Chapter 7. Investigating equitable access to greenspace during the COVID-19 pandemic: Implications for children’s mental health in Durham, North Carolina
Sharmi Amin, Kate Hoffman, PhD, Catherine Kastleman, MPH and Heather M Stapleton, PhD
Trinity College of Arts and Sciences, Duke University, Durham and Nicholas School of the Environment, Duke University, Nicholas School of the Environment, Durham, North Carolina, United States of America
Past research suggests positive correlations between time spent outdoors and better mental health in children. During the COVID-19 pandemic, researchers predicted that limitations on social gathering could have lasting impacts on children’s mental well-being. We hypothesized that protective guidelines set in place to prevent COVID-19 infection would decrease children’s time spent in greenspaces, adversely impacting mental well-being. We also investigated changes in children’s time spent outdoors during the pandemic, the social and structural barriers to accessing local greenspaces, and the potential impacts on children’s mental health in Durham, North Carolina, USA. An online survey was distributed via parent Facebook groups to collect data (n = 95 children). The Pediatric Symptom Checklist (PSC) was used as a proxy for indicating children’s mental well-being. Most parents indicated a change in the amount of time spent outside during the pandemic. Children who spent more time outdoors in general, and children who spent more time outdoors during the pandemic, had lower PSC scores, indicating better mental well-being. When examining barriers to greenspace access, we observed no difference in the walkability index between higher- and lower-income zip codes. We did find that those residing in lower-income zip codes indicated more safety concerns about greenspaces particularly related to criminal activity. However, we found that the distribution of PSC scores was lower for children living in lower-income zip codes compared to higher-income zip codes, suggesting better mental well-being. Cumulatively, our results indicate that time spent outdoors has positive impacts on children’s mental health.
 Oxford. Greenspace definition. Lexico 2021. URL: https://www.lexico.com/en/definition/green_space.
 Mitra R, Moore SA, Gillespie M, Faulkner G, Vanderloo LM, Chulak-Bozzer T, et
al. Healthy movement behaviours in children and youth during the COVID-19
pandemic: Exploring the role of the neighbourhood environment. Health Place
2020;65:102418. DOI: https://doi.org/10.1016/j.healthplace.2020.102418.
 Uchiyama Y, Kohsaka R. Access and use of green areas during the COVID-19
pandemic: Green infrastructure management in the “new normal”. Sustainability
2020;12(23):9842. DOI: https://doi.org/10.3390/su12239842.
 McCormick R. Does access to green space impact the mental well-being of
children: A systematic review. J Pediatr Nurs 2017;37:3–7. DOI:
 Tappe KA, Glanz K, Sallis JF, Zhou C, Saelens BE. Children’s physical activity
and parents’ perception of the neighborhood environment: Neighborhood
impact on kids study. Int J Behav Nutr Phys Act 2013;10:39. DOI:
 Zuniga-Teran AA, Stoker P, Gimblett RH, Orr BJ, Marsh SE, Guertin DP, et al.
Exploring the influence of neighborhood walkability on the frequency
of use of greenspace. Landsc Urban Plan 2019;190:103609. DOI:
 Shumow L, Vandell DL, Posner J. Risk and resilience in the urban neighborhood:
Predictors of academic performance among low-income elementary school
children. Merrill Palmer Q 1999;45(2):309–31.
 AJMC Staff. A timeline of COVID-19 developments in 2020. AJMC 2021. URL:
 Lancker WV, Parolin Z. COVID-19, school closures, and child poverty: A
social crisis in the making. Lancet Public Health 2020;5(5):e243-4. DOI:
 Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and
mental health for children and adolescents. JAMA Pediatr 2020;174(9):819. DOI:
 Tulchin-Francis K, Stevens W, Gu X, Zhang T, Roberts H, Keller J, et al.
The impact of the coronavirus disease 2019 pandemic on physical activity in US
children. J Sport Health Sci 2021;10(3):323–32. DOI: https://doi.org/10.1016/j.jshs.2021.02.005.
 Pediatric symptom checklist. Massachusetts General Hospital.
 Jellinek M, Little M, Murphy JM, Pagano M. The Pediatric symptom checklist:
Support for a role in a managed care environment. Arch Pediatr Adolesc Med
1995;149(7):740–6. DOI: https://doi.org/10.1001/archpedi.1995.02170200030004.
 Jellinek MS, Murphy JM, Little M, Pagano ME, Comer DM, Kelleher KJ. Use of
the pediatric symptom checklist to screen for psychosocial problems in pediatric
primary care: A national feasibility study. Arch Pediatr Adolesc Med
1999;153(3):254–60. DOI: https://doi.org/10.1001/archpedi.153.3.254.
 Durham NC profile: Facts and data, 2020. URL: https://northcarolina.hometownlocator.com/nc/durham/durham.cfm.
 Zipcodes in Durham county. Zipdatamaps.Com 2021. URL: https://zipdatamaps.com.
 Durham NC demographics. World Population Review 2021. URL:
 Fyfe-Johnson AL, Marcuse EK, Tandon P, Hazlehurst M, Bratman GN, Thomas R,
et al. Nature and children’s health: A systematic review. Pediatrics 2021;
148(4):e2020049155. DOI: 10.1542/peds.2020-049155.
 Gold S. Nonuse of neighborhood parks. J Am Inst Plann 1972;38(6):369-78. DOI:
 Vukojević M, Zovko Grbeša A, Talić I, Tanović M, Rešić B, Vrdoljak I, et al.
Parental socioeconomic status as a predictor of physical and mental health outcomes
in children—literature review. Acta Clin Croat 2017;56:742–8. DOI:
 Cummings JR, Allen L, Clennon J, Ji X, Druss BG. Geographic access to specialty
mental health care across high- and low-income US communities. JAMA
Psychiatry 2017;74(5):476–84. DOI: https://doi.org/10.1001/jamapsychiatry.2017.0303.
 Prince M. 9—Epidemiology. In: Wright P, Stern J, Phelan M, eds. Core Psychiatry
2012;3:115–29. DOI: https://doi.org/10.1016/B978-0-7020-3397-1.00009-4.
 Rubin L, Geller R, Coles CD, Greeen V, Mutic A, Mutic N, et al. Break the cycle
of children’s environmental health disparities: 14th Annual review of program and
student projects. Int J Child Health Hum Dev 2019;12(4):283-99.
 Knowles M, Rabinowich J, Ettinger de Cuba S, Cutts DB, Chilton M. “Do you
wanna breathe or eat?”: Parent perspectives on child health consequences of food
insecurity, trade-offs, and toxic stress. Matern Child Health J 2016;20(1):25–32.
 Kuruvilla A, Jacob K. Poverty, social stress and mental health. Indian J Med Res