Where does physical activity fit into preschool postpandemic? A qualitative exploration with parents, teachers and administrators.

OBJECTIVES: During the preschool years, children depend on adult caregivers to provide opportunities for physical activity (PA). Research has focused on measuring PA in preschool, as well as barriers and facilitators to children's PA but caregiver perceptions remain largely unknown especially in light of the COVID-19 pandemic. This study aims to understand the value of PA in preschool following the pandemic from three types of adult caregivers, parents of a young child (n=7), preschool teachers (n=7) and preschool administrators (n=7). METHODS: In-depth qualitative interviews were conducted to explore the following research questions: (a) how do caregivers describe the importance of PA in preschool postpandemic? (b) how do caregivers support and prioritise PA in preschool postpandemic and what challenges do they face in doing so? and (c) how do caregivers interact with one another to promote PA? Qualitative answers were coded using a codebook developed to answer the research questions of interest. RESULTS: Parents, teachers and administrators all described valuing PA for preschoolers, but each caregiver type described a different way of promoting it. All the caregivers listed barriers that inhibit their ability to prioritise and promote PA, some heightened postpandemic. Lastly, there were limited caregiver interactions when it came to promoting PA, with the burden largely falling on teachers. CONCLUSION: Our findings indicate that one particularly important area for intervention is supporting parents, teachers and preschool administrators in creating a shared understanding of the importance of PA for young children and ways to collaborate to promote it.

Advocacy for Equitable Recess in Washington State.

Recess in schools is a critical opportunity for children to engage in important behaviors that can promote their health and well-being, and daily recess is recommended by the American Academy of Pediatrics and other national organizations. In Washington state, school recess is not equitably provided, with parents reporting a wide range from as little as 10 minutes to >45 minutes daily. State laws can help promote equitable and high-quality recess, but most states in the United States do not have recess laws. In 2023, a bill (Senate Bill 5257) mandating a minimum of 30 minutes of daily recess for all elementary students with provisions for other recess best practices (including not withholding recess as punishment and encouraging movement breaks for middle/high-schoolers) passed with bipartisan support in the Washington state Legislature and was signed into law. In this case study, we describe the process undertaken and lessons learned by the cross-sector coalition that spearheaded the advocacy efforts, which included pediatricians, parents, educators, community organizations, and youth.

Individual and Neighborhood Level Predictors of Children's Exposure to Residential Greenspace.

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.

Associations of residential green space with internalizing and externalizing behavior in early childhood.

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.

Physical activity and social interaction assessments in schoolyard settings using the System for Observing Outdoor Play Environments in Neighborhood Schools (SOOPEN).

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.

Physical activity and TV viewing parenting practices for toddlers among South Asian and white families in the UK: born in Bradford 1000 study.

BACKGROUND: Children of South Asian (SA) origin in the UK have lower levels of physical activity (PA), compared to their White counterparts. Parents play an important role in establishing PA habits among young children. The aim of this study was to compare PA and television (TV) viewing parenting practices for young children between SA British (SAB) and White British (WB) parents living in the UK. METHODS: We conducted a secondary analysis of the Born in Bradford (BiB) 1000 study, using survey data at child ages 24 and 36 months. The study sample included three groups of mothers (n = 1,149): foreign-born SAB (n = 458), UK-born SAB (n = 276), and WB (n = 455). Mothers completed a survey about parenting practices (i.e., PA supports, PA restrictions, TV viewing restrictions) at child age 24 months and child PA and TV viewing behaviors at child ages 24 and 36 months. Parenting practices were compared among the three groups. Multivariable linear regression analyses compared children's weekly walking frequency and daily TV viewing hours by parenting practices in the three groups. RESULTS: The foreign-born SAB group showed the lowest frequencies of PA-supportive parenting practices (verbal encouragement: 3.7 ± 3.1 times/week; logistic support: 1.5 ± 1.8 times/week) and the highest frequencies of PA-restrictive parenting practices (7.8 ± 7.7 times/week) among the three groups (p < 0.01). Children of Foreign-born SAB mothers had the most frequent TV watching during a mealtime (4.0 ± 3.1 times/week) among the three groups (p < 0.01). Less frequent PA-supportive parenting practices and SA ethnicity were associated with lower walking frequency at 24 and 36 months of age among children (p < 0.01). More frequent exposure to TV at mealtimes and SA ethnicity were associated with higher TV viewing time at 24 and 36 months of age among children (p < 0.01). CONCLUSIONS: This study demonstrated that SAB parents, particularly those who are foreign-born, apply parenting practices for their young children that are less supportive of PA and more supportive of TV viewing, and their children have lower PA and higher TV viewing time, compared with their WB counterparts.

