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Are Physically and Mentally Healthier

Research shows what many parents have long known, that children who learn and play in nature are healthier both mentally and physically. Active, unstructured play outdoors helps build a child’s physical strength and also helps children build social and emotional skills such as problem solving and self-esteem.

Children today are spending seven to 11 hours per day sitting with media and only minutes per day playing outdoors. With that sedentary lifestyle we’ve found a rise in childhood obesity, depression, near-sightedness and ADHD. The good news is this is a situation that everyone can improve by taking the kids in their life outside. Families who make a plan to be active in nature are helping their children build skills that will contribute to a healthier life.

Green space in childhood is associated with lower risk of psychiatric disorders later in life

This study investigated whether the presence of green space during childhood is associated with the risk of developing psychiatric disorders later in life. The study also sought to determine if and to what extent the amount of green space exposure during childhood changed the overall effect regarding the risk for later psychiatric disorders. A third aim of the study was to examine if green space presence at a specific age during childhood would have an effect on the risk of psychiatric disorders later in life.

The study considered data on all persons born in Denmark from 1985 to 2003 and who were alive and still living in Denmark at their 10th birthday. By linking individual longitudinal data on mental health outcomes with levels of childhood green space, researchers found that children living with higher levels of green space had lower risks of developing psychiatric disorders during adolescence or adulthood. This protective association remained after adjusting for other known risk factors, such as urbanization, socioeconomic factors, family history of mental illness, and parental age. The association was similar in strength, or sometimes stronger, than associations between mental health and other known risk factors, such as socioeconomic status, prior history of mental illness, and age. Finally, the association was somewhat stronger for the development of mental illness in adolescence vs. adulthood.

  • Engemann, Kristine, Carsten Bøcker Pedersen, Lars Arge, Constantinos Tsirogiannis, Preben Bo Mortensen, and Jens-Christian Svenning. 2019. “Residential Green Space in Childhood Is Associated with Lower Risk of Psychiatric Disorders from Adolescence into Adulthood.” Proceedings of the National Academy of Sciences 116 (11): 5188–93. https://doi.org/10.1073/pnas.1807504116.

Access to nature can promote the mental well-being of children

This systematic review of the literature examined evidence of the mental health benefits for children and teenagers interacting with different types of nature. This research differs from some other studies relating to children and teenagers’ mental health status in that it focuses on external influences (including home and neighborhood environments) versus individual-level factors (such as biological and socio-economic characteristics). A specific objective of the review was to determine how interacting with different types of nature may benefit the mental health of children and teenagers. Such a determination could have long-term implications, as mental health issues developed during childhood may persist into adulthood.

Studies included in this review met the following criteria: (1) the population included children and teenagers 18 years and under, (2) the intervention incorporated an element of nature, (3) the outcome or outcomes included a component of mental health, and (4) the study was based on quantitative versus qualitative data. Additional search parameters included publication dates 1990 to March 1, 2017 and published in English or French. Studies deemed to be of poor quality were eliminated. The remaining 35 papers meeting all the selection criteria were included in this review.

Eleven of the studies were conducted in the USA, 8 in the UK, and 2 in Canada. The 14 remaining studies were conducted in other countries. The studies addressed eight categories of mental health outcomes: emotional well-being, attention deficit disorder/hyperactivity disorder, overall mental health, self-esteem, stress, resilience, depression, and health-related quality of life. Of these, emotional well-being and attention deficit disorder/hyperactivity disorder were studied the most often. Childhood depression was rarely studied, and anxiety was not studied at all. Approximately half of the studies reported statistically significant positive relationships between nature and mental health outcomes; approximately half reported no statistical significance. The studies addressed various forms of interactions with nature, including accessibility, exposure, and engagement.

  • Tillmann, Suzanne, Danielle Tobin, William Avison, and Jason Gilliland. 2018. “Mental Health Benefits of Interactions with Nature in Children and Teenagers: A Systematic Review.” Journal of Epidemiology and Community Health 72 (10): 958. https://doi.org/10.1136/jech-2018-210436.

Another systematic review of the literature examined the association between access to green space and the mental well-being of children. Selection criteria included original research focusing on children (0-18 years) published between 2012 and 2017. Twelve articles fitting these criteria were identified. Three additional articles – published prior to 2012 — were included in the review, as they were often cited as important early research on nature-related benefits for children.

Access to green space was associated with improved mental well-being, overall health and cognitive development of children. It promotes attention restoration, memory, competence, supportive social groups, self-discipline, moderates stress, improves behaviors and symptoms of ADHD and was even associated with higher standardized test scores.

