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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Public Health</journal-id>
<journal-title>Frontiers in Public Health</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Public Health</abbrev-journal-title>
<issn pub-type="epub">2296-2565</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fpubh.2024.1483862</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Public Health</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Supporting children&#x2019;s wellbeing through outdoor time: opportunities to integrate consistent outdoor time into the elementary school day</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Patchen</surname> <given-names>Amie K.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/1911077/overview"/>
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<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Edwards</surname> <given-names>Amanda</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
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</contrib>
<contrib contrib-type="author">
<name><surname>Rakow</surname> <given-names>Donald A.</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/875028/overview"/>
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</contrib>
<contrib contrib-type="author">
<name><surname>Meredith</surname> <given-names>Genevive R.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/692646/overview"/>
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<aff id="aff1"><sup>1</sup><institution>Department of Public and Ecosystem Health, Cornell University</institution>, <addr-line>Ithaca, NY</addr-line>, <country>United States</country></aff>
<aff id="aff2"><sup>2</sup><institution>Public Health Program, Cornell University</institution>, <addr-line>Ithaca, NY</addr-line>, <country>United States</country></aff>
<aff id="aff3"><sup>3</sup><institution>Section of Horticulture, School of Integrative Plant Science, Cornell University</institution>, <addr-line>Ithaca, NY</addr-line>, <country>United States</country></aff>
<author-notes>
<fn fn-type="edited-by" id="fn0001">
<p>Edited by: Oriana Mosca, University of Cagliari, Italy</p>
</fn>
<fn fn-type="edited-by" id="fn0002">
<p>Reviewed by: Jeff Mann, Western Sydney University, Australia</p>
<p>Emiliane Rubat du M&#x00E9;rac, Sapienza University of Rome, Italy</p>
</fn>
<corresp id="c001">&#x002A;Correspondence: Amie K. Patchen, <email>akp59@cornell.edu</email></corresp>
</author-notes>
<pub-date pub-type="epub">
<day>04</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>12</volume>
<elocation-id>1483862</elocation-id>
<history>
<date date-type="received">
<day>20</day>
<month>08</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>19</day>
<month>11</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2024 Patchen, Edwards, Rakow and Meredith.</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Patchen, Edwards, Rakow and Meredith</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec id="sec1">
<title>Background</title>
<p>Time in nature supports cognitive, psychological, academic, and health benefits. Outdoor time during school can provide young people with equitable access to these benefits, however, there are within-school constraints. Understanding if and how teachers can frequently and consistently incorporate outdoor time in the schoolyard into their classroom activities can inform broader implementation.</p>
</sec>
<sec id="sec2">
<title>Methods</title>
<p>A mixed-methods observational study was conducted with 17 teachers from five elementary schools. Teachers reported on how they incorporated outdoor time into their classes over an eight-week period. Data on outdoor time, activities, locations, barriers, motivations, and facilitators were collected through surveys on 15 randomly pre-selected days, and through a post-survey.</p>
</sec>
<sec id="sec3">
<title>Results</title>
<p>On the 15 randomly selected days surveyed, classes went outside 78% of the time, ranging from 6&#x2013;15 outdoor days per class, and 0&#x2013;285&#x202F;min per day. Time, activities, locations, motivations, barriers, and facilitators varied across classes and days. The most common activities were free play (<italic>n</italic>&#x202F;=&#x202F;138) and intentional engagement with nature (<italic>n</italic>&#x202F;=&#x202F;57). Health benefits (<italic>n</italic>&#x202F;=&#x202F;68) and having time (<italic>n</italic>&#x202F;=&#x202F;58) were the most common motivations teachers reported for incorporating outdoor time.</p>
</sec>
<sec id="sec4">
<title>Implications for school health, policy, practice, and equity</title>
<p>Consistent outdoor time in the school day can support students&#x2019; wellbeing and academic success. Encouraging free play, highlighting the health benefits, using a systems approach, and flexible implementation may help teachers increase their use of outdoor time during the school day.</p>
</sec>
<sec id="sec5">
<title>Conclusion</title>
<p>Teachers consistently incorporated outdoor time, but implementation varied across classes and days. Implementation findings from this district could help inform practices at other schools.</p>
</sec>
</abstract>
<kwd-group>
<kwd>mental wellbeing</kwd>
<kwd>children</kwd>
<kwd>elementary schools</kwd>
<kwd>nature</kwd>
<kwd>outdoor learning</kwd>
<kwd>schoolyard</kwd>
</kwd-group>
<counts>
<fig-count count="0"/>
<table-count count="5"/>
<equation-count count="0"/>
<ref-count count="61"/>
<page-count count="12"/>
<word-count count="9353"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Children and Health</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="sec6">
<title>Introduction</title>
<p>Outdoor time during the school day has been identified as a promising practice to support academic, health, and wellbeing outcomes (<xref ref-type="bibr" rid="ref1 ref2 ref3 ref4 ref5 ref6">1&#x2013;6</xref>). Time spent outdoors and in nature during childhood brings cognitive, psychological, academic, and health benefits to children, and supports environmental stewardship. Studies have documented positive outcomes including reducing stress (<xref ref-type="bibr" rid="ref7 ref8 ref9">7&#x2013;9</xref>) and increasing attention (<xref ref-type="bibr" rid="ref10">10</xref>), resilience (<xref ref-type="bibr" rid="ref11">11</xref>), physical health (<xref ref-type="bibr" rid="ref12">12</xref>), academic test scores (<xref ref-type="bibr" rid="ref13">13</xref>), content learning (<xref ref-type="bibr" rid="ref14">14</xref>, <xref ref-type="bibr" rid="ref15">15</xref>), and self-regulation (<xref ref-type="bibr" rid="ref4">4</xref>), even from short interactions with nature (<xref ref-type="bibr" rid="ref16">16</xref>). Additionally, guided interactions with nature have been found to support development of environmental attitudes and behaviors (<xref ref-type="bibr" rid="ref17 ref18 ref19">17&#x2013;19</xref>), an important factor at a time when environmental changes are having a substantial impact on human health (<xref ref-type="bibr" rid="ref20">20</xref>). Overall, however, young people are spending less time outdoors than in previous generations (<xref ref-type="bibr" rid="ref21">21</xref>, <xref ref-type="bibr" rid="ref22">22</xref>), and access to outdoor spaces is not equitable for all children due to environmental and structural barriers (<xref ref-type="bibr" rid="ref23 ref24 ref25">23&#x2013;25</xref>). Further, a lack of engagement with nature compounds pressing problems: young people are experiencing high rates of stress and anxiety (<xref ref-type="bibr" rid="ref26">26</xref>, <xref ref-type="bibr" rid="ref27">27</xref>), and inequitable gaps in academic achievement persist (<xref ref-type="bibr" rid="ref28">28</xref>).</p>
<p>Schools hold great potential as venues for increasing nature contact for students in ways that open access to all students, particularly as schools work to support students&#x2019; mental wellbeing (<xref ref-type="bibr" rid="ref27">27</xref>) and help students bridge the academic gaps (<xref ref-type="bibr" rid="ref29">29</xref>). Several recent reviews have found generally positive impacts on students&#x2019; mental and physical health, cognitive development, and academic outcomes from school-related outdoor learning across settings (<xref ref-type="bibr" rid="ref30">30</xref>), holding weekly or biweekly content classes outdoors in various settings (<xref ref-type="bibr" rid="ref31">31</xref>), and immersive outdoor education experiences (<xref ref-type="bibr" rid="ref32">32</xref>). Research focused on outdoor learning in the schoolyard has identified benefits related to content learning, student interest or motivation to learn, community involvement, social development, sense of belonging, stress reduction, increased attention, and physical health (<xref ref-type="bibr" rid="ref1 ref2 ref3">1&#x2013;3</xref>, <xref ref-type="bibr" rid="ref6">6</xref>). A recent review of research on how nature affects children&#x2019;s health identified green schoolyards as a major category of nature exposure tied to physical health, mental health, and academic outcomes, though they note that studies did not routinely measure actual use of the schoolyard space (<xref ref-type="bibr" rid="ref5">5</xref>). In some places nature experiences have been well integrated into the routine function of schools, notably in Scandinavian countries (<xref ref-type="bibr" rid="ref33">33</xref>). National surveys in Denmark and Norway found that 18% (<xref ref-type="bibr" rid="ref34">34</xref>) and 69% (<xref ref-type="bibr" rid="ref35">35</xref>), respectively, of schools practiced &#x201C;udeskole&#x201D; (outdoor learning) weekly or biweekly, with a higher prevalence in lower grades in both countries. Rates of outdoor learning and nature exposure during school are not consistent across countries: in a 2018 survey of teachers from 713 schools in the United States (US), United Kingdom (UK), Canada, and Australia that participated in an outdoor learning project, teachers from the US reported significantly less outdoor playtime during the school day for all grades than other countries, and 29% of teachers reported taking their students outside for learning less than once a month (<xref ref-type="bibr" rid="ref36">36</xref>).</p>
