WRITTEN BY THE NCCS FOR ENVIRONMENTAL

HEALTH AND DETERMINANTS OF HEALTH

Source: iStock
Environmental influences on population
mental health promotion for children and youth

This document is part of a collection produced by the six National Collaborating Centres for Public
Health to encourage mental health promotion for children and youth within a strong, integrated
public health practice. The collection provides numerous entry points for the public health sector
to collaborate with other stakeholders to support evidence-informed action that addresses the
determinants of mental well-being for all children and youth in Canada.

This paper explores how the structural and intermediary determinantsi of mental wellbeing
intersect with physical and social environments to both influence risk for poor mental health
and protect positive mental health in children and youth. Details on search methods and terms
used for this paper can be found in the introduction document: Population mental health
promotion for children and youth - a collection for public health in Canada.

WHAT ENVIRONMENT MEANS 3. The social environment refers to the physical

The term “environment” encompasses three major areas
(Barnett & Casper, 2001; Schulz & Northridge, 2004):
1. The built environment refers to buildings, spaces and
products created or modified by people. This includes
houses, roads, traffic noise, transport systems, buildings,
public spaces and urban green-space.
i
2. The natural environment includes the air, water,
landscapes, natural green space such as forests and fields,
and chemical contaminants and pollutants in these spaces.
surroundings, social relationships and cultural settings
within which people function. It includes social and
economic processes, beliefs about place and community,
and influences such as income, race, social supports,
cultural practices (including religion), community
connectedness, stress, social inequities, networks, family
influences and power relations (Barnett & Casper, 2001).
Structural (mechanisms generating social stratification) and
intermediary determinants (influence differences in exposure and
vulnerability as a consequence of social stratification) as defined in
Solar & Irwin, 2010.