  • McCormick, Rachel. 2017. “Does Access to Green Space Impact the Mental Well-Being of Children: A Systematic Review.” Journal of Pediatric Nursing: Nursing Care of Children and Families 37 (November): 3–7. https://doi.org/10.1016/j.pedn.2017.08.027.

Mental health, emotional regulation and enhanced physical activity

Spending time in nearby nature leads to improvements in mental health and emotional regulation, both for specific groups of children (such as those with ADHD) and children as a whole. Living nearby green spaces is associated with greater physical activity.

A systematic literature review was conducted on research related to the benefits of time in nature for children under twelve years old. Inclusion criteria of the review included peer-reviewed research published in English between 1990 and 2011 that had a robust methodology and focused on children’s experiences in nearby nature. These criteria yielded 61 studies that were categorized based on the specific benefits that were addressed in the research. The review identified benefits for children related to time in nature in the general areas of health, well-being, cognitive processes, social skills, emotional/behavior issues, and ethics/attitude towards the natural world. The studies were grouped together by specific benefit to develop an overall assessment of the extent to which evidence supports the existence of each benefit.

Overall, the literature review supports the view that spending time in nature is an important childhood experience that promotes their healthy development, well-being and positive attitudes towards the natural world. The review helps to shed particular light on the relationship between benefits and the way in which children engage with the natural environment, highlighting “the value of more playful engagement styles such as free play, exploration, leisure and child initiated learning.” An overall theme was that more playful engagement with nature was associated with health benefits as well as positive environmental attitudes and less playful approaches, such as school gardening projects and field trips, yielded more educational benefits. This insight into the importance of children’s playful engagement with the natural world is an important contribution to the literature and provides support for “initiatives that allow for more open-ended, child-directed and playful experiences in natural environments.”

  • Gill, Tim. 2014. “The Benefits of Children’s Engagement with Nature: A Systematic Literature Review.” Children, Youth and Environments 24 (2): 10–34. https://doi.org/10.7721/chilyoutenvi.24.2.0010.

Unstructured Free Play Brings Cognitive, Social and Health Benefits

Unstructured free play in the out-of-doors brings a host of benefits to children-from being smarter to more cooperative to healthier overall. This well-documented article by two physicians builds a strong case for the importance of unstructured free play in the out-of-doors for all age groups, and especially young children. While concerned about the "obesity epidemic" in young children, the authors say that the health benefits from outdoor play are only one aspect of the overall benefits. They suggest that the concept of "play" is more compelling and inviting to most adult caregivers, parents and guardians than "exercise." The authors cite cognitive benefits from play in nature, including creativity, problem-solving, focus and self-discipline. Social benefits include cooperation, flexibility, and self-awareness. Emotional benefits include stress reduction, reduced aggression and increased happiness. Children will be smarter, better able to get along with others, healthier and happier when they have regular opportunities for free and unstructured play in the out-of-doors.

  • Burdette, Hillary L., M.D., M.S.; and Robert C. Whitaker, M.D, M.P.H. "Resurrecting Free Play in Young Children: Looking Beyond Fitness and Fatness to Attention, Affiliation and Affect." © 2005 American Medical Association.

Childhood Obesity

The prevalence of obesity among children aged 6 to 11 more than doubled in the past 20 years, to 17 percent of children in this age group. The rate of clinically obese adolescents (aged 12-19) more than tripled, to 17.6 percent. The Centers for Disease Control concludes that a major missing ingredient is an hour per day of moderate physical activity.

  • CDC's National Center for Chronic Disease Prevention and Health Promotion. Division of Adolescent and School Health. Childhood Obesity. 20 Oct. 2008.

Lack of Vitamin D

Many children in the U.S., especially minorities, need more Vitamin D. Spending time outside raises levels of Vitamin D, protecting children from bone problems and other health issues.

Cognitive Development

An estimated 4.4 million children in the United States suffer from Attention Deficit/Hyperactivity Disorder (ADHD), and most would benefit from a low‐cost, side‐effect‐free way of managing their symptoms. Previous research suggests that after isolated exposures to greenspace, children's ADHD symptoms are reduced. This study examined whether routine exposures to greenspace, experienced through children's everyday play settings, might yield ongoing reductions in ADHD symptoms. Data on 421 children's ADHD symptoms and usual play settings were collected using a national Internet‐based survey of parents.

