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Nature is nurture: Outdoors are key to children’s health, buffer to pandemic stress

Nov. 4, 2021 Updated Fri., Nov. 5, 2021 at 7:52 a.m.

Green spaces near homes and schools bring measurable benefits for children both in physical activity and mental health, according to widespread data. In citing science versus what’s intuitive, a new study could affect public policies on better nature access for all children.

Amber Fyfe-Johnson, a Washington State University researcher in Seattle and former pediatrician, is the lead author in a review of nearly 300 studies on the health impacts of being in green spaces for children of all ages. The research team’s review was published online Sept. 29 in the journal Pediatrics.

The work also supports two ideas – that spending time in nature can help families and young children deal better with the stresses of the pandemic – and access for children in underserved neighborhoods is more than a nicety; it’s a necessity, Fyfe-Johnson said.

“What we walked away with feeling confident about was that nature exposure increases physical activity in children, and it also improves cognitive behavior and mental health in childhood,” said Fyfe-Johnson, an assistant professor with WSU’s Institute for Research and Education to Advance Community Health and Elson S. Floyd College of Medicine.

“The primary nature exposure we saw having an impact was residential green spaces and, secondarily, school green spaces, and that makes sense because that’s where children are commonly found. That’s not to say a backpacking trip doesn’t have a positive effect. There’s just not a lot of literature on that.”

In reviewing data, much of it also considered cognitive behavioral and mental health impacts. Those health issues are often intertwined with physical health outcomes beyond cardiovascular benefits, she said, such as how fitness can benefit mental health and reduce depression.

For outdoor physical activity, a majority of the studies measured that objectively, she said, meaning they often put accelerometers on kids for time spent in moderate to vigorous physical activity.

An accelerometer worn at the waist can measure how fast movement is and separate sitting, walking and running. Some studies used observers. It included studies in Europe and Australia, followed by the United States.

One of the reasons for the review is to put some hard evidence before policymakers, Fyfe-Johnson said. It should also back up the recommendations made to families by pediatricians based on the findings of the one study.

“Pediatricians in some ways really want to recommend and suggest that families take their kids outside, but to date, the literature has been so spread out that pediatricians didn’t have one paper that could summarize it all,” she said. “That’s why we published in Pediatrics. We wanted clinicians to have the evidence in one paper.

“It’s actually hard to get families to be more active and to make these behavioral changes, so it’s easier for clinicians to say, ‘Don’t worry about being physically active, just go outside as family, and we’re pretty confident you’ll be more physically active’ because of what this paper says.”

The review, which involved WSU and University of Washington researchers, also could influence school administration policies such as for recesses.

There is intuition that being outside is a good thing for kids, Fyfe-Johnson said. “But the problem is that policies don’t necessarily align with that intuition, so I often get questions in my research, don’t we already know this? I think in some ways we intuitively know, but we do need science and data to back up that intuition.

“What I wanted to do with this paper based on all the research that exists right now, what do we know about the impact of nature on health in childhood and what are some holes that we know we need to fill going forward?”

Although not specifically studied in the review, the work backs what’s known about underserved neighborhoods where nature access is less unattainable, she said.

Having access to nature isn’t equitable, she added, including where residents lack nearby parks or the transportation to get to natural areas. Changes in city policies might require that neighborhoods have a walkable distance to a park. A few places, such as Minneapolis, are enacting such measures, she said.

“We hoped we’d find a benefit because when you find that, yes, there is a benefit, then the next step is that all kids deserve this benefit. It’s not that being outside is nice and some people have access to a park and others don’t. There are health benefits to being outside for kids, and if there are health benefits, then that needs to be equitable.

“We know for example from COVID there are disproportionate impacts from COVID on marginalized communities. We know this for kids because they’re being less active. They’re struggling with mental health. So having access to nature particularly during COVID can have a meaningful impact.

“There is a little bit of accumulating evidence – not concrete – that marginalized communities have even larger benefits from nature exposure, although I want to be clear we did not examine that in this paper. But we thought it was relevant based on the access issues that are known.”

Other obstacles that can affect access to nature might be urbanization, increased screen time and more sedentary indoor lifestyles.

Separately, Fye-Johnson also has ongoing research into the health benefits of outdoor preschools. She initially worked on a one-year study that helped back a newly enacted law to license full-day outdoor preschools.

The 2018 pilot study found there was a 13%-14% reduction in overweight and obesity issues among kids who started at an outdoor preschool to the end of one academic year.

In general in Washington state for any preschools, children are recommended to get 60 minutes of outdoor time outside each day, she said.

“But it’s not a requirement, so there’s a difference,” she said. “A recommendation is something that’s a good idea.”

For a long time, recesses for all ages of students were considered a nicety, but the review suggests it is a necessity, she said. “It is important for cognitive health and academic success in school.”

Washington preschoolers on average get 30 minutes of outdoor time at school every day, Fyfe-Johnson said.

When children are home, and as the pandemic lingers, families should seek out green spaces regularly, she added.

“But if you are a family that doesn’t have a park nearby, that’s a real problem. That’s where we bring up the equity framework. If people are really struggling – and communities of color on average are struggling more – and they don’t have access to these outdoor spaces, it’s perpetuating inequities and health disparities.”

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