Visit NCCPH.CA to download the complete collection

ENVIRONMENTAL INFLUENCES ON POPULATION MENTAL 1

HEALTH PROMOTION FOR CHILDREN AND YOUTH
The physical environment is a term often used to describe
the natural environment, as well as the built environment
(Goldsteen, Goldsteen, & Dwelle, 2015).
The environment is more than just a place in which positive
outcomes can be obtained - it impacts every aspect of
the human experience, including circumstances directly
influenced by genetic factors, psychological predispositions
and personal practices (Corral-Verdugo & Frías-Armenta,
2016). It is a web of interrelated human, physical and social
elements that evolve over time. Political and economic
processes are fundamental factors that influence how the
physical environment and social structures intersect to
impact health and well-being. Attention to both social
conditions and physical environmental hazards are necessary
to address disparities in environmental health (Gee & Payne-
Sturges, 2004).
OVERVIEW OF EVIDENCE
CONNECTING ENVIRONMENT
WITH THE MENTAL HEALTH
OF CHILDREN AND YOUTH
All aspects of the environment have distinct and interrelated
influences on child and youth mental health. Children
are more vulnerable than adults to exposures in their
environment. The developing brain is most sensitive in utero
and throughout early childhood, to toxic physical, chemical
and biological exposures, as well as to the effects of social
factors and psychological stress (Rauh & Margolis, 2016).
Societal factors, including poverty, education, employment,
income, security, social support and housing are independent
structural determinants of mental health that also modify
or exaggerate the effects of exposures to physical factors in
the environment (Tost, Champagne, & Meyer-Lindenberg,
2015). The cumulative effects of toxic environmental
exposures in children and youth over the life course can cause
physiological disruptions that persist into adulthood, and lead
to lifelong impairments of physical or mental health (Shonkoff
et al., 2012). Further research is needed to understand the
impact of interactions between environmental exposures on
the developing human brain.
2 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH -
A COLLECTION FOR PUBLIC HEALTH IN CANADA
RISK AND PROTECTIVE FACTORS
IN THE PHYSICAL ENVIRONMENT
Risk factors
Children and youth can be exposed to toxins prenatally, and
when they breathe contaminated air, drink contaminated
water, breastfeed, ingest food and touch contaminated soil
and objects. Known toxic exposures in the natural and built
environments that affect neurodevelopment and the mental
health of children and youth include lead, manganese,
cadmium, polyaromatic hydrocarbons and organochlorine and
organophosphate pesticides. Pesticide exposures in particular
are more common for children living in rural agricultural
areas (Rauh & Margolis, 2016). Heavy metal contaminants
and pesticides have been linked to hyperactivity behavior,
including attention-deficit/hyperactivity disorder (ADHD)
(Bouchard, Bellinger, Wright, & Weisskopf, 2010; Grandjean &
Landrigan, 2014; Rauh & Margolis, 2016; Sioen et al., 2013).
There is a direct relationship between increasing blood lead
levels and risk of ADHD in children, noting that ADHD
is more prevalent among boys (Braun, Kahn, Froehlich,
Auinger, & Lanphear, 2006). A study showed higher risks of
hyperactivity among 7 to 8 year old children from prenatal
lead exposure. For girls, there was a higher risk of greater
total difficulties (summed scores on emotional, conduct,
hyperactivity and peer problems) from prenatal exposure to
a DDT pesticide metabolite (p,p’-DDE). Boys experienced a
higher risk of emotional problems related to prenatal exposure
to cadmium, suggesting that sex-specific effects need to be
considered in studies of environmental contaminants related
to mental health (Sioen et al., 2013).
Noise and traffic-related exposures in the built environment
have been associated with poor mental health outcomes.
Children exposed to higher levels of traffic noise at home
were shown to have increased hyperactivity (Tiesler et al.,
2013) as well as emotional symptoms and conduct problems
(Dreger, Meyer, Fromme, & Bolte, 2015). Prenatal exposure
to polyaromatic hydrocarbons, an indicator of urban air
pollution, has been shown to have lasting effects across early
and middle childhood on the development of self-regulation
(successful cognitive, emotional and behavioral control) and
social competence (Margolis et al., 2016). For young children
and youth who live in low income urban neighbourhoods,
poor quality housing (with structural or maintenance
deficiencies and environmental hazards) has been associated
with poor emotional and behavioral functioning, when
compared to other factors such as residential instability,
housing type and affordability (Coley, Leventhal, Lynch, &
Kull, 2013). Contaminated dust from chipping, lead-based
paint in poor quality, older homes, is a major route of lead
exposure in children (Braun et al., 2006).
Protective factors
In the built and natural environments, green space, such
as parks, gardens, woods and fields, has consistently been
shown to promote positive mental health and reduce mental
health problems (Rugel & Ward, 2015). In children and youth,
increased access to urban green space near homes and schools
has been associated with increased attention, self-regulation
and reduced symptoms of ADHD (Flouri, Midouhas, &
Joshi, 2014; McCracken, Allen, & Gow, 2016). Greater use and
presence of more green space surrounding a child’s residence
has been associated with reduced scores for ADHD (Amoly et
al., 2014). Young children in poorer households, with access
to a higher percentage of green space in their neighbourhood,
have fewer emotional problems (including conduct disorders
and hyperactivity) compared with those in less green
ENVIRONMENTAL INFLUENCES ON POPULATION MENTAL
neighborhoods (Flouri, et al., 2014). Positive emotional well-
being among Canadian teenagers who live in small cities has
been found to be related to green space (Huynh, Craig, Janssen,
& Pickett, 2013). Similarly, Inuit youthii describe being on
the land, connecting to their culture and participating in
traditional activities which relate to the land, as protective
for their mental health (Petrasek MacDonald, Cunsolo Willox,
Ford, Shiwak, & Wood, 2015) (Gray, Richer, & Harper, 2016).
Green space is considered to benefit mental health through
reduced exposure to air pollution, noise and stress, as well as
through enhanced physical activity, social networks and social
participation (Dadvand et al., 2015; Rugel & Ward, 2015). Actions
that may foster positive mental health and reduce environmental
health inequities among children and youth include, improving
access to the quality and quantity of green space (particularly in
deprived urban areas) and aiming for a healthy built environment
to facilitate exercise through active outdoor play (Tost, et al.,
2015). More research is needed to understand the frequency,
duration, and timeframe (i.e., life stage) of exposure to green
space and possibly blue-space (such as oceans and rivers) which
are most beneficial to the long-term mental health of children
and youth and to Indigenous populations reconnecting to
traditional cultural practices on the land.
ii
For more information, please see Considerations for Indigenous
child and youth population mental health promotion in Canada
in this Collection.
Source: Getty
3
HEALTH PROMOTION FOR CHILDREN AND YOUTH
RISK AND PROTECTIVE FACTORS
IN THE SOCIAL ENVIRONMENT
Risk factors
Exposure to strong, frequent or prolonged stressors in the
home environment, and stressful living conditions in the
community, such as substandard housing, food insecurity,
neighborhood crime and inadequate health care, can
contribute to an increased risk of behavioural problems
and poor mental health (Poole-Di Salvo, Silver, & Stein,
2016; Rauh & Margolis, 2016). Inequitable distribution of
environmental exposures in the population according to social
constructs such as race and socioeconomic status, results in
an “environmental injustice” because of a greater toxic burden
among socially disadvantaged groups (Landrigan, Lambertini,
& Birnbaum, 2012). People of lower socio-economic status
who have the same level of exposure as other groups, may
have greater negative health effects and deeper consequences
of illnessiii or injury (Blas & Kurup, 2010).
Communities and individuals with fewer social, economic
and political resources experience greater psychological
stressors (Schulz & Northridge, 2004), and also have greater
exposure to environmental hazards due to adverse conditions,
such as substandard housing. Crowded living conditions
have significant negative effects on children’s well-being
(Solari & Mare, 2012). Living in an overcrowded household
or in a community with inadequate housing and prevalent
violence are particular risk factors for Inuit youth mental
health (Gray, et al., 2016). Higher levels of traffic-related air
pollution, which harms the development of positive mental
health (Margolis et al., 2016) have been observed in the built
environment of socially disadvantaged communities (based
on household income, unemployment rates, immigrant
population and percent of income spent on rent) (Sider,
Hatzopoulou, Eluru, Goulet-Langlois, & Manaugh, 2015).
Protective factors
Enhanced social networks and social supports are protective
for mental health and can influence the frequency and
duration of exposure to stressors (Heaney & Israel, 2008).
Healthy childhood development, which includes nurturing
caregivers and supportive social systems, can buffer the
adverse impacts of environmental stressors (Shonkoff, et al.,
2012). When children have healthy coping resources, it

