Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.

A diverse, cross-sectorial group of partners, stakeholders and researchers, collaborated to develop an evidence-informed Position Statement on active outdoor play for children aged 3–12 years. The Position Statement was created in response to practitioner, academic, legal, insurance and public debate, dialogue and disagreement on the relative benefits and harms of active (including risky) outdoor play. The Position Statement development process was informed by two systematic reviews, a critical appraisal of the current literature and existing position statements, engagement of research experts (N = 9) and cross-sectorial individuals/organizations (N = 17), and an extensive stakeholder consultation process (N = 1908). More than 95% of the stakeholders consulted strongly agreed or somewhat agreed with the Position Statement; 14/17 participating individuals/organizations endorsed it; and over 1000 additional individuals and organizations requested their name be listed as a supporter. The final Position Statement on Active Outdoor Play states: “Access to active play in nature and outdoors—with its risks— is essential for healthy child development. We recommend increasing children’s opportunities for self-directed play outdoors in all settings—at home, at school, in child care, the community and nature.” The full Position Statement provides context for the statement, evidence supporting it, and a series of recommendations to increase active outdoor play opportunities to promote healthy child development.

Social media use (SMU) has become an intrinsic part of adolescent life. Negative consequences of SMU for adolescent health could include exposures to online forms of aggression. We explored age, gender, and cross-national differences in adolescents' engagement in SMU, then relationships between SMU and victimization and the perpetration of cyber-bullying. We used data on young people aged 11-15 years (weighted n = 180,919 in 42 countries) who participated in the 2017-2018 Health Behaviour in School-aged Childrenstudy to describe engagement in the three types of SMU (intense, problematic, and talking with strangers online) by age and gender and then in the perpetration and victimization of cyber-bullying. Relationships between SMU and cyber-bullying outcomes were estimated using Poisson regression (weighted n = 166,647 from 42 countries). Variations in SMU and cyber-bullying follow developmental and gender-based patterns across countries. In pooled analyses, engagement in SMU related to cyber-bullying victimization (adjusted relative risks = 1.14 [95% confidence interval (CI): 1.10-1.19] to 1.48 [95% CI: 1.42-1.55]) and perpetration (adjusted relative risk = 1.31 [95% CI: 1.26-1.36] to 1.84 [95% CI: 1.74-1.95]). These associations were stronger for cyber-perpetration versus cyber-victimization and for girls versus boys. Problematic SMU was most strongly and consistently associated with cyber-bullying, both for victimization and perpetration. Stratified analyses showed that SMU related to cyber-victimization in 19%-45% of countries and to cyber-perpetration in 38%-86% of countries. Accessibility to social media and its pervasive use has led to new opportunities for online aggression. The time adolescents spend on social media, engage in problematic use, and talk to strangers online each relate to cyber-bullying and merit public health intervention. Problematic use of social media poses the strongest and most consistent risk.

Background: Positive emotional well-being is fundamentally important to general health status, and is linked to many favorable health outcomes. There is societal interest in understanding determinants of emotional well-being in adolescence, and the natural environment represents one potential determinant. Psychological and experimental research have each shown links between exposure to nature and both stress reduction and attention restoration. Some population studies have suggested positive effects of green space on various indicators of health. However, there are limited large-scale epidemiological studies assessing this relationship, specifically for populations of young people and in the Canadian context. The objective of this study was to examine the relationship between exposure to public natural space and positive emotional well-being among young adolescent Canadians.Methods: This cross-sectional study was based upon the Canadian 2009/10 Health Behaviour in School-aged Children Survey with linked geographic information system (GIS) data. Following exclusions, the sample included 17 249 (grades 6 to 10, mostly ages 11 to 16) students from 317 schools. Features of the natural environment were extracted using GIS within a 5 km radius circular buffer surrounding each school. Multilevel logistic regression was used to examine the relationship between the presence of public natural space (features include green and blue spaces such as parks, wooded areas, and water bodies) and students’ reports of positive emotional well-being, while controlling for salient covariates and the clustered nature of the data.Results: Over half of Canadian youth reported positive emotional well-being (58.5% among boys and 51.6% among girls). Relationships between measures of natural space and positive emotional well-being were weak and lacked consistency overall, but modest protective effects were observed in small cities. Positive emotional well-being was more strongly associated with other factors including demographic characteristics, family affluence, and perceptions of neighbourhood surroundings.Conclusion: Exposure to natural space in youth’s immediate living environment may not be a leading determinant of their emotional well-being. The relationship between natural space and positive emotional well-being may be context specific, and thus different for Canadian youth compared to adult populations and those studied in other nations. Factors of the individual context were stronger potential determinants.

Exposures to outdoor environments have great potential to be protective factors for the mental health of young people. In a national analysis of Canadian adolescents, we explored how such exposures, as well as self-perceptions of connectedness with nature, each related to the prevalence of recurrent psychosomatic symptoms. The data source for this cross-sectional study, consisting of a weighted sample of 29,784 students aged 11-15 years from 377 schools, was the 2013/2014 cycle of the Health Behaviour in School-aged Children (HBSC) study. We modeled reports of exposure to the outdoors and then perceived connection(s) to nature as correlates of reduced psychosomatic symptoms. Associations varied by sex. Among girls, spending on average >0.5 h/week outdoors was associated with a 24% (95% CI: 5%, 40%) lower prevalence of high psychosomatic symptoms, compared to those who averaged no time playing outdoors. No such relationship was observed among boys. Perception of connection to nature as 'important' was similarly associated with a 25% (95% CI: 9%, 38%) reduction in the prevalence of high psychosomatic symptoms; this association did not differ by sex or age. Our analysis highlights the potential importance of adolescent engagement with nature as protective for their psychological well-being. It also emphasizes the importance of accounting for differences between boys and girls when researching, planning, and implementing public mental health initiatives that consider exposure to the outdoors.

BACKGROUND AND OBJECTIVES: No recent international studies provide evidence about its prevalence, trends, or social determinants of physical fighting in adolescents. We studied cross-national epidemiologic trends over time in the occurrence of frequent physical fighting, demographic variations in reported trends, and national wealth and income inequality as correlates. METHODS: Cross-sectional surveys were administered in school settings in 2002, 2006, and 2010. Participants (N = 493874) included eligible and consenting students aged 11, 13, and 15 years in sampled schools from 30 mainly European and North American countries. Individual measures included engagement in frequent physical fighting, age, gender, participation in multiple risk behaviors, victimization by bullying, and family affluence. Contextual measures included national income inequality, absolute wealth and homicide rates. Temporal measure was survey cycle (year). RESULTS: Frequent physical fighting declined over time in 19 (63%) of 30 countries (from descriptive then multiple Poisson regression analyses). Contextual measures of absolute wealth (relative risk 0.96, 95% confidence interval 0.93–0.99 per 1 SD increase in gross domestic product per capita) but not income inequality (relative risk 1.01, 95% confidence interval 0.98–1.05 per 1 SD increase) related to lower levels of engagement in fighting. Other risk factors identified were male gender, younger age (11 years), multiple risk behaviors, victimization by bullying, and national homicide rates. CONCLUSIONS: Between 2002 and 2010, adolescent physical fighting declined in most countries. Specific groups of adolescents require targeted violence reduction programs. Possible determinants responsible for the observed declines are discussed.