<p>In this project we were particularly interested in the potential of schools to support student wellbeing through integration of outdoor time in the elementary school day at public schools in the US, where many (though not all, particularly in urban locations) have greenspace in the schoolyard, but routine integration of outdoor learning is less common than in other countries (<xref ref-type="bibr" rid="ref36">36</xref>). We posited that understanding if and how teachers are able to use the greenspace in the schoolyard could support efforts to provide consistent access to nature-rich spaces. Current literature related to three factors&#x2014;time dose, activities and locations, and barriers guided our project.</p>
<sec id="sec7">
<title>Time dose</title>
<p>Research into the &#x201C;dose&#x201D; of nature contact needed to achieve health and cognitive benefits includes many different measures of nature exposure, ranging from residential greenness to specific time exposure to immersive outdoor learning (<xref ref-type="bibr" rid="ref4">4</xref>). This reflects different approaches taken by different fields, and multiple theories on the mechanisms through which nature exposure affects humans (<xref ref-type="bibr" rid="ref4">4</xref>). In this project we were interested in the potential benefits from short exposure time&#x2014;the type of nature exposure that seemed most likely to be consistently integrated into the school day at public elementary schools. Research on time-based exposure for adults indicates that 10&#x2013;50&#x202F;min per session can produce mental health benefits (<xref ref-type="bibr" rid="ref16">16</xref>), and between 120 and 300&#x202F;min a week in nature is correlated with better health (<xref ref-type="bibr" rid="ref37">37</xref>). For children, a meta-analysis (<xref ref-type="bibr" rid="ref4">4</xref>) exploring self-regulation (cognitive, affective, behavioral) benefits from nature exposure included only a handful of studies that directly examined the impact of a short time dose; the studies found benefits after 3&#x202F;min watching a nature video (<xref ref-type="bibr" rid="ref38">38</xref>), 10&#x202F;min in the school garden (<xref ref-type="bibr" rid="ref39">39</xref>), or 20&#x202F;min walking in natural parks (<xref ref-type="bibr" rid="ref40">40</xref>, <xref ref-type="bibr" rid="ref41">41</xref>). These studies suggest that short exposure to nature of the type that may be the most likely to be consistently integrated into the elementary school day could provide cognitive and health benefits across the week.</p>
<p>There are, however, limited data indicating the dose of nature students may receive through school activities in the schoolyard. Studies that include reports of the time spent outside during the school day frequently do so based on the time scheduled in the design of a particular program (rather than implementation of outdoor time) or on estimates across a school or time period (<xref ref-type="bibr" rid="ref10">10</xref>, <xref ref-type="bibr" rid="ref42 ref43 ref44">42&#x2013;44</xref>). For example, studies have reported that classes participated in ten 40-min outdoor lessons for a specific project (<xref ref-type="bibr" rid="ref10">10</xref>) and a majority of schools have 15&#x2013;30&#x202F;min of scheduled daily recess and estimated spending 66&#x2013;88% of that recess outdoors annually (<xref ref-type="bibr" rid="ref42">42</xref>). In other examples, schools estimated missing 3&#x2013;40&#x202F;days of outdoor recess annually due to outdoor temperature (<xref ref-type="bibr" rid="ref43">43</xref>) and teachers were able to utilize an outdoor classroom on 82% of intended days, but did not report the amount of time spent outside on those days (<xref ref-type="bibr" rid="ref44">44</xref>). These studies provide helpful partial estimates of time students spent outdoors during school hours, but they do not indicate the dose of outdoor time that can be consistently integrated into the school day.</p>
</sec>
<sec id="sec8">
<title>Activities and locations</title>
<p>School-based nature engagement in the schoolyard can take many forms including instruction focused on nature or sustainability topics (<xref ref-type="bibr" rid="ref3">3</xref>), outdoor instruction on other topics (e.g., literacy) (<xref ref-type="bibr" rid="ref45">45</xref>), gardening (<xref ref-type="bibr" rid="ref2">2</xref>), physical activity (<xref ref-type="bibr" rid="ref46">46</xref>), and free play (<xref ref-type="bibr" rid="ref47">47</xref>). Outdoor spaces vary by school but can include playgrounds, blacktop, grass playing fields (<xref ref-type="bibr" rid="ref46">46</xref>), gardens (<xref ref-type="bibr" rid="ref2">2</xref>), woods or nature trails, or outdoor classrooms (<xref ref-type="bibr" rid="ref44">44</xref>). While there is extensive research into the structure and developmental outcomes for specific outdoor learning projects (<xref ref-type="bibr" rid="ref1 ref2 ref3">1&#x2013;3</xref>), and the impact of various schoolyard locations on physical activity (<xref ref-type="bibr" rid="ref46">46</xref>), there is less documentation of the ways in which individual teachers combine spaces and activities to independently integrate outdoor time into their classes. Structured outdoor learning projects can be an excellent way to engage students with nature, but individual projects have limitations as a means for making outdoor time a consistent part of the school day across the academic year. For instance, projects focused on a particular science topic (<xref ref-type="bibr" rid="ref3">3</xref>) or activity such as gardening (<xref ref-type="bibr" rid="ref2">2</xref>) may end when the unit or gardening season ends; costs (<xref ref-type="bibr" rid="ref6">6</xref>, <xref ref-type="bibr" rid="ref48">48</xref>, <xref ref-type="bibr" rid="ref49">49</xref>) or the need for buy-in from administrators (<xref ref-type="bibr" rid="ref50 ref51 ref52">50&#x2013;52</xref>) may limit opportunities to engage in specific projects; projects that are not aligned to required curricular topics may not be used (<xref ref-type="bibr" rid="ref51">51</xref>, <xref ref-type="bibr" rid="ref53">53</xref>, <xref ref-type="bibr" rid="ref54">54</xref>); and outdoor activities that do align to the curriculum may not be implemented due to instructional (e.g., materials, technology, writing surfaces) or logistical (schedules, staffing, weather, available spaces) considerations (<xref ref-type="bibr" rid="ref48">48</xref>, <xref ref-type="bibr" rid="ref55">55</xref>).</p>
</sec>
<sec id="sec9001">
<title>Barriers</title>
<p>While there are many excellent examples of projects related to environmental education, green schoolyards, outdoor classrooms, and other outdoor learning (<xref ref-type="bibr" rid="ref1">1</xref>, <xref ref-type="bibr" rid="ref56">56</xref>), incorporation of time in nature depends on individual teacher characteristics and school/environmental structures (<xref ref-type="bibr" rid="ref50">50</xref>, <xref ref-type="bibr" rid="ref52">52</xref>, <xref ref-type="bibr" rid="ref57">57</xref>). This is because schools are dynamic institutions and teachers encounter many shifting factors that may limit outdoor opportunities (<xref ref-type="bibr" rid="ref48">48</xref>). Barriers that appear to limit outdoor opportunities include school schedules, resources, appropriate spaces, teacher knowledge, curriculum requirements, staff ratios, safety and liability concerns, policies, support from administrators, weather and clothing, logistical issues, and equity concerns (<xref ref-type="bibr" rid="ref1">1</xref>, <xref ref-type="bibr" rid="ref6">6</xref>, <xref ref-type="bibr" rid="ref48 ref49 ref50 ref51 ref52 ref53">48&#x2013;53</xref>, <xref ref-type="bibr" rid="ref58">58</xref>, <xref ref-type="bibr" rid="ref59">59</xref>).</p>
</sec>
<sec id="sec9">
<title>Study focus</title>
<p>In this project we sought to explore strategies to help teachers overcome barriers to outdoor time, and to increase integration of frequent (e.g., multiple days a week) and consistent (i.e., maintained throughout the academic year) outdoor time into the elementary school day, as a possible means to support student wellbeing. As a step towards integrating outdoor time frequently and consistently across the school year, we wanted to understand the ways in which elementary teachers were able to integrate outdoor time into their class schedule independently (i.e., without the structure of a specific curriculum or outdoor learning project); how long they were able to spend outside; and what facilitated or limited opportunities. Understanding if and how teachers are able to consistently incorporate &#x2018;useful doses&#x2019; of outdoor time into their classes could help increase uptake of this promising practice. Thus, this action-research project focused on these specific research questions:</p><list list-type="order">
<list-item>
<p>To what extent can elementary teachers consistently incorporate outdoor time during the school day? (minutes, days)</p>
</list-item>
<list-item>
<p>In what ways were elementary teachers able to consistently incorporate outdoor time? (location, activity)</p>
</list-item>
<list-item>
<p>What motivated teachers to consistently incorporate outdoor time? (reasons)</p>
</list-item>
<list-item>
<p>What helped teachers consistently incorporate outdoor time? (facilitators)</p>
