[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].
Ciriza-Barea E, Carballal-Mariño M, et al. • Revista espanola de salud publica • 2026
This paper describes a protocol for a multicenter cross-sectional study analyzing the association between degree of connection with nature and the incidence of childhood obesity and other common pathologies (asthma, neurodevelopmental disorders, emotional and psychiatric disorders, sleep disorders, and quality of life) in Primary Care pediatric clinics in Spain.
Key Findings
Background
Interacting with nature has been identified as having significant benefits for physical and psychosocial health, while lack of contact with nature has been linked to obesity, asthma, neurodevelopmental disorders, and learning disabilities.
The association between nature deficit and pathologies is presented as established background knowledge motivating the study.
Lack of contact with nature from an early age is described as contributing to an unhealthy lifestyle.
These associations form the theoretical basis for the planned investigation.
Background
Excessive screen use in children and adolescents has been associated with obesity, mental health problems (anxiety, depression), and sleep disorders.
Screen use is framed as a compounding factor alongside lack of nature contact.
The combination of nature deficit and excessive screen use is described as contributing to an unhealthy lifestyle.
These associations are cited as background evidence motivating the study design.
Methods
A descriptive multicenter cross-sectional study protocol has been designed to analyze the relationship between connection with nature and childhood obesity and other pathologies in Primary Care pediatric settings in Spain.
The study will be conducted through the PAPenRed research group of the Spanish Association of Primary Care Pediatrics (AEAPap).
The study period spans 12 months, from July 2025 to June 2026.
Target population is children aged seven to fourteen years attending routine health visits.
Three simultaneous surveys will be administered at each visit: one for the child, one for the parents, and one for the pediatrician.
Methods
The study aims to examine the association between nature connection and multiple health outcomes including obesity, asthma, neurodevelopmental disorders, emotional and psychiatric disorders, sleep disorders, and perceived quality of life.
Childhood and adolescent obesity is listed as the primary health outcome of interest.
Secondary outcomes include asthma, neurodevelopmental disorders, emotional and psychiatric disorders, sleep disorders, and worsening of perceived quality of life.
The study targets common pathologies encountered in Primary Care pediatric clinics.
The multicenter design through PAPenRed enables data collection across multiple Spanish primary care settings.
What This Means
This paper describes the protocol — essentially the detailed plan — for a study that has not yet been completed. Researchers in Spain are designing a large study to investigate whether children who have more connection with nature are less likely to be obese or to have health problems like asthma, anxiety, depression, sleep disorders, or neurodevelopmental conditions. The study will also look at how much time children spend on screens, since excessive screen use has already been linked to many of the same health problems that arise from lack of nature contact.
The study will take place over 12 months (July 2025 to June 2026) across multiple primary care pediatric clinics in Spain. Children aged 7 to 14 attending routine health checkups will be invited to participate. At each visit, three separate questionnaires will be filled out simultaneously — one by the child, one by the parents, and one by the pediatrician — to capture different perspectives on the child's health and lifestyle.
This research suggests that understanding the relationship between children's connection with nature and their physical and mental health could have important implications for public health recommendations. If the completed study finds strong associations, it could support efforts to increase children's access to green spaces and outdoor activities as a way to promote healthier development. However, since this paper only describes the study plan and contains no results yet, no conclusions about those associations can be drawn at this time.
Ciriza-Barea E, Carballal-Mariño M, Díaz-Martínez F, Núñez-Jiménez C, Sánchez-Almeida E, Balaguer-Martínez J, et al.. (2026). [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].. Revista espanola de salud publica. https://pubmed.ncbi.nlm.nih.gov/42690077/