Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents

Unraveling the longitudinal relationships between connectedness to nature, depressive symptoms, and learning burnout in adolescents

INTRODUCTION

Following the conservation of resource theory and natural stress reduction theory, the current study investigated mediated pathways, reverse mediated pathways, and reciprocal pathways between connectedness to nature, depressive symptoms, and adolescent learning burnout via a half-longitudinal analysis, and discussed gender differences in the three models.

METHODS

Two waves of data were collected in December 2022 (T1) and June 2023 (T2) for this study. The sample consisted of 1092 Chinese adolescents (52.20% girls, Mage = 13.03, SD = 1.43). Semi-longitudinal analyses were conducted to examine the relationship between connectedness to nature, depressive symptoms, and adolescent academic burnout.

RESULTS

The results indicated that connectedness to nature can serve as a positive resource to alleviate the levels of depressive symptoms among adolescents and thereby decrease learning burnout. However, the protective effect of connectedness to nature was smaller, and the decreasing effect of learning burnout on connectedness to nature was stronger than the alleviating effect of connectedness to nature on learning burnout. Additionally, the study found that depressive symptoms and academic burnout have a mutually reinforcing effect over time and that the effects of this interaction are more pronounced in females.

CONCLUSIONS

The present study emphasizes the protective role of nature connectedness and the detrimental effects of learning burnout in adolescents.

Originalarbeiten / Original Articles. Die Bedeutung der Freizeitgestaltung für die Suizidalität bei Jugendlichen und jungen Erwachsenen

The Importance of Leisure Activities for Suicidality in Adolescents and Young Adults Leisure time is important for the development of adolescents. It influences adolescents' psychological well-being and psychosocial development. It may also have a protective effect on suicidality. This study investigates how adolescents' leisure time is related to suicidality, distinguishing between general aspects and various specific leisure time activities. Data from adolescents in counseling (n = 25) and the general population (n = 57) were analyzed. Adolescents who spend most of their leisure time alone are more suicidal than adolescents who spend their leisure time with others. General aspects of leisure activities were related to suicidality; among specific activities, only sports activities were found to be significant.The strongest association with suicidality was shared activities with others. Based on these results, it can be shown that leisure time activities could be effective as a preventive measure. In particular, social activities in leisure time should be encouraged.

Community Health Scholars: a summer program developing a public health workforce pipeline for diverse high school students

In response to the growing interest in public health and needs to both increase and diversify the public health workforce, opportunities to engage students early in their educational journey are essential. The University of Hawai'i at Mānoa launched the Community Health Scholars Program to provide activities for high school students to learn about and build enthusiasm for the field of public health. During the 6-week, in-person summer program, students underrepresented in higher education and who are from historically underrepresented communities completed a college course and participated in activities to enhance their successful entry into a higher education institution. The Community Health Scholars completed an introduction to public health course and gained an array of public health skills through different hands-on activities. The students gained self-confidence and expanded their social capital by attending workshops led by campus faculty, staff, and community partners. A final project highlighting what students learned about themselves and their community was part of a final program showcase. Here we share information about the process of developing the program, the components of the program curriculum, and feedback from both students of the initial cohort and program faculty, where overall satisfaction with the program was reported.

Defining young people's mental health self-care: a systematic review and co-development approach

Self-care is among the emerging types of mental health support which operate outside traditional services, although the meaning and practice of self-care for young people with mental health difficulties are currently unclear. This systematic review was pre-registered with PROSPERO (CRD42021282510) and investigated conceptualizations of self-care in academic publications which investigated or discussed self-care for young people's mental health or wellbeing. A Patient and Public Involvement (PPI) workshop facilitated young people with experience of mental health difficulties to respond to the identified concepts and co-develop a definition of self-care. Searches in PsycINFO, MEDLINE, Embase, CINAHL Plus, Scopus, Cochrane Library of Systematic Reviews, and gray literature sources resulted in 90 included publications. Content analysis indicated little conceptual consistency, with health and wellness promotion most commonly used to define self-care. The PPI workshop co-developed a definition of mental health self-care, which attendees felt should emphasize an individual process of self-awareness, self-compassion, and specific strategies to work toward emotional balance. This study highlights the gap between current academic understandings of young people's mental health self-care and young people's experience. The presented definition will enable future research to begin from an understanding of self-care which is relevant to young people with experience of mental health difficulties.

Connections associated with a healthy spirituality: are these unrecognized intermediary determinants that shape health inequities in Canadian young people?

BACKGROUND

The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. Past analyses of cross-national adolescent health data show that measures of child spirituality, conceptualized as the strength of the connections in our lives, may operate as intermediary determinants in some Western countries. Inspired by this idea, the current analysis provides an in-depth exploration of such pathways among Canadian adolescents. Our objectives were to confirm the existence of relationships between economic position and seven indicators of adolescent health status, then explore whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality.

METHODS

Cycle 8 of the Canadian Health Behaviour in School-aged Children (HBSC) study was conducted in 2017-18. A school-based sample (n = 18,962) of adolescents was obtained from across Canada following a standard cross-national protocol. Eligible participants completed a general survey about their health, health behaviours and their determinants. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from weighted log-binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality.

RESULTS

As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domain "connections to self" (i.e., the importance of meaning, purpose, joy and happiness in life) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes in boys and girls. "Connections to others" (the importance of kindness, respect and forgiveness) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls.

