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Community Forests and Public Health: A Research Agenda
The natural environment is integral to supporting healthy and resilient communities. Community forests (CFs) are forested parcels, typically in rural areas, where community members have access, share governance, and receive various benefits. While considerable research demonstrates that urban parks and forests are important for human health, similar assessments are less available for CFs specifically. Although CFs exist in multiple countries, their policy, ecological, ownership, and governance contexts differ significantly. This review focuses on CFs in the United States. The goals of this project were to systematically review current evidence on the relationship between CFs and human health, identify knowledge gaps in the existing research, and propose a scientific research agenda that identifies critical questions related to CFs and public health in the U.S., with application in other contexts. We conducted a systematic review of the literature, screening 351 studies and assessing twenty-four full-text articles, only one of which met inclusion criteria. This mixed-methods study characterized 70 CFs in the Eastern U.S. and featured four case studies. The majority of CFs (93%) and all case studies identified recreational use as their most common purpose. The evidence base on the health implications of CFs is very thin. Targeted research on CFs and their impact on health could provide evidence to inform CF processes and help optimize their health outcomes. We propose a research agenda on CFs in the U.S. based on several pathways of public health promotion: nature contact, climate mitigation/adaptation, economic opportunities, community cohesion, and equity.
Read morePromoting Children’s Active Play in Nature via Primary Care
Objective To assess the feasibility, acceptability, and utility of Project Nature (PN), an intervention during well-child checks, to promote children’s active play in nature from the perspectives of parents and clinic staff. Study Design Six primary care clinics in Washington State implemented PN, including anticipatory guidance from a clinician, a nature-based toy, and written/internet based family resources, during well-child checks for 1-10 year olds. We conducted quantitative surveys of different groups of parents before (control group, n = 154) and after (intervention group, n = 131) the implementation of PN at each clinic. We analyzed differences between the 2 groups using chi-square and Mann–Whitney U tests. Postintervention, we conducted qualitative interviews with 11 clinic staff members about implementation, coded the data, and conducted thematic analysis. Results The proportion of parents reporting that their child’s clinician encouraged daily outdoor time was higher postintervention than the control group (85% vs 54%, P = .02). A higher proportion of parents in the intervention compared with the control group reported that the clinician encouraged daily physical activity (86% vs 71%, P = .09). Families generally reported strong satisfaction with all the intervention components. Clinic staff felt PN facilitated conversation around active outdoor play and believed that PN was feasible within their existing workflows. Conclusions PN is a feasible and acceptable approach for supporting children’s active play in nature via primary care clinics. These results provide a foundation for a larger evaluation assessing the impact of PN on families’ physical activity and nature-based experiences.
Read moreThe Importance of (Not Just Visual) Interaction With Nature: A Study With the Girl Scouts
This study investigated whether children’s nature interactions that are embodied (versus only visual) would be associated with a state of being highly aware without thought, including being in “the present moment,” and/or feeling connected to something beyond the self. We refer to this state of being as Presence in nature. Using an interaction pattern approach, we coded written narratives from 127 Girl Scouts (8-11 years old) about a recent meaningful nature experience and, through a questionnaire designed for the study, assessed the degree to which participants experienced Presence in that nature experience. Exploratory analyses indicated that participants who enacted embodied interactions with nature (e.g., “making snowman,” “wrapping arms around tree,” “talking to chickens”) reported a greater sense of Presence in nature than participants whose interactions relied solely on vision (e.g., “seeing snow,” “seeing moss,” “watching pileated woodpecker”). Discussion focuses on the implications of Girl Scouts’ embodied nature interactions for environmental education. Related Media Q&A: UW Researchers Examine Mental Impact of Girl Scouts’ Interactions With Nature (April 21, 2025)
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Associations of Residential Green Space with Internalizing and Externalizing Behavior in Early Childhood
