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The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults. Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics. Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities. The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Lewis R Elliott reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Mathew P White reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Benedict W Wheeler reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. James Grellier reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Marta Cirach reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Matilda van den Bosch reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Mark Nieuwenhuijsen reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Lora E Fleming reports financial support was provided by EU Framework Programme for Research and Innovation Societal Challenges. Co-author Mark Niewenhuijsen is co-Editor-in-Chief of Environment International.]., (Copyright © 2023. Published by Elsevier Ltd.)

Context: Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health., Objective: We systematically evaluated evidence regarding the relationship between nature contact and children's health., Data Sources: The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021., Study Selection: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms., Data Extraction: Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed., Results: The strongest evidence for type of nature exposure was residential green space studies ( n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity ( n = 108, 32%) and cognitive, behavioral, or mental health ( n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design., Limitations: Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional ( n = 204, 69%), limiting our ability to assess causality., Conclusions: Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)