CONCLUSION

Specific connections afforded by a healthy spirituality could be intermediary determinants of health in Canadian adolescent populations.

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.

Traces of health-A landscape design task as a diagnostic aid for detecting mental burden? A qualitative focus group study

Background

Mental disorders are most common causes of illness worldwide. Studies on art and drawing tasks, such as the tree-drawing test have already proven their prognostic quality for the diagnosis of Alzheimer's disease, depression or trauma. In the depiction of art in public space, gardens and landscapes are one of the oldest human forms of artistic expression. This study thus aims at exploring the impact of a landscape design task as a prognostic tool to detect mental burden.

Materials and methods

A total of 15 individuals (eight female) aged between 19 and 60 years completed the Brief Symptom Inventory BSI-18 and the State Trait Anxiety Inventory (STAI-S) before being asked to design a landscape in a 3 × 3 m squared area. Material to be used included plants, flowers, branches, and stones. The complete process of landscape design was videotaped and the tapes were analyzed in a two-step focus group analysis from a group of gardening trainees, psychology students and students of arts therapies. Results were condensed in a second step into major categories.

Results

Scores of the BSI-18 showed a range of 2-21 points and STAI-S scores ranged between 29 and 54 points indicating a light to moderate mental burden. Focus group participants identified three mutually perpendicular major components associated with mental health: "Movement and Activity," "Material Selection and Design," and "Connectedness to the task." In a subsample of the three least and three most mentally stressed subjects (based on their GSI and STAI-S scorings), clear differences were found in body posture, action planning and the choice of material and aspects of design.

Discussion

In addition to the well-known therapeutic potential of gardening, this study for the first time showed that gardening and landscape design contains diagnostic elements. Our preliminary findings are in coherence with similar research indicating a high association of movement and design patterns with mental burden. However, due to the pilot nature of the study, the results should be interpreted cautiously. Based on the findings further studies are currently planned.

Processes underpinning survival in gay men living with HIV and a history of suicidality

Gay men living with HIV represent a particularly high risk group for suicide; however, little is known about suicidality, specifically, resiliencies in the context of suicidality among this particular group of men. The current study draws on photovoice and grounded theory methods to examine the processes that underpin survival for gay men living with HIV who have experienced suicidality. Twenty-two Canadian-based gay men participated, taking photographs to depict and discuss their perspectives on resiliencies. Analyses revealed three processes that supported men's survival: (1) connecting to key supports, (2) finding sanctity in the outdoors, and (3) giving help as purposeful value-adding. Connecting to key supports highlighted the utility of connection and therapeutic communication, listening and support provided by friends, family and professionals. Finding sanctity in the outdoors emphasised the healing capacity of outdoor green spaces, and giving help as purposeful value-adding illustrated the meaning and purpose men derived from supporting others. These findings can inform public health and primary care interventions to foster gay men's resilience and coping, and ultimately suicide prevention efforts.

The Relationship between Extensive Application of Technology and “Withdrawal from Nature” of Young People

The aim of this study is to explore the relationship between the extensive application of technology and young people’s “withdrawal from nature”. Among them, “withdrawal from nature” is mainly manifested in a reduced connection with and concern for nature. Two rounds of semi-structured interviews were conducted with 101 young people from China. Thematic analysis was performed to analyze the interview data and resulted in three main themes: the “compensation”, “shifting” and “shielding” effects of technology. More specifically, the application of technology can partially make up for nature’s reduced role in the growth of young people, shift their concerns for ecological problems, and even affect their perception and evaluation of ecological destruction. Thus, it was proved that the application of technology has an impact on young people’s “withdrawal from nature”. This study supplemented the current research on the factors that influence young people’s “withdrawal from nature” and also provided inspiration for better establishing the connection between young people and nature.

How Is Connectedness With Nature Linked to Life Satisfaction or Depression Among Chinese People Living in Rural Low-Income Households? A Serial Mediation Model

Objectives

In this study a serial multiple mediation model is tested to investigate the potential sequentially-mediating effect of affect balance and social cohesion on the association between connectedness to nature and life satisfaction or depression.

Methods

A total of 675 Chinese people from Jiangsu province living in rural low-income households participated in the study. The Connectedness to Nature Scale (CNS), the Positive Affect and Negative Affect Scale (PANAS), the Social cohesion scale (SCS), the Satisfaction with Life Scale (SWLS), and the Patient Health Questionnaires (PHQ9) were measured in this paper.

Results

Results indicated that the multiple serial mediation of affect balance and social cohesion on the association between connectedness to nature and life satisfaction was significant among the full-size sample, the adult-report, and the old people report, but that this effect is relatively small. Specifically, serial mediation accounted for 2.01, 1.69, 2.67% of the total effect explained by connectedness to nature on life satisfaction, while it accounted for 2.66, 2.35, 2.91% of the total effect explained by connectedness to nature on depression among the full sample population, adults, and old people, respectively.

Conclusions

The findings corroborate the important roles of affect balance and social cohesion in activating connectedness to nature. We discussed the possible ways that affect balance and social cohesion might enhance life satisfaction and decrease depression for Chinese people living in rural low-income households. We also discussed the limitations of this study. More mechanisms could be considered in future studies.

Adolescents' thoughts and feelings about the local and global environment: a qualitative interview study

BACKGROUND

Despite a recent increase in engagement with environmental issues among young people, their impact upon adolescent mental health and wellbeing is not yet fully understood. Therefore, this study aimed to explore adolescents' thoughts and feelings about current environmental issues.