Figure 1. Associations between residential green space and CBCL scores. Background Green space exposures may promote child mental health and well-being across multiple domains and stages of development. The aim of this study was to investigate associations between residential green space exposures and child mental and behavioral health at age 4–6 years. Methods Children’s internalizing and externalizing behaviors in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort in Shelby County, Tennessee, were parent-reported on the Child Behavior Checklist (CBCL). We examined three exposures—residential surrounding greenness calculated as the Normalized Difference Vegetation Index (NDVI), tree cover, and park proximity—averaged across the residential history for the year prior to outcome assessment. Linear regression models were adjusted for individual, household, and neighborhood-level confounders across multiple domains. Effect modification by neighborhood socioeconomic conditions was explored using multiplicative interaction terms. Results Children were on average 4.2 years (range 3.8-6.0) at outcome assessment. Among CANDLE mothers, 65% self-identified as Black, 29% as White, and 6% as another or multiple races; 41% had at least a college degree. Higher residential surrounding greenness was associated with lower internalizing behavior scores (-0.66 per 0.1 unit higher NDVI; 95% CI: -1.26, -0.07) in fully-adjusted models. The association between tree cover and internalizing behavior was in the hypothesized direction but confidence intervals included the null (-0.29 per 10% higher tree cover; 95% CI: -0.62, 0.04). No associations were observed between park proximity and internalizing behavior. We did not find any associations with externalizing behaviors or the attention problems subscale. Estimates were larger in neighborhoods with lower socioeconomic opportunity, but interaction terms were not statistically significant. Conclusions Our findings add to the accumulating evidence of the importance of residential green space for the prevention of internalizing problems among young children. This research suggests the prioritization of urban green spaces as a resource for child mental health.
Read moreDigging Into Nature: Outdoor Adventures for Healthier and Happier Kids
Children living in the United States spend an average of 7 hours a day on entertainment media, including TVs, phones, computers, and video game systems. It’s a lose-lose scenario. Kids are suffering the effects of too much screen time and they’re missing out on the very real benefits of spending time outside. Pediatricians and nature experts Pooja Sarin Tandon and Danette Swanson Glassy make the convincing case that children and families will be happier, healthier, and more resilient when spending time in nature. They offer a wealth of suggestions for nature-based activities and suggestions for overcoming common challenges busy families face when trying to increase their outdoor time. The authors address the importance of nature for children’s health at every age from infancy through adolescence and link their suggested activities to key developmental milestones. Digging Into Nature takes an inclusive approach, providing practical tips for parents of children with special health care needs, chronic health conditions, and cultural considerations to help all children reap the gifts that the great outdoors offer. Related Media Podcasts Outdoors Adventures for Happier Kids (November 2024) The Importance of Getting Our Children Into Nature (September 30, 2024) Pediatricians Share Why Kids Need Time in Nature (September 30, 2024) Reviews Parent Review: Digging into Nature (October 14, 2024)
Read moreIndividual and Neighborhood Level Predictors of Children’s Exposure to Residential Greenspace
Figure 1. Distribution of (A) residential surrounding greenness, (B) tree cover, and (C) park proximity, in the CANDLE cohort for the residential address reported at the time of the age 4–6 year study visit (n = 1012). Residential surrounding greenness is assessed using the normalized difference vegetation index (NDVI) within a 300-m radial buffer of the home address. Tree cover is assessed as the percentage of the census block group. Park proximity is assessed as the distance to the nearest boundary of a park; the x-axis is truncated at 5 km for visualization purposes. Inequities in urban greenspace have been identified, though patterns by race and socioeconomic status vary across US settings. We estimated the magnitude of the relationship between a broad mixture of neighborhood-level factors and residential greenspace using weighted quantile sum (WQS) regression, and compared predictive models of greenspace using only neighborhood-level, only individual-level, or multi-level predictors. Greenspace measures included the Normalized Difference Vegetation Index (NDVI), tree canopy, and proximity of the nearest park, for residential locations in Shelby County, Tennessee of children in the CANDLE cohort. Neighborhood measures include socioeconomic and education resources, as well as racial composition and racial residential segregation. In this sample of 1012 mother–child dyads, neighborhood factors were associated with higher NDVI and tree canopy (0.021 unit higher NDVI [95% CI: 0.014, 0.028] per quintile increase in WQS index); homeownership rate, proximity of and enrollment at early childhood education centers, and racial composition, were highly weighted in the WQS index. In models constrained in the opposite direction (0.028 unit lower NDVI [95% CI: − 0.036, − 0.020]), high school graduation rate and teacher experience were highly weighted. In prediction models, adding individual-level predictors to the suite of neighborhood characteristics did not meaningfully improve prediction accuracy for greenspace measures. Our findings highlight disparities in greenspace for families by neighborhood socioeconomic and early education factors, and by race, suggesting several neighborhood indicators for consideration both as potential confounders in studies of greenspace and pediatric health as well as in the development of policies and programs to improve equity in greenspace access.