Findings suggest that everyday play settings make a difference in overall symptom severity in children with ADHD. Specifically, children with ADHD who play regularly in green play settings have milder symptoms than children who play in built outdoor and indoor settings. This is true for all income groups and for both boys and girls. Interestingly, for hyperactive children, the apparent advantage of green spaces is true only for relatively open green settings.

  • Taylor, Andrea Faber, and Frances E. (Ming) Kuo. 2011. “Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children’s Play Settings.” Applied Psychology: Health and Well-Being 3 (3): 281–303. https://doi.org/10.1111/j.1758-0854.2011.01052.x.

Natural Settings and Cognitive Behavior: Children who are exposed to natural or outdoor settings receive benefits to their cognitive health, such as reduction of ADHD symptoms.

Anxiety, Rumination, Mood

This study investigated the impact of nature experience on affect and cognition. We randomly assigned sixty participants to a 50-min walk in either a natural or an urban environment in and around Stanford, California. Before and after their walk, participants completed a series of psychological assessments of affective and cognitive functioning. Compared to the urban walk, the nature walk resulted in affective benefits (decreased anxiety, rumination, and negative affect, and preservation of positive affect) as well as cognitive benefits (increased working memory performance). This study extends previous research by demonstrating additional benefits of nature experience on affect and cognition through assessments of anxiety, rumination, and a complex measure of working memory (operation span task). These findings further our understanding of the influence of relatively brief nature experiences on affect and cognition, and help to lay the foundation for future research on the mechanisms underlying these effects.

Childhood Obesity and Equity

Currently, obesity affects 17% or 12.5 million of America’s children and adolescents aged 2-19 years. According to the Institute of Medicine, the prevalence of obesity has doubled over the past 30 years for preschoolers and adolescents, and more than tripled for children aged 6-11. Disparities in childhood obesity are also rising. While obesity prevalence increased by 10% for all US children from 2003-2007, children of lower socioeconomic status from high unemployment households saw a 23%-33% increase in obesity. Among Hispanic children, obesity prevalence increased by 24% from 2003-2007, and odds of obesity and overweight were twice as high for black and Hispanic children than white children. Furthermore, obese children are more likely to grow up with a negative self-image, lower levels of advanced education, lower family income, and a lower rate of marriage as adults[1].

Type 2 Diabetes

Type 2 diabetes is being diagnosed with increasing frequency in children. Due to the increase in prevalence over the past few decades, the definition has now changed from its previous title, “adult-onset” diabetes. According to the CDC, 1 in 3 children born in 2000 will eventually develop diabetes mellitus if present rates of obesity continue.

Hypertension

Hypertension in children has increased because of the childhood obesity epidemic, with 10% of obese children having elevated blood pressure. Sedentary behavior may influence the development of hypertension in children. For example, high blood pressure in children age 3 through 8 years old has been associated with high periods of television viewing and screen time.

Cardiovascular Disease and Metabolic Syndrome

Overweight adolescents are at an increased risk of coronary heart disease and premature death. Most overweight and obese children have at least one risk factor for cardiovascular disease, including higher cholesterol levels, abnormal glucose tolerance, high blood pressure, and elevated triglycerides.

Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease refers to the fatty infiltration of the liver without excessive alcohol consumption. It is closely related to obesity and insulin resistance. A population-based study estimated that the prevalence of nonalcoholic fatty liver disease among children aged 2-19 at nearly 10%, and that the prevalence of fatty liver among obese children at 38%.

Obstructive Sleep Apnea

Obesity is a well-documented risk factor for the development of obstructive sleep apnea in adults, and it may be a risk factor for sleep apnea in children as well. Obesity may also increase a child’s risk for the consequences of obstructive sleep apnea. For example, obstructive sleep apnea was found to be an independent predictor of nocturnal hypertension.

Asthma

Approximately 7 million American children (9.4%) have asthma, a percentage that has doubled since the 1980s. Children who are overweight or obese are more likely to have asthma symptoms. Of the 7 million children reported to have asthma in 2003-2006, black and Puerto Rican children have the highest prevalence. Furthermore, asthma is more prevalent in urban environments; factors contributing to this disparity include indoor and outdoor air pollution, housing and neighborhood conditions, poverty, health care inequities, and social and psychosocial stressors. These circumstances support the notion that black children are 1.6 times more likely to be diagnosed with asthma when compared with white children. However, Puerto Rican children have the highest prevalence of asthma of all racial and ethnic groups; they are 2.4 times more likely than white children to have asthma. Along with the factors of living in an urban environment, television viewing has also been associated with asthma. A population-based study investigated the relationship of BMI with wheezing and asthma in 20,016 children. The authors found that subjects who spent 5 or more hours a day watching television were more likely to experience wheeze and asthma in comparison with those who watched television less than 1 hour a day.