METHODS

Semi-structured interviews were conducted with a convenience sample of 15 UK-based adolescents aged 14-18 years (66.7% female). Transcripts were inductively thematically analysed by the interviewing researcher and two adolescent co-researchers, with priority given to the co-researchers' impressions to strengthen interpretations of the personal experiences of the interviewees.

RESULTS

Six themes were identified: the local environment, efficacy, challenging emotions, information, hindrances and perceptions of the future. The local environment was found to affect adolescents positively and negatively. Factors including greenspace and fresh air had a positive impact, and factors including noise and litter had a negative impact. Most participants reported feeling disempowered to personally influence environmental problems but were engaged with them and felt that trying to make a difference was beneficial for their wellbeing. Adolescents largely reported negative expectations about the environment's future.

CONCLUSION

The UK adolescents interviewed appeared to be very engaged and emotionally affected by a perceived lack of care towards the environment, locally and globally. It is therefore imperative to amplify young people's voices and involve them in influencing environmental policy, for the benefit of young people and the planet. Further research should quantify the extent to which environmental issues affect young people's mental health and identify factors that could prevent or alleviate distress.

Neighbourhood, Built Environment and Children's Outdoor Play Spaces in Urban Ghana: Review of Policies and Challenges

Although a great deal of research work has been done by social scientists on walkability and playability, the focus to a large extent has been on the global north. Research work on the urban built environment and children's play has not engaged Africa in general and Ghana in particular. More importantly, there is limited evidence of policies in terms of community-based practices and governmental policies and programmes for the promotion of play. The limited effort in promoting physical activities have to a large extent focused on walkability, yet evidence to date indicates that walking only constitutes a small proportion of the physical activities of children. This is against the backdrop of growing urbanization and the increasing reported incidence of sedentary lifestyles, less physical activity and obesity among children and the youth. Our main objective in this paper is to contribute to the literature on Ghana, and by extension Sub-Saharan Africa, by examining the extent to which playability features in city and national policies and strategies in urban Ghana. We conclude that while there is dearth of public policies on children's play, with the situation in communities compounded by weak city government capacity to plan, implement and enforce development control to protect open spaces for children's play and recreational purposes. The paper recommends a change in policy and practice on creating spaces in urban built-environments for children's play in urban Ghana.

Adolescent psychological well-being and adulthood cardiovascular disease risk: longitudinal association and implications for care quality management

Purpose

Prior research suggests that 80% of cardiovascular disease (CVD) events can be prevented by modifying certain behaviors, yet it remains the primary cause of mortality worldwide. Early detection and management of critical modifiable factors have the potential to improve cardiovascular care quality as well as the associated health outcomes. This study aims to assess the independent impact of psychological well-being in adolescence, a modifiable factor, on long-term CVD risk and promote targeted early interventions through quality management principles.

Design/methodology/approach

Data from the Add Health study, which employed a series of surveys and health tests (Wave 1 – Wave 4) on individuals for 14 years (from adolescence to adulthood), were obtained and analyzed longitudinally. Psychological well-being in adolescence was assessed using four Wave 1 survey questions, and 30-year CVD risk was estimated 14 years later with Wave 4 data. Three different logistic regression models were examined to understand the impact of adding covariates.

Findings

This study’s sample included 12,116 individuals who responded to all the relevant questions and underwent clinical risk factor measurements in Wave 1 (adolescence) and Wave 4 (young adulthood). Psychological well-being was protective with reduced risk for CVD across the three models tested. There is a statistically significant association, where increasing psychological well-being reduced the 30-year CVD risk exponentially in all the models. The analysis also suggested an exposure–response relationship, where the 30-year risk category of adulthood CVD decreased with an increase in psychological well-being.

Practical implications

This research uncovers an inverse association between adolescent psychological well-being and adulthood CVD risk. This study also identifies quality management-based preventive tools/techniques to improve psychological well-being in adolescence and therefore reduce CVD risk later in life.

Originality/value

This study is among the first to establish a long-term association between positive well-being and CVD risk. Also, unlike the existing literature, this work provides implications for improving CVD care from a quality management perspective.

Smartphone Addiction and Depression among Low-Income Boys since COVID-19: The Moderating Effect of Being an Only Child

Even though boys’ depression has become important, and their smartphone use has increased since COVID-19, little is known about low-income middle and high school boys’ depression in the context of whether they have siblings. Thus, this study investigates the relationship between smartphone addiction and depression as well as the moderating effect of being an only child on the relationship. Participants were limited to middle and high school students whose families were regarded as having a low-income. A total of 129 low-income boys were selected for the final sample. The PROCESS macro 3.4 for Statistical Product and Service Solutions was used to identify the moderating effect. Smartphone addiction was positively related to depression among low-income male students. Being an only child significantly moderated the relationship between smartphone addiction and depression. This study contributes to understanding the importance of examining mental health problems among middle school boys since COVID-19, particularly among low-income boys. It is necessary to provide tailored mental health services for middle school boys in low-income families. Alternative activities and social programs should be provided for adolescent boys who are only children to safely socialize with friends and peers without a smartphone.

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.

The Association between Exposure to Nature and Children's Happiness: The Diathesis-Stress or Differential Susceptibility Models?