Structural Inequities in Self-compassion and Parental Burnout.

Objectives: When parenting-related stressors and coping resources are chronically imbalanced, there is risk of parental burnout, and consequent negative impact on parent and child wellbeing. The objective of this study was to determine the relations between structural and social determinants of health inequities, self-compassion (a theoretically indicated coping practice), and parental burnout during the COVID-19 pandemic. Method: Participants were parents (n = 2324) with at least one child aged 4-17 in the household recruited from NORC's AmeriSpeak Panel (a probability-based panel providing coverage of 97% of the US household population). Parents completed an online or telephone questionnaire in English or Spanish in December 2020. Structural equation modeling was used to test a system of relations between income, race and ethnicity, parental burnout, and parent and child mental health. Indirect effects and moderation by self-compassion were also tested. Results: On average, parents experienced symptoms of burnout several days per week. Symptoms were the most frequent among parents with the least income, as well as female-identified and Asian parents. More self-compassion was associated with less parental burnout, and fewer parent and child mental health difficulties. Black and Hispanic parents were more self-compassionate compared to white parents, helping to explain similar levels of parental burnout and relatively better mental health outcomes, despite comparatively more stressors. Conclusions: Self-compassion is a potentially promising target for interventions aiming to address parental burnout; however, such efforts must not detract from critical structural changes to reduce parenting stressors, particularly those impacting parents experiencing systemic racism and other forms of socioeconomic disadvantage. Preregistration: This study is not preregistered. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02104-9.

Parent Behavior Management Training for Child ADHD Enhanced to Address Health Behaviors: Comparison of Telemedicine "Telegroup" Versus In-Person Delivery.

OBJECTIVE: ADHD is associated with suboptimal health behaviors including physical activity (PA). LEAP is a parent BMT group program enhanced to focus on health behaviors, integrated with mHealth technology. Little is known about implementing BMT via telemedicine "telegroups." METHODS: Children ages 5 to 10 with ADHD and their caregiver wore activity trackers and participated in an 8 to 9 week parent BMT and social media group emphasizing PA, sleep, and screen use. A 7-day child accelerometer-wear and parent and teacher measures were completed pre- and post-group. Groups were in-person prior to the COVID-19 pandemic and in telegroup format during the pandemic. RESULTS: Thirty-three families participated in person and 23 participated via virtual telegroup. Group attendance was superior for telegroup with equivalent satisfaction and skill use. Changes in health behavior and clinical outcomes were equivalent. CONCLUSIONS: LEAP is a feasible and novel BMT intervention that can be delivered in an accessible telegroup format with high participation and acceptability.

Feasibility and acceptability of at-home play kits for middle school physical activity promotion during the COVID-19 pandemic.

BACKGROUND: Schools are central to providing opportunities for youth physical activity (PA), however such opportunities were limited during the COVID-19 pandemic. Identifying feasible, acceptable, and effective approaches for school-based PA promotion amid pandemic-related barriers can inform resource allocation efforts in future circumstances necessitating remote instruction. The aims of this study were to: (1) describe the pragmatic, stakeholder-engaged and theory-informed approach employed to adapt one school's PA promotion efforts to pandemic restrictions, leading to the creation of at-home "play kits" for students, and (2) assess the feasibility, acceptability, and preliminary effectiveness of this intervention. METHODS: Intervention activities occurred in one middle school (enrollment: 847) located in a Federal Opportunity Zone in the Seattle, WA area, with control data from a nearby middle school (enrollment: 640). Students at the intervention school were eligible to receive a play kit during the quarter they were enrolled in physical education (PE) class. Student surveys were completed across the school year (n = 1076), with a primary outcome of days/week that the student engaged in ≥ 60 min of PA. Qualitative interviews (n = 25) were conducted with students, staff, parents, and community partners, and focused on play kit acceptability and feasibility. RESULTS: During remote learning play kits were received by 58% of eligible students. Among students at the intervention school only, students actively enrolled in PE (versus not enrolled) reported significantly more days with ≥ 60 min of PA in the previous week, however the comparison between schools was not statistically significant. In qualitative interviews, most students reported the play kit motivated them to participate in PA, gave them activity ideas, and made virtual PE more enjoyable. Student-reported barriers to using play kits included space (indoors and outdoors), requirements to be quiet at home, necessary but unavailable adult supervision, lack of companions to play outdoors, and inclement weather. CONCLUSIONS: A pre-existing community organization-school partnership lent itself to a rapid response to meet student needs at a time when school staff and resources were highly constrained. The intervention developed through this collaborative response-play kits-has potential to support middle school PA during future pandemics or other conditions that necessitate remote schooling, however modifications to the intervention concept and implementation strategy may be needed to improve reach and effectiveness.

