The missing middle of childhood

Climate change and child wellbeing: a systematic evidence and gap map on impacts, mitigation, and adaptation

We developed a systematic evidence and gap map (2014-24) to assess how climate change impacts, mitigation, and adaptation affect the wellbeing of children aged 0-18 years globally, and discussed findings with the Children in All Policies 2030 Youth Advisory Board. Health was the most researched child wellbeing domain (84%; 948 of 1127 studies), followed by education (15%; n=171), and food security and nutrition (14%; n=160). Research on children's agency and resilience, displacement, socioeconomic distress, and safety received less attention. Health research gaps included limited studies on vector-borne diseases, children's mental health beyond post-traumatic stress disorder, and health outcomes for children aged 5-18 years. Mitigation and adaptation research focused largely on educational (45%; 114 of 252 studies) and behavioural changes (31%; n=79), with gaps in the evaluation of financing, infrastructure, technology, clean energy, and policy actions. Youth advisory board members emphasised the importance of schools, social media, and intergenerational dialogue in driving climate action while protecting children's wellbeing.

Typologies of activity-related behaviours during adolescence and their transitions: a longitudinal analysis of the ELSPAC cohort

OBJECTIVES

The objective of this study was to identify typologies of activity-related behaviours during adolescence and to explore transitions between the identified typologies. Additionally, we aimed to identify demographic indicators associated with the transitions and typology membership.

DESIGN

Prospective cohort study.

SETTING

Czech Republic.

PARTICIPANTS

Individuals involved in the Czech part of the European Longitudinal Study of Pregnancy and Childhood study, aged 11 to 18 years. The study involved over 563 individuals, of whom 380 provided complete data for the analysis.

PRIMARY OUTCOME MEASURES

Time spent outdoors, participation in organised physical activity (PA) and sport activities, time spent watching television and using a personal computer, and total sleep duration at ages 11, 15 and 18 years. Typologies were identified using Latent Transition Analysis.

RESULTS

Four typologies of activity-related behaviours were identified and labelled to reflect their behavioural profiles: (1) Actives (high outdoor time and organised PA and sport participation, low screen time and optimal sleep duration); (2) Active screeners (median outdoor time, high organised PA and sport participation, high screen time, and optimal sleep duration); (3) Poor sleepers (average outdoor time and organised PA and sport participation, low screen time and not meeting sleep guidelines) and (4) Averages (average duration of all behaviours and optimal sleep duration). A major shift in typology membership from 11 to 18 years was observed, with a decreasing proportion of individuals in typologies characterised by a high proportion of outdoor time and participation in organised PA and sport activities (ie, Actives; Active screeners). A high proportion of individuals also transitioned to the typology with poor sleeping habits (ie, Poor sleepers). Sex and maternal education were associated with the typology membership and transition probabilities (p<0.05).

CONCLUSIONS

Targeting lifestyle interventions to those with specific lifestyle patterns in early adolescence may be beneficial for reducing the risk of poor sleep and promoting healthy lifestyle patterns later in life.

Care Competencies Training Enhances Adolescents' Well-being: A Randomized Controlled Trial

Objective: This intervention study seeks to assess the impact of a care competencies training program on students' well-being. Method: This randomized controlled trial involved 191 Vietnamese adolescents (65.4% female, Mage = 16 years and 8 months) in a 7-week intervention study that used video vignettes to build their care competencies. Validated scales were used to determine their care competencies (Care Competencies Questionnaire for Adolescents) and well-being (Strengths and Difficulties Questionnaire, Perceived Stress Scale and Satisfaction with Life Scale) at three points in time: before, immediately after, and two months after the intervention. The full-information maximum likelihood approach was applied to latent growth curve modeling (LGM) in Mplus 8.5 to estimate the initial level (i.e., intercept) and the change (i.e., slope) in care competencies and well-being among adolescents over time. Factor scores of LGMs were saved for correlation and multiple linear regression analysis by using SPSS (version 26.0) to explore the relationships between the changes in care competencies/failures and the changes in well-being. Results: Results showed that, next to a significant increase in care competencies and a significant decrease in care failures, other well-being variables also significantly changed in the intervention group. In the intervention group, but not in the control group, changes in care competencies and failures consistently and significantly predicted changes in well-being. Conclusion: The results support the potential of the video vignette-based intervention to promote the development of adolescents' care competencies.

Child health prioritisation in national adaptation policies on climate change: a policy document analysis across 160 countries

Integration of child-specific adaptation measures into health policies is imperative given children's heightened susceptibility to the health impacts of climate change. Using a document analysis method, we examined 160 national adaptation policies for inclusion of child-relevant measures and identified 19 child health-related adaptation domains. 44 (28%) of 160 countries' policies that were analysed failed to include any domains, 49 (31%) included at least one child-related domain, 62 (39%) included between two and six domains, and five (3%) included at least seven domains. Predominant domains among child-specific adaptation measures included education and awareness raising, followed by community engagement and nutrition. No country addressed children's direct needs in the domain of mental health. National adaptation policies tend towards overly simple conceptualisations of children across four major lenses: age, social role, gender, and agency. Limited inclusion of child-specific measures in national adaptation policies suggests insufficient recognition of and action on children's susceptibility to climate change effects.

Green Space and Internalizing or Externalizing Symptoms Among Children

Importance

Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare.

Objective

To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms.

Design, Setting, and Participants

Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included.

Exposures

Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment.

Main Outcome and Measures

Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples.

Results

Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood.

Conclusions and Relevance

In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.