Position Statement on Active Outdoor Play

"Can I Play Too?" A Qualitative Study of Outdoor Play and Participation Among Autistic Preschoolers

IMPORTANCE

Outdoor play in homes, schools, and communities provides children with unique opportunities to explore their worlds, develop fundamental life skills, and experience belonging. However, few studies have explored outdoor free play among autistic preschoolers in natural settings from a neurodivergent-informed perspective.

OBJECTIVE

To explore the play preferences, opportunities, and challenges in outdoor play for autistic preschoolers.

DESIGN

In this qualitative study, the authors used a multimethod approach to data collection using visual, verbal, and projective techniques and thematic analysis to identify and describe outdoor play occupation as expressed by autistic preschoolers.

SETTING

Home, community, and preschool environments in a city in Ireland.

PARTICIPANTS

Seven autistic children and their parents, from seven diverse preschool settings in Ireland.

RESULTS

Two overarching themes were identified: (1) outdoor play preferences and meaning and (2) the physical and social environments of outdoor play. The findings suggest that autistic preschoolers demonstrate distinctive play styles and preferences when playing freely outdoors, with physical and social barriers to outdoor play existing in community and educational contexts.

CONCLUSIONS AND RELEVANCE

The findings suggest that autistic preschoolers' outdoor play styles and preferences require support from adult advocates. Although the importance of relationships and social play cannot be overlooked, infrastructural accommodations for parents and schools are required if we are to create supportive and inclusive outdoor play environments and opportunities for freedom of expression for autistic children. Plain-Language Summary: This study explored the distinctive outdoor play preferences, opportunities, and challenges for autistic preschoolers. The findings show that autistic preschoolers face physical and social barriers to outdoor play and that they need parents, schools, and communities to create supportive and inclusive play environments and opportunities for freedom of expression.

Play as Occupation: The State of Our Science and a Research Agenda for the Profession

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.

Exploring the world of active play: A comprehensive review of global surveillance and monitoring of active play based on the global matrix data

A valid assessment tool that measures active play is not yet available due to the sporadic and spontaneous nature of play, as well as the potential differences in how active play is understood and measured across different age groups, cultures, and contexts. The purpose of this review was to identify the scope and gaps in the measurement of active play based on data gathered from 68 countries that participated in the Global Matrix (GM) initiative, led by the Active Healthy Kids Global Alliance (AHKGA). GM is the global-level, biennial evaluation system of physical activity related behaviors among children and youth, including the Active Play indicator, and the sources of influence using letter grades (ranging between "A" and "F"). Based on the identified scope and gaps, this study offers recommendations for future research dedicated to the measurement/surveillance of active play. Out of the 68 countries involved in the previous GM (2014-22), 55% of the grades remained unassigned due to insufficient data on the Active Play indicator. The high number of unassigned grades, combined with the absence of valid measurement tool, highlight a need for a standardized measurement tool for improved global data generation of active play among children and youth. Our findings emphasize the need to address challenges in measuring active play. This review offers future considerations, research recommendations specific to the GM initiative, and two sets of age- and location-specific (indoor and outdoor settings) questionnaire items along with guidelines for its use. Together, these elements provide a roadmap for guiding future research and evaluation efforts on active play.

Validation of an Instrument That Measures Factors Affecting Saudi Parents' Tolerance of Risky Play: A Rasch Analysis

IMPORTANCE

Benefits of children's participation in risky play are broadly recognized. However, most related research originates in Western countries; none focuses on outdoor play in Eastern countries, including Saudi Arabia. Furthermore, although the literature identifies varying perspectives on risky play among parents, there is no objective measure to assess personal, situational, and cultural factors shaping their risk tolerance.

OBJECTIVE

To establish the construct validity and internal reliability of data gathered with the newly developed Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS).

DESIGN

Instrument development.

SETTING

Online survey.

PARTICIPANTS

Ninety Saudi parents with children ages 7 to 10 yr.

OUTCOMES AND MEASURES

The FAC-TRiPS, a 17-item, self-report measure. We used Rasch analysis (Winsteps 4.4.4) to establish evidence for construct validity (item fit, match of item difficulty and parent tolerance, principal-components results) and internal reliability (person reliability index).

RESULTS

Item fit analysis revealed that data from 15 of 17 items (88%) conformed to Rasch model expectations. Item difficulty closely matched parents' risk tolerance level. The principal-components analysis of residuals demonstrated that observed variance (49.6%) closely matched expected variance (49.7%). The first contrast's unexplained variance had an eigenvalue slightly greater than 2.5, suggesting possible multidimensionality. The person reliability index was .90.

CONCLUSIONS AND RELEVANCE

Preliminary analysis suggests that the FAC-TRiPS yields valid, reliable data measuring factors that influence parents' risk tolerance. Further research is needed. Plain-Language Summary: This study contributes to the knowledge of how parents in Eastern countries perceive risky play. The Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS) is a newly developed tool that occupational therapy practitioners can use to understand parents' beliefs about and tolerance for their children's participation in risky play. The findings facilitate an understanding of the complex nature of parenting when determining whether to allow children to participate in risky play activities.

Examining associations between physical activity context and children meeting daily physical activity guidelines: the role of outdoor play, sports, and other organized activities

Background

Less than one-quarter of US children meet physical activity (PA) guidelines. Understanding the context in which PA occurs and how these contexts may play a role in meeting PA guidelines is an essential step toward developing effective behavioral interventions. The purpose of this study was to examine associations between PA context (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines in a representative sample of children living in Texas.

Methods

We analyzed cross-sectional data from a statewide sample of fourth-grade children in Texas who completed the 2019-2020 Texas School Physical Activity and Nutrition (Texas SPAN) survey. The Texas SPAN survey was designed to monitor the statewide prevalence of overweight/obesity among school children and assess habitual self-reported obesity-related behaviors, including diet and PA. Weighted Poisson regression models were employed to examine the associations between PA contexts (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines, adjusting for sex, race/ethnicity, overweight/obesity, urban-rural status, and economic disadvantage.

Results

A total of 16.7% of fourth-grade children met physical activity guidelines every day during the week (mean age = 9.4 ± 0.6 years; female = 48.7, 51.8% Hispanic, mean days meeting PA guideline = 3.6 ± 2.3 days). One in ten (11.2%) children did not meet daily PA guidelines on any day of the week, and 72.1% met them between 1 and 6 days. Participating in sports (b = 0.22, 95%CI:0.14, 0.30), any other organized physical activities (b=0.13, 95%CI:0.017, 0.19), and playing outdoors 1-3 days (b = 0.25, 95%CI:0.04, 0.46) and 4-7 days in the past week (b = 0.77, 95%CI:0.57, 0.97) was significantly and positively associated with the number of days children met PA guidelines.

Conclusion

Participating in sports, participating in other organized physical activities, and playing outdoors may beneficially influence the number of days children meet PA guidelines. PA programs should consider these contextual factors and investigate how to promote organized activities and outdoor play effectively and appropriately among children.

An updated systematic review of correlates of children's physical activity and sedentary time in early childhood education services

BACKGROUND

Early childhood education services (ECE) continue to be a key setting to promote physical activity and limit sedentary behaviour. Thus, the aim of this study was to (1) provide an updated systematic review of correlates of physical activity and sedentary behaviour among children in ECE settings and (2) discuss changes in physical activity and sedentary behaviour correlates among children in ECEC settings over time.

METHODS

A systematic search of eight databases identified 40 studies published between 2015 and 2023 that met the inclusion criteria. The variables were categorized into four domains (child, educator, physical environmental and organizational). Fifty-eight variables were identified.

RESULTS

For data from 2015 to 2023, strong associations were identified in all domains (child, educator, physical environmental and organizational) for physical activity, yet no strong associations for sedentary behaviour were identified. Aggregated data (i.e., combining data from previous review and this review) showed strong associations with children's physical activity and age, motor coordination and sex (child), educator behaviour and presence (educator), presence and size of outdoor environments (physical environmental) and active opportunities and service quality (organizational). For sedentary behaviour, sex, outdoor environments and active opportunities were strongly associated in the combined data.

CONCLUSION

The correlates of physical activity and sedentary behaviour in ECE settings continue to be multi-dimensional and span different domains. Variables such as educator behaviours and intentionality, provision of active opportunities, use of outdoor space and service quality should be the key focus area for improving physical activity and sedentary behaviour levels of young children.

