The effects of changes to the built environment on the mental health and well-being of adults: Systematic review

Age-friendly environment, social support, sense of community, and loneliness among middle-aged and older adults in Korea

OBJECTIVES

The purpose of this research is to explore the relationship between age-friendly environment, social support, sense of community, and loneliness of Korean adults aged 45 and above.

METHODS

A total of 590 participants from a cross-sectional and secondary data from an age integration survey conducted in 2018 was used for analysis. Structural equation modelling and bootstrapping method were applied to examine the mediating role of social support and sense of community on the relationship between age-friendly environment and loneliness.

RESULTS

Age-friendly environment was positively associated with social support (β=.310, p<.001) and sense of community (β=.479, p<.001). Social support was negatively associated with loneliness (β=-.190, p<.001). Full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI: -0.135 to -0.036).

CONCLUSION

Social support was fundamental in lowering loneliness in an age-friendly environment. There was no significant association linking age-friendly environment, sense of community, and loneliness. The results support the adoption of AFE to protect people at risk of loneliness with social support mediating this relationship.

Contextual factors influencing the urban mobility infrastructure interventions and policies for older adults in low- and middle-income countries: a realist review

Transportation is among the key aspects that influence active ageing. This realist review intends to understand the mechanisms of urban mobility infrastructure interventions and policies in low- and middle-income countries for older adults and to identify factors, which influenced the success or failure of interventions. We followed the steps suggested by Pawson and colleagues for a realist review. Electronic databases were searched from inception until August 2020. Studies were screened based on titles, abstracts and full text. The quality of included studies was assessed based on rigour and relevance. The evidence was obtained from 36 articles with diverse study designs conducted in 36 low- and middle-income countries. Findings were validated through stakeholder consultations from three low- and middle-income countries. Of the various individual factors identified, behaviour change communication interventions were low-cost, had a long-term impact and were efficient in increasing awareness among users to improve safety, social inclusion and about transport schemes for older adults. Improved transport infrastructure resulted in a shift from private to public transportation. For a sustainable urban transport infrastructure, good governance and involvement of stakeholders for planning and implementing transport interventions were considered necessary. Lack of evaluation, experience of transport planners, and inter-sectoral coordination were key challenges to successful interventions. The review highlighted a lack of older adult-specific transportation policies, and gender-targeted interventions for older women, suggesting a need for interventions and policies based on the contextual factors existing in a region.

Conceptualising public mental health: development of a conceptual framework for public mental health

BACKGROUND

Numerous determinants have been linked to public mental health; however, they have not been brought together in a comprehensive conceptual framework. The goal of this work was to bring together academic research, practitioner expertise, and public perspectives to create a public mental health conceptual framework.

METHODS

The development process proceeded in four stages. First, we identified a comprehensive list of potential determinants through a state-of-the-art academic literature review, grey literature review, and created mind maps created by peer researchers. Next, we conducted in-person workshops, consultations, and an online survey with academics, practitioners, policy makers, and members of the public to review the potential determinants, nominate additional determinants, and prioritise determinants by importance for understanding public mental health. This iterative process resulted in the final list of determinants contained in the framework. We then conducted rapid reviews to define each determinant and to identify key research, interventions, and resources. Finally, we worked with a design team to visualise the conceptual framework as an online tool and printable infographic.

RESULTS

We found substantial overlap between sources reflecting a shared understanding of the key drivers of public mental health. The unique determinants that emerged from each data source highlighted the importance of using multiple sources to create a comprehensive model. 72 potential determinants were prioritised through stakeholder consultations, resulting in a final list of 55 determinants and organised into four levels: individual, family, community, and structural.

CONCLUSIONS

This is the most complete conceptual framework for public mental health to date, bringing together academic research, policy and practitioner views, and lived experience perspectives. The co-production processes and tools we used provides a template for researchers looking to include multiple perspectives in their research. The conceptual framework draws together current knowledge on each determinant, but also highlights areas where further research is needed to better understand the relationship between each factor and mental health, which can inform the research agenda. This online tool and infographic can be used by practitioners to identify interventions for promoting mental health, and by the general public as a resource to increase awareness of the broad factors which shape public mental health.

Do inhabitants profit from integrating a public health focus in urban renewal programmes? A Dutch case study

Background

Urban renewal traditionally involves policy sectors such as housing, transport, and employment, which potentially can enhance the health of residents living in deprived areas. Additional involvement of the public health sector might increase the health impact of these urban renewal activities. This study evaluates the health impact of an additional focus on health, under the heading of Healthy District Experiments (HDE), within districts where an urban renewal programme was carried out.

Methods

We evaluated changes in health outcomes before the start of the HDE and after implementation, and compared these changes with health changes in control areas, e.g. districts from the urban renewal programme where no additional HDE was implemented. Additionally, we gathered information on the content of the experiments to determine what types of activities have been implemented.

Results

The additional activities from the HDE were mostly aimed at strengthening the health care in the districts and at promoting physical activity. When we compared the prevalence in general health, mental health, overweight, obesity, smoking, and physical activity during the study period between the HDE districts and control districts, we found no significant differences in the rate of change. The study is limited by a small sample size and the cross-sectional nature of the data. These and other limitations are discussed.

Conclusion

We found no evidence for a beneficial health impact of the activities that were initiated with a specific focus on health, within a Dutch urban renewal programme. Specific attention for network management and the integration of such activities in the wider programme, as well as an allocated budget might be needed in order to sort a health impact.

