Association between connection with nature and determinants of health (obesity, mental health and quality of life) in childhood: protocol of a multicenter cross-sectional study

e202609048

Authors

  • Edurne Ciriza-Barea Servicio Navarro de Salud-Osasunbidea, Atención Primaria. Gerencia de Atención Primaria de Navarra. IdisNa. Comité de Salud Medioambiental de la Asociación Española de Pediatría (AEP), coordinadora del Grupo de investigación de la Asociación Española de Pediatría de Atención Primaria (AEPap), coordinadora navarra de la Red de Investigación de Pediatría de Atención Primaria de la AEPap (PAPenRed). Pediatra de Atención Primaria. Pamplona. España. https://orcid.org/0000-0003-0062-9098
  • Marta Carballal-Mariño Coordinadora Nacional de PAPenRed. Pediatra de Atención Primaria del Centro de Salud Novo Mesoiro (A Coruña). A Coruña. España. https://orcid.org/0000-0001-6507-6004
  • Francisco Díaz-Martinez Unidad de Salud Medioambiental Pediátrica (PEHSU Murcia), Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia. Laboratorio de Salud Humana y Medioambiente (EH2), Instituto Murciano de Investigación Sanitaria Pascual Parrilla (IMIB), Universidad de Murcia. Murcia. España. https://orcid.org/0000-0003-0069-1131
  • Catalina Núñez-Jiménez Servicio de promoción de la salud, Dirección General de Salud Pública y Participación de las Illes Balears. Coordinadora del grupo de Educación para la Salud y atención comunitaria de la Asociación Española de Pediatría de Atención Primaria (AEPap). Grupo de trabajo del Plan Nacional contra la Obesidad infantil 2022-2030. Palma de Mallorca. España. https://orcid.org/0000-0002-4218-2768
  • Elena Sánchez-Almeida Grupo coordinador de PAPenRed, Coordinadora PAPenRed Canarias. Pediatra de Atención Primaria del Centro de Salud La Guancha (Tenerife). Tenerife. España. https://orcid.org/0009-0000-1994-3330
  • Josep Vicent Balaguer-Martínez Director de la Revista Pediatría de Atención Primaria. Grupo Coordinador PAPenRed. Pediatra de Atención Primaria del CAP Sant Ildefons (Cornellà de Llobregat). Barcelona. España. https://orcid.org/0000-0001-5155-5987
  • Juan Antonio García-Sánchez Pediatra de Atención Primaria del Centro de Salud de San Lorenzo del Escorial. PAPenRed Madrid. Profesor asociado coordinador de practicas de la Universidad Francisco de Vitoria. Madrid. España. https://orcid.org/0009-0009-0620-565X
  • Susana Viver-Gómez Pediatra y directora del Centro de Salud Dr. Luengo Rodríguez (Móstoles). Tesorera y Coordinadora del Grupo de Ecografía clínica pediátrica de la Asociación Española de Pediatría de Atención Primaria (AEPap). Madrid. España. https://orcid.org/0000-0002-1582-7735
  • Pedro Gorrotxategi-Gorrotxategi Pediatra del Centro de Salud Pasaia San Pedro (Pasaia). Presidente de la AEPap. Pasaia. España. https://orcid.org/0000-0002-6603-9982
  • Elena Codina-Sampera Pediatra. Responsable de la Unidad de Salud Medioambiental Pediátrica del Hospital Sant Joan de Déu. Barcelona. España. https://orcid.org/0000-0002-0989-5635
  • Noelia Moreno-López Pediatra. Comité de Salud Medioambiental de la Asociación Española de Pediatría (AEP). Madrid. España. https://orcid.org/0009-0006-4770-7304
  • Juan Antonio Ortega-García Profesor de la Unidad Especializada de Salud Medioambiental Pediátrica del Hospital Clinico Universitario Virgen de la Arrixaca. Universidad de Murcia. Murcia. España. https://orcid.org/0000-0001-8577-4168
  • Ferran Campillo-López Unidad de Salud Medioambiental Pediátrica, Fundació Hospital d’Olot i Comarcal de la Garrotxa (Olot). Girona. España. https://orcid.org/0000-0002-0903-4499
  • PAPenRed Red de Investigación en Pediatría de Atención Primaria (PAPenRed), Asociación Española de Pediatría de Atención Primaria (AEPap). Madrid. España.