Opportunities for risk-taking during play alters cognitive performance and prefrontal inhibitory signalling in rats of both sexes

Social play behaviour is a rewarding activity that can entail risks, thus allowing young individuals to test the limits of their capacities and to train their cognitive and emotional adaptability to challenges. Here, we tested in rats how opportunities for risk-taking during play affect the development of cognitive and emotional capacities and medial prefrontal cortex (mPFC) function, a brain structure important for risk-based decision making. Male and female rats were housed socially or social play-deprived (SPD) between postnatal day (P)21 and P42. During this period, half of both groups were daily exposed to a high-risk play environment. Around P85, all rats were tested for cognitive performance and emotional behaviour after which inhibitory currents were recorded in layer 5 pyramidal neurons in mPFC slices. We show that playing in a high-risk environment altered cognitive flexibility in both sexes and improved behavioural inhibition in males. High-risk play altered anxiety-like behaviour in the elevated plus maze in males and in the open field in females, respectively. SPD affected cognitive flexibility in both sexes and decreased anxiety-like behaviour in the elevated plus maze in females. We found that synaptic inhibitory currents in the mPFC were increased in male, but not female, rats after high-risk play, while SPD lowered prefrontal cortex (PFC) synaptic inhibition in both sexes. Together, our data show that exposure to risks during play affects the development of cognition, emotional behaviour and inhibition in the mPFC. Furthermore, our study suggests that the opportunity to take risks during play cannot substitute for social play behaviour.

Associations between outdoor play features and children's behavior and health: A systematic review

The decline of children's opportunities to play outdoors raises a new concern about the quality of outdoor play environments, and their developmental and well-being benefits for children. This systematic review aims to synthesize the associations between outdoor play features and children's behavior and health. PRISMA guidelines were followed (2021). The inclusion criteria were studies with children aged between 5 and 12 (Population); that addressed presence, absence or disposition of equipment, natural elements, loose parts, resources availability, type of terrain and space modifications (Intervention or Exposure); in pre-post intervention or between groups (Comparison); related to health and behavior in different domains (Outcomes); with an experimental, observational, descriptive or longitudinal design (Study design). Indoor context, adult-led activities and structured activities were excluded. A literature search of five databases (PubMed, Web of Science, ERIC, Scopus, and PsycINFO) was concluded in March 2022. After identifying 28,772 records, duplicates and irrelevant titles were removed, and abstracts and full-text articles were screened in duplicate. The remaining 51 eligible articles (45 primary studies) were assessed for risk of bias with QualSyst. A narrative synthesis of the results was conducted. The most frequent behavioral or health outcome addressed was physical activity. Included studies focused on the following space features: fixed structures, space naturalness, floor markings, loose parts/equipment, area available, and the combination of factors. Although some positive effects were found, the heterogeneity between studies did not allow to draw firm conclusions on the effects of each environmental feature on primary children's health and behavior. Systematic review registration: PROSPERO CRD42020179501.

Correlates of Physical Activity in Children from Families Speaking Non-official Languages at Home: a Multi-site Canadian Study

BACKGROUND

Children from families speaking a non-official language at home may be particularly at risk for low physical activity (PA), underscoring a need to investigate correlates of PA in this subpopulation.

METHODS

We recruited 478 children in 37 schools stratified by area-level socioeconomic status (SES) and type of urbanization within three regions of Canada. Steps/day were measured using SC-StepRx pedometers. We assessed potential social-ecological correlates with child and parent surveys. We used gender-stratified linear mixed models to examine the correlates of steps/day.

RESULTS

Outdoor time was the strongest correlate of boys' and girls' PA. Lower area-level SES was associated with less PA among boys, but outdoor time attenuated this difference. The strength of association between outdoor time and PA decreased with age in boys and increased with age in girls.

DISCUSSION

Outdoor time was the most consistent correlate of PA. Future interventions should promote outdoor time and address socioeconomic disparities.

The Associations Between Parental-Reported and Device-Based Measured Outdoor Play and Health Indicators of Physical, Cognitive, and Social-Emotional Development in Preschool-Aged Children

PURPOSE

Examine in preschool-aged children: (1) the associations between parental-reported and device-measured outdoor play (OP) and health indicators of physical, cognitive, and social-emotional development and (2) whether associations were independent of outdoor moderate- to vigorous-intensity physical activity (MVPA).

METHODS

This cross-sectional study included 107 participants. Children's OP was measured via a parental questionnaire and the lux feature of accelerometers. Children's growth, adiposity, and motor skills were assessed as physical development indicators. Visual-spatial working memory, response inhibition, and expressive language were assessed as cognitive development indicators. Sociability, prosocial behavior, internalizing, externalizing, and self-regulation were assessed as social-emotional development indicators. Regression models were conducted that adjusted for relevant covariates. Additional models further adjusted for outdoor MVPA.

RESULTS

Parental-reported total OP, OP in summer/fall months, and OP on weekdays were negatively associated (small effect sizes) with response inhibition and working memory. After adjusting for outdoor MVPA, these associations were no longer statistically significant. OP on weekdays was negatively associated with externalizing (B = -0.04; 95% confidence interval, -0.08 to -0.00; P = .03) after adjusting for outdoor MVPA. A similar pattern was observed for device-based measured total OP (B = -0.49; 95% confidence interval, -1.05 to 0.07; P = .09).

CONCLUSIONS

Future research in preschool-aged children should take into account MVPA and contextual factors when examining the association between OP and health-related indicators.

Investigating social inequalities in children's independent mobility, active transportation and outdoor free play in two Canadian cities

Background

Active transportation (AT) and free play (FP) are the primary ways in which children engage in unstructured physical activity in cities, with independent mobility (IM) gaining increased attention as a potential precursor of AT and FP. However, current trends show that children are engaging in less FP and AT, and have less IM, than previous generations and it is not well understood how these practices, and their interrelatedness, differ by neighbourhood-level socio-economic stats (SES) and municipal contexts.

Objectives

This study aims to address the gaps in knowledge by quantifying, comparing, and correlating IM, AT, and FP practices in high and low-SES neighbourhoods within and across the cities of Montreal and Kingston, Canada.

Methods

584 questionnaires were distributed among children in grades 1 to 5, living in low- and high-SES neighbourhoods of these two citiesResultsEngagement in the three practices was low in every study neighbourhood, though all three practices were higher in high-SES compared to low-SES neighbourhoods in both cities. Levels of FP were higher in Kingston compared to Montreal, while AT was higher in Montreal than in Kingston.

Conclusion

This study revealed social inequalities in all three of these practices based on socioeconomic status and city. Since IM is likely a precursor to both independent FP and AT, more research is warranted into how our cities can become more conducive to IM in children, particularly in low SES neighbourhoods where children have less freedom of movement independently and otherwise.

Project nature: promoting outdoor physical activity in children via primary care

BACKGROUND

Families face a range of barriers in supporting their children's active play in nature including family circumstances, environmental constraints, and behavioral factors. Evidence-based strategies to address these barriers are needed. We aimed to develop and pilot test a primary care-based family-centered behavioral intervention to promote active outdoor play in 4-10 year-old children.

METHODS

Project Nature, a provider-delivered intervention that provides informational resources and an age-appropriate toy for nature play, was initially developed for children ages 0-3. With stakeholder input, we adapted existing materials for 4-10 year-olds and conducted usability testing at an urban clinic serving families from diverse backgrounds. Subsequently, we conducted a mix-methods pilot study to evaluate intervention feasibility and acceptability. Parents of 4-10 year-olds completed pre- and post-surveys (n = 22), and a purposive subset (n = 10) completed qualitative interviews. Post-intervention, pediatric providers (n = 4) were interviewed about their implementation experiences.

RESULTS

The majority (82%) of parents liked the information provided and the remaining (18%) were neutral. Qualitatively, parents reported that: the toy provided a tangible element to help children and parents be active, they did not use the website, and they wished the intervention emphasized strategies for physical activity during cold and wet seasons. Providers felt the materials facilitated discussion about behavior change with families. There were no statistically significant changes in PA and outdoor time pre- and post-intervention.

CONCLUSIONS

Project Nature was welcomed by providers and families and may be a practical intervention to promote outdoor active play during well-child visits. Providing an age-appropriate nature toy seemed to be a critical component of the intervention, and may be worth the additional cost, time and storage space required by clinics. Building from these results, Project Nature should be revised to better support active outdoor play during suboptimal weather and evaluated to test its efficacy in a fully-powered trial.

