Association of Education Outside the Classroom and Pupils' Psychosocial Well-Being: Results From a School Year Implementation

Efficacy and mechanisms of an education outside the classroom intervention on pupils' health and education: the MOVEOUT study protocol

BACKGROUND

Education can create better opportunities for health, and vice versa. Using a so-called 'add-in' approach, school-based physical activity (PA) promotion and prevention of sedentary behaviours can increase pupils' wellbeing and learning and, on the longer term, reduce the risk of non-communicable diseases. A PA 'add-in' approach involves integrating PA into teachers' curricular obligations without being an extra burden as opposed to an 'add-on' approach which requires additional operational resources and include activities that do not explicitly contribute towards curricular targets making them less long-term acceptable in a school-based context. Previous studies investigating education outside the classroom (EOtC) show mutual benefits for both health and education outcomes among children and adolescents. However, the evidence is of mixed quality and questionable certainty, which calls for further investigation. The aim of this study protocol is to describe and discuss the study design and methods to investigate the efficacy and mechanisms of EOtC as a vehicle for health and education. The study investigates the intervention developed and conducted in the TEACHOUT study with updated and strengthened design and measures.

METHODS

The efficacy of EOtC will be investigated in a cluster randomised waitlist design. Participants will be pupils in ~54 classes, grades 4-10 (ages 10-15 years) in ~30 Danish elementary schools. Fifteen schools will be randomised to the intervention: a two-day EOtC training course targeting teachers followed by the teachers implementing EOtC >5 hours weekly over the course of one school year. Pre- and post-measures of health (PA and wellbeing) and learning (school motivation and academic achievement) will be collected. Investigation of pedagogical and motivational mechanisms will be based on observations of EOtC.

DISCUSSION

The updated randomised controlled design will provide firmer evidence for the efficacy and mechanisms of EOtC and provide knowledge about how mutual benefits of health and education can be obtained.

TRIAL REGISTRATION

Registered with ClinicalTrials.gov (ID NCT05237674 ) [University of Copenhagen. MOVEOUT: a Cluster RCT of the Efficacy, Mechanisms, and Mediation of an Education Outside the Classroom Intervention on Adolescents' Physical Activity, 2023], February 14, 2022. Most recently updated on November 23, 2022 (Version 2).

Protocol for the Open Sky School: a two-arm clustered randomized controlled trial to test the effectiveness of a nature-based intervention on mental health of elementary school children

BACKGROUND

This article outlines the protocol for a trial to test the effectiveness of a nature-based intervention called Open Sky School to reduce mental health problems among elementary school children. Experimental studies show that contact with nature (e.g. walks in parks) improve mental health. A growing number of teachers have been applying outdoor education within the regular school curriculum and evidence suggests that such teaching methods could improve students' mental health but a randomized controlled trial has never been conducted.

METHODS

A two-arm clustered randomized controlled trial will be conducted in elementary schools across Québec, Canada. Following informed consent by teachers, parents and students, schools will be randomly assigned 1:1 to the intervention or the control group with a total of 2500 5-6^th grade students and 100 teachers expected to participate. The intervention will take place outdoors in a green-space (2 h per week for 12 weeks) and include a toolkit of 30 activities to foster well-being (e.g. mindfulness) and academic competencies (e.g. mathematics). Questionnaires will be administered to teachers and students before, immediately after and 3 months after the intervention. The primary outcome will be reductions of mental health problems in children from pre-to-post test (Social Behavior Questionnaire: self and teacher reports). Secondary outcomes include depression, positive and negative affect, nature connectedness, and pro-environmental behaviors among children. We will explore, immediate benefits on teacher's well-being and positive and negative affect and sustained benefits among students at 3 months follow-up. For the primary outcome, we will explore moderators including child's sex, child's disability status, the green-space of neighbourhoods, the school's socio-economic position and teacher's experience.

DISCUSSION

In conducting the first randomized controlled trial of the Open Sky School, our results could provide empirical evidence on the effectiveness of nature-based interventions in reducing mental health problems among elementary school children.

TRIAL REGISTRATION

This study was registered with clinicaltrials.gov: NCT05662436 on December 22, 2022.