Barriers and facilitators to comprehensive, school-based physical activity promotion for adolescents prior to and during the COVID-19 pandemic: a qualitative study.

This study aimed to identify barriers and facilitators to comprehensive, school-based physical activity (PA) promotion among adolescents prior to and during the coronavirus disease of 2019 (COVID-19) pandemic, considering the perspectives of students, parents, and school staff. Data were collected from 2020 to 2021 using semi-structured individual interviews with students (n = 15), parents (n = 20), and school staff (n = 8) at a Title I middle school (i.e. high percentage of students from low-income families). Two theoretical frameworks guided analysis: the Comprehensive School Physical Activity Program framework and Bronfenbrenner's ecological systems theory. Using an iteratively developed codebook, data were coded, thematically analyzed, and synthesized. PA barriers and facilitators were present throughout the school day, at home, and in the community. Key determinants included pandemic-induced challenges (e.g. COVID-19 exposure); neighborhood characteristics/weather (e.g. neighborhood safety); school-family communication/collaboration; implementation climate (i.e. school staff's support for programming); time, spatial, and monetary resources (e.g. funding); staffing capacity/continuity and school champions; staffing creativity and adaptability; PA opportunities before, during, and after school; and child's motivation/engagement. Efforts to improve school-based PA programs, irrespective of pandemic conditions, should include strategies that address factors at the community, school, family and individual levels. School-family communication/collaboration, school staff programming support, and PA opportunities throughout the day can help promote comprehensive, school-based PA.

A 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.

Problematic Child Media Use During the COVID-19 Pandemic.

OBJECTIVES: Assess how family stressors (including structural stressors, social determinants of health inequities, and parent psychological distress) relate to media rule implementation and problematic child media use during the coronavirus disease 2019 pandemic. METHODS: Nationally representative survey of 1000 United States parents with at least one 6 to 17 year old child was conducted in October through November 2020. RESULTS: Problematic use was greater in families where parents were employed full time, present in the home (eg, working from home), had low levels or formal educational attainment, and were experiencing more psychological distress. Although there was a small decline in the number of media-related rules implemented during the pandemic (fewer parents enforced screen limits on weekdays or weekends or limited screen use at mealtimes), there was no association between rule implementation and problematic media use. CONCLUSIONS: Family stressors were associated with problematic child media use during the coronavirus disease 2019 pandemic. As we emerge from the pandemic, it will be important to help parents adjust their family's media practices cognizant of the fact that additional children may have developed problematic screen use behaviors. Such efforts should center the role of structural and social determinants of health inequities on the stressors that families experience and that impact media use.

Cross-sectional association of light sensor-measured time outdoors with physical activity and gross motor competency among U.S. preschool-aged children: the 2012 NHANES National Youth Fitness Survey.

BACKGROUND: Time spent outdoors (outdoor time) has been suggested to be beneficial for physical activity (PA) and healthy development among preschool-aged children. The aim of this study was to quantify PA level and gross motor competency associated with light sensor-measured daily outdoor time in a representative sample of U.S. children aged 3 to 5 years. METHODS: The study sample included 301 participants (149 girls) aged 3 to 5 years from the 2012 U.S. National Health and Examination Survey National Youth Fitness Survey. ActiGraph GT3X+ accelerometers with a built-in ambient light sensor were used to measure PA (expressed in monitor-independent movement summary [MIMS]) and outdoor time. The Test of Gross Motor Development-Second Edition (TGMD-2) was used to assess gross motor skills. Multivariable linear regression models were fit to predict daily and gross motor scores by daily outdoor time. RESULTS: Average daily outdoor time was 95 min (median of 84 min; interquartile range of 52 to 123 min). Means of daily outdoor time and daily MIMS were not significantly different between boys and girls. Among girls, every additional 10 min of daily outdoor time was associated with an additional 540 daily total MIMS (95% CI = 372, 708). Among boys, every additional 10 min of daily outdoor time was associated with an additional 296 daily total MIMS (95% CI = 131, 460). Every additional 10 min of daily outdoor time was associated with a 0.1-point (95% CI = 0.001, 0.130) higher object control standard score. Daily outdoor time was not associated with a locomotor standard score. CONCLUSIONS: In a representative sample of U.S. preschool-aged children, daily outdoor time was positively associated with daily PA. The contribution of outdoor time to PA was greater among girls than boys, suggesting that providing outdoor opportunities is critical for promoting PA, particularly among girls.