Association between preschooler outdoor play and home yard vegetation as measured by high resolution imagery: Findings from the PLAYCE study

Outdoor play in the home yard is an important source of physical activity for many preschoolers. This study investigated if home yard size and vegetation are related to preschooler outdoor play time. High-resolution remotely sensed data were used to distinguish between types of vegetation coverage in the home yard. Shrub and tree cover, and yard size, were positively associated with outdoor play. Following stratification by socio-economic status (SES - parent education), only tree cover was positively associated with preschooler outdoor play in low SES households. All types of vegetation cover were positively associated with preschooler outdoor play in higher SES households. This study highlights the importance of larger yard sizes and higher levels of vegetation for facilitating outdoor play in preschoolers.

The intensification of parenting and generational fracturing of spontaneous physical activity from childhood play in the United Kingdom

Despite an increased drive over the past two decades in Western societies to promote children's physically active play to improve their health, there are concerns that childhood has become less physically active. There are also fears that a previously naturally occurring aspect of childhood has become less authentically playful. Both trends highlight changes over time in the amount and type of play practiced by children and are often cited as consequences of generational shifts. Yet, research which analytically employs the concept of generation to connect changes to childhood with relevant social transformations is lacking. Inspired by Mannheim's conceptualisation of generations, this paper draws on life history interviews with 28 United Kingdom residents born between 1950 and 1994 to propose a fracturing of naturally occurring physical activity from childhood play. As shifts in childhood and parenting have become inextricably linked, this argument illustrates the impact of an intensification to parenting upon greater parental surveillance of increasingly organised forms of childhood physical activity at the expense of spontaneous play. Future physical activity policy should be sensitive to the social climate in which recommendations for children are made, as this places expectations upon parents due to how childhood is currently understood within neoliberal contexts.

Usability of Public Play Spaces for Children with Disabilities

Purpose

To investigate the usability of public play spaces for children with disabilities by exploring their experiences in accessing and using these spaces and to further discuss recommendations for designing such spaces that are usable for these children.

Methods

A hermeneutic phenomenological approach was employed to explore the experience of children with disabilities regarding the public play spaces. Seven children and their caregivers from two inclusive elementary schools in Central Java Province, Indonesia, participated in the study. Online semistructured interviews with the children were held using Zoom, followed by telephonic interviews with their parents. In addition, video recordings of the observation of the children's participation in the play spaces were gathered. The interview and video observation data were analyzed using van Manen's hermeneutic phenomenology thematic analysis method.

Results

Five themes arose regarding the experiences of children with disabilities of accessing and using the public play spaces: (1) where time appeared to speed up, (2) "I like the tall one … I like extreme," (3) fostering connectedness, (4) the need for a safe space, and (5) how a play space should be.

Conclusion

The public play spaces have meaningful values for the children with disabilities and their family, as they offered the opportunities to play, explore, interact with friends and families, enjoy nature, interact with animals, and learn. However, it is essential to provide a safe space in which children are free from physical and emotional harm, so that they can fully participate with confidence and a sense of autonomy. Nevertheless, it was also found that children, regardless of their abilities, craved risky and challenging play opportunities. This study also highlights the necessity of awareness-raising intervention programs to foster the inclusion of children with disabilities in public play space settings.

Educational outcomes of recess in elementary school children: A mixed-methods systematic review

BACKGROUND

Recess provides a key physical activity opportunity for students in school, yet a wide range of recess requirements exist. To design optimal recess policies, the effect of recess on students' educational outcomes must be better understood. Therefore, the purpose of this mixed-method systematic review is to identify and systematically evaluate research on the effects of recess on student educational outcomes, including behavior, cognitive performance and academic achievement.

METHODS

A systematic search of the literature in ERIC (EBSCO), ProQuest Central, PsycINFO, Teacher Reference Center, MEDLINE Complete (EBSCO), and CINAHL Complete was performed through September 2022. Data was extracted from quantitative studies, and reported themes with exemplar quotes were extracted from qualitative studies. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality.

RESULTS

The search identified 932 articles, of which 13 were included in the review, including 8 quantitative and 5 qualitative studies. Eleven studies were conducted in the United States, and reported sample size of studies ranged from 12 to 11,624. Studies found mixed effects on student behavior, discipline referrals and academic achievement. Qualitative studies reported multiple benefits of recess including increased focus, improved problem solving and academic achievement.

CONCLUSIONS

Overall, evidence suggests positive benefits for behavior and either positive or null benefits of recess on academic achievement. However, evidence is limited by non-controlled study designs and diversity in outcome assessments. Additional quantitative evidence is needed to convince policymakers of the specific evidence supporting recess, but also to advise on the optimal recess policies and practices to improve student learning.

The mediating role of social support in promoting physical activity among children in South Africa

Background

Low physical activity (PA) participation levels and increasing non-communicable diseases in children are concerning in South Africa and globally.

Objectives

We sought to assess the mediating role of perceived social support factors on the relationship between PA enjoyment and PA levels among rural, peri-urban and urban school children.

Method

A cross-sectional study was adopted to assess peer, family and teacher encouragement as mediators on the relationship between perceived PA enjoyment and perceived physical activity participation among children, using the Physical Activity Questionnaire for Older Children (PAQ-C). The sample comprised a random sample of primary school learners aged 9-14 years.

Results

The sample consisted of 870 primary school learners with a mean age of 11.0 ± 1.49 years. Most participants were girls (n = 519; 59.7%). The findings suggest low levels of perceived PA participation (mean = 2.33, standard deviation [s.d.]: 0.43). Peer (β = 0.0187, 95% confidence interval [CI]: 0.0088, 0.0307), family (β = 0.0280, 95% CI: 0.0155, 0.0425) and teacher (β = 0.0242, 95% CI: 0.0127, 0.0378) encouragement partially mediates the relationship between perceived PA enjoyment and perceived PA participation. Family encouragement (β = 0.0158, 95% CI: 0.0017, 0.0311) has the most considerable mediating effect, followed by teacher encouragement (β = 0.0125, 95% CI: 0.0010, 0.0269).

Conclusion

The findings demonstrated low levels of perceived PA participation in school learners. Therefore, we recommends including social factors as mediators in PA intervention programmes in primary schools.

Clinical implications

Social support factors as mediators on the relationship between PA enjoyment and PA participation among children may improve children's PA participation levels and help prevent non-communicable diseases in future.

Exploring the relationship between home environmental characteristics and restorative effect through neural activities

As society and the economy have advanced, the focus of architectural and interior environment design has shifted from practicality to eliciting emotional responses, such as stimulating environments and innovative inclusive designs. Of particular interest is the home environment, as it is best suited for achieving restorative effects, leading to a debate between interior qualities and restorative impact. This study explored the relationships between home characteristics, restorative potential, and neural activities using the Neu-VR. The results of the regression analysis revealed statistically significant relationships between interior properties and restorative potential. We examined each potential characteristic of the home environment that could have a restorative impact and elucidated the environmental characteristics that should be emphasized in residential interior design. These findings contribute evidence-based knowledge for designing therapeutic indoor environments. And combining different restorative potential environments with neural activity, discussed new neuro activities which may predict restorativeness, decoded the new indicators of neuro activity for environmental design.

Early Childhood Educators' Knowledge, Self-Efficacy and Risk Tolerance for Outdoor Risky Play Following a Professional Risk Re-Framing Workshop

Children's outdoor risky play is important for healthy development. However, Early Childhood Educators (ECEs) concern for child safety often restricts risky play affordances during childcare. To reduce this trend, an Outdoor Play Risk Re-Framing workshop was delivered to ECEs in London, Ontario, and the immediate/short-term impact of the workshop on ECEs' knowledge, self-efficacy, and risk tolerance for engaging children in outdoor risky play was examined. Via a natural experiment, using a quasi-experimental design, ECEs in the experimental group (n = 119) completed an Outdoor Play Risk Re-Framing workshop, while ECEs in the comparison group (n = 51) continued their typical curriculum. All ECEs completed the same survey assessing their knowledge (n = 11 items), self-efficacy (n = 15 items), and risk tolerance (n = 27 items) at baseline and 1-week post-intervention. A maximum likelihood linear mixed effects model was conducted, while deductive content analysis was used for open-ended items. The workshop intervention resulted in significant improvements in ECEs' self-efficacy (p = 0.001); however, no significant changes were observed for knowledge (i.e., awareness and practices; p = 0.01 and p = 0.49, respectively) or risk tolerance (p = 0.20). Qualitative data revealed similar findings across both groups, highlighting physical development as a benefit to outdoor risky play and fear of liability as a barrier. In conclusion, providing ECEs with an Outdoor Play Risk Re-Framing workshop shows promise for supporting their self-efficacy to promote this behavior but does not impact ECEs' knowledge or risk tolerance to lead outdoor risky play.