</list-item>
<list-item>
<p>What limited teachers&#x2019; opportunities to consistently incorporate outdoor time? (barriers)</p>
</list-item>
</list>
<p>To examine this, we asked teachers to try to take their classes outdoors at times other than daily recess for 8&#x202F;weeks and report to us on what they were able to accomplish, what supports helped increase outdoor time, what motivated them, and what limited opportunities.</p>
</sec>
</sec>
<sec sec-type="materials|methods" id="sec10">
<title>Materials and methods</title>
<p>This study was part of an action research project that prioritized implementation of outdoor time in elementary schools by providing guidance, support, and resources to motivated teachers, those who wanted to increase outdoor time for their classes. This study was reviewed and approved by the Cornell University Institutional Review Board (Cornell IRB # 1812008455). Using a Design-Based Implementation Research (DBIR) approach (<xref ref-type="bibr" rid="ref60">60</xref>) we worked with teachers to understand their current use of outdoor time on the school grounds, and facilitators and barriers to incorporating outdoor time into their classes. This resulted in the collaborative development of a guide with teacher-elucidated strategies (<xref ref-type="bibr" rid="ref61">61</xref>). Phase 1 of the study (reported elsewhere) examined barriers that limited teachers&#x2019; access to outdoor time (<xref ref-type="bibr" rid="ref48">48</xref>). In this phase (Phase 2, reported here), we examine teachers&#x2019; opportunities to independently integrate outdoor time into their school day when given encouragement, a flexible structure, and modest tangible supports. Teachers participated in a workshop and agreed to try to incorporate outdoor time in addition to daily school recess as a frequent, consistent, part of their class time for a period of 8&#x202F;weeks. Data collection occurred over the 8&#x202F;weeks (15 randomly selected school days), and at one time-point after the project ended.</p>
<sec id="sec11">
<title>Participants</title>
<p>Participants included 17 teachers from five elementary schools (grades preK-5) in one school district in the northeastern US. The school district is in a small city located in a predominantly rural area. Three schools had extensive greenspace on the school grounds including fields, nature trails, and outdoor classrooms consisting of log seats. Two schools were in the city center and had cultivated greenspace (garden boxes, pollinator garden) on the school grounds, as well as walkable access to nearby city parks that teachers occasionally used. Participants were recruited through short presentations at virtual school staff meetings and digital flyers about the project. Participants were &#x201C;early adopters&#x201D; and volunteered for the project because they were interested in increasing the time their classes spent outdoors. Recruited teachers included four pre-K, four kindergarten, one 1<sup>st</sup> grade, two 2<sup>nd</sup> grade, two 3<sup>rd</sup> grade, three 5<sup>th</sup> grade, and one who worked across K-5 (<xref ref-type="table" rid="tab1">Table 1</xref>). One teacher, &#x201C;P,&#x201D; was removed from the sample as survey responses were consistently not related to the questions asked.</p>
<table-wrap position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Teacher school and position.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top">Teacher</th>
<th align="left" valign="top">School (location)</th>
<th align="center" valign="top">Grade</th>
<th align="left" valign="top">Position</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="bottom">A</td>
<td align="left" valign="bottom">1 (City Center)</td>
<td align="center" valign="bottom">K</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">B</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">PreK-5</td>
<td align="left" valign="bottom">Librarian</td>
</tr>
<tr>
<td align="left" valign="bottom">C</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">K</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">D</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">2,3</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">E</td>
<td align="left" valign="bottom">3 (Green schoolyard)</td>
<td align="center" valign="bottom">PreK</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">F</td>
<td align="left" valign="bottom">1 (City Center)</td>
<td align="center" valign="bottom">PreK</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">G</td>
<td align="left" valign="bottom">4 (Green schoolyard)</td>
<td align="center" valign="bottom">4,5</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">H</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">K</td>
<td align="left" valign="bottom">Aide</td>
</tr>
<tr>
<td align="left" valign="bottom">I</td>
<td align="left" valign="bottom">3 (Green schoolyard)</td>
<td align="center" valign="bottom">3</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">J</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">5</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">K</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">5</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">L</td>
<td align="left" valign="bottom">1 (City Center)</td>
<td align="center" valign="bottom">K</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">M</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">3,4</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">N</td>
<td align="left" valign="bottom">2 (City Center)</td>
<td align="center" valign="bottom">PreK,K</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">O</td>
<td align="left" valign="bottom">1 (City Center)</td>
<td align="center" valign="bottom">2,3</td>
<td align="left" valign="bottom">ESL</td>
</tr>
<tr>
<td align="left" valign="bottom">Q</td>
<td align="left" valign="bottom">5 (Green schoolyard)</td>
<td align="center" valign="bottom">1</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
<tr>
<td align="left" valign="bottom">R</td>
<td align="left" valign="bottom">3 (Green schoolyard)</td>
<td align="center" valign="bottom">PreK</td>
<td align="left" valign="bottom">Classroom</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="sec12">
<title>Instrumentation</title>
<p>Data were collected through two different mixed-method Qualtrics surveys. Implementation surveys, distributed on the 15 randomly selected days, asked teachers to report if they took their class outside that day, for how long (minutes), the location (categorical responses; e.g., playground, outdoor classroom, garden, natural area) and activities (categorical responses; e.g., free play or free choice, instruction focused on a nature topic, etc.), as well as the reasons they went outside and the barriers that prevented them from going outside (open-ended qualitative responses). The <italic>post-survey</italic> asked teachers to reflect on what facilitated (or limited) their ability to integrate outdoor time into their classroom activities.</p>
</sec>
<sec id="sec13">
<title>Procedure</title>
<p>Preparation workshop: participants attended a two-hour professional development workshop conducted by the project team at the start of the project. The workshop covered the benefits of outdoor time, discussion of the barriers participants faced in incorporating outdoor time for their classes, and strategies for increasing outdoor time during school hours using a Toolkit (<xref ref-type="bibr" rid="ref61">61</xref>) developed earlier in this project. Participants developed plans for the strategies they would use to incorporate outdoor time for their classes in the following weeks.</p>
<p>Implementation: for 8&#x202F;weeks following the workshop, participants worked independently to incorporate outdoor time into their classes, in the manner that worked for each class. The project team did not prescribe any particular outdoor activities or suggest any amount of time to spend outside; participants were asked to incorporate outdoor time when and how it worked for them.</p>
<p>Implementation supports and resources: during the project participants were provided with access to the strategy Toolkit, email consultations with the project team, approval for the project from school principals, and $300 grants to support implementation. Participants were asked to make a plan for how they would use the funding during the workshop but were not required to stick to their predicted plans. Concurrently, outdoor gear (rain gear, boots) was provided to all elementary students through a separate district project.</p>
<p>Data collection: All data were collected through online surveys (Qualtrics XM). Implementation surveys were sent to participants at the end of the school day on 15 randomly selected days across the 8&#x202F;weeks of implementation. The survey days were the same for all participants and identified by the research team before implementation so their selection would not be influenced by conditions week to week; participants were not informed which days would be surveyed. Participants were sent a reminder email if they had not completed the survey by the end of the next day. Weather conditions at noon on each of the survey days were collected from <ext-link xlink:href="http://weather.gov" ext-link-type="uri">weather.gov</ext-link> by the research team. The post-survey was sent to participants 2&#x202F;weeks after the 8&#x202F;weeks of implementation.</p>
</sec>
<sec id="sec14">
<title>Analytical approaches</title>