Improving Body Mass Index of School-Aged Children Using a Nine-Week Rope Skipping Training Intervention: A One-Group Pre-Test Post-Test Design

Studies examining the effectiveness of rope skipping training to improve the body mass index (BMI) of school children are scarce. Hence, this study examined the effectiveness of nine-week skipping training on the BMI of primary six school-aged children (n = 77). The participants underwent 30 min of skipping training three days per week over a nine-week period. The participants’ BMI was measured at the baseline and during weeks 3, 6 and 9. The results from a one-way ANOVA with repeated measures indicated a statistically significant difference in the BMI for both males [F(3,111) = 9.42, p < 0.001, ηp2 = 0.203] and females [F(3,114) = 7.35, p < 0.001, ηp2 = 0.162], suggesting an improvement in BMI. Post hoc comparisons with a Bonferroni adjustment revealed significant differences in BMI after nine weeks of intervention for males between the pre-test (M = 21.47, SD = 4.94) and the 9-week post-test (M = 20.15, SD = 4.36), and for females between the pre-test (M = 21.56, SD = 5.80) and the 9-week post-test (M = 20.68, SD = 5.32). This study demonstrated that regular participation in vigorous physical activity such as skipping training could promote child health by preventing the likelihood of young children being overweight. This result has implications for the inclusion of skipping training into the school life of school-aged children to help manage their BMI levels.

When are you taking us outside? An exploratory study of the integration of the outdoor learning in preschool and primary education in Quebec

Introduction

Recent research investigating the benefits of being outdoors and contact with nature in children showed strong associations with children’s health and development. More teachers are choosing to integrate outdoor learning (OL) into their practice in Quebec, but few studies have focused on OL in the school environment, particularly in Canada and more specifically in Quebec, despite the fact that the school context lends itself favorably to this practice.

Objective

The purpose of this study was to portray OL in preschool and primary schools in Québec by identifying three key elements: (1) teachers’ perception of the outdoors, (2) the uses of OL in schools, and (3) teaching strategies and factors that influence teachers’ integration of OL.

Methodology

Semi-structured group interviews (n = 4) conducted with 14 teachers and participant observations (n = 4) were used for data collection. Inclusion criteria were to be a preschool or primary school teacher, to have taught at least eight sessions of OL in the past year, and to have no connection or contact with the research team prior to the start of the study.

Results

First, the results showed that teachers commonly understood the outdoors as being in the open air, practicing a physical activity, having the presence of nature, providing physical freedom and targeting a pedagogical intention. Second, teachers appeared to incorporate a variety of pedagogical intentions in OL (e.g., environmental awareness, interdisciplinary learning), in a variety of settings (e.g., city parks, woodlands), and with a variety of academic subjects (e.g., French, mathematics) and learning tasks (e.g., walking, nature shelter building). Third, teachers used a wide range of teaching strategies in OL (e.g., flexible planning, well-established routines). Participants also identified multiple factors specific to their setting that appeared to facilitate (e.g., parental support) or limit (e.g., storage of materials) their integration of OL into the school environment.

Conclusion

This study provided a better understanding of the current use of the OL in the Quebec school environment by identifying the common characteristics, limitations and winning strategies of its use in schools. Teachers and schools interested in OL could benefit from the results of this study, particularly those interested in adopting a Forest School or Udeskole approach.

School educational models and child mental health among K-12 students: a scoping review

BACKGROUND

The promotion of mental health among children and adolescents is a public health imperative worldwide, and schools have been proposed as the primary and targeted settings for mental health promotion for students in grades K-12. This review sought to provide a comprehensive understanding of key factors involved in models of school education contributing to student mental health development, interrelationships among these factors and the cross-cultural differences across nations and societies.

METHODS

This scoping review followed the framework of Arksey and O'Malley and holistically reviewed the current evidence on the potential impacts of school-related factors or school-based interventions on student mental health in recent 5 years based on the PubMed, Web of Science, Embase and PsycExtra databases.

RESULTS/FINDINGS

After screening 558 full-texts, this review contained a total of 197 original articles on school education and student mental health. Based on the five key factors (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) identified in student mental development according to thematic analyses, a multi-component school educational model integrating academic, social and physical factors was proposed so as to conceptualize the five school-based dimensions for K-12 students to promote student mental health development.

CONCLUSIONS

The lessons learned from previous studies indicate that developing multi-component school strategies to promote student mental health remains a major challenge. This review may help establish appropriate school educational models and call for a greater emphasis on advancement of student mental health in the K-12 school context among different nations or societies.