Factors associated with implemented teacher-led movement and physical activity in early childhood education and care

Movement and physical activity (MoPA) is critical for children's development and health. This study aimed to explore early childhood education and care (ECEC) educators' reported frequency of implemented gross motor and physical activities (MoPA) among children in ECEC, as well as the educators' reported personal physical activity (PA) levels in leisure time. A cross-sectional survey was performed in 68 preschools in southern Sweden. Data were obtained from questionnaires completed by 359 ECEC educators. The participation rate was 61%. About two thirds offered MoPA once a week or more seldom, while one quarter offered MoPA at least every other day. Educators who reported personal PA three times or more per week, offered MoPA for the children at least every other day to a higher extent (37%) compared to colleagues who reported personal PA once or twice a week (26%) or colleagues who reported that they were never or seldom active (18%) (p = 0.034). The results from multiple logistic regression analysis showed that reported implemented MoPA among children in ECEC was significantly associated with the educators' perceptions that free play improved children's gross motor skills (OR 2.7), the educators' perceptions of needed curricular guidelines for MoPA (OR 2.1), the educators' own leisure PA level (OR 2.0) and the educators' perceptions that adequate gross motor skills were not learned at home (OR 0.4). Teacher-led MoPA occurs sparingly during the preschool day and the teachers believe that the children get sufficient MoPA in free play. The children are expected to develop their motor skills to a sufficient extent during the short moments of offered outdoor play. Teachers who are physically active in their leisure-time seem to offer gross motor training for the children to a higher extent than less active or inactive colleagues.

Cross-sectional and longitudinal associations of domain-specific physical activity composition with health-related quality of life in childhood and adolescence in Australia

BACKGROUND

Health benefits have been linked with physical activity (PA), as well as some domains of PA among youth (e.g. organized PA and active transport). However, less is known about whether some PA domains are more beneficial than others. There is also a lack of evidence about whether health outcomes are related to the composition of PA (i.e. the share of PA spent in different domains). This study aimed to identify: (1) how the absolute durations of organized PA, non-organized PA, active transport and active chores/work at 10-11y are individually associated with physical, psychosocial and total health-related quality of life (HRQOL) at 10-11y and 12-13y; and (2) how the domain-specific composition of PA at 10-11y is associated with HRQOL at 10-11y and 12-13y.

METHODS

Data from the Longitudinal Study of Australian Children were used in cross-sectional (n ≥ 2730) and longitudinal analyses (n ≥ 2376). Measurement included the Pediatric Quality of Life Inventory (PedsQL™) for HRQOL domains and one-day time-use diaries (TUDs) for PA domains. Robust linear regression models were used, controlling for age, sex, pubertal status, socioeconomic position, body mass index and TUD context (season and school attendance). Compositional models additionally adjusted for total PA duration and longitudinal models controlled for baseline PedsQL™ scores.

RESULTS

Non-compositional models indicated that the duration of organized PA, and to a lesser extent non-organized PA, were positively but weakly associated with some HRQOL outcomes at 10-11y. These trends were not reflected in longitudinal models, although a 30-min increase in non-organized PA per day did predict marginally better psychosocial HRQOL at 12-13y (+ 0.17%; 95%CI =  + 0.03%, + 0.32%). Compositional models revealed that a 30-min increase in organized PA relative to other domains was positively but weakly associated with physical (+ 0.32%; 95%CI =  + 0.01%, + 0.63%), psychosocial (+ 0.41%; 95%CI =  + 0.11%, + 0.72%) and total HRQOL (+ 0.39%; 95%CI =  + 0.12%, + 0.66%) at 10-11y. However, the overall PA composition at 10-11y was not related to HRQOL at 12-13y.

CONCLUSIONS

Non-compositional and compositional models generally concurred on the direction of cross-sectional and longitudinal relationships (and lack thereof) between PA domains and HRQOL outcomes. The strongest associations were cross-sectional between organized PA and HRQOL at 10-11y. However, all associations between PA domains and HRQOL outcomes were weak and may not be clinically meaningful.

The Relative Contributions of Center Demographic, Director, Parental, Social, Environmental, and Policy Factors to Changes in Outdoor Play in Childcare Centers During the COVID-19 Pandemic

BACKGROUND

The primary objective of this study was to investigate the relative contributions of factors from multiple social-ecological levels in explaining outdoor play changes in childcare centers during the COVID-19 pandemic.

METHODS

In Alberta, Canada, licensed childcare center directors (n = 160) completed an online questionnaire. For outcomes, changes in the frequency and duration of outdoor play in childcare centers during COVID-19 compared to before COVID-19 were measured. For exposures, center demographic, director, parental, social, environmental, and policy-level factors were measured. Hierarchical regression analyses were conducted separately for winter (December-March) and nonwinter months (April-November).

RESULTS

In most instances, factors at each social-ecological level explained a statistically significant amount of unique variance in changes in outdoor play in childcare centers during COVID-19. Full models accounted for more than 26% of the variance in the outcomes. Changes in parental interest in outdoor play was the most consistent correlate of changes in the frequency and duration of outdoor play in both winter and nonwinter months during COVID-19. In terms of changes in the duration of outdoor play, social support from the provincial government, health authority, and licensing, and changes in the number of play areas in licensed outdoor play spaces were also consistent correlates in both winter and nonwinter months during COVID-19.

CONCLUSIONS

Factors from multiple social-ecological levels uniquely contributed to changes in outdoor play in childcare centers during the COVID-19 pandemic. Findings can help inform interventions and public health initiatives related to outdoor play in childcare centers during and after the ongoing pandemic.

School Children's Physical Activity and Preferred Activities during Outdoor Recess in Estonia: Using Accelerometers, Recess Observation, and Schoolyard Mapping

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess PA in two urban and two rural primary schools in Estonia. Schoolyards were described with the geographical mapping method, children's activities during outdoor recess were registered by using observations, and PA levels were measured with accelerometers. Students from grades two to six (8-13-year-olds) were included in the study. All observed schoolyards had different spaces including various ball game areas, climbing facilities, and slacklines. The natural environment dominated in the rural schools, and artificial surfaces dominated in the urban schools. Boys in the study tended to enjoy more sport-related activities, whereas girls preferred more social and less active activities. Students participating in outdoor recess spent about twice as much time (20.4%) on moderate-to-vigorous PA (MVPA) compared to indoor recess (9.5%), although boys were more active than girls (22.9% vs. 17.3%). All schoolyards afforded more MVPA during outdoor recess compared to indoor recess, whereas schoolyards with more space per child and natural environment elements generated more varied PA and higher MVPA. These findings confirm the importance of schoolyard design and quality for the variety and intensity of students' PA during outdoor recess.

Protocol for the PLAY Study: a randomised controlled trial of an intervention to improve infant development by encouraging maternal self-efficacy using behavioural feedback

INTRODUCTION

The early infant caregiving environment is crucial in the formation of parent-child relationships, neurobehavioural development and thus child outcomes. This protocol describes the Play Love And You (PLAY) Study, a phase 1 trial of an intervention designed to promote infant development through encouraging maternal self-efficacy using behavioural feedback, and supportive interventions.

METHODS AND ANALYSIS

210 mother-infant pairs will be recruited at delivery from community clinics in Soweto, South Africa, and individually randomised (1:1) into two groups. The trial will consist of a standard of care arm and an intervention arm. The intervention will start at birth and end at 12 months, and outcome assessments will be made when the infants are 0, 6 and 12 months of age. The intervention will be delivered by community health helpers using an app with resource material, telephone calls, in person visits and behavioural feedback with individualised support. Every 4 months, mothers in the intervention group will receive rapid feedback via the app and in person on their infant's movement behaviours and on their interaction styles with their infant. At recruitment, and again at 4 months, mothers will be screened for mental health risk and women who score in the high-risk category will receive an individual counselling session from a licensed psychologist, followed by referral and continued support as necessary. The primary outcome is efficacy of the intervention in improving maternal self-efficacy, and the secondary outcomes are infant development at 12 months, and feasibility and acceptability of each component of the intervention.

ETHICS AND DISSEMINATION

The PLAY Study has received ethical approval from the Human Research Ethics Committee of the University of the Witwatersrand (M220217). Participants will be provided with an information sheet and required to provide written consent prior to being enrolled. Study results will be shared via publication in peer-reviewed journals, conference presentation and media engagement.