Read morePhysical Activity and Social Interaction Assessments in Schoolyard Settings Using the System for Observing Outdoor Play Environments in Neighborhood Schools (SOOPEN)
Figure 1. (a) Schoolyard 1, (b) schoolyard 2, and (c) schoolyard 3 target areas for SOOPEN observations. Black outlines indicate the boundaries of each target area and white dots indicate the location where observers stood to conduct scans. For example, at School 3 (panel C), zone 1 is a paved surface, zone 2 is a covered basketball court (paved surface), zone 3 is a paved surface, zone 4 is a set of swings, zone 5 is a play structure, and zone 6 is a grass field bordered by a paved walking path Background The schoolyard environment provides key opportunities to promote physical activity and socioemotional development for children. Schoolyards can also serve as a community park resource outside of school hours. We aimed to: (i) implement and evaluate reliability of the System for Observing Outdoor Play Environments in Neighborhood Schools (SOOPEN), (ii) assess schoolyard use by children during recess and community members of all ages outside of school hours, and (iii) investigate relationships of schoolyard and children´s group characteristics with physical activity levels and prosocial interactions. Methods In this cross-sectional study, we observed student and community visitor behavior using SOOPEN at three urban elementary schoolyards in Tacoma, Washington, USA, prior to renovations intended to expand each facility’s use as a community park in neighborhoods with poor park access. We assessed interrater reliability using intraclass correlation coefficients and described current levels of schoolyard use (at the group level), physical activity, and prosocial behavior. Physical activity was assessed on a five-point scale and dichotomized to indicate moderate-to-vigorous physical activity (MVPA). Social interactions were coded as prosocial, antisocial, or neutral. We examined associations of selected schoolyard features and group characteristics with group MVPA and prosocial behavior during recess using modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Results We observed a total of 981 activity-defined, informal groups in the schoolyards, and achieved good to excellent interrater reliability using SOOPEN. Community use of the schoolyards during evenings and weekends was limited (n = 56 groups). During 26, 25–50 min recess periods (n = 833 groups), 19% of groups were engaged in MVPA. Schoolyard areas with paved surfaces were associated with more MVPA (PR = 1.52, 95% CI: 1.04, 2.23) compared to field/grass areas; supervised groups were associated with less MVPA than groups not directly supervised by an adult (PR = 0.59, 95% CI: 0.36, 0.96). Schoolyard characteristics were not associated with prosocial behavior. Mixed-gender groups were associated with more MVPA and more prosocial behavior. Conclusions Our study using SOOPEN, a reliable new activity observation tool, highlights the multi-dimensional dynamics of physical activity and social interactions in schoolyards, which could be leveraged to promote healthy behaviors during and outside of school hours.
Read moreTime Spent Interacting with Nature Is Associated with Greater Well-Being for Girl Scouts Before and During the COVID-19 Pandemic
The onset of the COVID-19 pandemic rendered daily life overwhelmingly difficult for many children. Given the compelling evidence for the physical and mental health benefits of interaction with nature, might it be the case that time spent interacting with nature buffered the negative effects of the pandemic for children? To address this question, we conducted a longitudinal investigation with a cohort of 137 Girl Scouts across two time periods: right before the onset of the pandemic (December 2019–February 2020) and one year later (December 2020–February 2021). We found that during the pandemic (compared to pre-pandemic), Girl Scouts fared worse on measures of physical activity, positive emotions, negative emotions, anxiety, behavioral difficulties, and problematic media use. However, by using mixed models, we also found that, on average, Girl Scouts who spent more time interacting with nature fared less poorly (in this sense, “did better”) on measures of physical activity, positive emotions, anxiety, and behavioral difficulties, irrespective of the pandemic. Further analysis revealed that these advantageous associations were present even when accounting for the amount of nature near each child’s home (as measured by the normalized difference vegetation index, percent of natural land cover, and self-reported access to nature). To the best of our knowledge, this is the first study investigating nature interaction and children’s well-being to use data collected from the same cohort prior to and during the pandemic. In addition, we discuss the importance of opportunities to interact with nature for children’s well-being during future periods of social upheaval.