Are Physically Active Breaks in School-Aged Children Performed Outdoors? A Systematic Review

(1) Background: Children spend an ever-increasing amount of time performing sedentary behaviors, and an important part of their daily life is at school. Learning in an outdoor environment improves children’s physical activity levels, and their cognitive and social spheres. Furthermore, physically active breaks are a solution to reduce sedentary behaviors and improve well-being and academic performance. The study evaluated the published literature on physically active breaks during school hours and explored (a) if the interventions were proposed in an outdoor context and (b) the outcomes of these interventions. (2) Methods: This review collected 31,559 articles from different electronic databases. After the screening, the results were analyzed narratively. (3) Results: 41 studies have been included in the analysis. As reported by the results, most of the interventions took place in the classroom, and only three studies were performed outside. A common aspect of all studies is the feasibility of active breaks, assessing positive outcomes. (4) Conclusions: Physically active outdoor breaks are poorly adopted, highlighting the necessity for deeper study on this topic. Although the protocols considered present differences, generally breaks increase physical activity levels, present positive learning outcomes, and improve social well-being. Furthermore, they are sustainable in terms of time, cost, and effort of the teacher.

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.

Methodological Considerations for Movement Education Interventions in Natural Environments for Primary School Children: A Scoping Review

Background: Education is the ideal setting for carrying out projects to improve primary students’ capacities. In recent years, interventions in natural environments have been more frequently proposed, but there is still a lack of standardization, making deeper study of the topic necessary. This review aims to report on what previous scientific research has been carried out, and eventually, to propose standard operating procedures for future interventions. Methods: This is a scoping review that adopted the PRISMA guidelines. Primary school children have been included, and the interventions had to be proposed adopting nature as the primary element of the learning process. Results: A total of 19 studies have been included, and a wide range of methodological differences has been detected regarding the included intervention protocols. Conclusions: Learning in nature is a feasible intervention that, despite the high heterogeneity of interventions, demonstrates positive outcomes in the learning sphere of children.

Health-related quality of life, motivational regulation and Basic Psychological Need Satisfaction in Education Outside the Classroom: an explorative longitudinal pilot study

BACKGROUND

Given a suboptimal state of mental health among children, an urgent need exists to seek approaches related to health promotion in this population's settings, such as in schools. Increased health-related quality of life (HRQoL) and improved school motivation could be crucial for children's mental health. Based on self-determination theory, paths can be identified that could lead to such improvements by strengthening the basic psychological needs (BPN). This study aimed to examine the impact on and the relationships among HRQoL, school motivation and BPN within the promising concept of education outside the classroom (EOtC).

METHODS

In this exploratory study, we employed a between-subjects cohort study design with no blinding or randomisation. We surveyed fifth graders (mean = 10.1 years) attending EOtC (experimental group [EG], n = 25) and normal indoor lessons (control group, [CG], n = 41) at the beginning (T1) and end (T2) of a semester. We used the translations of validated questionnaires and established linear mixed-effects models to evaluate whether the students in EOtC show higher scores of HRQoL and school motivation and, whether the satisfaction of BPN of autonomy (PAut), competence (PCom), social relatedness with classmates (PSRC) and teachers (PSRT) show associations with these outcomes.

RESULTS

Regarding intrinsic and identified motivational regulation, results showed significant increases over time in the overall sample and significant higher scores in the EG than in the CG. For HRQoL, no group differences were found, but a significant decrease over time in the EG. Regarding possible associations between the outcomes and BPN, such could only be found between HRQoL and PSRC, but not for the other BPN and not for motivational regulation and BPN.

CONCLUSIONS

Without having been able to explain this on the basis of increased BPN values, our results show that EOtC can support improvements in specific regulation types of school motivation. This could contribute to an improvement in the mental health situation in children, as school represents a major stressor for them. Future steps in terms of researching HRQoL in this setting are discussed, as this pilot study does preliminary work for necessary examinations, e.g. in structural equation approaches.

The Association between Education Outside the Classroom and Physical Activity: Differences Attributable to the Type of Space?