TRIAL REGISTRATION NUMBER

This trial was registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 10 February 2022 (identifier: PACTR202202747620052).

Changes in social interaction, social relatedness, and friendships in Education Outside the Classroom: A social network analysis

Introduction

Social interaction is associated with many effects on the psychological level of children such as mental health, self-esteem, and executive functions. Education Outside the Classroom (EOtC) describes regular curricular classes/lessons outside the school building, often in natural green and blue environments. Applied as a long-term school concept, EOtC has the potential to enable and promote social interaction. However, empirical studies on this topic have been somewhat scant.

Methods

One class in EOtC (N  = 24) and one comparison class (N = 26) were examined in this study to explore those effects. Statistical Actor-Oriented Models and Exponential Random Graph Models were used to investigate whether there are differences between EOtC and comparison class regarding changes over time in social interaction parameters; whether a co-evolution between social interaction during lessons and breaks and attendant social relatedness and friendships exists; whether students of the same gender or place of residence interact particularly often (homophily).

Results

Besides inconsistent changes in social interaction parameters, no co-evolutional associations between social interaction and social relatedness and friendships could be determined, but grouping was evident in EOtC. Both classes showed pronounced gender homophily, which in the case of EOtC class contributes to a fragmentation of the network over time.

Discussion

The observed effects in EOtC could be due to previously observed tendencies of social exclusion as a result of a high degree of freedom of choices. It therefore seems essential that in future studies not only the quality of the study design and instruments should be included in the interpretation - rather, the underlying methodological-didactic concept should also be evaluated in detail. At least in Germany, it seems that there is still potential for developing holistic concepts with regards to EOtC in order to maximize the return on the primarily organizational investment of implementing EOtC in natural environments.

Navigating Neighbourhood Opposition and Climate Change: Feasibility and Acceptability of a Play Street Pilot in Sydney, Australia

BACKGROUND

Play Streets are community-led initiatives that provide opportunities for outdoor play and recreation when parks or other facilities may not be easily accessible. This pragmatic evaluation aims to determine the feasibility and acceptability of a pilot Play Street in Inner West Sydney.

METHODS

We used a post-only mixed methods design. Brief intercept surveys with pilot Play Street visitors assessed their reasons for attending the event and perceptions thereof. Semi-structured interviews explored stakeholders' experiences related to planning and implementing Play Streets.

RESULTS

Approximately 60 adults and children attended the pilot Play Street. The majority of survey respondents (n = 32) were female, aged 35-54, lived in the Play Street's postcode, and visited in groups consisting of adults and children. Overall respondents rated the pilot positively in enjoyment (100%), safety (97%), and organisation (81%), although there were significant differences between certain demographic subgroups in the perception of organisation and the children's enjoyment of the pilot Play Street. Stakeholder interviews (n = 2) highlighted the importance of community consultation and reaching compromises, noting concerns about safety and insurance costs, and emphasised the role of Council as a facilitator to help residents take ownership of Play Streets. Delays due to community concerns, poor air quality arising from bushfires, heavy rain on the event day, and COVID-19 lockdowns hindered pilot Play Street implementation and evaluation.

CONCLUSION

This pilot demonstrated that Play Streets are a feasible and acceptable way to use streets as outdoor recreation spaces in Sydney's Inner West. The evaluation highlights two elements for future sustainability: managing neighbourhood opposition and adapting to climate change.

Determinants of Outdoor Time in Children and Youth: A Systematic Review of Longitudinal and Intervention Studies

Spending more time outdoors can improve children's social and cognitive development, physical activity, and vision. Our systematic review summarized the determinants of outdoor time (OT) based on the social-ecological model. We searched nine databases: MEDLINE, APA PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORTDiscus, ERIC, SocINDEX, and ProQuest Dissertations and Theses. To be included, studies needed to be quantitative and longitudinal, include ≥1 potential determinant of OT among 0- to 17-year-olds, and be published in English, French, Japanese, or Spanish. We extracted the authors, publication year, country, design, sample size, OT measures, follow-up period, potential determinants, main results, and potential moderators or mediators. Fifty-five studies examining 119 potential determinants met the inclusion criteria. OT was consistently higher in warmer seasons and among participants reporting more OT at baseline. All three interventions that included both parent sessions and additional resources to promote OT (e.g., specific advice and community guides) were effective. COVID-19 restrictions and sun safety interventions discouraging midday outdoor activities led to less OT. The quality of evidence was rated as weak for 46 studies. Most potential determinants were examined in ≤3 studies; thus, more longitudinal studies are needed to enable stronger conclusions about the consistency of evidence and meta-analyses.

The association among SES, screen time, and outdoor play in children at different ages: The GECKO Drenthe study

Introduction

This study examined the association among socioeconomic status (SES), screen time, and outdoor play in children at different ages in the GECKO Drenthe birth cohort study.

Methods

Valid data were obtained from two surveys at ages 3-4 years and 10-11 years. Screen time (TV watching and computer use) and outdoor play were reported by parents. Childhood SES was derived by a synthetic "Equivalized Household Income Indicator," an estimated disposable income. Quantile regression models (cross-sectional analysis) and linear regression models (change between 3-4 and 10-11 years) were used.

Results

In general, screen time increased strongly from a median of 51 min/day at 3-4 years (n = 888) to 122 min/day at 10-11 years (n = 1023), whereas time spent on outdoor play remained stable over age (77 min/day at 3-4 years and 81 min/day at 10-11 years). More time spent on outdoor play (50th quantile) was found in children with low SES families at 3-4 years, while at 10-11 years, more outdoor play was found in the high SES group. At 10-11 years, in the higher ranges of screen time, children from high SES had relatively lower screen time [50th quantile: -10.7 (-20.8; -0.6); 75th quantile: -13.6 (-24.4; -2.8)]. In the longitudinal analysis (n = 536), high SES was associated with an increasing time spent on outdoor play [11.7 (2.7; 20.8)].

Conclusion

Socioeconomic disparities in children's outdoor play and screen behavior may be more obvious with increasing age. Low SES may facilitate both outdoor play (at 3-4 years) and screen time (at 10-11 years); however, children from high SES families develop slightly more favorable behavior patterns with age.

Relationship between Perceived Physical Competence and Outdoor Play among Children Aged 9-12 Years-Focused Sex-Specific Differences

BACKGROUND

Outdoor play (OP), which is considered important for children's development, is declining every year. Perceived physical competence (PPC) is a vital factor that promotes physical activity such as OP, sports clubs, etc., but the relationship between PPC and OP was unknown. The purpose of this research was to investigate the relationship between PPC and OP in children and consider whether there were any sex-specific changes.

METHODS

A cross-sectional study was conducted in Japan with 288 children (134 girls, age: 10.6 ± 1.01 years). OP was assessed using an original self-report questionnaire. Each weekday, the children reported the time of OP and were classified as "high" if they played outside for at least an hour three times. PPC was evaluated with a self-report questionnaire developed by Okazawa et al. (1996). It has 12 questions and was assessed on a 5-point Likert scale. After adjusting for age, sex, BMI, screen time, sports club participation, and the number of friends, logistic regression analyses were carried out.

RESULTS

Children with better PPC were significantly more likely to be classified as "high" [crude odds ratio (OR): 1.04; 95% confidence interval (CI): 1.00-1.08; adjusted OR: 1.04; 95% CI: 1.00-1.08]. Only girls with better PPC were significantly more likely to be classified as "high" in a sex-based stratified analysis [crude OR: 1.08; 95% CI: 1.01-1.15, adjusted OR 1.09; 95% CI: 1.02-1.17].

CONCLUSIONS

Particularly among girls, OP could be promoted as a voluntary physical activity with improved PPC.

Physical activity in the era of climate change and COVID-19 pandemic: Results from the South Korea's 2022 Report Card on physical activity for children and adolescents

Background

With intensifying air pollutant levels and the COVID-19 pandemic, physical inactivity of South Korean children and adolescents may be threatened. Therefore, monitoring and surveillance of physical activity (PA) and relevant indicators are important for policy making pertaining to health promotion. Report Card is a third comprehensive evaluation of PA-related behaviors among and the sources of influence for South Korean children and adolescents.

Purpose

To provide the outcome of the South Korea's 2022 Report Card on PA for children and adolescents.

Methods

Based on a variety of sources including national surveys collected pre- and during-COVID-19 and information collected from government webpages, 11 indicators were graded by a committee of experts informed by the best available evidence. Data from during-COVID-19 were available for Overall PA, Sedentary Behavior, and Sleep and considered together in generating the overall grades.