Research has demonstrated that both family environments and individual characteristics are associated with children's happiness. However, relatively less research has explored whether and how natural environments are associated with children's happiness. The current study examines whether the association between exposure to nature and children's happiness is moderated by temperament (negative affectivity and effortful control), whether there is a gender difference in the moderating mechanisms, and whether the detected moderation supports the diathesis-stress or differential susceptibility models. Four hundred and ten children and one parent of each child participated in our study. We found that boys' effortful control, not negative affectivity, moderated the association between exposure to nature and happiness. Furthermore, the results support the differential susceptibility model with boys' low effortful control as a vulnerability factor. Specifically, for boys with lower effortful control, a lower exposure to nature was associated with lower happiness, and a higher exposure to nature was associated with higher happiness than in boys with higher effortful control. However, girls' negative affectivity and effortful control did not moderate the association between exposure to nature and happiness. These findings suggest that the association between natural environments and children's positive developmental outcomes varies with their effortful control and gender.

Relating outdoor play to sedentary behavior and physical activity in youth - results from a cohort study

BACKGROUND

Outdoor play, sedentary behavior (SB), and moderate-to-vigorous physical activity (MVPA) are related to youth's health, however, there are research gaps regarding 1) associations between outdoor play, SB, and MVPA across a broad pediatric age range (6-17 years), and 2) longitudinal associations between outdoor play, SB, and MVPA across childhood and adolescence. Two studies were conducted to address those research gaps: Study 1 aimed to investigate relationships between outdoor play and accelerometer-assessed SB and MVPA in a cross-sectional nationwide sample of children and adolescents in Germany. Study 2 aimed to investigate prospective associations between outdoor play and self-reported screen-time SB and MVPA and in a sample of children with three measurement timepoints across 11 years.

METHODS

Data were obtained of the German national representative Motorik-Modul (MoMo) Study and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In Study 1, N = 2278 participants (6-17 years) were included with self-reported outdoor play and accelerometer-assessed SB and MVPA. Associations were examined via multiple linear regressions. In Study 2, N = 570 participants (baseline: 4-7 years) were included in the longitudinal analysis with follow-ups six and 11 years later. Screen-time SB (TV watching and PC/Gaming), MVPA, and outdoor play were self-reported. Associations were investigated through a path prediction model.

RESULTS

Study 1 showed that compared to <1 h outdoor play, higher engagement in daily outdoor play was related to lower SB (1-2 h: - 9.75 min/day, P = 0.017; ≥2 h: - 17.78 min/day, P < 0.001) and higher MVPA (≥2 h: + 3.87 min/day, P = 0.001). The cross-sectional relationship between MVPA and outdoor play was moderated by sex (in favor of males) and age (in favor of younger children). Study 2 showed that outdoor play in early childhood negatively predicted PC use/Gaming in later childhood, but was unrelated to MVPA.

CONCLUSION

In Study 1, outdoor play was negatively related to SB cross-sectionally. In Study 2, outdoor play in early childhood was negatively related to PC and Gaming time in later childhood. Thus, providing outdoor play opportunities, especially during early childhood, has potential to prevent SB. Future research should investigate longitudinal relationships using device-based assessments for SB and MVPA.

Exploring the beliefs and perceptions of spending time in nature among U.S. youth

Purpose

The prevalence of poor mental health continues to rise among youth; however, large-scale interventions to improve mental and physical health remain a public health challenge. Time spent in nature is associated with improved health among youth. This study aimed to assess youth experiences with nature and the self-perceived impact on their mental and physical health among a nationwide sample of US youth.

Methods

In September 2020, five open-ended questions that aimed to assess perceptions regarding nature were posed to 1174 MyVoice youth, aged 14–24 years. Qualitative responses were analyzed using thematic analysis, and data were summarized using descriptive statistics.

Results

The mean (SD) age of the 994 respondents (RR = 84.7%) was 18.9 (2.7) years; 47.4% were female, and 57.4% Non-Hispanic White. Among youth, many felt that spending time in nature positively impacted their mental health, with 51.6% mentioning that it made them “feel calm when I am out in nature”; 22.1% said that it relieved stress or “reduces my anxiety,” and 17.1% felt that being in nature positively impacted their physical health and “makes me feel more active and in shape.” However, 7.0% said it negatively impacted their health, such as “It makes me feel isolated.” Most youth (87.8%) want to spend more time in nature, with 22% mentioning barriers (i.e., busy schedules, built environment, and COVID-19) impeding them from doing so.

Conclusions

Youth in our sample generally report feeling physically and mentally better when spending time in nature and want to spend more time in nature. Public health policies and practices that eliminate barriers and actively support time spent outside may be a feasible and acceptable practice to promote overall well-being among youth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11622-x.

Get Outside! Promoting Adolescent Health through Outdoor After-School Activity

BACKGROUND

The Get Outside: After School Activity Program (GO-ASAP) exemplifies how a rural community can utilize its natural resources and community partnerships to promote adolescent health.

METHODS

A qualitative descriptive inquiry was conducted using convenience sampling. Data were collected from students (n = 13/2018; n = 13/2019) via focus group and art-based method (2018 only) and parent (n = 6/2018) focus group. Data were analyzed via qualitative content analysis using the applied theoretical frameworks of Social Cognitive Theory and Social Determination Theory.