Vitamin D Deficiency

Children continue to demonstrate evidence of vitamin D deficiency, as noted in an analysis of the 2001-2004 NHANES. It is indicated that 9% of the pediatric population, or 7.6 million US children and adolescents had insufficient levels of vitamin D. Additionally, low levels of vitamin D may lead to osteoporosis, cardiovascular disease, metabolic syndrome, hypertension, diabetes, myocardial infarctions, and peripheral arterial disease. Spending time outside raises levels of Vitamin D, protecting children from bone problems and other health issues. Historically, the main source of vitamin D comes from synthesis in the skin after exposure to UVB light. In a cohort study conducted in Japan in 2003, authors evaluated the degree of association between vitamin D and lifestyle factors in Japanese women aged 19-25. Lifestyle factors included nutrient intake, physical activity, and duration of sunlight exposure. Two main findings of the study were that daily energy expenditure and numbers of steps taken per day were positively associated with vitamin D. Furthermore, the average amount of time per day spent in sedentary activity was negatively associated with vitamin D. Asthma may also be related to vitamin D deficiency. Twenty-eight percent of the children with asthma had insufficient levels of vitamin D.

Depression and Anxiety

Children and adolescents are increasingly being prescribed medication for depression, anxiety, or behavioral difficulties. Six percent of adolescents 14-18 years old have been diagnosed with depressive disorders, as well as 3% of children younger than 13 years old. Stress is also a top health concern for adolescents in the USA, according to a 2009 survey by the American Psychological Association. The survey found that nearly half of the adolescents in the USA said that their level of stress had increased in the past year, and the 14% of adolescents categorized their stress as extreme. The prevalence of ADHD has increased considerably in recent decades, labeled by the CDC as “a serious public health problem.” The results of the National Health Interview Survey showed that 9% of children have ADHD. Another study in 2005 found that 5% of US children between the ages of 4 and 17 were prescribed medication for difficulties with emotions or behavior, and 90% of these were treatment for symptoms of ADHD[2].

Children’s Health and Sedentary Lifestyle

In the US in recent decades, there has been a nationwide shift to a sedentary lifestyle, leaving children vulnerable to the negative effects of inactivity. Physical activity is known to reduce the risk of premature mortality, coronary heart disease, hypertension, diabetes mellitus, osteoporosis, colon cancer, depression, and anxiety. Nonetheless, in 2006, approximately 40% of US adults reported no participation in any leisure-time physical activity. Inactivity has also been measured in children and adolescents. While research shows that adolescents who are physically active are more likely to be active during adulthood, only 35% of high school students met currently recommended levels of physical activity in 2005. Children’s lack of physical activity and their growing disconnect with the natural environment have been influenced by the rise in electronic media, decreased time for unstructured free play, and environmental barriers. Per capita visits to US national parks have decreased since 1987, coincident with the rise in electronic entertainment media, video game, and internet use. Young people spend roughly 7.5 hours a day consuming some forms of electronic media – an hour more than was reported 5 years ago. Additionally, each added hour of television significantly increases the odds of having social or emotional problems such as low self-esteem. Free, unstructured play also affects the amount of physical activity children engage in each day.

According to the AAP, play allows children to use their creativity and imagination while building dexterity and physical strength. Unstructured play is also important for healthy brain development; children learn how to work in groups, share, negotiate, resolve conflicts, and learn self-advocacy skills.

Since the 1970s, children have lost roughly 12 hours a week of free time, including a 25% decrease in play and a 50% decrease in unstructured outdoor activities. In fact, children now spend more time in vehicles being transported from one indoor activity to another than in nature. This statistic speaks to the important role of parents in raising healthy children. Parents’ encouragement and presence are actually key predictors of the amount of time children spend outdoors; authors of a 2009 ecological study observed that older children who had less adult supervision after school spent less time outside. Not only does the parents’ role in raising a child affect his/her health, but the built environment is another important factor, speaking to racial and ethnic issues. Differences in the built environment also may contribute to racial and ethnic health disparities in the USA. Minority children and those from lower socio-economic classes generally have less access to recreational facilities, which is linked to decreased physical activity and overweight. Neighborhoods with large minority populations, on average, have fewer supermarkets and produce stores. Therefore, they must rely on convenience stores and fast food restaurants that carry food high in fat, sodium, and sugar that are also associated with a higher body mass index (BMI).

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