Results

Grades were assigned to behavioral indicators (Overall PA: D-; Active Transportation: B+; Sedentary Behavior: D; Sleep: F) and sources of Influence (Family and Peers: C-; School: A; Community and Environment: B-; Government: A). Organized Sport and PA, Active Play, and Physical Fitness could not be graded due to the lack of data. The results largely indicated that children and adolescents show unfavorable behavioral grades even with favorable grades observed for the sources of influence indicators. Trivial differences were observed pre- and during-pandemic for Overall PA (≥60 min of MVPA for ≥4 d/wk: 20.8% vs 19.9%) and Sleep (met age-specific recommendation: 14.1% vs 15.0%); however, a marked increase in Sedentary Behavior was observed (≤2 h/d screen time: 28.8% vs 20.1%). A stark weekday vs weekend difference was observed in sleep duration. In terms of PA related sources of influence, high accessibility to PA facilities (81.1%) and high satisfaction of neighborhood public transit (74.6%) and safety (80.7%) were well reflected in our Active Transportation grade (B+). Nonetheless, perception of green environments including outdoor air quality (44.0%), noise (39.6%) and green space (56.5%) showed lower scores, suggesting that new barriers to active lifestyles are emerging for South Korean children and adolescents. Gender differences were also observed for overall PA (≥60 min of MVPA for ≥4 d/wk: 29.1% for boys vs 11.3% for girls) and sleep (met age-specific recommendations: 17.3% for boys vs 11.4% for girls), but not for sedentary behavior (≤2 h/d screen time: 26.4% for boys and 24.9% for girls).

Conclusions

Government and school policies/programs and the built environment are, in general, conducive to physically active lifestyles for South Korean children and adolescents; however, behavioural indicators received poor grades except for Active Transportation. A thorough evaluation of policies/programs at government, local, and school levels is needed to ensure that the efforts to have PA-enhancing infrastructure and systems are actually being translated into the behavior of children and adolescents in South Korea. Furthermore, improving PA surveillance, monitoring, and advocacy to ultimately establish healthy lifestyle patterns among children and adolescents is a top priority.

Implications of time and space factors related with youth substance use prevention: a conceptual review and case study of the Icelandic Prevention Model being implemented in the context of the COVID-19 pandemic

Purpose: This research examines the implementation of the Icelandic Prevention Model (IPM) in Canada to identify opportunities revealed by the COVID-19 pandemic to re-design our social eco-system to promote wellbeing. This paper has two objectives: 1) to provide a conceptual review of research that applies the bioecological model to youth substance use prevention with a focus on the concepts of time and physical space use and 2) to describe a case study that examines the implementation of the IPM in Canada within the context of the COVID-19 pandemic. Method: Study data were collected through semi-structured qualitative interviews with key stakeholders involved in implementing the IPM.

Results: Findings are organized within three over-arching themes derived from a thematic analysis: 1) Issues that influence time and space use patterns and youth substance use, 2) Family and community cohesion and influences on developmental context and time use and 3) Opportunities presented by the pandemic that can promote youth wellbeing.

Conclusion: We apply the findings to research on the IPM as well as the pandemic to examine opportunities that may support primary prevention and overall youth wellbeing. We use the concepts of time and space as a foundation to discuss implications for policy and practice going forward.

Cumulative Risk Exposure and Social Isolation as Correlates of Carer and Child Mental Health During the COVID-19 Pandemic: An Online Study with Families from Various Europeans Countries

This study adopted a cumulative risk approach to examine the relations between various domains of risk factors (i.e., social isolation and home confinement, other pandemic-related risk factors, and pre-existing psychosocial risk factors) and carers' and children's mental health during the first wave of the COVID-19 pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old children and adolescents residing in five European countries (Portugal, United Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. The results showed that each of the three domains of adversity accounted for unique variation in carers' and children's mental health outcomes. Also, the results indicated that pre-existing psychosocial risk factors moderated the relationship between pandemic-related risk factors and children and carers' anxiety and between social isolation and confinement and carers' well-being. Simple slopes analysis suggested a stronger relationship between these domains of adversities and mental health outcomes in already more vulnerable families. It is important to consider the implications of social isolation measures and confinement for families' mental health, paying special attention to families with pre-existing psychosocial vulnerabilities.

Scoping review of children's and youth's outdoor play publications in Canada

INTRODUCTION

Since 2015, interest in the benefits of outdoor play for physical, emotional, social and environmental health, well-being and development has been growing in Canada and elsewhere.

METHODS

This scoping review aims to answer the question, "How, and in what context, is children's and youth's outdoor play being studied in Canada?" Included were studies of any type on outdoor play published after September 2015 in English or French by authors from Canadian institutions or assessing Canadian children and/or youth. Articles retrieved from MEDLINE, CINAHL and Scopus by March 2021 were organized according to eight priority areas: health, well-being and development; outdoor play environments; safety and outdoor play; cross-sectoral connections; equity, diversity and inclusion; professional development; Indigenous Peoples and land-based outdoor play; and COVID-19. Within each priority, study design and measurement method were tallied.

RESULTS

Of the 275 articles included, the most common priority area was health, wellbeing and development (n = 239). The least common priority areas were COVID-19 (n = 9) and Indigenous Peoples and land-based outdoor play (n = 14). Cross-sectional studies were the most common; the least common were rapid reviews. Sample sizes varied from one parent's reflections to 999 951 data points from health databases. More studies used subjective than objective measurement methods. Across priorities, physical health was the most examined outcome, and mental/emotional development the least.

CONCLUSION

A wealth of knowledge on outdoor play in Canada has been produced since 2015. Further research is needed on the relationship between outdoor play and mental/emotional development among children and youth.

A qualitative study of parental strategies to enable pre-school children's outdoor and nature experiences during COVID-19 restrictions

Outdoor and nature experiences including play have been shown to be beneficial for children's physical, cognitive, social and emotional development. Parents/carers play an important role in encouraging or impeding their child's access to the outdoor environment and participation in outdoor play. The COVID-19 pandemic and associated restrictions on free movement and social interactions placed an unprecedented pressure on families to manage the drastic change in their daily routines. This paper reports findings from two combined data sets generated in 2020 during the COVID-19 pandemic and provides a deeper understanding of the interconnected nature of how contextual factors influence parenting processes and outcomes relating to young children's outdoor and nature experiences and subsequent child health. Findings have the potential to inform the messaging of existing outdoor play policies and the content of new interventions aiming to promote the exposure of children to the natural outdoor environment.

"Are They Going to Play Nicely?" Parents' Evaluations of Young Children's Play Dates

Over the last 20 years, opportunities for young children to engage in self-directed free play with peers outdoors or during the school day has dramatically declined. Consequently, it is likely that play dates, defined as pre-arranged social contact at home, have become increasingly significant play environments for children. Preliminary research suggests that play dates are positively associated with young children's social and emotional development, but that access can be strongly influenced by parental social networking priorities. However, little is currently known about the nature and frequency of play dates, the types of play children engage in, or the impact of parental management and supervision on children's play in this context. Exploratory qualitative research is essential to understand the extent to which parental gatekeeping may limit opportunities for children and families perceived to have low social capital, and to begin to define the nature and content of young children's play dates more broadly. Parents of children aged 5-6 years old took part in a semi-structured interview to describe common practices and attitudes (N = 11). Inductive thematic analysis indicated that play dates are complex play environments that parents associate with a range of social, emotional, and cognitive benefits for children. However, close parental monitoring and supervision may limit the extent to which play dates provide opportunities for self-directed free play. Findings also show that access to play dates is strongly influenced by parents' motivations to enhance children's social status which restricts access to some children. Implications for future research are discussed.

The impact of media on children during the COVID-19 pandemic: A narrative review

Although mobile technologies are a fundamental part of daily life, several studies have shown increased use of electronic devices, TV, and gaming during childhood in conjunction with the COVID-19 pandemic. The virus affected almost every country, causing uncertainty about the future, social isolation, and distress. This narrative review has searched the scientific literature in the field focusing on children. A non-systematic literature review was conducted in May 2022. Various databases were employed to conduct the document research for this paper, such as "Google Scholar", "PubMed", "Web of Science". Keywords for the search included "screen time", "media", "digital use", "social media", "COVID-19", "pandemic", "lockdown", "children", "effect of media on children during COVID". It was found that both children and adolescents seem to have used technologies to confront struggles provoked by COVID-19, such as the onset or exacerbation of symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder. However, moreover, other studies have suggested that increased media use can have positive effects on children depending on usage and monitoring by the parents.