<p>Implementation survey data: Descriptive statistics of quantitative (days and time outside) and categorical (activity, location) data were calculated in Excel. The number of days outside, number of days doing various activities, and number of days using each type of location were counted for each teacher and summed for all teachers. Qualitative data (motivations/reasons to go outside, limitations) were coded for themes using both pre-existing and emergent themes to identify common and unexpected factors. Thematic analysis was used to examine the factors that encouraged or prevented outdoor time across teachers. The number of days where each motivation category was mentioned by a teacher was counted for each teacher, and cumulatively for the cohort. The number of days each limitation theme was mentioned as a barrier by an individual teacher was also counted.</p>
<p>Post-survey data: Qualitative data on facilitators were coded for themes based on responses. The themes were then used as categories to identify factors that facilitated outdoor time across teachers. The number of teachers who mentioned each category was counted.</p>
</sec>
</sec>
<sec sec-type="results" id="sec15">
<title>Results</title>
<p>The 17 study participants completed 249 of 255 implementation surveys (98% response rate), and all completed the post-survey (100% response rate). Data indicated that across the study period, teachers were able to take their students outside, but the amount of time, activities, locations, motivations, barriers, and facilitators varied across participants and days. These are elucidated below.</p>
<sec id="sec16">
<title>Days and time outside</title>
<p>Participants took their classes outdoors on 78% of opportunities (198 occurrences of 249 implementation surveys; <xref ref-type="table" rid="tab2">Table 2</xref>). Outdoor time ranged from 6&#x2013;15 outdoor days per class (out of 15 possible days), and 0&#x2013;285&#x202F;min per day (average of 104&#x202F;min on days with time outside). A few teachers (e.g., C, Q) reported relatively consistent minutes outside across days, but for most teachers the minutes outside varied on different days. Younger grades generally reported both more days where they went outside and more minutes outside on those days than the higher grades. On average, kindergarten classes (<italic>n</italic>&#x202F;=&#x202F;4) went outside on 12.5&#x202F;days for 145&#x202F;min/day, while 5<sup>th</sup> grade classes (<italic>n</italic>&#x202F;=&#x202F;3) went outside on 6.5&#x202F;days for 34&#x202F;min/day.</p>
<table-wrap position="float" id="tab2">
<label>Table 2</label>
<caption>
<p>Days and time outside by teacher.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th/>
<th/>
<th/>
<th align="center" valign="top" colspan="17">Teacher (grade)</th>
</tr>
<tr>
<th align="left" valign="top" rowspan="2">Date</th>
<th align="left" valign="top" rowspan="2">Weather</th>
<th align="center" valign="top" rowspan="2">Temp (F)</th>
<th align="center" valign="top">A</th>
<th align="center" valign="top">B</th>
<th align="center" valign="top">C</th>
<th align="center" valign="top">D</th>
<th align="center" valign="top">E</th>
<th align="center" valign="top">F</th>
<th align="center" valign="top">G</th>
<th align="center" valign="top">H</th>
<th align="center" valign="top">I</th>
<th align="center" valign="top">J</th>
<th align="center" valign="top">K</th>
<th align="center" valign="top">L</th>
<th align="center" valign="top">M</th>
<th align="center" valign="top">N</th>
<th align="center" valign="top">O</th>
<th align="center" valign="top">Q</th>
<th align="center" valign="top">R</th>
</tr>
<tr>
<th align="center" valign="top">(K)</th>
<th align="center" valign="top">(PK-5)</th>
<th align="center" valign="top">(K)</th>
<th align="center" valign="top">(2,3)</th>
<th align="center" valign="top">(PK)</th>
<th align="center" valign="top">(PK)</th>
<th align="center" valign="top">(4,5)</th>
<th align="center" valign="top">(K)</th>
<th align="center" valign="top">(3)</th>
<th align="center" valign="top">(5)</th>
<th align="center" valign="top">(5)</th>
<th align="center" valign="top">(K)</th>
<th align="center" valign="top">(3,4)</th>
<th align="center" valign="top">(PK,K)</th>
<th align="center" valign="top">(2,3)</th>
<th align="center" valign="top">(1)</th>
<th align="center" valign="top">(PK)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="middle">20-Apr</td>
<td align="left" valign="middle">Overcast</td>
<td align="center" valign="middle">44</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">15</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">d</td>
<td align="center" valign="bottom">b</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">75</td>
</tr>
<tr>
<td align="left" valign="middle">21-Apr</td>
<td align="left" valign="middle">Heavy Snow</td>
<td align="center" valign="middle">31</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">a</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">a, f</td>
<td align="center" valign="bottom">a</td>
<td align="center" valign="bottom">a,f</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">a</td>
<td align="center" valign="bottom">200</td>
<td align="center" valign="bottom">a</td>
</tr>
<tr>
<td align="left" valign="middle">26-Apr</td>
<td align="left" valign="middle">Partly Cloudy</td>
<td align="center" valign="middle">39</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">a</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">255</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">120</td>
</tr>
<tr>
<td align="left" valign="middle">30-Apr</td>
<td align="left" valign="middle">Overcast</td>
<td align="center" valign="middle">49</td>
<td align="center" valign="bottom">b<xref ref-type="table-fn" rid="tfn1">
<sup>1</sup></xref></td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">15</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">f,g</td>
<td align="center" valign="bottom">75</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">135</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">90</td>
</tr>
<tr>
<td align="left" valign="middle">5-May</td>
<td align="left" valign="middle">Light Rain</td>
<td align="center" valign="middle">49</td>
<td align="center" valign="bottom">&#x002A;</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">a,d</td>
<td align="center" valign="bottom">d</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">75</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">120</td>
</tr>
<tr>
<td align="left" valign="middle">6-May</td>
<td align="left" valign="middle">Mostly Cloudy</td>
<td align="center" valign="middle">44</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">35</td>
<td align="center" valign="bottom">270</td>
<td align="center" valign="bottom">80</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">45</td>
</tr>
<tr>
<td align="left" valign="middle">7-May</td>
<td align="left" valign="middle">Overcast</td>
<td align="center" valign="middle">51</td>
<td align="center" valign="bottom">b</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">75</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">35</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">&#x002A;</td>
<td align="center" valign="bottom">20</td>
</tr>
<tr>
<td align="left" valign="middle">10-May</td>
<td align="left" valign="middle">Overcast</td>
<td align="center" valign="middle">49</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">d</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">d</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">100</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">65</td>
</tr>
<tr>
<td align="left" valign="middle">11-May</td>
<td align="left" valign="middle">Overcast</td>
<td align="center" valign="middle">48</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">&#x002A;</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">190</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">d,e</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">90</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">270</td>
<td align="center" valign="bottom">65</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">75</td>
</tr>
<tr>
<td align="left" valign="middle">13-May</td>
<td align="left" valign="middle">Partly Cloudy</td>
<td align="center" valign="middle">60</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">35</td>
<td align="center" valign="bottom">180</td>
<td align="center" valign="bottom">25</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">45</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">285</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">240</td>
<td align="center" valign="bottom">120</td>
</tr>
<tr>
<td align="left" valign="middle">19-May</td>
<td align="left" valign="middle">Fair</td>
<td align="center" valign="middle">77</td>
<td align="center" valign="bottom">120</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="bottom">210</td>
<td align="center" valign="bottom">&#x002A;</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">c</td>
<td align="center" valign="bottom">50</td>
<td align="center" valign="bottom">20</td>
<td align="center" valign="bottom">f</td>
<td align="center" valign="bottom">60</td>
<td align="center" valign="top">65</td>
<td align="center" valign="top">&#x002A;</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">45</td>
</tr>
<tr>
<td align="left" valign="top">21-May</td>
<td align="left" valign="top">Fair</td>
<td align="center" valign="top">84</td>
<td align="center" valign="top">b</td>
<td align="center" valign="top">40</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">g</td>
<td align="center" valign="top">f,a</td>
<td align="center" valign="top">240</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">210</td>
<td align="center" valign="top">90</td>
<td align="center" valign="top">240</td>
<td align="center" valign="top">40</td>
</tr>
<tr>
<td align="left" valign="top">25-May</td>
<td align="left" valign="top">A few clouds</td>
<td align="center" valign="top">63</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">35</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">25</td>