RESULTS

(1) Increasing Health-Related Competencies. Students increased their physical activity, improved their sleep, perceived less stress, and reported changes in dietary habits and electronic use. (2) Increasing Social Relatedness. Students made new friends, felt more connected, and spent less time home alone after school. (3) Increasing Autonomy and Intrinsic Motivation. Students recognized their emerging capabilities, and their increased confidence stimulated more action-oriented behavior. Parent-perceived changes support and mirror student reports.

CONCLUSION

Outdoor, nature-based, activity programs are a novel upstream approach to promote adolescent health, especially in rural communities where natural resources often exceed health-service resources and community partnerships are a way of life.

A Scoping Review of Nature, Land, and Environmental Connectedness and Relatedness

The importance of nature and the environment in relation to human health is coalescing, as demonstrated by the increased research that attempts to measure nature connectedness and relatedness. These findings align with constructs of cultural connectedness that assess for land connectedness as part of Indigenous ways of knowing. From an Indigenous worldview, relationships with the environment are critical to wellbeing. The purpose of this comprehensive systematic scoping literature review was two-fold: (1) identify and summarize existing measures of land, nature, and/or environmental connectedness, relatedness, and attitudes and (2) evaluate the psychometric properties of these scales. In total, 1438 articles were retrieved from select databases including PubMed/MEDLINE, PsycINFO, CINAHL (EBSCO), and Academic Search Complete (EBSCO). The final searches and application of the inclusion/exclusion criteria resulted in 57 unique articles and 38 scales categorized as connectedness and relatedness scales (n = 9 scales), attitudinal and values-based scales (n = 16 scales), cultural and spiritually based scales (n = 9 scales), and paradigm-based scales (n = 4 scales) (articles could be placed in multiple categories). Psychometric properties and general outcomes associated with nature-related scales are reported, with implications for future education, research, practice, and policy.

Children's Play and Independent Mobility in 2020: Results from the British Children's Play Survey

The British Children’s Play Survey was conducted in April 2020 with a nationally representative sample of 1919 parents/caregivers with a child aged 5–11 years. Respondents completed a range of measures focused on children’s play, independent mobility and adult tolerance of and attitudes towards risk in play. The results show that, averaged across the year, children play for around 3 h per day, with around half of children’s play happening outdoors. Away from home, the most common places for children to play are playgrounds and green spaces. The most adventurous places for play were green spaces and indoor play centres. A significant difference was found between the age that children were reported to be allowed out alone (10.74 years; SD = 2.20 years) and the age that their parents/caregivers reported they had been allowed out alone (8.91 years; SD = 2.31 years). A range of socio-demographic factors were associated with children’s play. There was little evidence that geographical location predicted children’s play, but it was more important for independent mobility. Further, when parents/caregivers had more positive attitudes around children’s risk-taking in play, children spent more time playing and were allowed to be out of the house independently at a younger age.

Paving the Way for Outdoor Play: Examining Socio-Environmental Barriers to Community-Based Outdoor Play

Outdoor play and independent, neighborhood activity, both linked with healthy childhood development, have declined dramatically among Western children in recent decades. This study examines how social, cultural and environmental factors may be hindering children’s outdoor and community-based play. A comprehensive survey was completed by 826 children (aged 10–13 years) and their parents from 12 schools (four each urban, suburban and rural) from a large county in Ontario, Canada. Five multilevel regression models, controlling for any school clustering effect, examined associations between outdoor play time per week and variable sets representing five prevalent factors cited in the literature as influencing children’s outdoor play (OP). Models predicted that younger children and boys were more likely to spend time playing outdoors; involvement in organized physical activities, other children nearby to play with, higher perception of benefits of outdoor play, and higher parental perceptions of neighborhood social cohesion also predicted more time in outdoor play. Time outdoors was less likely among children not allowed to play beyond home without supervision, felt they were ‘too busy’ with screen-based activities, and who reported higher fears related to playing outdoors. Study findings have important implications for targeting environmental, cultural and policy changes to foster child-friendly communities which effectively support healthy outdoor play.

Effects of Children's Outdoor Physical Activity in the Urban Neighborhood Activity Space Environment

The rapid development of cities results in many public health and built-up environmental problems, which have vital impacts on children's growth environment, the development of children, and city contradictions. There is a lack of children being a main concern when constructing new urban areas or reconstructing old districts. Children's activity spaces tend to be standardized and unified (kit, fence, and carpet) “KFC style” designs, which leads to the urban neighborhood space and the environment being insufficient to attract children to conduct activities. Therefore, starting from the urban neighborhood space environment, this paper explores what kind of spatial environment is needed for children's physical activity and its impact on children's physical activity. Taking six residential areas in the Changchun Economic Development Zone as the research object, based on the theory of children's ability development and game value, this paper uses the Woolley and Lowe evaluation tool to quantify the impact of the theory on the urban neighborhood space environment and children's physical activity. It can be confirmed that there is a significant correlation between the spatial characteristics of an urban neighborhood and the general signs of the environment on the duration and intensity of the physical activity of children. The results show that: (1) the differences in children's ages result in differences in the duration and intensity of children's physical activity in the urban neighborhood space environment; (2) the open space factor of the neighborhood space has the most significant influence on the duration of children's physical activity; (3) in terms of the environmental characteristics, whether children can be provided with education and learning opportunities has a significant impact on the duration of children's physical activity; (4) there is a significant positive correlation between children's age and the duration and intensity of the physical activity, exercise type, and imaginative activity. These results show that the urban neighborhood space environment can affect the duration of children's physical activity. In future urban residential area planning and design, urban children can meet the self-demand of physical activity in the neighborhood space through the reasonable balance and combination of neighborhood space characteristics and environmental characteristics.