Ghummeida: Outdoor Play in a Militarized Zone

This paper connects two seemingly distinct subjects-the right to health and children's play in contexts of a militarized settler colony. Following Ignacio Martín-Baró's articulation of a critical psychology "of the people," we outline the spatial and psychosocial economies of childhood outdoor play as forms of social and political determinants of health and human rights.¹ We offer an analysis through the words and reflections of Palestinian Jerusalemite children that expose the mundane violence produced and sustained by the colonizer, whereby children's play creates spaces of livability against necropolitics. We draw on 50 observations of Palestinian children's play of Ghummeida-hide and seek-spanning 2020 through 2022 in four locations in occupied East Jerusalem. Our analysis proposes three overlapping fields through which Ghummeida operates: as a game, as resistance to spatial suffocation, and against unchilding. Across each of these fields, children's ways of embodying their right to play and live are presented as acts of refusing the chronic political violence they are exposed to. The produced processes include generativity, ownership of space, the surface and the body, and psychic repair. The paper concludes by unveiling how Ghummeida, with its metaphoric and embodied imprints, enables Palestinian children's psychosocial well-being, and pursuit of human rights, through defying their reality under a brutal system of apartheid.

Correlates of Outdoor Time in Schoolchildren From Families Speaking Nonofficial Languages at Home: A Multisite Canadian Study

BACKGROUND

Previous research shows that children from ethnic minority groups spend less time outdoors. Using data collected in 3 regions of Canada, we investigated the correlates of outdoor time among schoolchildren who spoke a nonofficial language at home.

METHODS

A total of 1699 children were recruited from 37 schools stratified by area-level socioeconomic status and type of urbanization. Among these, 478 spoke a nonofficial language at home. Children's outdoor time and data on potential correlates were collected via questionnaires. Gender-stratified linear multiple regression models examined the correlates of outdoor time while controlling for age and sampling variables.

RESULTS

In boys, higher independent mobility, higher outdoor air temperature, mobile phone ownership, having older parents, and parents who biked to work were associated with more outdoor time. Boys living in suburban (vs urban) areas spent less time outdoors. The association between independent mobility and outdoor time became weaker with increasing age for boys. In girls, lower parental education and greater parental concerns about neighborhood safety and social cohesion were associated with less outdoor time.

CONCLUSIONS

Correlates of outdoor time differ by gender and span the social ecological model underscoring the need for gender-sensitized interventions targeted at individual, family, social, and physical environmental correlates to increase outdoor time.

Children Who Experience Unintentional Injuries: Their Functional Profiles

Unintentional injuries are accidents that pose a major health problem among school children. This study compared the functional behavior and executive function characteristics of school-aged children who experienced unintentional injuries with those of controls who had not been injured. We investigated the background characteristics of injured children, injury characteristics, and parents' perceptions of the children's functional behaviors and executive function abilities. The study included 53 children aged 6 years to 18 years. Of them, 32 had experienced unintentional injuries. The 21 children who had not experienced unintentional injuries served as a control group matched for age and living environment. Parents of both groups completed (1) a demographic questionnaire addressing their children's background, daily functional behavior characteristics, and injury characteristics and (2) the Behavior Rating Inventory of Executive Function (BRIEF). Sixty percent of the children in the research (injured) group had been prediagnosed with learning disabilities or attention deficit hyperactivity disorders, compared with no child in the control (uninjured) group. Most injuries were limb fractures (60%) and sustained outside the home (50%). Parents of children who had been injured expressed significantly more concerns about their children's daily behavior than did parents of the control group and reported their children as usually, but not always, independent and responsible. Compared with the children in the uninjured group, the children in the injured group had significantly lower executive function abilities in the BRIEF's eight subscales, total behavioral regulation and metacognitive indices, and global executive function scores (p < .001). Children with certain diagnoses, functional behavior features, and deficient executive function abilities may be at risk for unintentional injuries. Raising occupational therapists' awareness of these aspects may contribute to identifying, treating, and preventing accidental injuries among at-risk children.

How young children's play is shaped through common iPad applications: a study of 2 and 4-5 year-olds

Digital devices such as iPads are prevalent in children's play from an early age. How this shapes young children's play is an area of considerable debate without any clear consensus on how different forms of play are brought into the iPad interaction. In this study, we examined 98 play activities of children in two preschool settings, featuring 2 and 4-5-year-olds, their play with iPads and non-digital artefacts. Three analytical approaches were used: an index built on a digital play framework [Bird, Jo, and Susan Edwards. 2015. "Children Learning to Use Technologies Through Play: A Digital Play Framework." British Journal of Educational Technology 46 (6): 1149-1160. doi:10.1111/bjet.12191 ], a quantitative description of the index, and a qualitative interaction analysis of children's play. Results show how play with iPads is characterised as less ludic than play with other artefacts, and diverges from the age-typical norms of play. We discuss what these results might mean for children's play in contemporary early childhood settings and for children's learning.

A Tale of Two Cities: Unpacking the Success and Failure of School Street Interventions in Two Canadian Cities

One innovative strategy to support child-friendly cities is street-based interventions that provide safe, vehicle-free spaces for children to play and move about freely. School streets are one such innovation involving closing streets around elementary schools to vehicular traffic to improve children's safety as they come and go from school while providing opportunities for children to play and socialize on the street. Launching these initiatives in communities dominated by automobiles is enormously challenging and little is known about why these interventions are successfully launched in some places but not others. As part of a larger research project called Levelling the Playing Fields, two School Street initiatives were planned for the 2021-2022 school year; one initiative was successfully launched in Kingston, ON, while the second initiative failed to launch in Montreal, QC. Using a critical realist evaluation methodology, this paper documents the contextual elements and key mechanisms that enabled and constrained the launch of these School Streets in these cities, through document analysis and key informant interviews. Our results suggest that municipal and school support for the initiative are both imperative to establishing legitimacy and collaborative governance, both of which were necessary for a successful launch.

"Children are precious cargo; we don't let them take any risks!": Hearing from adults on safety and risk in children's active play in schools: a systematic review

Background

Understanding determinants of children’s outdoor play is important for improving low physical activity levels, and schools are a key setting for both. Safety concerns shape children’s opportunity to play actively outdoors, therefore, this qualitative evidence synthesis aimed to i) examine adult (e.g., parent, teacher, yard supervisor, principal) perspectives on safety and risk in children’s active play during recess in elementary and/or middle schools, and ii) identify how safety and risk influence playground supervision and decision making in this setting.

Methods

Six electronic databases were systematically searched in March 2021, with an updated search in June 2022. Records were screened against eligibility criteria using Covidence software, and data extraction and synthesis were performed using predesigned coding forms in Microsoft Excel and NVivo. Framework synthesis methodology was employed, guided by a conceptual framework structured on the socio-ecological model (SEM) and affordance theory.

Results

From 10,370 records, 25 studies were included that represented 608 adults across 89 schools from nine countries. The synthesis identified 10 constraining and four affording factors that influenced whether school staff were risk-averse or risk tolerant during recess, and, in turn, the degree to which children’s play was managed. Constraining factors stemmed from fears for children’s physical safety, and fear of blame and liability in the event of playground injury, which shaped parent, school staff and institutional responses to risk. Interrelated factors across SEM levels combined to drive risk-averse decision making and constraining supervision. Emerging evidence suggests children’s active play in schools can be promoted by fostering a risk tolerant and play friendly culture in schools through play facilitation training (e.g., risk-reframing, conflict resolution) and engaging stakeholders in the development of school policies and rules that balance benefits of play against potential risks.

Conclusions

Findings show several socio-cultural factors limited the ability of school staff to genuinely promote active play. Future work should seek to foster risk tolerance in schools, challenge the cultural norms that shape parent attitudes and institutional responses to risk in children’s play, and explore novel methods for overcoming policy barriers and fear of liability in schools.

Trial registration

PROSPERO registration: CRD42021238719.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01344-7.

Playground Inclusivity for Children With a Disability: Protocol for a Scoping Review

Background

Although playgrounds are designed to promote outdoor play, children with disabilities may be unable to engage in these spaces due to intrinsic and extrinsic factors. Previous research has examined inclusive/accessible playground design when developing new playgrounds; however, it is unclear if there is a best-practice tool for evaluating the inclusivity of existing playground structures.

Objective

A scoping review of both peer-reviewed and grey literature will be employed to explore evaluation tools for playground inclusivity, to enable the participation of children with disabilities.