DOI:

https://doi.org/10.67113/resp.v100i1.1544

Keywords:

Healthy environments, Wild nature, Adolescence, Child well-being, Community health workers, Determinants of health, Healthy lifestyle , Environment and public health, Health promotion, Community health, Child health, Mental health, Environmental health, Planetary health

Abstract

Interacting with nature has significant benefits for our physical and psychosocial health. However, a lack of contact with nature has been linked to various pathologies such as obesity, asthma, neurodevelopmental disorders, and learning disabilities. Furthermore, excessive screen use is also associated with health problems in children and adolescents, such as obesity, mental health problems (anxiety, depression), and sleep disorders. Lack of contact with nature from an early age, combined with excessive screen use, contributes to an unhealthy lifestyle and has been associated with the development of these pathologies. This study aims to analyze the relationship between the degree of connection with nature, and the incidence of childhood and adolescent obesity and other common pathologies in Primary Care pediatric clinics: asthma, neurodevelopmental disorders, emotional and psychiatric disorders, as well as sleep disorders and worsening perceived quality of life. A descriptive cross-sectional study will be conducted through the PAPenRed research group of the Spanish Association of Primary Care Pediatrics (AEAPap) over a 12-month period (July 2025 to June 2026). During health visits for children aged seven to fourteen, three surveys will be administered simultaneously: one for the child, another for the parents, and a third for the pediatrician.

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References

1. Kondo MC, Fluehr JM, McKeon T, Branas CC. Urban Green Space and Its Impact on Human Health. Int J Environ Res Public Health. 2018;15(3):445. doi: https://doi.org/10.3390/ijerph15030445. PMID: 29510520; PMCID: PMC5876990.

2. Rojas-Rueda D, Nieuwenhuijsen MJ, Gascon M, Perez-Leon D, Mudu P. Green spaces and mortality: a systematic review and meta-analysis of cohort studies. Lancet Planet Health. 2019 Nov;3(11):e469-e477. doi: 10.1016/S2542-5196(19)30215-3. Erratum en: Lancet Planet Health. 2021;5(8):e504. doi: https://doi.org/10.1016/S2542-5196(21)00208-4. PMID: 31777338; PMCID: PMC6873641.

3. Smith N, Georgiou M, King AC, Tieges Z, Webb S, Chastin S. Urban blue spaces and human health: A systematic review and meta-analysis of quantitative studies. Cities. 2021. Vol. 119,103413.ISSN 0264-2751. https://doi.org/10.1016/j.cities.2021.103413

4. De Bont J, Márquez S, Fernández-Barrés S, Warembourg C, Koch S, Persavento C, Fochs S, Pey N, de Castro M, Fossati S, Nieuwenhuijsen M, Basagaña X, Casas M, Duarte-Salles T, Vrijheid M. Urban environment and obesity and weight-related behaviours in primary school children. Environ Int. 2021;155:106700. doi: https://doi.org/10.1016/j.envint.2021.106700. Epub 2021 Jun 15. PMID: 34144474.

5. De Bont J, Casas M, Barrera-Gómez J, Cirach M, Rivas I, Valvi D, Álvarez M, Dadvand P, Sunyer J, Vrijheid M. Ambient air pollution and overweight and obesity in school-aged children in Barcelona, Spain. Environ Int. 2019;125:58-64. doi: https://doi.org/10.1016/j.envint.2019.01.048. PMID: 30703612; PMCID: PMC6380992.

6. Masdor NA, Abu Bakar MF, Hod R, Mohammed Nawi A. Green space exposure and colorectal cancer: A systematic review. Heliyon. 2023;9(5):e15572. doi: https://doi.org/10.1016/j.heliyon.2023.e15572. PMID: 37153430; PMCID: PMC10160744.

7. Mirrahimi S, Tawil NM, Abdullah NAG, Surat M, Usman IMS. (2011). Developing conducive sustainable outdoor learning: The impact of natural environment on learning, social and emotional intelligence. Procedia Engineering, 20, 389-396.

8. Roe JJ, Thompson CW, Aspinall PA, Brewer MJ, Duff EI, Miller D, Mitchell R, Clow A. Green space and stress: evidence from cortisol measures in deprived urban communities. Int J Environ Res Public Health. 2013;10(9):4086-4103. doi: https://doi.org/10.3390/ijerph10094086. PMID: 24002726; PMCID: PMC3799530.