A bio-ecological framing of evidence on the determinants of adolescent mental health - A scoping review of the international Health Behaviour in School-Aged Children (HBSC) study 1983-2020

This paper extracts, organises and summarises findings on adolescent mental health from a major international population study of young people using a scoping review methodology and applying a bio-ecological framework. Population data has been collected from more than 1.5 million adolescents over 37 years by the Health Behaviour in School-Aged Children: WHO Cross-National (HBSC) Study. The paper reviews the contribution that this long standing study has made to our understanding of the individual, developmental, social, economic, cultural determinants of adolescent mental health by organising the findings of 104 empirical papers that met inclusion criteria, into individual, microsystem, mesosystem and macrosystem levels of the framework. Of these selected papers, 68 were based on national data and the other 36 were based on international data, from varying numbers of countries. Each paper was allocated to a system level in the bio-ecological framework according to the level of its primary focus. The majority (51 papers) investigate individual level determinants. A further 28 concentrate primarily on the microsystem level, 6 on the mesosystem level, and 29 on the macrosystem level. The paper identifies where there is evidence on the determinants of mental health, summarises what we have learned, and highlights research gaps. Implications for the future development of this population health study are discussed in terms of how it may continue to illuminate our understanding of adolescent mental health in a changing world and where new directions are required.

Is Knowledge of Circular Economy, Pro-Environmental Behavior, Satisfaction with Life, and Beliefs a Predictor of Connectedness to Nature in Rural Children and Adolescents? A Pilot Study

Sustainable development (SD) is crucial to maintaining and preserving the planet we live on. The new paradigm of circular economy (CE) corresponds to the sustainable development goals and includes environmental, economic, and social dimensions. The United Nations has set quality education and the search for good health and well-being in the long term as tools for achieving SD. This study aims to identify the predictors of connectedness to nature in children and adolescents using knowledge of CE, pro-environmental behavior, beliefs about caring for the environment, and satisfaction with life as possible predictive variables. The exploration of the influence of these predictors on connectedness to nature, taking sex and age as covariates, was performed using a binary logistic regression model. We found that low scores on pro-environmental behavior, satisfaction with life, knowledge of waste management and CE, and beliefs about environmental behavior were related to a low degree of connectedness to nature. Thus, our findings suggest that the educational system must promote not only the assimilation of knowledge and beliefs but also satisfaction with life given its relationship with connectedness to nature.

Psychological impacts of "screen time" and "green time" for children and adolescents: A systematic scoping review

Technological developments in recent decades have increased young people's engagement with screen-based technologies (screen time), and a reduction in young people's contact with nature (green time) has been observed concurrently. This combination of high screen time and low green time may affect mental health and well-being. The aim of this systematic scoping review was to collate evidence assessing associations between screen time, green time, and psychological outcomes (including mental health, cognitive functioning, and academic achievement) for young children (<5 years), schoolchildren (5-11 years), early adolescents (12-14 years), and older adolescents (15-18 years). Original quantitative studies were identified in four databases (PubMed, PsycInfo, Scopus, Embase), resulting in 186 eligible studies. A third of included studies were undertaken in Europe and almost as many in the United States. The majority of studies were cross-sectional (62%). In general, high levels of screen time appeared to be associated with unfavourable psychological outcomes while green time appeared to be associated with favourable psychological outcomes. The ways screen time and green time were conceptualised and measured were highly heterogeneous, limiting the ability to synthesise the literature. The preponderance of cross-sectional studies with broadly similar findings, despite heterogeneous exposure measures, suggested results were not artefacts. However, additional high-quality longitudinal studies and randomised controlled trials are needed to make a compelling case for causal relationships. Different developmental stages appeared to shape which exposures and outcomes were salient. Young people from low socioeconomic backgrounds may be disproportionately affected by high screen time and low green time. Future research should distinguish between passive and interactive screen activities, and incidental versus purposive exposure to nature. Few studies considered screen time and green time together, and possible reciprocal psychological effects. However, there is preliminary evidence that green time could buffer consequences of high screen time, therefore nature may be an under-utilised public health resource for youth psychological well-being in a high-tech era.

The association between natural outdoor environments and common somatic symptoms

There is growing evidence that urban natural outdoor environments (NOE) may positively impact health by reducing stress and stress-related symptoms. However, there is limited research investigating this link across a range of NOE indicators. This cross-sectional study investigated the association between neighbourhood NOE (availability, use, and satisfaction with NOE) and common somatic symptoms and the role of potential mediators. Data were analysed from 3481 adults from Barcelona (Spain), Doetinchem (Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (United Kingdom). NOE data were obtained through self-reported data and environmental measurements. Common somatic symptom data were self-reported. Mixed effects regression models were used for analysis, with models adjusted for potential sociodemographic confounders. Higher satisfaction with neighbourhood NOE was associated with lower prevalence of common somatic symptoms (exp(β) 0.97; 95% CI 0.96, 0.98); an association partially mediated by mental health, social cohesion and air quality concern. A longer time spent in NOE was associated with lower prevalence of common somatic symptoms in low socioeconomic status neighbourhoods (exp(β) 0.98; 95% CI 0.96, 1.00). A higher number of neighbourhood green spaces (300m buffer) was associated with higher prevalence of common somatic symptoms (exp(β) 1.03; 95% CI 1.00, 1.05). No statistically significant associations were found for other NOE indicators. Study findings suggest that higher satisfaction with NOE may be associated with lower prevalence of common somatic symptoms, with mental health, social cohesion and concern about air quality playing partial mediating roles. Little evidence was found of an association between objective NOE measurements and common somatic symptoms, underlining the importance of perceptions of NOE for conferring health benefits.

