The relationship between residential proximity to outdoor play spaces and children's mental and behavioral health: The importance of neighborhood socio-economic characteristics
Urban outdoor play spaces are reported to improve children's health. However, there is little empirical evidence on the impact of outdoor play spaces on childhood mental and behavioral health. To fill this gap, we investigated the associations between residential proximity to outdoor play spaces and the prevalence of diagnosed mental and behavioral disorders. We explored whether these associations differ by individual and area-level socio-economic status (SES). This cross-sectional study included 151 110 children who were 0-12 years old in 2014 and were visited in public primary health care centers in Barcelona (Spain). Each child's demographic and mental and behavioral disorders information was extracted for 2005-2014, including diagnoses on disorders of psychological development together with other four types of mental and behavioral disorders. The pediatrician diagnosed mental and behavioral disorders we explored in this study were: mood/affective; neurotic, stress-related and somatoform; psychological development; behavioral and emotional; and overall mental and behavioral disorders. We assessed 300 m network buffer residential proximity to overall outdoor play spaces (i.e., the overall sum of play spaces of any type), outdoor green play spaces, and to a diversity of outdoor play spaces. We used robust Poisson regression models to investigate the association between proximity to outdoor play spaces indicators and each health outcome. We tested interaction terms for indicators of proximity to outdoor play spaces and individual and area SES. For measures with significant interaction terms, we conducted stratified models. We found residential proximity to outdoor play spaces to be protective of disorders of psychological development. Proximity to overall outdoor play spaces, proximity to outdoor green play spaces and proximity to a greater diversity of outdoor play spaces were associated with a 4% (95% CI: 1,7), 4% (95% CI: 1,7) and 5% (95% CI: 2,9) lower prevalence rates of disorders of psychological development respectively. Most of the associations were found to be in the same direction-although more pronounced-in low SES areas, but in the opposite direction for children living in high SES areas. No differences in these associations were found by individual SES. Residential proximity to outdoor play spaces is protective of children's mental and behavioral health living in low SES areas. ; This work was supported by the GREENLULU's Project under the European Union's Horizon 2020 research and innovation framework [grant number 678034]; the NATURVATION Project under the European Union's Horizon 2020 research and innovation framework [grant number 730243]; the ECHOCAT project of La Marató de TV3 Foundation [grant number 201621–30] and the the María de Maeztu Program for Units of Excellence of the Spanish Ministry of Science and Innovation [grant number CEX 2019-000940-M]. HC and MTM are funded by Juan de la Cierva fellowships awarded by the Spanish Ministry of Economy and Competitiveness [grant number FJCI-2018-035322 and FJCI-2017-33842]. The sponsors had no role in the design or analysis of this study.