<td align="center" valign="top">200</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">20</td>
<td align="center" valign="top">d</td>
<td align="center" valign="top">f</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">75</td>
<td align="center" valign="top">275</td>
<td align="center" valign="top">d</td>
<td align="center" valign="top">240</td>
<td align="center" valign="top">180</td>
</tr>
<tr>
<td align="left" valign="top">2-Jun</td>
<td align="left" valign="top">Light Rain</td>
<td align="center" valign="top">63</td>
<td align="center" valign="top">120</td>
<td align="center" valign="top">40</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">45</td>
<td align="center" valign="top">140</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">30</td>
<td align="center" valign="top">210</td>
<td align="center" valign="top">a</td>
<td align="center" valign="top">a</td>
<td align="center" valign="top">30</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">270</td>
<td align="center" valign="top">90</td>
<td align="center" valign="top">120</td>
<td align="center" valign="top">d</td>
</tr>
<tr>
<td align="left" valign="top">3-Jun</td>
<td align="left" valign="top">Overcast</td>
<td align="center" valign="top">70</td>
<td align="center" valign="top">120</td>
<td align="center" valign="top">40</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">140</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">f</td>
<td align="center" valign="top">240</td>
<td align="center" valign="top">c</td>
<td align="center" valign="top">d</td>
<td align="center" valign="top">f</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">20</td>
<td align="center" valign="top">240</td>
<td align="center" valign="top">&#x002A;</td>
<td align="center" valign="top">210</td>
<td align="center" valign="top">30</td>
</tr>
<tr>
<td/>
<td align="left" valign="top" colspan="2">Total days outside</td>
<td align="center" valign="top">11</td>
<td align="center" valign="top">12</td>
<td align="center" valign="top">14</td>
<td align="center" valign="top">14</td>
<td align="center" valign="top">13</td>
<td align="center" valign="top">11</td>
<td align="center" valign="top">9</td>
<td align="center" valign="top">10</td>
<td align="center" valign="top">10</td>
<td align="center" valign="top">7</td>
<td align="center" valign="top">6</td>
<td align="center" valign="top">15</td>
<td align="center" valign="top">14</td>
<td align="center" valign="top">13</td>
<td align="center" valign="top">12</td>
<td align="center" valign="top">14</td>
<td align="center" valign="top">13</td>
</tr>
<tr>
<td/>
<td align="left" valign="top" colspan="2">Avg min when outside</td>
<td align="center" valign="top">115</td>
<td align="center" valign="top">35</td>
<td align="center" valign="top">180</td>
<td align="center" valign="top">40</td>
<td align="center" valign="top">169</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">29</td>
<td align="center" valign="top">207</td>
<td align="center" valign="top">29</td>
<td align="center" valign="top">34</td>
<td align="center" valign="top">34</td>
<td align="center" valign="top">80</td>
<td align="center" valign="top">46</td>
<td align="center" valign="top">239</td>
<td align="center" valign="top">75</td>
<td align="center" valign="top">220</td>
<td align="center" valign="top">79</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>&#x002A;Did not complete survey.</p>
<fn id="tfn1">
<label>1</label>
<p>Barrier that prevented outdoor time: (a) weather, (b) distance learning day, (c) teacher absent, (d) curriculum need (tech, space, materials), (e) insufficient time, (f) schedule conflict, (g) not enough staff.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="sec17">
<title>Barriers that limited outdoor time</title>
<p>There were 51 instances where a teacher did not take their class outside on a surveyed day. Barriers that prevented classes from going outside on a particular day included teacher absence (15), schedule conflict (14), weather (11), curriculum needs (10), distance learning logistics (4), insufficient staff (2), and time pressure (1) (<xref ref-type="table" rid="tab2">Table 2</xref>). Looking across teacher responses, most teachers who reported more than 1&#x202F;day where they did not go outside reported more than one type of barrier. The three teachers that reported the fewest days outside all taught 5<sup>th</sup> grade (Teachers G, J, K). For these three teachers, the most common barrier was schedule conflict (12&#x202F;days), followed by curriculum need (5), weather (4), teacher absence (2) insufficient staff (2), and distance learning (1).</p>
</sec>
<sec id="sec18">
<title>Activities and locations</title>
<p>Teachers reported where they took their classes (location) and what type of activities they did on the days they went outside. Total locations and activities for each teacher are shown in <xref ref-type="table" rid="tab3">Table 3</xref>. Many teachers reported more than one activity and location on a single day, indicating multiple or overlapping outdoor experiences. Free play (138) was the most common activity, followed by intentional engagement with nature (57), instruction focused on nature (44), instruction but not focused on nature (40), other activities such as lunch outside or special events (33), emotional or energy breaks (24), transit (11), and instruction specifically focused on sustainability (4). Human made spaces (playground, blacktop) were the most commonly selected location (138 instances), but natural spaces [school garden (89); outdoor classroom (81); other natural space (65)] were used more frequently when counted collectively (235 total instances).</p>
<table-wrap position="float" id="tab3">
<label>Table 3</label>
<caption>
<p>Locations and activities by teacher.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" rowspan="2">Location</th>
<th align="left" valign="top" rowspan="2">Total<xref ref-type="table-fn" rid="tfn2">
<sup>1</sup></xref></th>
<th align="center" valign="top" colspan="17">Teacher</th>
</tr>
<tr>
<th align="center" valign="top">A</th>
<th align="center" valign="top">B</th>
<th align="center" valign="top">C</th>
<th align="center" valign="top">D</th>
<th align="center" valign="top">E</th>
<th align="center" valign="top">F</th>
<th align="center" valign="top">G</th>
<th align="center" valign="top">H</th>
<th align="center" valign="top">I</th>
<th align="center" valign="top">J</th>
<th align="center" valign="top">K</th>
<th align="center" valign="top">L</th>
<th align="center" valign="top">M</th>
<th align="center" valign="top">N</th>
<th align="center" valign="top">O</th>
<th align="center" valign="top">Q</th>
<th align="center" valign="top">R</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="bottom">Human-Made Space (playground, blacktop)</td>
<td align="center" valign="bottom">138</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">15</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">12</td>
</tr>
<tr>
<td align="left" valign="bottom">Natural Space (combined)<xref ref-type="table-fn" rid="tfn3">
<sup>2</sup></xref></td>
<td align="center" valign="bottom">235</td>
<td align="center" valign="bottom">21</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">27</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">18</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">18</td>
<td align="center" valign="bottom">12</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">19</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">31</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">30</td>
<td align="center" valign="bottom">12</td>
</tr>
<tr>
<td align="left" valign="bottom">School Garden</td>
<td align="center" valign="bottom">89</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">8</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">3</td>
</tr>
<tr>
<td align="left" valign="bottom">Outdoor Classroom</td>
<td align="center" valign="bottom">81</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">14</td>
<td align="center" valign="bottom">5</td>
</tr>
<tr>
<td align="left" valign="bottom">Other Natural space</td>
<td align="center" valign="bottom">65</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">4</td>
</tr>
<tr>
<td align="left" valign="bottom">Other</td>
<td align="center" valign="bottom">18</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
</tr>
<tr>
<td align="left" valign="middle" colspan="19">Activity</td>
</tr>
<tr>
<td align="left" valign="middle">Free play or free choice time</td>
<td align="center" valign="bottom">138</td>
<td align="center" valign="bottom">11</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">14</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">12</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">14</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">10</td>
</tr>
<tr>
<td align="left" valign="bottom">Intentional engagement with nature</td>
<td align="center" valign="bottom">57</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">6</td>
</tr>
<tr>
<td align="left" valign="bottom">Instruction focused on nature topic (e.g., bugs, seasons)</td>
<td align="center" valign="bottom">44</td>
<td align="center" valign="bottom">11</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">3</td>
</tr>
<tr>
<td align="left" valign="bottom">Instruction not focused on nature topic (e.g., math)</td>
<td align="center" valign="bottom">40</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">8</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">4</td>
</tr>
<tr>
<td align="left" valign="bottom">Other (e.g., lunch, assembly)</td>
<td align="center" valign="bottom">33</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">2</td>
</tr>
<tr>
<td align="left" valign="bottom">Guided emotional or energy break</td>
<td align="center" valign="bottom">24</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">6</td>