9. Zhang Y, Mavoa S, Zhao J, Raphael D, Smith M. The Association between Green Space and Adolescents’ Mental Well-Being: A Systematic Review. Int J Environ Res Public Health. 2020 Sep 11;17(18):6640. doi: https://doi.org/10.3390/ijerph17186640. PMID: 32932996; PMCID: PMC7557737.

10. Gladwell VF, Brown DK, Wood C, Sandercock GR, Barton JL. The great outdoors: how a green exercise environment can benefit all. Extreme physiology & medicine, 2013; 2(1), 1-7.

11. Lahart I, Darcy P, Gidlow C, Calogiuri G. The Effects of Green Exercise on Physical and Mental Wellbeing: A Systematic Review. Int J Environ Res Public Health. 2019 Apr 15;16(8):1352. doi: https://doi.org/10.3390/ijerph16081352. PMID: 30991724; PMCID: PMC6518264.

12. Ortega-García JA, Tellerías L, Ferrís-Tortajada J, Boldo E, Campillo-López F, Van den Hazel P et al. Amenazas, desafíos y oportunidades para la salud medioambiental pediátrica en Europa, América Latina y el Caribe. Anales de Pediatría. 2019;90(2):124.e1-124.e11

13. Ni Y, Loftus CT, Szpiro AA, Young MT, Hazlehurst MF, Murphy LE, Tylavsky FA, Mason WA, LeWinn KZ, Sathyanarayana S, Barrett ES, Bush NR, Karr CJ. Associations of Pre- and Postnatal Air Pollution Exposures with Child Behavioral Problems and Cognitive Performance: A U.S. Multi-Cohort Study. Environ Health Perspect. 2022 Jun;130(6):67008. doi: https://doi.org/10.1289/EHP10248. Epub 2022 Jun 23. PMID: 35737514; PMCID: PMC9222764

14. Johnson M, Mazur L, Fisher M, Fraser WD, Sun L, Hystad P, Gandhi CK. Prenatal Exposure to Air Pollution and Respiratory Distress in Term Newborns: Results from the MIREC Prospective Pregnancy Cohort. Environ Health Perspect. 2024 Jan;132(1):17007. doi: https://doi.org/10.1289/EHP12880. Epub 2024 Jan 25. PMID: 38271058; PMCID: PMC10810300

15. Annual Update. (s/f). AIR QUALITY LIFE INDEX | 2025. Uchicago.edu. Recuperado el 25 de abril de 2026, de https://aqli.epic.uchicago.edu/files/Report%20-%20English%20Global%20View.pdf

16. Fyfe-Johnson AL, Hazlehurst MF, Perrins SP, Bratman GN, Thomas R, Garrett KA, Hafferty KR, Cullaz TM, Marcuse EK, Tandon PS. Nature and Children’s Health: A Systematic Review. Pediatrics. 2021;148(4):e2020049155. doi: https://doi.org/10.1542/peds.2020-049155. Epub 2021 Sep 29. PMID: 34588297

17. Ortega-García JA, Martínez-Gómez C, Bach A, Benítez-Rodríguez L, Ramis R. Creciente desconexión de la naturaleza. Urge una alianza de salud global para la prescripción de naturaleza. An Pediatr (Engl Ed). 2024;100(6):e10-e12. doi: https://doi.org/10.1016/j.anpede.2024.03.004

18. Díaz-Martínez F, Sánchez-Sauco MF, Cabrera-Rivera LT, Sánchez CO, Hidalgo-Albadalejo MD, Claudio L, Ortega-García JA. Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents. Int J Environ Res Public Health. 2023 Feb 23;20(5):3958. doi: https://doi.org/10.3390/ijerph20053958. PMID: 36900969; PMCID: PMC10001910

19. Wolf KL, Lam ST, McKeen JK, Richardson GRA, van den Bosch M, Bardekjian AC. Urban Trees and Human Health: A Scoping Review. Int J Environ Res Public Health. 2020 Jun 18;17(12):4371. doi: https://doi.org/10.3390/ijerph17124371. PMID: 32570770; PMCID: PMC7345658

