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Review
. 2023 Jan 18;20(3):1746.
doi: 10.3390/ijerph20031746.

School-Based Interventions to Support Healthy Indoor and Outdoor Environments for Children: A Systematic Review

Amanda Fernandes  1   2   3 , Mònica Ubalde-López  1   2   3 , Tiffany C Yang  4 , Rosemary R C McEachan  4 , Rukhsana Rashid  4 , Léa Maitre  1   2   3 , Mark J Nieuwenhuijsen  1   2   3 , Martine Vrijheid  1   2   3
Affiliations
Review

School-Based Interventions to Support Healthy Indoor and Outdoor Environments for Children: A Systematic Review

Amanda Fernandes et al. Int J Environ Res Public Health. .

Abstract

Environmental exposures are associated with children's health. Schools are often urban exposure 'hotspots' for pollution, noise, lack of green space and un-walkable built environments. The aim of this systematic review was to explore the impact of school-based interventions on the modification of indoor and outdoor stressors related to the built and natural environment on children's exposure and health. A systematic review of seven databases was performed. We included quantitative studies on children aged 5-12, which reported intervention delivered within school settings aimed at addressing key environmental exposures including air pollution, green spaces, traffic noise or active travel; and reported physical and mental health, physical activity or active travel behavior. The quality of studies was assessed and interventions were described using a standardized framework. A narrative synthesis approach was used to describe the findings. Thirty-nine papers were included on three main intervention types: improve indoor air quality by the increase of ventilation rates in classrooms; increase children's green time or greening schools, and multicomponent interventions to increase active travel to school by changes in pedestrian facilities. No eligible intervention to reduce traffic noise at school was found. Increasing ventilation rates improved short-term indoor air quality in classrooms, but the effect on cognitive performance was inconsistent. Greening schools and increasing children's green time have consistent positive effects on cognition and physical activity, but not in behavior. Multi-component interventions can increase walking and cycling after three years. Overall, the studies were rated as having poor quality owing to weak study designs. We found modest evidence that school-based built and natural environment interventions can improve children's exposure and health.

Keywords: active travel; air pollution; road-traffic noise; school children; systematic review; urban green space.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PICO-driven question scheme.
Figure 3
Figure 3
Impact of interventions per exposure target. Each slice represents an outcome. One study can have more than one eligible outcome. For more details on each intervention study see Supplementary Material S2. a = [41] effect dependent on the school location (level of nearby traffic) and year of construction (> or <15 years); b = [42] 2 school gyms from primary schools; c = [43] effect only for within late-start schools (9 AM) located near major roads; d = [44]; f = [46]; g = [47]; h = [48] not for outdoor generated pollutants (NO2 and PM2.5; i = [45]; j = [49] total number of errors in attention test increased significantly in worse condition; k = [50] significant results only when motivated students were kept, less eye pain in the recirculation condition; l = [66] only for selective attention not for processing speed; m-study 1 = [67] selective attention and working memory tests; m-study 2 = [67] only working memory tests; n = [60]; o-study 1 = [61]; o-study 2 = [61]; p = [62] playground sports increased MVPA more than nature recess; q = [63]; r = [54]; s = [56]; t = [57]; u = [58]; v = [59]; w = [55] only for general effect: positive in boys; x = [53]; y = [52]; z = [51] in contrast with qualitative data; aa = [64]; bb = [65]; cc = [76]; dd = [71]; ee = [79]; ff = [75]; gg = [78] 53 primary schools; hh = [77]; ii = [73]; jj = [72]; kk = [69] only when combined with Education component; ll = [68]; mm = [70] 79% primary K8 schools (5 to 14 y); nn = [74].
Figure 2
Figure 2
PRISMA flow diagram of study search and selection [40].
Figure 4
Figure 4
Recommendations for future studies and policymakers from each intervention target.
See this image and copyright information in PMC

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