Read moreA Framework for Pediatric Health Care Providers to Promote Active Play in Nature for Children
Aim: Time outdoors and contact with nature are positively associated with a broad range of children’s health outcomes. Pediatricians are uniquely positioned to promote active play in nature (APN) but may face challenges to do so during well child visits. The objective of this study was to understand barriers to children’s APN, before and during the COVID-19 pandemic, and how health care providers could promote APN. Methods: Focus groups were conducted with 14 pediatric providers and interviews with 14 parents (7 in English, 7 in Spanish) of children ages 3 to 10 on public insurance. Dedoose was used for coding and content analysis. We contextualized this work within the WHO’s Commission on Social Determinants of Health conceptual framework. Results: Parents mentioned a range of material circumstances (time, finances, family circumstances, access to safe outdoor play spaces and age-appropriate activities) and behavioral/psychosocial factors (previous experiences in nature, safety, and weather concerns), many of which were exacerbated by the pandemic, that serve as barriers to children’s APN. Providers said they were motivated to talk to families about children’s APN but mentioned barriers to this conversation such as time, other pressing priorities for the visit, and lack of resources to give families. Conclusions: Many pre-pandemic barriers to APN were exacerbated by the COVID-19 pandemic. Well-child visits may be an effective setting to discuss the benefits of APN during and beyond the pandemic, and there is a need for contextually appropriate resources for pediatric providers and families.
Read morePark Access and Mental Health Among Parents and Children During the COVID-19 Pandemic
Table 2. Parent and child physical activity and mental health outcomes Background Time spent outdoors and in nature has been associated with numerous benefits to health and well-being. We examined relationships between park access and mental health for children and parents during the COVID-19 pandemic. We also explored associations between park access and co-participation of parent and child in time outdoors, and child and parent physical activity. Methods We used data from 1,000 respondents to a nationally representative U.S. survey of parent–child dyads during October–November 2020. Park access was defined as an affirmative response to: “do you have a park that you can safely walk to within 10 min of your home?” Child mental health was operationalized as the Strengths and Difficulties Questionnaire (SDQ) total difficulties score. The Patient Health Questionnaire-4 (PHQ-4) total score assessed parent mental health and the International Physical Activity Questionnaire (IPAQ) assessed parent physical activity. Child physical activity and co-participation in outdoor activity were reported as number of days in the prior week. Linear regression was used to examine relationships between park access and health outcomes in models adjusted for child and parent characteristics and COVID-19 impact. Results Our sample included 500 parents of children ages 6–10 years, and 500 parent–child dyads of children ages 11–17 years. Park access was associated with a lower SDQ total score among children (β: -1.26, 95% CI: -2.25, -0.27) and a lower PHQ-4 total score among parents (β: -0.89, 95% CI: -1.39, -0.40). In models stratified by child age, these associations were observed for SDQ scores among adolescents ages 11–17 and for PHQ-4 scores among parents of children ages 6–10 years. Park access was also associated with 0.50 more days/week of co-participation in outdoor time (95% CI: 0.16, 0.84), and higher levels of parent physical activity (β: 1009 MET-min/week, 95% CI: 301, 1717), but not child physical activity (β: 0.31 days/week, 95% CI: -0.03, 0.66). Conclusions Park access was associated with better mental health among children and parents, and more parent physical activity and parent–child co-participation in outdoor activity during the COVID-19 pandemic. Access to nearby parks may be an important resource to promote health and well-being, for both individuals and families.