Education outside the classroom (EOtC) has become an attractive approach, not only for learning but also for health. This explorative, cross-sectional study investigated children’s sedentary behaviours (SED), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) on school days with an EOtC session in green space compared to school days with EOtC in other environments and without EOtC. Teachers from 17 Danish school classes practised EOtC for one school year on a weekly basis and self-reported the characteristics of the EOtC environment. The pupils’ PA was device-measured for seven consecutive days in a random period during the school year with AX3 accelerometers. Across 617 pupils (age 9–13 years), PA intensity cases (N = 2264) on school days (8:10–14:00 h) with (n = 317) or without (n = 1947) EOtC were included in a mixed-effects regression analysis. Mean exposure to EOtC was 262 min per session. School days with green EOtC (e.g., parks, forests and nature schools) were associated with (mean, [95% CI]) −24.3 [−41.8, −7.7] min SED and +21.3 [7.7, 36.4] min LPA compared to school days with non-green EOtC (e.g., cultural and societal institutions or companies) and with +6.2 [−0.11, 11.48] min MVPA compared to school days with a school-ground EOtC. No sex differences were found. In conclusion, school days with green EOtC must be considered promising to counteract children’s sedentary behaviours during school hours.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

Education outside the classroom as upstream school health promotion: 'adding-in' physical activity into children's everyday life and settings

INTRODUCTION

It is central for public health to answer questions related to how to change health and wellbeing in populations through interdisciplinarity and health in all policies and sectors. For a school physical activity promotion initiative to be acceptable and thus feasible, the buy-in of teachers is fundamental. Therefore, school physical activity promotion should be integrated into and support teaching activities.

AIMS

We discuss the use of education outside the classroom as a feasible pedagogical approach that integrates and promotes physical activity for school children.

METHODS

We present and discuss theoretical arguments and empirical evidence to argue and illustrate that education outside the classroom is a promising approach for promoting physical activity.

RESULTS

Education outside the classroom is characterised by regular curriculum-based experiential teaching activities outside the classroom with the inclusion of physical activity as a means to pedagogical ends. School subjects are taught outside the classroom drawing on problem-based learning and experiential education. Here, physical activity is integrated without compromising curriculum goals which increases teacher buy-in and thereby intervention acceptability and feasibility. Empirical evidence suggests that education outside the classroom increases boys' moderate to vigorous physical activity and girls' light intensity physical activity. We contend that the mechanisms are a mix of place, pedagogy and pupil motivations.

CONCLUSIONS

Education outside the classroom is a feasible and acceptable approach to public health and physical activity promotion because it is integrated into children's everyday settings through curriculum time and applied broadly to child populations at a low cost. The practice of education outside the classroom is context-dependent and culturally bound, and practices therefore need to be adapted to the individual sociocultural context.

A Systematic Review Protocol to Identify the Key Benefits and Efficacy of Nature-Based Learning in Outdoor Educational Settings

Outdoor Learning in natural environments is a burgeoning approach in the educational sector. However, the evidence-base of research has not kept pace with teacher perceptions and increased practitioner usage. Anecdotal evidence and formal research suggest the significant health and wellbeing benefits of nature connection. Offering low-cost, non-invasive pedagogical solutions to public health challenges—particularly around mental health, wellbeing, physical literacy, and increasing physical activity–the pedagogical benefits of Outdoor Learning are yet to be fully enunciated. The proposed systematic review will search for studies across eight academic databases which measure the academic and socio-emotional benefits of Outdoor Learning, with a focus on school-aged educational settings. Using the inclusion criteria set out in this paper (and registered with PROSPERO: CRD42020153171), relevant studies will be identified then summarised to provide a synthesis of the current literature on Outdoor Learning. The goal of this review is to document the widespread international investigation into Outdoor Learning and its associated benefits for development, wellbeing, and personal growth. The systematic review will provide insights for teacher-training institutions, educational policy makers, and frontline teachers to improve the learning experiences of future students.