</tr>
<tr>
<td align="left" valign="bottom">Transit (e.g., Walked back from music class outside)</td>
<td align="center" valign="bottom">11</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
</tr>
<tr>
<td align="left" valign="top">Instruction focused on sustainability</td>
<td align="center" valign="top">4</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">1</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">1</td>
<td align="center" valign="top">1</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">0</td>
<td align="center" valign="top">1</td>
<td align="center" valign="top">0</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn2">
<label>1</label>
<p>Total refers to the number of individual daily surveys out of 249 that listed this location or activity.</p>
</fn>
<fn id="tfn3">
<label>2</label>
<p>Combined natural spaces may exceed 15 if more than one natural space was used on a survey day.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>Most teachers utilized a range of locations. Some teachers used multiple locations fairly equally while other teachers preferred one or two locations and occasionally utilized others. For activities, nine teachers selected free play most frequently, three selected free play and another activity most often and equally, and only five selected a different activity more than free play. While all teachers did indicate conducting more than one type of activity outside over the 8&#x202F;weeks, it seemed that most conducted a small number of activities frequently and only occasionally included others. Free play was the most frequent overall and identified as a frequent activity by the most teachers, but the other frequently-selected activities varied across teachers.</p>
</sec>
<sec id="sec19">
<title>Motivations</title>
<p>Teachers described the reasons they decided to take their classes outside that day on each of the survey days. Ten themes were identified in their responses (<xref ref-type="table" rid="tab4">Table 4</xref>). Across the 249 implementation surveys and 17 teachers, the health benefits of time outside was mentioned the most often (68 individual surveys) and by the most teachers (14), followed by having time in the schedule on that day (58 surveys, 10 teachers), wanting to get out in nice weather (49 surveys, 12 teachers), doing an activity specifically to incorporate time in nature (41 surveys, 13 teachers), doing a planned content activity (e.g., reading, science) outside (32 surveys, 12 teachers), gardening projects (18 surveys, 7 teachers), a class reward for hard work (10 surveys, 4 teachers), improving the group dynamic (9 surveys, 5 teachers), the fact that the teacher wanted to (2 surveys, 2 teachers), and instruction that worked better outside (1 survey, 1 teacher). All but one teacher indicated more than one reason for taking students outside across survey days, and many indicated more than one reason on any given day.</p>
<table-wrap position="float" id="tab4">
<label>Table 4</label>
<caption>
<p>Teachers&#x2019; motivations for outdoor time across implementation period.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" rowspan="2">Reasons</th>
<th align="center" valign="top" rowspan="2">Total times<xref ref-type="table-fn" rid="tfn4">
<sup>1</sup></xref></th>
<th align="center" valign="top" rowspan="2">Total teachers<xref ref-type="table-fn" rid="tfn5">
<sup>2</sup></xref></th>
<th align="center" valign="top" colspan="17">Teacher</th>
</tr>
<tr>
<th align="center" valign="top">A</th>
<th align="center" valign="top">B</th>
<th align="center" valign="top">C</th>
<th align="center" valign="top">D</th>
<th align="center" valign="top">E</th>
<th align="center" valign="top">F</th>
<th align="center" valign="top">G</th>
<th align="center" valign="top">H</th>
<th align="center" valign="top">I</th>
<th align="center" valign="top">J</th>
<th align="center" valign="top">K</th>
<th align="center" valign="top">L</th>
<th align="center" valign="top">M</th>
<th align="center" valign="top">N</th>
<th align="center" valign="top">O</th>
<th align="center" valign="top">Q</th>
<th align="center" valign="top">R</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="bottom">Total per teacher</td>
<td/>
<td/>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">8</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">5</td>
</tr>
<tr>
<td align="left" valign="bottom">Health</td>
<td align="center" valign="bottom">68</td>
<td align="center" valign="bottom">14</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">8</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">11</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">6</td>
</tr>
<tr>
<td align="left" valign="bottom">Time</td>
<td align="center" valign="bottom">58</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">14</td>
<td align="center" valign="bottom">0</td>
</tr>
<tr>
<td align="left" valign="bottom">Weather</td>
<td align="center" valign="bottom">49</td>
<td align="center" valign="bottom">12</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">7</td>
</tr>
<tr>
<td align="left" valign="bottom">Nature Incorporation</td>
<td align="center" valign="bottom">41</td>
<td align="center" valign="bottom">13</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">6</td>
</tr>
<tr>
<td align="left" valign="bottom">Content Activity</td>
<td align="center" valign="bottom">32</td>
<td align="center" valign="bottom">12</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">6</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
</tr>
<tr>
<td align="left" valign="bottom">Gardening</td>
<td align="center" valign="bottom">18</td>
<td align="center" valign="bottom">7</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">3</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
</tr>
<tr>
<td align="left" valign="bottom">Reward</td>
<td align="center" valign="bottom">10</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
</tr>
<tr>
<td align="left" valign="bottom">Group Dynamic</td>
<td align="center" valign="bottom">9</td>
<td align="center" valign="bottom">5</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">4</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
</tr>
<tr>
<td align="left" valign="bottom">Teacher Interest</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">2</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
</tr>
<tr>
<td align="left" valign="bottom">Instructional Need</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">1</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
<td align="center" valign="bottom">0</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn4">
<label>1</label>
<p>Total times refers to the number of individual daily surveys out of 249 that listed this reason.</p>
</fn>
<fn id="tfn5">
<label>2</label>
<p>Total teachers refers to the number of individual teachers who listed this reason at least once.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="sec20">
<title>Facilitators</title>
<p>In the post-survey, teachers reflected on the factors that helped them incorporate outdoor time in their teaching. Three themes, with 10 categories of supports, were identified in their responses (<xref ref-type="table" rid="tab5">Table 5</xref>). Seven teachers mentioned just one support in their reflection, eight mentioned two or three, one mentioned six, and one did not answer the question. <italic>Encouragement</italic>, in the form of supportive colleagues or nudges from the project, appeared to facilitate outdoor time. Having supportive colleagues was mentioned most often, with teachers stating that having a supportive principal (6) or co-teacher (2) facilitated outdoor time. Five teachers mentioned that knowing we might ask them on the implementation survey served as a reminder and encouragement to have something &#x201C;worthwhile&#x201D; to report. Second, teachers identified <italic>structural or logistical</italic> supports. Teachers mentioned having appropriate weather gear for all students (5), sufficient and appropriate space for the outdoor activity (3), flexible schedules (3), funding for supplies (2), sufficient staff (2), and connections to the curriculum (1). Third, <italic>intentionally planning</italic> to include outdoor time was mentioned by three teachers. Of note, this is the only facilitator that teachers independently controlled.</p>
<table-wrap position="float" id="tab5">
<label>Table 5</label>
<caption>
<p>Factors that Facilitated Outdoor Time by Teacher.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" rowspan="2">Facilitator</th>
<th align="center" valign="top" rowspan="2">Total<xref ref-type="table-fn" rid="tfn6">
<sup>1</sup></xref></th>
<th align="center" valign="top" colspan="17">Teacher</th>
</tr>
<tr>
<th align="center" valign="top">A</th>
<th align="center" valign="top">B</th>
<th align="center" valign="top">C</th>
<th align="center" valign="top">D</th>
<th align="center" valign="top">E</th>
<th align="center" valign="top">F</th>
<th align="center" valign="top">G</th>
<th align="center" valign="top">H</th>
<th align="center" valign="top">I</th>
<th align="center" valign="top">J</th>
<th align="center" valign="top">K</th>
<th align="center" valign="top">L</th>
<th align="center" valign="top">M</th>
<th align="center" valign="top">N</th>
<th align="center" valign="top">O</th>
<th align="center" valign="top">Q</th>
<th align="center" valign="top">R</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="bottom">Total per teacher</td>
<td/>
<td align="center" valign="middle">2</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">3</td>
<td align="center" valign="middle">2</td>
<td align="center" valign="middle">3</td>
<td align="center" valign="middle">2</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">0</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">6</td>