Connecting High School Students With Nature - How Different Guided Tours in the Influence the Success of Extracurricular Educational Programs

Zoos attract millions of visitors every year, many of whom are schoolchildren. For this reason, zoos are important institutions for the environmental education of future generations. Empirical studies on the educational impact of environmental education programs in zoos are still rare. To address this issue, we conducted two studies: In study 1, we investigated students’ interests in different biological topics, including zoos (n = 1,587). Data analysis of individual topics revealed large differences of interest, with advanced students showing less interest in zoos. In study 2, we invited school classes of this age group to visit different guided tours at the zoo and tested connection to nature before and after each educational intervention (n = 608). The results showed that the guided tours are an effective tool to raise students’ connection to nature. Add-on components have the potential to further promote connection to nature. The education programs are most effective with students with a low initial nature connection.

Exploring Access to Nature Play in Urban Parks: Resilience, Sustainability, and Early Childhood

Nature play is an important component of the development of resilience in early childhood. Nature play is also an element of urban sustainability through a consideration of access to urban nature. From the foundation of access to nature play as a part of both resilience and sustainability considerations, a mixed-method case study was initiated. Spatial analysis, survey outreach, and focus group methodology have been combined to consider whether city parkland provides access for preschools to incorporate nature play, and, further, whether other barriers may exist to limit or prevent the use of city parks for nature play by preschool programs. The results indicate the existence of quality proximate access, but other factors creating barriers for broader application of nature play exist. The results also illustrate the critical role of public access to public parks as part of urban sustainability and the development of resilience in young children. The implications for the use of city parkland for nature play are presented.

The impacts of unstructured nature play on health in early childhood development: A systematic review

BACKGROUND

Nature play is growing in popularity as children's play spaces are transforming from traditional playgrounds into more nature-based play spaces with considerable financial and resource investment from government bodies. This has resulted in the re-development of children's play spaces to incorporate more natural elements such as trees, plants and rocks. Despite this, it is unclear whether there is empirical evidence to support claims that play in nature is beneficial for child health and development.

AIM

To conduct a systematic review examining the impacts of nature play on the health and developmental outcomes of children aged 2-12 years.

METHODS

Seven electronic databases were searched (MEDLINE, ERIC, Embase, PsycINFO, The Cochrane Library, The Joanna Briggs Institute and Emcare) from inception to July/August 2018 (search updated July/August 2019). The Inclusion criteria were children aged 2-12 years with no health/developmental conditions. The exposure/intervention of interest was unstructured, free play in nature. Critical appraisal of included studies was conducted using the McMaster Critical Appraisal Tool. Descriptive synthesis was then undertaken using the NHMRC FORM Framework.

RESULTS

Out of 2927 articles identified, 16 studies met the inclusion criteria. The nature play exposure/intervention was heterogeneously described, and a plethora of outcome measures were used. Nature play had consistent positive impacts on physical activity outcomes and cognitive play behaviours (imaginative and dramatic play). However, there remain some concerns regarding the quality of the evidence base, heterogeneity in intervention description and parameters in the outcome measures used.

CONCLUSIONS

While the positive impacts of nature play were encouraging in terms of physical activity and cognitive development, nature play stakeholders should focus on producing a universal definition for nature play, the development of standardised outcome measures and the conduct of robust research designs. Implications of these findings suggest the need for the development of standardised guidelines to inform practice and policy in the design of children's play spaces in different contexts.

Electronic screen technology use and connection to nature in Canadian adolescents: a mixed methods study

OBJECTIVES

Declines in exposure to nature may deprive young people of experiences that are positive for their mental health. One factor that may interfere with connections to nature is use of electronic screen technologies. The objectives of this study are to (1) document variations in the perceived importance of connections to nature nationally among adolescents; (2) explore relationships between these connections and the use of electronic screens, both epidemiologically and qualitatively; and (3) integrate core findings from both strands in order to provide evidence-based recommendations for health promotion.

METHODS

The study involved a mixed methods design. Strand 1 involved a qualitative study of 74 Canadians (ages 10-18, years 2016-2018) with data collected through focus groups and interviews. Strand 2 involved a cross-sectional observational analysis of a national survey of 23,920 Canadians (ages 11-15, years 2013-2014). Findings from both strands were integrated through an established protocol.

RESULTS

Increased use of electronic screen technology was consistently associated with lower perceived importance of connections to nature. Barriers to connecting to nature included choices that young people are making, the addictive properties of technology, and beliefs that being indoors is more comfortable and safer than being outdoors. When young people disconnected, their appreciation of being outdoors increased.

INTERPRETATION

This novel study showed, quantitatively, that the time young people spend with electronic screens displaces time that they spend engaging in outdoor activities. Deeper reasons why such associations occur emerged in the qualitative strand. Temporary disconnection from screens may lead to renewed opportunities for outdoor exposures.