iii
For more information, please see Chronic diseases and population
mental health promotion for children and youth and Infectious
diseases and population mental health promotion for children
and youth in this Collection.

Source: iStock

4 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH -

A COLLECTION FOR PUBLIC HEALTH IN CANADA
is possible to avoid stress-related compromises in mental
health (Taylor & Stanton, 2007). Interventions to improve
neighborhood social and physical conditions may lessen the
burden of stress and depressive symptoms as well as improve
relationships between neighbours, even in neighbourhoods
where physical conditions are deteriorating (Kruger, Reischl,
& Gee, 2007). Children who grow up in neighborhoods with
higher levels of social cohesion and control experience lower
levels of depressive and anxiety symptoms during adolescence,
regardless of socio-economic disadvantage, household
income and sex of the child. Policy efforts to strengthen
neighborhood social cohesion and control, especially in
disadvantaged communities where residents are at increased
risk for poor health, combined with greater investment in
community organizations could improve neighborhood
collective efficacy and ultimately, adolescent mental health
(Donnelly et al., 2016). Further research is needed to
determine how physical and social protective factors for
mental health may differ for boys and girls. Additional study
could also explore how exposure to neighborhood conditions
influences children’s developmental trajectories, both in
Indigenous communities and in the general population.
ENVIRONMENTAL INFLUENCES ON POPULATION MENTAL
For rural areas of Canada, collaborative approaches to care,
multi-sectoral capacity-building and further engagement with
informal social support networks are suggested as promising
strategies for the promotion of mental health (Caxaj, 2015).
Indigenous communities in remote areas of Northern Canada
face additional challenges from extreme weather conditions
and loss of sea ice caused by climate change. For example,
Inuit youth experience challenges related to rapid changes in
the land and environment, as well as social inequities such as
overcrowded housing, low educational attainment and high
rates of poverty. Protective factors for enhanced well-being
described by Inuit youth include strong communities and
relationships with family and friends (Petrasek MacDonald,
et al., 2015). Pride in Inuit identity, and living in a community
with greater social cohesion and greater socio-economic
success are factors associated with greater mental wellness
for Inuit youth (Gray, et al., 2016). Social and physical
environment initiatives relevant to the mental health
of Indigenous populationsiv need to consider additional
challenges of diversity, colonization, inequity and
vulnerability to climate change, as well as their differential
effects on girls and boys.
iv
For more information, please see Considerations for Indigenous
child and youth population mental health promotion in Canada
in this Collection.
Source: iStock
5
HEALTH PROMOTION FOR CHILDREN AND YOUTH
EXAMPLES OF INTERVENTIONS
THAT ADDRESS ENVIRONMENTAL
INFLUENCES ON THE MENTAL
HEALTH OF CHILDREN AND
YOUTH
This section outlines promising practices and intervention
examples that public health practitioners can consider to
address environmental influences on mental health promotion
for children and youth within specific settings. The intention
is to introduce intervention examples in the context of public
health practice. This list is not meant to be exhaustive.
Family and childcare setting (prenatal care,
daycare, Indigenous programs for childcare)
Strategies:
R5 attachment formation
R5 emotion and behaviour regulation
R5 parent-practitioner collaborations
R5 sleep, feeding, and activity routines
R5 collaborating with community resources
R5 daycare as well as programs for Indigenous child care
Examples of interventions:
R5 Handle with care. Strategies for Promoting the
Mental Health of Young Children in Community-
Based Child Care
R5 Promising practices in First Nations and Aboriginal
Maternal and Child Health Programs: Community
perspectives on What Works
6 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH -
A COLLECTION FOR PUBLIC HEALTH IN CANADA
School setting (elementary schools, middle/
high school, adolescents/ young adults)
Strategies:
R5 violence/bullying prevention
R5 gender-affirmative
R5 safe and accessible recreation
R5 youth engagement
R5 workforce and education/training for youth
Examples of interventions:
R5 Healthy Schools Approach. Peel Region Public Health
Pilot project.
R5 Genderspectrum (U.S.) Resources and best practices
on gender and mental health.
Community setting (living conditions,
community capacity, urban planning and built
environment, access to healthcare services)
Strategies:
R5 safe and affordable housing, neighborhood renewal
and crime reduction
R5 acting as advisory board member or engaging in
intersectoral work
R5 retail food environments with healthy choices,
developing green spaces, accessible transportation,
bike lanes and good lighting
R5 delivery of healthcare more accessible to vulnerable
populations
Examples of interventions:
R5 Healthy Communities, Northern Health BC
R5 The City of Vancouver’s Greenest City Action Plan
envisions that all residents will live within a five-
minute walk of a park, greenway or other green space
by 2020.
R5 Build Healthy Places Network promotes collaboration
across health and community development sectors
to improve low-income communities and the lives
of people living in them.
R5 Winnipeg Regional Health Authority (WRHA)
mental health promotion program.