Is It a Good Idea for Chemistry and Sustainability Classes to Include Industry Visits as Learning Outside the Classroom? An Initial Perspective

Learning outside the classroom (LOtC) activities are part of pedagogical methodologies that are currently applied in the development of student skills. The objective of this study is to determine the perceptions of faculty and undergraduate students concerning industrial visits and define the advantages and disadvantages of these activities. A survey was designed with 17 questions, from a sample of 296 students and 32 professors from various chemistry and sustainability courses. The statistical samples correspond to a population of 2275 students and 246 professors. Descriptive statistics were used to analyze and compare participant perceptions on industrial visits, as LOtC activities. Results indicated a positive perception for making industrial visits, generating more interest in the class material and helping students acquire knowledge. Despite this positive perception, it was found that professors are unlikely to organize industrial visits frequently due to the work required to plan, perform, and evaluate these activities. This issue suggests that approximately 40% of the students may lose the advantages that LOtC activities could offer. Professors must be motivated and supported by administrators to include industrial visits in their courses as a teaching strategy to provide a beneficial experience to the majority of students enrolled in chemistry and sustainability undergraduate programs.

Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotional development in children

BACKGROUND

Existing research indicates that spending time in nature is associated with diverse aspects of children's health and wellbeing. Although fundamental to later life chances and health, no systematic reviews, to our knowledge, have focused specifically on the effects of interaction with nature on socioemotional functioning in childhood.

OBJECTIVES

Amongst children, what is the consistency of associations between the availability of or spending time in nature on socioemotional function and development? Furthermore, which child behaviours and states independently associate with socioemotional function and availability of or spending time in nature, and what is the consistency of associations between these behaviours and states and contact with nature?

DATA SOURCES

Embase, Environment Complete, MEDLINE, and APA PsycINFO. Eligible studies were backward and forward snowball-searched.

STUDY ELIGIBILITY CRITERIA

Studies investigating effects of, or associations between, availability of or interaction with nature on socioemotional or proximal outcomes in children under the age of 12 years were included in this review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The internal validity of studies investigating socioemotional outcomes were based on assessments of elements of study design, conduct, and reporting to identify potential issues related to confounding or other biases. The number of analyses indicating positive, negative, and non-significant associations between availability or interaction with green space and the outcomes were summed.

RESULTS

A total of 223 eligible full-texts, of which 43 pertained to socioemotional outcomes and 180 to proximal outcomes, met eligibility criteria. Positive associations between availability of and spending time in green space were found with children's intra- and interpersonal socioemotional function and development. Proportions of positive findings ranged from 13.9% to 55% across experimental and observational research, exposures, populations, and contexts. Modifying and mediating factors were identified. We found consistent evidence for improved aspects of cognition and, for children over six years, reduced risk of obesity and overweight in association with green space; consistent links between movement behaviours in the experimental, but not observational research; tentative trends suggesting associations with play, motor skills, language, screen time, and communication skills; little evidence for positive associations between green space and mood, physical wellbeing, and stress; some evidence for associations with healthy birth outcomes, and little evidence for direct associations between availability of green space and asthma and allergy prevalence, however, mediation via, for example, air pollution was likely.

LIMITATIONS

We identified few studies without either probable or severe risk of bias in at least one item. Improved study quality may therefore result in different results. Restricting analyses to include only studies considered at low risk of bias indicated similar or slightly lower proportions of positive findings. Risk of bias in proximal outcomes was not assessed.

CONCLUSIONS

The empirical evidence for benefits of availability of and interaction green space for child socioemotional function and development must currently be considered limited. A number of proximal indicators were identified. Systematic review registration number.

PROSPERO ID

CRD42019135016.

Promoting Sustainable Wellbeing: Integrating Positive Psychology and Environmental Sustainability in Education

This article proposes an integrative policy approach to defining and promoting wellbeing through the joint lenses of positive psychology and environmental sustainability. The study suggests that while both positive education and environmental education address various aspects of wellbeing, a common definition is still absent. The study proposes a framework for advancing a mutual concept of wellbeing: “sustainable wellbeing”, integrating aspects of individual wellbeing and the wellbeing of the environment. Sustainable wellbeing is achieved when improving individual wellbeing is correlated with improving the wellbeing of other members of society and the natural environment. It suggests a framework for integrating the benefits of positive education and environmental education into a coherent approach for exploring, discussing, and experiencing sustainable wellbeing. The paper mainly develops, explores, and demonstrates ten rules for implementing sustainable wellbeing literacy in schools, based on cognitive behavioral therapy and positive psychology insights. It contributes to the development and understanding of wellbeing, highlights the benefits of parallel developments of two distinct educational fields, and offers practical guidelines for implementing educational programs. Furthermore, the paper contributes to developing 21st century educational systems and further develops the emerging field of positive sustainability.

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.