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Digging 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 moreHealth Professionals and the Climate Crisis
Health professionals from every corner of the health sector—from allergy to vascular surgery, from epidemiology to environmental health, from nursing to hospital administration—have recognized the magnitude and urgency of the climate crisis. A growing literature provides guidance on how to conceptualize and meet the vast challenges we face and on how to keep our spirits up as we do so.
Read morePhysical Activity in Natural Settings: An Opportunity for Lifestyle Medicine
Physical activity is a well-known behavior for promoting health and preventing a variety of chronic diseases. Despite widespread knowledge of the benefits of physical activity, most Americans do not engage in sufficient physical activity. Over the past decade, there has been increasing recognition of the health benefits of spending time in nature, mediated in part through physical activity. This has led to new partnerships across health, parks and recreation, public lands, and environmental organizations to increase time spent, and physical activity, in natural settings. This review assesses the current evidence around physical activity in natural settings (PANS), strategies for promoting PANS including health professional engagement, and current gaps in the research literature. Related Media Does Greenspace Plus Exercise Boost the Individual Health Benefits of Each? (June 11, 2024)
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 moreDevelopment and Validation of Self-Efficacy and Intention Measures for Spending Time in Nature
Figure 1. Pictorial representation of methodology steps Purpose The purpose of this study was to develop and evaluate the reliability and validity of self-efficacy and intentions measures for time spent in nature (TSN). TSN is related to improvement in psychological well-being and health, yet most American adults spend very little time in such settings. Theory-based interventions have been effective in increasing physical activity, a related behavior, and may be one mechanism to increase TSN. Self-efficacy and intentions have been shown to be strong predictors of health behaviors and are used across several theories. However, scales to measure these factors have not yet been developed and are needed to facilitate effective interventions. Methods TSN self-efficacy and intentions scales were developed using a sequential nine-step procedure: identification of the domain and item generation; content validity; pre-testing of questions; sampling and survey administration; item reduction; extraction of factors; tests of dimensionality; tests of reliability; and tests of validity. The 14-member multidisciplinary, researcher and practitioner investigative team generated 50 unique items for self-efficacy and 24 unique items for intentions. After subjecting items to content validity and pre-testing, item sets were reduced to 21 assessing self-efficacy and nine assessing intentions. A nationwide sample of 2109 adult participants (49.7% female, Mean Age = 58.1; 59.8% White, 18.4% Hispanic, 13.3% Black) answered these items via an on-line survey. Results Using split-half measures, principal components analysis indicated a one-factor solution for both scales. The factor structure was upheld in confirmatory factor analyses and had high internal consistency (α = .93 self-efficacy; .91 intentions). The scales were moderately correlated with each other (r = .56, p < .001) and were strongly related to TSN with large effect sizes (eta2 > .20). Conclusions The study resulted in reliable and valid self-efficacy (14 items) and intentions (8 items) scales that can be used to develop future theory-based interventions to increase TSN and thereby improve population health.
Read moreHope, Health, and the Climate Crisis
Hope has been viewed since ancient times as a bedrock of human thriving, and contemporary evidence suggests that hope is a determinant of health. However, the climate crisis, in addition to its many direct and indirect threats to human health, erodes hope in many people. This article describes medical aspects of hope and hopelessness, including clinical definitions, measurement methods, and treatments. It then touches on literary and philosophical perspectives on hope, from both ancient and modern sources, emphasizing the centrality of hope to human thriving. Finally, it applies these clinical and cultural perspectives to the climate crisis, arguing that health professionals should propel hope in themselves, their patients, and the broader society, and drawing on clinical insights to propose concrete ways of doing so.
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 moreAdvancing Sustainable Development and Protected Area Management with Social Media-Based Tourism Data
Figure 1. The Bahamian archipelago, including the network of marine protected areas (orange boundaries), geotagged Flickr photos (purple points), and Andros, the largest island in The Bahamas. Politically considered a single island, Andros is in fact comprised of three major landmasses, North Andros (which contains the districts of North Andros and Central Andros), Mangrove Cay, and South Andros. Sustainable tourism involves increasingly attracting visitors while preserving the natural capital of a destination for future generations. To foster tourism while protecting sensitive environments, coastal managers, tourism operators, and other decision-makers benefit from information about where tourists go and which aspects of the natural and built environment draw them to particular locations. Yet this information is often lacking at management-relevant scales and in remote places. We tested and applied methods using social media as data on tourism in The Bahamas. We found that visitation, as measured by numbers of geolocated photographs, is well correlated with counts of visitors from entrance surveys for islands and parks. Using this relationship, we predicted nearly 4 K visitor-days to the network of Bahamian marine protected areas annually, with visitation varying more than 20-fold between the most and least visited parks. Next, to understand spatial patterns of tourism for sustainable development, we combined social media-based data with entrance surveys for Andros, the largest island in The Bahamas. We estimated that tourists spend 125 K visitor-nights and more than US$45 M in the most highly visited district, five times that of the least visited district. We also found that tourists prefer accessible, natural landscapes—such as reefs near lodges—that can be reached by air, roads, and ferries. The results of our study are being used to inform development and conservation decisions, such as where to invest in infrastructure for visitor access and accommodation, siting new marine protected areas, and management of established protected areas. Our work provides an important example of how to leverage social media as a source of data to inform strategies that encourage tourism, while conserving the environments that draw visitors to a destination in the first place.
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 moreResults From an 18 Country Cross-Sectional Study Examining Experiences of Nature for People with Common Mental Health Disorders
Figure 1. Estimated anxiety (unstandardized coefficients, 95% Confidence Intervals) during last nature visit as a function of perceived social pressure for each CMD group. Estimates are based on models controlling for: sex, age, perceived financial strain, employment status, marital status, number of children in household, having a long-term limiting illness, smoking status, alcohol use seasonal wave and country; and visit-related factors, number of companions, presence of dog, transport mode, travel time, visit duration, and anxiety ‘yesterday’. Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but ‘green prescription’ programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.
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