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S

We conducted secondary data analyses of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting. Data were collected at the prescribing visit (baseline) and at one and three months of follow up from 78 families. Family characteristics were identified at baseline; regression models were used to explore changes during follow up in associations of park use with knowledge, attitudes and perceived access to parks. At baseline, park users differed from non-users in demographics, knowledge of park locations, attitudes about the value of park visits, but not affinity for nature. Park users were also more likely than non-users to feel that their neighborhood was safe for children to play in. Changes in knowledge of park locations, nature affinity, and perceived access to parks were each significantly associated with increased park use by families at one and three months after the park prescription. Adjusting for age, gender, race, poverty, and US birth, increases in knowing the location of parks were associated with an increase of 0.27 weekly park visits (95% CI 0.05, 0.49; p = 0.016); increases in feeling a caregiver had money to visit parks were associated with 0.48 more weekly park visits (95% CI 0.28, 0.69; p < 0.001); increases in perceived money for park outings were associated with 0.24 increased park visits per week (95% CI 0.05, 0.42; p = 0.01); each unit increase in nature affinity was associated with 0.34 more weekly park visits (95% CI 0.09, 0.59; p = 0.007). In other words, knowing where to go, valuing nature, and having time, and money contributed to increased likelihood of visiting a park. We discuss in terms of health behavior theory how demographics, knowledge, attitudes and perceived barriers to park use can inform park prescription interventions.

Psychological Symptoms and Behavioral Changes in Children and Adolescents During the Early Phase of COVID-19 Quarantine in Three European Countries

The coronavirus disease (COVID-19) pandemic forced the home confinement of the majority of population around the world, including a significant number of children and adolescents, for several weeks in 2020. Negative psychological effects have been identified in adults, but research about the impact of this type of social distancing measure on children and adolescents is scarce. The present study aimed to describe and compare the immediate psychological and behavioral symptoms associated with COVID-19 quarantine in children and adolescents from three southern European countries with different levels of restrictions (Italy, Spain, and Portugal). Parents of 1,480 children and adolescents (52.8% boys) between 3 and 18 years old (M = 9.15, SD = 4.27) participated in the study. An online survey using snowball sampling techniques was conducted during 15 days between March and April 2020, representing the early phase of the quarantine associated with COVID-19 outbreak. Parents answered questionnaires about sociodemographic data, housing conditions, immediate psychological responses during quarantine (e.g., anxiety, mood, sleep, and behavioral alterations), patterns of use of screens, daily physical activity, and sleep hours before and during the quarantine. The results revealed an increase in children's psychological and behavioral symptoms, increased screen-time, reduced physical activity, and more sleep hours/night. Italian children presented less psychological and behavioral symptoms compared with Portuguese and Spanish children. In general, hierarchical multiple regressions revealed that having an outdoor exit in the house (e.g., garden, terrace) contributed to lower levels of psychological and behavioral symptomatology. Future studies are needed to identify family and individual variables that can better predict children and adolescents' well-being during and after quarantine. Recommendations for families and implications for practice are discussed.

Domains of spirituality and their associations with positive mental health: a study of adolescents in Canada, England and Scotland

Spirituality is a concept with ancient roots yet contemporary relevance to mental health. Its assessment in populations of young people, however, remains an immense challenge. Efforts to perform such assessments typically involve use of unidimensional scales incorporating items related to four domains (connections to "self", "others", "nature", and the "transcendent"). For adolescents, it remains unclear whether these domains equally influence mental health, or if one domain is particularly important. Here we analyzed reports from adolescents who participated in the 2014 Health Behaviour in School-aged Children (HBSC) study conducted in Canada (n = 21,173), England (n = 4339) and Scotland (n = 5603). Reports of positive mental health were modelled as a function of ordinal scores describing each spiritual health domain, controlling for age, the other domains, and potential confounders. Subsequent analyses focused on the centrality of connections to "self" in these relationships. We identified strong and consistent associations between positive mental health and higher scores for each of the four spiritual health domains. In fully adjusted models, these effects were diminished or changed direction for connections to "others", "nature", and the "transcendent", while the positive association with "connections to self" remained. While associations exist between each of the four domains of spiritual health and positive mental health, it appears that associations with connections to "others", "nature", and the "transcendent" are sometimes mediated by connections to "self". Implications for assessment, models and related interventions and health promotion strategies, based on the idea that inner connections may be central to the protective effects of spiritual health, are considered.

Association Between Surrounding Greenness and Schizophrenia: A Taiwanese Cohort Study

This study aims to investigate the association between surrounding greenness and schizophrenia incidence in Taiwan. Data of 869,484 individuals without a history of schizophrenia were included from the Longitudinal Health Insurance Database from 2000 through 2010 for analysis. The diagnoses of schizophrenia were based on ICD-9 codes. Greenness exposure was assessed using the satellite-based normalized difference vegetation index, assuming individuals lived near the hospital they most often visited for common cold during the study period. Cox proportional hazards models were applied to assess the association between greenness exposure and schizophrenia incidence after adjustments were made for the potential confounders. A total of 5,069 schizophrenia cases were newly diagnosed during the study period. A negative significant (p < 0.05) association found using 2000-m buffer distances (distance of a moderately paced 20-min walk) in the whole Taiwan island, cities, and metropolitan areas. The results of the stratified analysis based on sex and health insurance rate suggested surrounding greenness has approximately equal effects of reducing the risk of schizophrenia, regardless of sex or financial status. In conclusion, our findings suggest that more surrounding greenness may reduce the risk of schizophrenia.