Read moreNature and Children’s Health: A Systematic Review
The American Academy of Pediatrics has long recognized the importance of play and has encouraged outdoor play to promote children’s health and social-emotional development. Outdoor play environments vary widely, from urban parking lots to grass sports fields to wilderness. There is increasing evidence that outdoor play environments containing natural elements may offer health benefits that come specifically from engaging in the natural world. Recent studies have demonstrated that a broad range of outcomes are related to access to, and contact with nature, including increased physical activity, reduced obesity, decreased stress, and improved mental health. However, nature contact is not regularly experienced by all children because of urbanization, sedentary indoor lifestyles, and disparities in access to green space. Neighborhoods with more socioeconomically disadvantaged residents and families of color tend to have fewer nearby residential parks, and financial and transportation limitations that prevent access to parks and wilderness outside of city limits. This inequity extends to school grounds in low-income neighborhoods, which are less likely to have school gardens compared with schools in high-income neighborhoods. Furthermore, there is evidence that contact with nature and green space may disproportionately benefit disadvantaged populations by attenuating the toxic effects of poverty: the so-called “equigenic” effect. For these reasons, promoting nature contact and ensuring equitable access to green spaces could play a role in improving health outcomes and behaviors, and reducing health disparities. Pediatricians are uniquely positioned to offer guidance about evidence-informed interventions to promote child health during clinical interactions, and through community advocacy. Our goal was to conduct a systematic review to aggregate and evaluate the evidence regarding the effects of nature contact on children’s health, and to make it available to pediatric health care providers. Therefore, we explore the full breadth of quantitative evidence with a systematic literature search and consensus-based review process to make the evidence accessible on which to base clinical recommendations, health-promoting programs, and policies and to guide future research. Related News As Outdoor Preschools Gain Traction, States Work to Unlock Funding (January 27, 2023) Nature is Nurture: Outdoors are Key to Children’s Health, Buffer to Pandemic Stress (November 5, 2021) Children with access to nature are mentally and physically healthier (September 30, 2021) Science backs nature as key to children’s health (September 29, 2021)
Read moreIllnesses and Injuries at Nature Preschools
A binder with a larger version of the log shown above, with spacing set for eight children on each page, was provided to preschool teachers participating in this study. The log was created to enable teachers to systematically and easily record absences due to illness and injuries occurring during the preschool day. All preschool teachers received a 15 to 20 min training on how to use the log prior to the start of the study. Nature preschools, where children spend the entire school day outdoors, are increasingly popular, but their health consequences have not been well researched. This study tested the hypothesis that nature preschools and conventional preschools differ in their illness and injury incidence, by comparing observed illness and injury occurrence in the two types of schools. For 14 weeks, teachers at five nature preschools and four conventional preschools in Seattle, Washington logged absences due to illness. Two nature preschools and three conventional preschools also logged injuries that occurred during the school day. There was no difference in illness incidence by preschool type, and no serious injuries were reported in either setting. Overall, the study found that nature preschools are a healthy and safe child-care model.
Read moreTrends and Knowledge Gaps in the Study of Nature-Based Participation by Latinos in the United States
Figure 1. Cumulative studies (n = 108) by publication year that relate to participation in nature-based activities by Latino communities. Studies include those that focused solely on Latino populations as well as cross-ethnic comparisons that included Latinos. Mounting evidence supports health and well-being benefits associated with nature experiences, while also highlighting race- and class-based inequalities in access and exposure. We synthesized the literature on nature contact by Latinos in the United States to assess the state of knowledge and strategically identify research needs to improve outcomes and reduce health disparities for this rapidly growing ethnic group. Our systematic review revealed 108 articles with a notable increase in number of papers over the past 3 decades. We noted that the body of research is focused on certain demographic targets (adults in urban areas) with a relative dearth of knowledge for others (children, seniors, and rural areas). Our analysis also revealed strong compartmentalizing of studies into research “clusters” based on nonoverlapping topics and types of outcomes that are measured. Although one-third of studies explored health outcomes, these studies rarely examined other outcomes or research topics. Moreover, less than 7% of studies reported on interventions. Given the potential for nature contact to enhance health and well-being, there is substantial need for multidisciplinary research that explores interactions between social, cultural, and economic factors, and how those ultimately relate to nature contact and outcomes for Latinos in the United States.
Read moreNature Contact and Human Health: A Research Agenda
Figure 1. A spectrum of forms of nature contact. Background At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding. Objectives We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions. Discussion We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science. Conclusions Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights.
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