Distributions and determinants of time spent outdoors among school-age children in China

The outdoor time is a key factor that determines children's exposure to environmental contaminants. Meanwhile, children reap numerous physical and mental health benefits from playing outdoors.

This study aimed to characterize the distributions and identify determinants of the time spent outdoors among school-age children in China.

The study recruited 41,439 children aged 6-17 years in Mainland China using a multi-stage cluster random sampling method. This sample was nationally representative with sample weights created to account for the complex survey design. Information on time-activity patterns were collected with a standard questionnaire through face-to-face interviews. Frequency distributions of time outdoors were created by age group, gender, region, and other sociodemographic factors with sample weights. The key factors influencing time outdoors were identified using multivariable linear regression models.

The grand mean (±standard deviation) time outdoors was 101 ± 51 min/day for all the study participants, 22.3% having <60 min/day. Children spent longer time outdoors in warm seasons and on weekends. Children's outdoor time was significantly influenced by gender, age, urbanicity, region, annual total household expenditure, building environment, and meteorological conditions (annual mean temperature, sunshine time, and precipitation). Girls, 15-17 year old, and urban children had 6 min/day, 8 min/day, and 13 min/day less outdoor time than boys, 6-8 year old, and rural children, respectively. Most significantly, urban girls and high school students had the shortest outdoor time. The cement ground was the most important type of ground for children playing outside.

This was the first national-scale study that characterized the time outdoors and where is it spent among school-age children in China. It revealed that one-fifth of Chinese children spent less than one hour outdoors every day, and urban girls had particular "indoor tendencies". The findings provide bases for future interventions and guidelines aimed at promoting children's physical activities.