Methods

The conduct of this study will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search for peer-reviewed research studies will be conducted in the following electronic databases: MEDLINE, Scopus, CINAHL, and Embase. Grey literature will be examined via a three-step process: (1) a search in the Canadian Health Research Collection Database; (2) a targeted Google search; and (3) reference list searching. Titles, abstracts, keywords, and full texts of identified studies will be independently screened for inclusion by two reviewers. A synthesis of included articles will describe the publication and auditing tool details. A summary of the findings will highlight the types of playgrounds measured, types of disability considered, measures of inclusion used, and psychometric properties.

Results

Database searches for peer-reviewed articles were completed in December 2021. A total of 1471 unique records were returned after the removal of 559 duplicate records. Full texts of 167 studies meeting eligibility criteria will be reviewed. The peer-reviewed research search will guide the grey literature search. The scoping review is planned for completion in 2022.

Conclusions

A rigorous search of the literature will determine the availability of tools for evaluating existing playground structures for the inclusivity of children with disabilities. The results will inform recommendations on tool applications, and applicable knowledge translation activities.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37312

Changes in the continuous leaping performance of Finnish adolescents between 1979 and 2020

The aims of this secular trend design study were: 1) to investigate whether the continuous leaping performance of Finnish adolescents (mean age 14.99 ± .61 years) changed between 6 data sets collected between 1979 and 2020, and 2) to analyse if variation in leaping performance increased from 1979 to 2020. The data for this secular trend study of 6 cohorts were collected in 1979 (n = 599), 1995 (n = 498), 1998 (n = 796), 2003 (n = 2383), 2010 (n = 1383), and 2020 (n = 719). All cohorts performed the 5-leaps test, following the same protocol. Between-cohort differences in scores were analysed using a General Linear Contrast Model. Between-cohort differences in variance were tested using Chi-square-based between-group tests. Sex, age, and BMI were used as covariates in the secular trend analyses. Continuous leaping performance demonstrated a decreasing trend in both girls and boys. Specifically, girls' scores were stable between 1979 and 1995, decreased from 1995 to 2010 and remained stable thereafter. Boys leaping performance improved from 1979 to 1995, was stable until 2003, and had declined by 2020. Within-group variation in continuous leaping was greater in girls and boys during the first decades of the 21st century than previously.

"All the fun stuff, the teachers say, 'that's dangerous!'" Hearing from children on safety and risk in active play in schools: a systematic review

Background

Active play is vital for healthy child development, and schools are a valuable setting to promote this behaviour. Understanding the determinants of children’s physical activity behaviour during recess, particularly the role of risk-taking and the influence safety concerns have on active play, is required. This systematic review aimed to 1) synthesise qualitative research with children that explored their perceptions of safety and risk in active play during recess in elementary and/or middle school, and 2) develop a model from the findings to guide efforts in schools to optimise children’s active play opportunities during recess.

Methods

Six online databases were systematically searched for articles published between January 2000 and March 2021. Following PRISMA guidelines, records were screened against eligibility criteria using Covidence software, and data extraction and synthesis was conducted using customised forms in Excel and NVivo software. Framework synthesis methodology was employed, conceptually guided by Bronfenbrenner’s socio-ecological model and Gibson’s affordance theory.

Results

Of 9664 records, 31 studies met inclusion criteria, representing 1408 children across 140 schools from 11 countries. An emergent conceptual framework was developed encompassing 23 risk and safety themes and 10 risky play types that children desired in schools. Individual characteristics (age, gender, physical literacy) influenced children’s engagement with risk and how they kept themselves safe. Across outer SEM levels, factors interacted to constrain or afford children’s active play. Socio-cultural factors (supervision practices, rules, equipment restrictions) constrained active play, which children perceived were driven by adults’ concern with physical safety. These factors contributed to a cycle of risk-averse decision making and diminished play affordances, which could inadvertently exacerbate safety issues. A model for risk tolerance in children’s active play has been proposed.

Conclusions

The findings show a disparity between the active play children want in schools and what they are able to do. Future work should balance the concerns of adults against the active play children want, involve children in decisions about playground policy, and foster a risk-tolerant culture in schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01305-0.

A Low-Cost Method for Understanding How Nature-Based Early Learning and Childcare Impacts Children's Health and Wellbeing

Nature-based play and learning provision is becoming increasingly popular across the early learning and childcare (ELC) sector in Scotland. However, there remains a lack of understanding of how the program is expected to function. This has implications for program learning and may affect wider rollout of the program. Secondary data analysis of parent interviews (n = 22) and observations (n = 7) in Scottish ELC settings, and review of internationally published studies (n = 33) were triangulated to develop a program theory using the Theory of Change approach. This approach makes a program's underlying assumptions explicit by systematically demonstrating the relationship between each component: inputs, activities, outcomes, impact, and the contexts of the program. Findings suggested that location of outdoor nature space, affordances, availability of trained practitioners, and transport to location lead to activities such as free play, educator-led activities, and interactions with nature, resulting in longer durations of physical activity, interactions with peers and educators, and increased engagement with the natural environment. These activities are vital for supporting children's physical, cognitive, social, and emotional development. Our results demonstrate the value of using secondary data analysis to improve our understanding of the underlying theory of nature-based ELC which can support future evaluation designs. These findings will be of interest to program evaluators, researchers, practitioners, and funders, who find themselves with limited resources and want to better understand their program before investing in an evaluation. We encourage researchers and evaluators in the field of early years and outdoor play in other countries to refine this logic model in their own context-specific setting.

Evaluating Outdoor Nature-Based Early Learning and Childcare Provision for Children Aged 3 Years: Protocol of a Feasibility and Pilot Quasi-Experimental Design

Systematic reviews have demonstrated the scarcity of well-designed evaluations investigating outdoor nature-based play and learning provision for children in the early learning and childcare (ELC) sector among global Western countries. This study will examine the feasibility and acceptability of the programme and the evaluation design of outdoor nature-based play and learning provision across urban ELC settings in a Scottish metropolitan city. Six ELC settings with different outdoor nature-based play delivery models will be recruited. One trial design will be tested: a quasi-experimental comparison of children attending three different models of outdoor play and learning provision. Measures will be assessed at baseline and five weeks later. Key feasibility questions include: recruitment and retention of ELC settings and children; suitability of statistical matching based on propensity score; completeness of outcome measures. Process evaluation will assess the acceptability of trial design methods and provision of outdoor nature-based play among ELC educators. These questions will be assessed against pre-defined progression criteria. This feasibility study will inform a powered effectiveness evaluation and support policy making and service delivery in the Scottish ELC sector.

Play, Learn, and Teach Outdoors-Network (PLaTO-Net): terminology, taxonomy, and ontology

BACKGROUND

A recent dialogue in the field of play, learn, and teach outdoors (referred to as "PLaTO" hereafter) demonstrated the need for developing harmonized and consensus-based terminology, taxonomy, and ontology for PLaTO. This is important as the field evolves and diversifies in its approaches, contents, and contexts over time and in different countries, cultures, and settings. Within this paper, we report the systematic and iterative processes undertaken to achieve this objective, which has built on the creation of the global PLaTO-Network (PLaTO-Net).

METHODS

This project comprised of four major methodological phases. First, a systematic scoping review was conducted to identify common terms and definitions used pertaining to PLaTO. Second, based on the results of the scoping review, a draft set of key terms, taxonomy, and ontology were developed, and shared with PLaTO members, who provided feedback via four rounds of consultation. Third, PLaTO terminology, taxonomy, and ontology were then finalized based on the feedback received from 50 international PLaTO member participants who responded to ≥ 3 rounds of the consultation survey and dialogue. Finally, efforts to share and disseminate project outcomes were made through different online platforms.

RESULTS

This paper presents the final definitions and taxonomy of 31 PLaTO terms along with the PLaTO-Net ontology model. The model incorporates other relevant concepts in recognition that all the aspects of the model are interrelated and interconnected. The final terminology, taxonomy, and ontology are intended to be applicable to, and relevant for, all people encompassing various identities (e.g., age, gender, culture, ethnicity, ability).

CONCLUSIONS

This project contributes to advancing PLaTO-based research and facilitating intersectoral and interdisciplinary collaboration, with the long-term goal of fostering and strengthening PLaTO's synergistic linkages with healthy living, environmental stewardship, climate action, and planetary health agendas. Notably, PLaTO terminology, taxonomy and ontology will continue to evolve, and PLaTO-Net is committed to advancing and periodically updating harmonized knowledge and understanding in the vast and interrelated areas of PLaTO.