PUBLIC HEALTH ROLES
Environmental health promotion interventions should
serve to disrupt the complex processes that produce social
inequalities, and target issues not commonly considered
within the scope of the health sector, such as poverty (Schulz
& Northridge, 2004). Public health professionals can integrate
mental health into their work activities, such as advocacy,
advisory roles, policy development,v partnership development,
intersectoral collaboration and ensuring regulatory
compliance with standards.
v
For more information, please see Healthy public policies
and population mental health promotion for children
and youth in this Collection.
ENVIRONMENTAL INFLUENCES ON POPULATION MENTAL
Source: Getty
Medical officers of health can ensure that mental health is
emphasized as part of their overall responsibility to promote
health in the community, with the goal of addressing health
inequities. Environmental health officers and public health
inspectors, through their focus on environmental health,
are in an ideal position to influence public health practice.
Managers, directors, nurses, dietitians, health promoters,
dental hygienists, planners, tobacco enforcement officers,
policy developers, program evaluators, psychologists and
epidemiologists, among other professions, can also play a
collaborative role in mental health promotion of children
and youth when they plan, prioritize and implement
environmental health promotion programs and interventions.
7
HEALTH PROMOTION FOR CHILDREN AND YOUTH

ACTIONS TO SUPPORT
MENTAL HEALTH PROMOTION
ENVIRONMENTAL PUBLIC
HEALTH PROGRAMS
The NCCDH framework Public Health Roles for Improving
Health Equity (National Collaborating Centre for
Determinants of Health, 2013) helps practitioners identify
actions to reduce risk factors and promote protective factors
for the mental health of children and youth.
Assess and report
Incorporate the impact of environmental inequities and
strategies to reduce them.
R5 Incorporate indicators for the mental health of children and
youth into health status reports, evaluation plans and strategic
plans for the public health unit/regional health authority.
8 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH -
A COLLECTION FOR PUBLIC HEALTH IN CANADA
Source: iStock
R5 Develop guidelines on how to measure and evaluate the
mental health impact of program/work plans for healthy
built environments, community development, social
network and social support development.
Modify and orient interventions
Plan how existing environmental interventions can include a
focus on mental health for children and youth, identifying key
populations affected.
R5 Identify key populations and strategies to reduce exposure
to environmental toxins and air pollution, strengthen
healthy built environments, improve housing quality,
improve neighborhood conditions, strengthen social
support networks and address inequitable distribution
of environmental exposures.
Partner with other sectors Participate in policy development
Identify partners from other health and non-health sectors Advocate for initiatives that target structural settings that
that can support the consideration of mental health in shape physical and social environments.
environmental health programming. R5 Initiate or participate in internal and external efforts
R5 Consult with other public health practitioners working to advocate for basic income, improved housing
on healthy built environments, whole-school approach conditions/availability, healthy built environments and
to health, preconception–early childhood programming, reduced environmental exposure to toxins in vulnerable
housing, food security programs and community populations and Indigenous peoples.
development.
R5 Consider collaborative opportunities external to public
health:
R5 education–school board, principals, teachers, support
workers, student development officers
R5 municipalities–economic development officer, city
planner, housing, parks and recreation, property
management, transportation, social services and liaison
with provincial government
R5 community organizations–youth centres, family
resource centres, coalitions focussed on social issues,
Indigenous organizations

POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH

Visit NCCPH.CA to download the complete collection

General resources Topical papers

t
Population mental health promotion for children t
Environmental influences on population mental
and youth – a collection for public health in Canada health promotion for children and youth
t
Foundations: definitions and concepts to frame t
Chronic diseases and population mental health
population mental health promotion for children promotion for children and youth
and youth t
Infectious diseases and population mental health
t
Scan Report: resources for population mental promotion for children and youth
health promotion for children and youth in Canada t
Healthy public policies and population mental
t
Database of resources for population mental health promotion for children and youth
health promotion for children and youth in Canada t
Considerations for Indigenous child and youth
population mental health promotion in Canada

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 Click the links below to access each
resource. Broken link? Let us know
at communications@nccph-ccnsp.ca
RESOURCES
The following resources have been included because of their combined focus on environment and mental health, as well as their
focus on children and youth. They provide a starting point to consider what public health practitioners and agencies can do to
address environmental influences on mental health promotion for children and youth.

Tools Training/Capacity building

Toolbox of resources to create supportive environments Pediatric Environmental Health Training Resources.
for youth Includes: Air Pollution Effects on Children; Children
R5 Retrieved from: Youthrive.ca and Nature; Pesticides and Children’s Health.
R5 Retrieved from: Children’s Environmental Health
Guidelines/Best practices Network (CEHN) Resources

Best practice guidelines for mental health promotion Frameworks/strategies

programs: Children (7–12) & youth (13–19) 2014
R5 Retrieved from: Centre for Addiction and Mental
Health (CAMH)
Social and emotional wellbeing in primary education
R5 Retrieved from: National Institute for Health and Care
Excellence (NICE)
Collection of materials about child health risks from
indoor and outdoor air pollution
R5 Retrieved from: Canadian Partnership for Children’s
Health and Environment (CPCHE)
Connecting the Dots: How Ontario Public Health Units
are Addressing Child and Youth Mental Health. Contains
case study and a focus on various environments.
R5 Retrieved from: Public Health Ontario
Evergreen: A child and youth mental health framework for Canada.
R5 Retrieved from: Mental Health Commission of Canada
Identifying Areas of Focus for Mental Health Promotion
in Children and Youth for Ontario. Public Health Child
and Youth Mental Health Promotion Locally Driven
Collaborative Project Team: 2014-2015. Includes focus
on social environments.
R5 Retrieved from: Public Health Ontario
Kids Matter: Australian early childhood framework
R5 Retrieved from: Kids Matter Australian Early Childhood
Mental Health Initiative

10 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH -

A COLLECTION FOR PUBLIC HEALTH IN CANADA
REFERENCES
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Population mental health promotion for children and youth is a collaborative project of the six National Collaborating Centres
(NCCs) for Public Health. The NCCs work together to promote and improve the use of scientific research and other knowledge to
strengthen public health practices, programs, and policies in Canada. A unique knowledge hub, the NCCs for Public Health identify
knowledge gaps, foster networks and provide the public health system with an array of evidence based resources, multi-media
products, and knowledge translation services.

This document was written by Helen Ward, Environmental Health Scientist at NCC for Environmental Health, and Dianne Oickle,
Knowledge Translation Specialist at NCC for Determinants of Health. We would like to thank our external reviewers for their
feedback: Pam Moore, Healthy Built Environment Specialist, Interior Health (BC) and Andrew Tugwell, Director of Health Promotion
and Prevention, British Columbia Children’s Hospital.

Download this document, and others in this collection, at www.nccph.ca.

Please cite this document as: National Collaborating Centre for Environmental Health and National Collaborating Centre
for Determinants of Health (2017). Environmental influences on population mental health promotion for children and youth.
Canada: National Collaborating Centres for Public Health.

This publication was funded by the National Collaborating Centres for Public Health and made possible through a financial
contribution from the Public Health Agency of Canada.

The views expressed herein do not necessarily represent

the views of the Public Health Agency of Canada.

ISBN 978-1-988833-13-2

12 POPULATION MENTAL HEALTH PROMOTION FOR CHILDREN AND YOUTH -

A COLLECTION FOR PUBLIC HEALTH IN CANADA