20. Browning MHEM, Locke DH, Konijnendijk C, Labib SM, Rigolon A, Yeager R, Bardhan M, Berland A, Dadvand P, Helbich M, Li F, Li H, James P, Klompmaker J, Reuben A, Roman LA, Tsai WL, Patwary M, O’Neil-Dunne J, Ossola A, Wang R, Yang B, Yi L, Zhang J, Nieuwenhuijsen M. Measuring the 3-30-300 rule to help cities meet nature access thresholds. Sci Total Environ. 2024 Jan 10;907:167739. doi: https://doi.org/10.1016/j.scitotenv.2023.167739. Epub 2023 Oct 11. PMID: 37832672; PMCID: PMC11090249

21. Nieuwenhuijsen MJ, Dadvand P, Márquez S, Bartoll X, Pereira Barboza E, Cirach M, Borrell C, Zijlema WL. The evaluation of the 3-30-300 green space rule and mental health. Environmental Research, Volume 215, Part 2, 2022,114387, ISSN 0013-9351, https://doi.org/10.1016/j.envres.2022.114387

22. Ciudades Amigas de la Infancia. UNICEF. 2024. Recuperado el 25 de abril de 2026. Disponible en: https://ciudadesamigas.org/movilidad-espacio-publico/

23. Ciudades que Caminan. 2023. Recuperado el 25 de abril de 2026. Disponible en: https://ciudadesquecaminan.org/accion/callegrafias/

24. Louv R (2005). Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder. Algonquin Books. ISBN 978-1-56512-605-3

25. Cheng JC-H, Monroe MC. (2012). Connection to nature: Children’s affective attitude toward nature. Environment and Behavior, 44(1), 31-49. https://doi.org/10.1177/0013916510385082

26. Richardson M et al. (2016). The Impact of Children’s Connection to Nature: A Report for the Royal Society for the Protection of Birds (RSPB). Royal Society for the Protection of Birds. Disponible en: https://www.researchgate.net/publication/295076291_The_Impact_of_Children%27s_Connection_to_Nature_A_Report_for_the_Royal_Society_for_the_Protection_of_Birds_RSPB

27. Informe técnico. Estudio de conexión con la naturaleza entre la población de 8 a 12 años de Gipuzkoa. Recuperado el 25 de abril de 2026. Disponible en: https://www.gipuzkoa.eus/documents/3767975/15494910/1+GFA_Conexi%C3%B3n+con+la+naturaleza_ES.pdf/9628de6c-b847-e762-8956-1bc78537a957

28. Ortega-García JA, Díaz-Martínez F, Cabrera-Rivera LT, Cánovas-Conesa CA, Codina E, Ramis R, Claudio L. (2026). Roots of resilience: Assessing child and adolescent nature connectivity in the Mediterranean Region of Murcia (Spain). People and Nature. 2026; 8, 378-391. https://doi.org/10.1002/pan3.70240

29. Barrera-Hernández LF, Sotelo-Castillo MA, Echeverría-Castro SB, Tapia-Fonllem CO. Connectedness to Nature: Its Impact on Sustainable Behaviors and Happiness in Children. Front Psychol. 2020;11:276. doi: https://doi.org/10.3389/fpsyg.2020.00276. PMID: 32174866; PMCID: PMC7054437

30. Sohn SY, Rees P, Wildridge B et al. Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence. BMC Psychiatry 19, 356 (2019). https://doi.org/10.1186/s12888-019-2350-x

31. Augner C, Vlasak T, Barth A. The relationship between problematic internet use and attention deficit, hyperactivity and impulsivity: A meta-analysis. J Psychiatr Res. 2023 Dec;168:1-12. doi: https://doi.org/10.1016/j.jpsychires.2023.10.032. Epub 2023 Oct 16. PMID: 37866293.

32. Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019 Apr;23(4):2324-2332. doi: https://doi.org/10.1111/jcmm.14170. Epub 2019 Feb 7. PMID: 30734486; PMCID: PMC6433686.

33. Haghjoo P, Siri G, Soleimani E, Farhangi MA, Alesaeidi S. Screen time increases overweight and obesity risk among adolescents: a systematic review and dose-response meta-analysis. BMC Prim Care. 2022 Jun 28;23(1):161. doi: https://doi.org/10.1186/s12875-022-01761-4. PMID: 35761176; PMCID: PMC9238177.

34. Cartanyà Hueso À, Lidón Moyano C, Martín Sánchez JC, González Marrón A, Pérez Martín H, Martínez Sánchez JM. Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years. An Pediatr (Engl Ed). 2022;97:333-341.