<td align="center" valign="middle">2</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">3</td>
<td align="center" valign="middle">2</td>
</tr>
<tr>
<td align="left" valign="bottom">Encouragement</td>
<td align="center" valign="middle">13</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Supportive admin</td>
<td align="center" valign="middle">6</td>
<td align="center" valign="middle">1</td>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td align="center" valign="middle">1</td>
</tr>
<tr>
<td align="left" valign="bottom">Supportive co-teacher</td>
<td align="center" valign="middle">2</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Reminders</td>
<td align="center" valign="middle">5</td>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
</tr>
<tr>
<td align="left" valign="bottom">Structural and logistical</td>
<td align="center" valign="middle">16</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Weather gear</td>
<td align="center" valign="middle">5</td>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Appropriate space</td>
<td align="center" valign="middle">3</td>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Flexible schedule</td>
<td align="center" valign="middle">3</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Funding for supplies</td>
<td align="center" valign="middle">2</td>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Sufficient staff</td>
<td align="center" valign="middle">2</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Curriculum</td>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td align="center" valign="middle">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="bottom">Intentional planning</td>
<td align="center" valign="middle">3</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="top">Planning to go out</td>
<td align="center" valign="top">3</td>
<td/>
<td/>
<td/>
<td align="center" valign="top">1</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td/>
<td align="center" valign="top">1</td>
<td/>
<td/>
<td align="center" valign="top">1</td>
<td/>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn6">
<label>1</label>
<p>Total column indicates the total number of teachers that mentioned each facilitator.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
</sec>
<sec sec-type="discussion" id="sec21">
<title>Discussion</title>
<p>The purpose of this study was to understand whether and how elementary teachers could consistently incorporate outdoor time in their classes, to guide our efforts to increase the time elementary students spend in nature during school time. We were particularly interested in understanding how time in nature could be frequently and consistently integrated into the elementary school day, rather than as an occasional or intermittent component, to better support students&#x2019; mental wellbeing. The findings from this study suggest that outdoor time can be frequently and consistently incorporated into elementary class schedules, but the duration, opportunities, supports, and challenges are not uniform either across classes or for individual teachers across days. Additionally, findings suggest that focusing on free play, highlighting the health benefits, and using a flexible and systems-based approach may help increase implementation. These points are outlined below.</p>
<sec id="sec22">
<title>Consistent outdoor time was possible, but implementation varied</title>
<p>Teachers in this study were able to incorporate consistent outdoor time into their class routine over the 8&#x202F;weeks of the study, but the activities, amount of time, and barriers varied across teachers and days. Our request to teachers during the 8&#x202F;weeks of the project was intentionally open-ended, encouraging teachers to do what worked best for their classes, to identify a range of possible activities. Across the study period, all 17 teachers were able to take their students outside for at least 10&#x202F;min (a minimum &#x201C;dose&#x201D; needed for mental health benefits) (<xref ref-type="bibr" rid="ref16">16</xref>), though the number of days they were able to do so varied across teachers. Extrapolating from the surveyed days to a full week suggests that some would reach the 120&#x2013;300&#x202F;min per week threshold (<xref ref-type="bibr" rid="ref37">37</xref>), but others would not. Collectively, teachers utilized all the locations and activities asked about in the surveys. This aligns with locations (<xref ref-type="bibr" rid="ref2">2</xref>, <xref ref-type="bibr" rid="ref44">44</xref>, <xref ref-type="bibr" rid="ref46">46</xref>) and activities (<xref ref-type="bibr" rid="ref2">2</xref>, <xref ref-type="bibr" rid="ref3">3</xref>, <xref ref-type="bibr" rid="ref45 ref46 ref47">45&#x2013;47</xref>) identified in previous literature, and adds some outdoor experiences that were not related to a specific instructional or physical activity goal (e.g., transit, outdoor lunch). Further, the data showed variation in the activities and locations teachers used. None of the locations or activities were utilized by all 17 teachers during the study period (each individual location/activity was not used by at least one teacher). All 17 teachers used a variety of activities and locations across the study days, and the activities that teachers chose to incorporate shifted from one day to the next. This suggests that different activities were feasible at different times, even within the same school and class. Utilizing multiple types of activities (e.g., instruction, free play, physical activity, social&#x2013;emotional breaks) in multiple locations as they are possible for a class on a given day could increase the feasibility of frequent and consistent outdoor time in the elementary school day. These data add to previous work by documenting teachers&#x2019; use of multiple activities and locations across instructional topics or outcome goals to give a more comprehensive picture of how outdoor time can be integrated into the school day and the amount of time teachers are able to incorporate.</p>
<p>Similarly, the barriers that prevented outdoor time varied between teachers and across days. Some teachers were consistently able to take their students outside, while others experienced more barriers that prevented outdoor time. The barriers that prevented teachers in this study from taking their classes outside align with barriers identified through previous research (<xref ref-type="bibr" rid="ref1">1</xref>, <xref ref-type="bibr" rid="ref6">6</xref>), as does the fact that the barriers shifted across classes and days (<xref ref-type="bibr" rid="ref48">48</xref>). Participants in this study were a coalition of the willing, but, as in previous studies (<xref ref-type="bibr" rid="ref48">48</xref>, <xref ref-type="bibr" rid="ref50">50</xref>, <xref ref-type="bibr" rid="ref55">55</xref>), interest was not always sufficient to overcome the dynamic barriers. This was particularly true for older grades: the majority of the schedule conflict (12 of 14) and half the curriculum conflict (5 of 10) barriers reported across teachers were for the three 5<sup>th</sup> grade classes. This aligns with the lower prevalence of outdoor learning in upper grades in the Scandinavian countries (<xref ref-type="bibr" rid="ref34">34</xref>, <xref ref-type="bibr" rid="ref35">35</xref>), where the cultural and institutional support for udeskole should theoretically reduce barriers. Further research into barriers that arise in upper grades could help support continued implementation. Additionally, as participants in this study were volunteer early adopters, and most were teaching younger elementary grades, research with a broader range of teachers would help identify factors affecting implementation among teachers who were not as eager or faced additional barriers in upper grades. Barriers that shift across classes and days suggest that flexible strategies will be required to increase consistent outdoor time.</p>
</sec>
<sec id="sec23">
<title>Free play may be easier to implement consistently than content</title>
<p>Teachers in this study were most frequently able to incorporate outdoor time as free play, and on human-made play locations (e.g., playground); connecting outdoor time to curriculum was not as common. While this was certainly influenced by the fact that specific curricular connections were not required or provided in this project, it also points to the challenges teachers may have making these connections when it is not built in to the curriculum. Teachers in this study were able to connect curricular pieces to outdoor experiences at times, it just happened less often than outdoor breaks or free play. This aligns with previous research that identified challenges with connecting outdoor learning to the curriculum and implementing content-specific outdoor instruction (<xref ref-type="bibr" rid="ref6">6</xref>, <xref ref-type="bibr" rid="ref51">51</xref>, <xref ref-type="bibr" rid="ref53 ref54 ref55">53&#x2013;55</xref>). Teachers who are independently interested in incorporating outdoor time into their class day without the structure of a guided curriculum project may find free play to be an easier approach. Although this may not support deeper learning on specific content, unstructured free play in settings where there is nature present (e.g., playground surrounded by trees) could support cognitive development and stress reduction outcomes (<xref ref-type="bibr" rid="ref7 ref8 ref9">7&#x2013;9</xref>). Previous research on attention benefits suggests that outdoor free play may enhance focus during subsequent indoor instruction (<xref ref-type="bibr" rid="ref10">10</xref>), thereby enhancing content learning. Encouraging and supporting outdoor free play at times other than recess may increase access to the cognitive and mental wellbeing benefits. Additionally, as opportunities for free play typically decrease in older grades, this suggests that older grades may need a more structured and intentional approach to support implementation, and one that considers the interaction of factors across the school system (<xref ref-type="bibr" rid="ref48">48</xref>, <xref ref-type="bibr" rid="ref50">50</xref>). Tying outdoor time to curriculum is a great structured option when it works, but also a barrier to implementation when it does not. Further research focused on the particular factors that make curricular connections possible or challenging could identify ways to make outdoor content learning more feasible for more teachers. Research into structured alternatives, such as scheduling nature breaks into the day, or a nature-based &#x201C;special&#x201D; similar to music or art could also potentially support implementation in settings where curricular connections or independent action by individual teachers are not possible.</p>