Park access and mental health among parents and children during the COVID-19 pandemic.

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 (ß: -1.26, 95% CI: -2.25, -0.27) and a lower PHQ-4 total score among parents (ß: -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 (ß: 1009 MET-min/week, 95% CI: 301, 1717), but not child physical activity (ß: 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 outdooractivity 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.

Needs assessment for physical activity information during COVID-19 among a nationally representative sample of parents and children ages 6-17 in the United States: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic presented novel barriers to youth physical activity engagement. Identifying what resources parents and children are interested in receiving can support efforts to mitigate the negative impact of the pandemic on youth physical activity behavior. This study aimed to identify physical activity-related information needs during the COVID-19 pandemic among a nationally representative sample of American parents of children 6-10 years-old and parent-child dyads of children 11-17 years-old. METHODS: A cross-sectional survey was conducted by a market research company in October-November 2020. Parents and children were asked about their interest in specific types of information about helping their family and themselves, respectively, be active (Yes/No). Weighted percentages were calculated for reported information needs and compared using two-sample test of proportions. RESULTS: Final analytic sample was 1000 parents (55.4% female; 74.7% White; 74.0% non-Hispanic); 500 children 11-17 years-old (52.1% male; 77.6% White). Over 40% of participants were interested in information about being active during COVID-19. Parents were more likely to be interested in information if they always (versus never) worked from home [53.3% (95% CI: 43.3-63.0%) versus 22.0% (95% CI: 14.9-31.3%), p < 0.001]; had children attending school remotely versus in-person [47.3% (95% CI:40.2-54.5%) versus 27.5% (95% CI: 19.6-37.1%), p < 0.001]; and lived in a big city versus a rural area [66.5% (95% CI:54.5-76.7%) versus 34.1% (95% CI: 22.8-47.6%), p < 0.001]. Children most interested were those who did not have resources for online activity engagement and those worried about their safety or getting infected with COVID-19. Children were also more likely to be interested if their parents worked full-time versus not working [48.6% (95% CI:41.7-55.6%) versus 31.5% (95% CI: 24.1-39.9%), p < 0.001], and lived in a big city versus a rural area [57.2% (95% CI:45.3-68.3%) versus 27.8% (95% CI:17.8-40.7%), p < 0.001]. CONCLUSIONS: Families are interested in physical activity resources, particularly those whose daily routines and opportunities for physical activity may have been most significantly impacted by the pandemic. This includes parents who always worked from home or whose children attended school remotely. Identifying felt needs is an important step in developing tailored interventions that aim to effectively and sustainably support families in promoting physical activity.

Association of Children's Physical Activity and Screen Time With Mental Health During the COVID-19 Pandemic.

Importance: Children's physical activity and screen time are likely suboptimal during the COVID-19 pandemic, which may influence their current and future mental health. Objective: To describe the association of physical activity and screen time with mental health among US children during the pandemic. Design, Setting, and Participants: This cross-sectional survey was conducted from October 22 to November 2, 2020, among 547 parents of children aged 6 to 10 years and 535 parent-child dyads with children and adolescents (hereinafter referred to as children) aged 11 to 17 years and matched down to 500 children per cohort using US Census-based sampling frames. Children aged 11 to 17 years self-reported physical activity, screen time, and mental health, and their parents reported other measures. Parents of children aged 6 to 10 years reported all measures. All 1000 cases were further weighted to a sampling frame corresponding to US parents with children aged 6 to 17 years using propensity scores. Exposures: Child physical activity, screen time, COVID-19 stressors, and demographics. Main Outcomes and Measures: Mental health using the Strengths and Difficulties Questionnaire for total difficulties and externalizing and internalizing symptoms. Results: Among the 1000 children included in the analysis (mean [SD] age, 10.8 [3.5] years; 517 [52.6%] boys; 293 [31.6%] American Indian/Alaska Native, Asian, or Black individuals or individuals of other race; and 233 [27.8%] Hispanic/Latino individuals), 195 (20.9%) reported at least 60 minutes of physical activity every day. Children reported a mean (SD) of 3.9 (2.2) d/wk with at least 60 minutes of physical activity and 4.4 (2.5) h/d of recreational screen time. COVID-19 stressors were significantly associated with higher total difficulties for both younger (ß coefficient, 0.6; 95% CI, 0.3-0.9) and older (ß coefficient, 0.4; 95% CI, 0.0-0.7) groups. After accounting for COVID-19 stressors, engaging in 7 d/wk (vs 0) of physical activity was associated with fewer externalizing symptoms in younger children (ß coefficient, -2.0; 95% CI, -3.4 to -0.6). For older children, engaging in 1 to 6 and 7 d/wk (vs 0) of physical activity was associated with lower total difficulties (ß coefficients, -3.5 [95% CI, -5.3 to -1.8] and -3.6 [95% CI, -5.8 to -1.4], respectively), fewer externalizing symptoms (ß coefficients, -1.5 [95% CI, -2.5 to -0.4] and -1.3 [95% CI, -2.6 to 0], respectively), and fewer internalizing symptoms (ß coefficients, -2.1 [95% CI, -3.0 to -1.1] and -2.3 [95% CI, -3.5 to -1.1], respectively). More screen time was correlated with higher total difficulties among younger (ß coefficient, 0.3; 95% CI, 0.1-0.5) and older (ß coefficient, 0.4; 95% CI, 0.2-0.6) children. There were no significant differences by sex. Conclusions and Relevance: In this cross-sectional survey study, more physical activity and less screen time were associated with better mental health for children, accounting for pandemic stressors. Children engaged in suboptimal amounts of physical activity and screen time, making this a potentially important target for intervention.