35. Grupo PAPenRED–AEPAP. (s/f). Aepap.org. Recuperado el 25 de abril de 2026, de https://aepap.org/001-pagina-de-grupo-4/

36. Estudio sobre la Alimentación, Actividad física, Desarrollo Infantil y Obesidad en España 2023. Gob.es. Recuperado el 25 de abril de 2026, de https://www.aesan.gob.es/AECOSAN/docs/documentos/nutricion/ALADINO_AESAN.pdf

37. García P, Goodman R, Mazaira J, Torres A, Rodríguez-Sacristán J, Hervas A, Fuentes J. (2000). El Cuestionario de Capacidades y Dificultades. Revista de Psiquiatría Infanto-Juvenil, 1, 12-17. https://aepnya.eu/index.php/revistaaepnya/article/view/443

38. Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800-812. doi: https://doi.org/10.1097/00005650-200108000-00006. PMID: 11468499.

39. Plan de Acción de Atención Primaria 2022-2023. Grupo de trabajo de salud comunitaria. Ministerio de Sanidad. Gobierno de España. https://www.sanidad.gob.es/areas/promocionPrevencion/entornosSaludables/saludComunitaria/estrategiasCCAA/home.htm

40. Nour T, Altıntas K. (2023). Effect of the COVID-19 pandemic on obesity and its risk factors: a systematic review. BMC Public Health, 23. https://doi.org/10.1186/s12889-023-15833-2

41. Hassan N, Salim H, Amaran S, Yunus N, Yusof N, Daud N, Fry D. (2023). Prevalence of mental health problems among children with long COVID: A systematic review and meta-analysis. PLOS ONE, 18. https://doi.org/10.1371/journal.pone.0282538

42. Theberath M, Bauer D, Chen W, Salinas M, Mohabbat A, Yang, J, Chon T, Bauer B, Wahner-Roedler D. (2022). Effects of COVID-19 pandemic on mental health of children and adolescents: A systematic review of survey studies. SAGE Open Medicine, 10. https://doi.org/10.1177/20503121221086712

43. Wilson EO. Biophilia. Cambridge (MA): Harvard University Press; 1984. ISBN 9780674074422

44. Gill T. The benefits of children’s engagement with nature: a systematic literature review. Child Youth Environ. 2014;24(2):10-34.

45. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva: WHO, 2019. Disponible en: https://www.who.int/publications/i/item/9789241550536

46. Chawla L. Benefits of nature contact for children. J Plan Lit. 2015;30(4):433-452.

47. Twohig-Bennett C, Jones A. The health benefits of the great outdoors: a systematic review and meta-analysis. Environ Res. 2018;166:628-637.

48. Lundgren O, Tigerstrand H, Lebena A et al. Impact of physical activity on the incidence of psychiatric conditions during childhood: a longitudinal Swedish birth cohort study. British Journal of Sports Medicine 2025;59:1001-1009. doi: https://doi.org/10.1136/bjsports-2024-108148

49. Engemann K, Pedersen CB, Arge L, Tsirogiannis C, Mortensen PB, Svenning JC. Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. Proc Natl Acad Sci U S A. 2019 Mar 12;116(11):5188-5193. doi: https://doi.org/10.1073/pnas.1807504116. Epub 2019 Feb 25. PMID: 30804178; PMCID: PMC6421415. doi: https://doi.org/10.1073/pnas.1807504116

50. Yi L, Harnois-Leblanc S, Rifas-Shiman SL et al. Satellite-Based and Street-View Green Space and Adiposity in US Children. JAMA Netw Open. 2024;7(12):e2449113. doi: https://doi.org/10.1001/jamanetworkopen.2024.49113

51. Alianza Global para Renaturalizar la Salud de la Infancia y Adolescencia (GRSIA). Comité de Salud Medioambiental. Asociación Española de Pediatría. https://static.aeped.es/ndp_grsia_703490d7e9.pdf

Published

2026-09-03

How to Cite

1.
Ciriza-Barea E, Carballal-Mariño M, Díaz-Martinez F, Núñez-Jiménez C, Sánchez-Almeida E, Balaguer-Martínez JV, et al. Association between connection with nature and determinants of health (obesity, mental health and quality of life) in childhood: protocol of a multicenter cross-sectional study : e202609048. Rev Esp Salud Pública [Internet]. 2026 Sep. 3 [cited 2026 Sep. 4];100(1):15 páginas. Available from: https://ojs.sanidad.gob.es/index.php/resp/article/view/1544