</sec>
<sec id="sec24">
<title>Focusing on health connections may help increase outdoor time</title>
<p>Highlighting the health benefits of time in nature could help increase educators&#x2019; motivation to take students outside. Teachers in this study mentioned multiple factors that motivated them to take students outside that connect to previous work. The desire to incorporate nature aligns with teacher interest and environmental attitudes identified as motivators in previous work (<xref ref-type="bibr" rid="ref50">50</xref>, <xref ref-type="bibr" rid="ref52">52</xref>, <xref ref-type="bibr" rid="ref57">57</xref>). Teachers&#x2019; statements that nice weather and having time in the schedule motivated them to take students outside identifies potential positive impact from factors that were also identified as barriers, in this study and previous work (<xref ref-type="bibr" rid="ref49">49</xref>, <xref ref-type="bibr" rid="ref51">51</xref>, <xref ref-type="bibr" rid="ref53">53</xref>). Unlike previous work, particularly related to outdoor environmental or science learning (<xref ref-type="bibr" rid="ref3">3</xref>, <xref ref-type="bibr" rid="ref57">57</xref>), teachers did not mention curriculum connections as a frequent motivator. Most of the motivations in this study, including the four mentioned most often (health, time, weather, nature incorporation) were not related to specific content learning. A majority of teachers (<xref ref-type="bibr" rid="ref12">12</xref>) did mention that doing a specific content activity motivated them to take students outside on at least one surveyed day, but health benefits, easy logistics, and the desire to be outside in nature were the main drivers.</p>
<p>Interestingly, the most common motivation in this study&#x2014;wanting to take advantage of the health benefits&#x2014;is not as prominent in other work on teachers&#x2019; reasons for using outdoor learning. Health benefits appeared to motivate teachers in this study even when there was not a curriculum-related reason to take students outside. Further, the data on the health benefits from time in nature is substantial (<xref ref-type="bibr" rid="ref4">4</xref>, <xref ref-type="bibr" rid="ref5">5</xref>, <xref ref-type="bibr" rid="ref7 ref8 ref9">7&#x2013;9</xref>), connects to many types of outdoor experiences, and is relevant across all grades and subjects. These findings suggest that individuals seeking to plan interventions or increase outdoor time may find it useful to highlight the health benefits in framing their projects.</p>
</sec>
<sec id="sec25">
<title>Flexibility and a systems view may increase opportunities</title>
<p>Finally, the findings suggest that taking a flexible approach to implementation that accounts for dynamic interactions in a complex system may increase opportunities for students to spend time outside. A common theme across the findings was the variation in what teachers were able to do, what motivated them, and what helped or hindered implementation, even for one teacher on different days. This variation speaks to the dynamic systems in schools, and the many shifting factors that influence what teachers are able to do (<xref ref-type="bibr" rid="ref48">48</xref>, <xref ref-type="bibr" rid="ref50">50</xref>). Multiple options would allow teachers to incorporate the one that fit for their classes in the moment, and adapt as the moment shifted. Flexibility in implementation may increase opportunities and lead to more successful implementation of outdoor time than a one-size-fits-all directed approach.</p>
<p>Additionally, teachers in this project suggested an array of factors that facilitated or limited outdoor time. The majority of these factors were beyond the control of the individual teacher, with several (school schedule, resources, appropriate outdoor spaces, sufficient staff, administrator support) more likely to be coordinated at the school or district level. This aligns with previous research that identified supportive administrators, resources, staffing, appropriate spaces, and schedules as factors that affected opportunities to take students outside (<xref ref-type="bibr" rid="ref1">1</xref>, <xref ref-type="bibr" rid="ref49 ref50 ref51">49&#x2013;51</xref>). The fact that these factors are outside the control of individual teachers points to the importance of coordinated support for outdoor learning. The facilitator mentioned most often&#x2014;encouragement in the form of a supportive colleague or the psychological &#x201C;nudge&#x201D; to have something to report on the project survey&#x2014; aligns with the interpersonal level of a multi-level understanding of the school system (<xref ref-type="bibr" rid="ref50">50</xref>) and presents a relatively simple opportunity to encourage implementation of nature exposure. Coordinating supportive colleagues or accountability partners across a school could leverage this interpersonal facilitator to increase prevalence of nature exposure. This echoes previous work (<xref ref-type="bibr" rid="ref50">50</xref>) and the findings from Phase 1 of this project (<xref ref-type="bibr" rid="ref48">48</xref>), which suggested that taking a systems approach to address shifting barriers could help increase consistent outdoor time.</p>
</sec>
<sec id="sec26">
<title>Limitations</title>
<p>This was a small study in a single context. The results can inform practice for other schools, but are not generalizable across all settings. In particular, since even the schools in the city center in this location had some greenspace in the schoolyard, the sample does not capture the challenges in accessing greenspace that may be present in more urban contexts. Repeating the study with a larger sample, with participants that were both eager and reticent about taking students outdoors, across a longer time span, and in different contexts could add reliability and detail to the findings. Student level data (socioeconomic status or demographics) and teacher background experience were beyond the scope of this project but would support comparison across locations in future studies. Additionally, data collection occurred when schools were dealing with the COVID-19 pandemic. This may have influenced motivations, considerations, and implementation.</p>
</sec>
</sec>
<sec sec-type="conclusions" id="sec27">
<title>Conclusion</title>
<p>This study builds on understanding of how teachers may be able to frequently and consistently implement outdoor time during the elementary school day. While not broadly generalizable, the implementation data provide a detailed day-to-day look at how teachers in this school district were able to incorporate outdoor time, how long students spent outside, teachers&#x2019; motivations, and the factors that facilitated and limited opportunities. Data showed variation across teachers and days. Teachers were most consistently able to implement additional outdoor free play, but most utilized a range of activities across days. Likewise, the factors that limited outdoor time shifted for individual teachers across days. Encouraging multiple types of outdoor activities, and supporting flexible implementation, may be more effective at increasing consistent outdoor time than focusing on any particular structure or activity. Highlighting the health benefits of outdoor time and examining the dynamic system of facilitators and barriers may help encourage frequent and consistent use of outdoor time to support health and development across classes and grades.</p>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="sec28">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec sec-type="ethics-statement" id="sec29">
<title>Ethics statement</title>
<p>The studies involving humans were approved by Cornell Institutional Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.</p>
</sec>
<sec sec-type="author-contributions" id="sec30">
<title>Author contributions</title>
<p>AP: Conceptualization, Data curation, Investigation, Methodology, Project administration, Writing &#x2013; original draft, Writing &#x2013; review &#x0026; editing. AE: Data curation, Formal analysis, Investigation, Project administration, Writing &#x2013; review &#x0026; editing. DR: Conceptualization, Funding acquisition, Supervision, Writing &#x2013; review &#x0026; editing. GM: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec sec-type="funding-information" id="sec31">
<title>Funding</title>
<p>The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Cornell Atkinson Center for Sustainability, the Cornell Einhorn Center for Community Engagement, and the Cornell Master of Public Health program.</p>
</sec>
<sec sec-type="COI-statement" id="sec32">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="sec33">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
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