Nature and Children's Health: A Systematic Review.

CONTEXT: Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health. OBJECTIVE: We systematically evaluated evidence regarding the relationship between nature contact and children's health. DATA SOURCES: The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021. STUDY SELECTION: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms. DATA EXTRACTION: Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed. RESULTS: The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design. LIMITATIONS: Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality. CONCLUSIONS: Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.

Socioeconomic Inequities in Youth Participation in Physical Activity and Sports.

Access to opportunities for physical activity and sports, and therefore potential benefits of participation, are distributed inequitably. The aims of this study were to describe and compare youth experiences related to sport and physical activity by socioeconomic factors. A cross-sectional survey was conducted of students in 5-12th grades in King County, Washington, USA. Students were asked about physical activity and sports experiences and about demographic factors including family affluence, which was categorized as low, medium, and high. Participants were 1038 youth (50% girls, 58% non-White, and 32% from homes where languages other than English are spoken). Children from low-affluence families reported fewer days/week of physical activity, fewer sports sampled, and lower rates of ever playing sports. Greater proportions of children from low-affluence families reported these barriers to sports: (1) don't want to get hurt, (2) don't feel welcome on teams, (3) too expensive, and (4) transportation. Middle school children from high-affluence families had three times higher odds of meeting physical activity recommendations, and high-affluence high schoolers had three times higher odds of ever participating in sports compared to peers from low-affluence families. Socioeconomic status was inversely associated with outcomes related to youth physical activity and sports participation. The disproportionately reported barriers to sports participation are modifiable, and cross-sector solutions can help promote play equity.

Evaluating the Feasibility and Acceptability of the Lifestyle Enhancement for ADHD Program.

OBJECTIVE: To evaluate the feasibility and acceptability of the Lifestyle Enhancement for Attention Deficit Hyperactivity Disorder (ADHD) Program (LEAP), a novel parent behavior management training program that promotes physical activity (PA) and positive health behaviors and is enhanced with mobile health technology (Garmin) and a social media (Facebook) curriculum for parents of children with ADHD. METHODS: The study included parents of children ages 5-10 years diagnosed with ADHD who did not engage in the recommended >60 min/day of moderate to vigorous PA based on parent report at baseline. Parents participated in the 8-week LEAP group and joined a private Facebook group. Children and one parent wore wrist-worn Garmin activity trackers daily. Parents completed the Treatment Adherence Inventory, Client Satisfaction Questionnaire, and participated in a structured focus group about their experiences with various aspects of the program. RESULTS: Of 31 children enrolled, 51.5% had ADHD combined presentation, 36.3% with ADHD, predominately inattentive presentation, and 12.1% had unspecified ADHD (age 5-10; M = 7.6; 48.4% female). Parents attended an average of 86% of group sessions. On average, parents wore their Garmins for 5.1 days/week (average step count 7,092 steps/day) and children for 6.0 days/week (average step count 9,823 steps/day). Overall, parents and children were adherent to intervention components and acceptability of the program was high. CONCLUSIONS: Findings indicate that the LEAP program is an acceptable and feasible intervention model for promoting PA among parents and their children with ADHD. Implications for improving ADHD symptoms and enhancing evidence-based parent training programs are discussed.