Fact Sheet: Children's Health and Nature (page 3)
Current State of Children’s Health
Our children may be the first generation at risk of having a shorter lifespan than their parents . Sedentary lifestyle and physical inactivity have contributed greatly to the numerous health problems plaguing today’s children. Chronic conditions such as childhood obesity, asthma, and attention-deficit disorder have all increased over the past few decades . These chronic conditions may lead to pulmonary, cardiovascular, and mental health problems in adulthood. Outdoor activity in the natural environment has taken a back seat to television, video games, the computer, and a demanding schoolwork and extracurricular schedule. Today’s youth are losing the contact with the natural environment that is potentially beneficial for their health and well-being.
Approximately 16% of US children (~ 9 million) aged 6-19 are overweight or obese . According to the Institute of Medicine, childhood obesity has doubled over the past 30 years for preschoolers and adolescents, and more than tripled for children aged 6-11 years old .
Type-2 Diabetes Due to the drastic increase in the prevalence of pediatric diabetes over the past few decades, the definition has changed from “adult-onset” diabetes to type-2 diabetes. Approximately 176,500 children and adolescents suffer from diabetes .
Asthma Currently 9.4% of children in the US have asthma . Overweight children are at an increased risk for developing asthma and other respiratory problems and for being hospitalized for asthma [7, 8].
Hypertension 1 in 10 children with a BMI* within or above the 95th percentile have hypertension (vs. only 2.6% with a BMI <85th percentile) .
Cardiovascular Disease Overweight adolescents are at increased risk of coronary heart disease and earlier death . Most overweight children have at least one risk factor for cardiovascular disease, including higher cholesterol levels, abnormal glucose tolerance, high blood pressure, and elevated triglycerides . The American Academy of Pediatrics recommends screening overweight children for high cholesterol and prescribing cholesterol-lowering drugs if needed .
*BMI = Body- mass index; calculated using the formula: weight (lb) / [height (in)] 2 x 703. To calculate BMI for children/adolescents, visit: http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx.
Attention-Deficit/Hyperactivity Disorder (ADD/ADHD)
According to the Centers for Disease Control and Prevention (CDC), ADD/ADHD is a serious public health problem that impacts approximately 4.3% of children aged 4-17 years old . It impairs school performance and socialization and may persist into adulthood.
Lack of an appropriate amount of vitamin D in children can cause rickets; a disease characterized by bone deformities and growth retardation. Long term deficiency can lead to osteoporosis. Sunlight exposure for 10-15 minutes at least twice a week is sufficient for the body to produce the necessary amount of vitamin D .
Nature and Health
Unstructured outdoor play time is important for children’s overall well-being. How does nature play a role in children’s health? Highlights of published literature supporting the health benefits of the natural environment are presented below.
Nearby Nature: A Buffer of Life Stress Among Rural Children 
Childhood stress has become an increasing issue of concern for pediatricians in America. The workload of school and extracurricular activities has the potential to create more stress upon a child, which can affect the child’s development. Evidence has shown that the outdoors is a stress reliever to highly stressed children. A study examined whether nearby nature acts as a buffer of life stress among rural elementary school children. The authors determined if the child lived near a natural environment, and then examined the child’s self-worth and levels of psychological distress. Contact with nature not only decreased their stress, but higher amounts of exposure to natural environments indicated lower levels of stress in a child.
Coping with ADD: The Surprising Connection to Green Play Settings 
An increasing amount of evidence is showing that exposure to natural environments can mitigate a child’s attention disorder. Experimenters of a 2001 study analyzed this concept by surveying parents to compare their child’s attentional functioning when engaging in leisure activities in indoor vs. outdoor settings. Results included that children had better attentional functioning after activities in greener settings. The greener the setting, the less severe the symptoms of the child’s attention disorder.
A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder. Evidence from a National Study 
A follow-up nationwide study published in The American Journal of Public Health by the same authors examined if “green” settings reduced symptoms of ADHD. Green outdoor after-school and weekend activities were compared to activities that were in built indoor and outdoor settings. They found that “green outdoor activities reduced symptoms significantly more than did activities conducted in other setting, even when matched across all settings”. However, this study was not randomized or controlled, and the “green activities” were not uniformly defined. The authors published an August 2008 study in The Journal of Attention Disorders showing that a 20-minute walk in nature is associated with better concentration in children with ADHD . Further research on this subject will help us better understand the true impact of the natural environment on attention functioning.
Outdoor Activity Reduces the Prevalence of Myopia in Children 
A population-based study published in 2008 determined if near-distance, mid-distance, and outdoor activities were associated with the prevalence of the eye condition myopia in 4,132 children aged 6 and 12. Authors found that higher levels of outdoor time spent was associated with less myopia and increased hyperopic mean refraction in 12 year old participants. Children with high near-distance activity and low outdoor activity had two- to three-fold higher odds of having myopia than normal. Authors concluded that more research is needed in this matter; however, outdoor activity should be promoted by the public health community and included in school curricula.
Children Living in Areas with More Street Trees Have Lower Prevalence of Asthma 
A recent ecological study conducted in New York City has suggested that being exposed to a natural environment may be protective against early childhood asthma. Streets with a high tree density were positively associated with a lower prevalence of early childhood asthma in 4-5 year olds. Further research is currently being conducted to determine the extent to which the trees play a role in the control of pediatric asthma.
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