilitated by having champions and support from multiple levels, adopting a phased approach, resources and having the buy-in to persevere over time. Significant challenges and 'how to' steps were also identified. Conclusions: Naturalizing schoolyards does not happen without a supportive context, significant time and effort. Implementation steps and issues were those commonly found in other school-based health promotion efforts.

The Restorative Effect of the Presence of Greenery on the Classroom in Children’s Cognitive Performance

Studies developed in a scholar context report a restorative effect of nature on human beings, specifically in terms of the psychological recovery from attention fatigue and restored mental resources that were previously spent in activities that require attention. Studies usually compare the performance of children in schools with or without access to green spaces. In this study, the effect of introducing greenery into the classroom context was compared across time. The experiment was developed in two primary schools with pupils in different socioeconomic contexts, at three moments: before introducing an artificial green wall into the classroom, one month later, and one month after the introduction of vegetable pots. Results showed a significant increase in sustained and selective attention, and work memory between the experimental and the control group, notably in the third moment when vegetable pots were introduced. In the second moment (green walls), only the work memory (tested with the inversed number) showed a significant effect. Theoretical and practical implications are discussed in terms of nature’s role both in terms of natural and artificial elements and the cumulative effect of direct interaction with natural elements.

Outdoor Activity Participation Improves Adolescents' Mental Health and Well-Being during the COVID-19 Pandemic

COVID-19 is reshaping human interactions with the natural environment, potentially generating profound consequences for health and well-being. To assess the effects of COVID-19 on the outdoor recreation participation and subjective well-being of adolescents, as well as how participation in outdoor activities may mitigate declines in subjective well-being, we used a Qualtrics XM panel to conduct a nationally representative survey of youth ages 10-18 across the United States (n = 624) between 30 April and 15 June 2020. Survey questions focused on frequency of participation in outdoor activities before and during the pandemic, as well as changes in subjective well-being. Paired t-tests revealed decreases in both outdoor recreation participation (64% reported declines) and subjective well-being (52% reported declines). A regression model examining correlates of changes in subjective well-being (R2 = 0.42) revealed strong associations with changes in outdoor play (B = 0.44, p < 0.001) and nature-based (B = 0.21, p = 0.016) activities. Adolescents' from all backgrounds who participated in these activities during the pandemic reported smaller declines in subjective well-being. Results highlight the critical role that time outdoors and time in nature play in bolstering adolescents' resilience to stressors such as the COVID-19 pandemic and underscore the need to facilitate outdoor recreation opportunities for youth during times of crisis.