Analysis of Domestic and International Green Infrastructure Research Trends from the ESG Perspective in South Korea

Government-level ESG (environmental, social, and governance) institutionalization and active ESG activation in the private sector are being discussed for the first time this year in Korea, spurred by increased national interest since the COVID-19 pandemic crisis and the declaration of a carbon-neutral society by 2050, and ESG discussion in many fields is spreading rapidly. In addition, global awareness of the crisis caused by environmental pollution and natural disasters has highlighted the importance of green infrastructure (GI) as a new conceptual alternative to improve public value. Based on sustainability, which is a common goal of ESG and green infrastructure, this study aimed to examine the research targets and techniques of green infrastructure from the perspective of ESG. This study selected and analyzed 98 domestic and international academic journal papers published over the past 10 years in the Web of Science academic journal database literature collection. Focusing on the research subjects, the focus on green infrastructure, and research keywords, we examined the aspects of the green infrastructure plan that have been focused on from the ESG perspective and compared domestic and international research trends. In addition, implications for how each research topic is connected to the concept of ESG according to its function and purpose were derived. By examining the domestic and international research trends of green infrastructure from the ESG perspective, we identified the need for a wider range of research on the diversity and relationship between humans and the ecological environment; policies and systems; and technical research that does not focus only on a specific field. In this regard, we intend to increase the contribution to ESG management in the public sector through the establishment of green infrastructure plans and policies in the future, as they account for a large portion of public capital.

The Impacts of Housing Characteristics and Built-Environment Features on Mental Health

In this study, we examined the relationships between housing characteristics, neighborhood built-environment features, and people's mental health in Hong Kong, an Asian city well known for its high-density and high-rise housing. The potential mediating effects of people's perceived living environment were also considered in the analysis. We collected data from 221 participants from two communities in Hong Kong, i.e., Sham Shui Po (SSP) and Tin Shui Wai (TSW), using a stratified random sampling approach. Big datasets were also used to derive relevant built-environment features at the street block level. We used structural equation modeling to explore the complex relationships among housing characteristics, built-environment features, and mental health. The results indicate that the associations between built-environment quality and people's mental health are weak. For communities with relatively poor housing conditions (i.e., SSP in this study), the impact of housing characteristics on mental health may be more direct; for communities with relatively good housing conditions (i.e., TSW in this study), the effect of housing characteristics on mental health may be indirect. Our findings shed light on the importance of considering different contexts in developing policies related to housing and built environment and mental health.

A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems

Given the links between the built environment and loneliness, there is interest in using place-based approaches (addressing built environment characteristics and related socio-spatial factors) in local communities to tackle loneliness and mental health problems. However, few studies have described the effectiveness, acceptability, or potential harms of such interventions. This review aimed to synthesize the literature describing local community-based interventions that target place-based factors to address loneliness and mental health problems, informing the development of future public health approaches. We searched PsycINFO, Medline, and Embase using a structured search strategy to identify English-language studies evaluating the effectiveness, acceptability, and potential harms of place-based community interventions in addressing loneliness and mental health problems, both in general and clinical populations. Seven studies met the inclusion criteria, classified as evaluating provision of community facilities (such as clubhouses), active engagement in local green spaces, and housing regeneration. None were randomised trials. Quantitative and qualitative findings suggested promising effects and/or acceptability of six interventions, with minimal potential harms. There is a clear need for randomised trials or quasi-experimental studies of place-based interventions to describe their effectiveness in addressing loneliness and mental health problems, as well as complementary qualitative work investigating acceptability. This will inform future policy development.

A Path Analysis of the Effect of Neighborhood Built Environment on Public Health of Older Adults: A Hong Kong Study

Introduction

Health deterioration among frail older adults is a public health concern. Among the multi-dimensional factors, the neighborhood built environment is crucial for one's health. Although the relationship between the built environment and health in the general population has been thoroughly investigated, it has been ignored in the case of frail older adults, who may have difficulties in their daily basic living skills. A path analysis is constructed to model the proposed theoretical framework involving the neighborhood built environment and health among frail older adults. This study thus aims to investigate the environmental influences on health, and to validate the theoretical framework proposed for health and social services.

Methods

This study used secondary data collected in Hong Kong. A sample of 969 older community dwellers aged 60 or above were frail with at least one activity of daily living. Demographic information, neighborhood built environment data, service utilization, and health conditions were collected from these participants and their caregivers. A path analysis was performed to examine the proposed theoretical framework.

Results

The health condition was of general concern, including frailty and incapacities in daily activities in frail older adults. Besides psychosocial factors, service use, and caregivers' care quality, the built environment had a significant impact on the health of older adults as well. Specifically, more facilities offering services and groceries, a shorter distance to the nearest metro station, and more greenery exposure are associated with a better-expected health condition among frail older adults.

Discussion

The proposed theoretical framework successfully supplements past negligence on the relationship between the built environment and the health of frail older adults. The findings further imply that policymakers should promote the usability of transit and greenery in neighborhoods and communities. In addition, service utilization should be improved to meet the basic needs of frail older adults in the communities.

Investigating the Association between Environmental Quality Characteristics and Mental Well-Being in Public Open Spaces

The issues related to the urban environment and mental well-being have become increasingly important in recent decades. Although this association has been mainly investigated in developed countries, there is limited knowledge on whether similar results can be acquired in the urban environments of developing countries like Iran. This study intends to present a new dynamic and active approach to determine the environmental quality characteristics that influence the mental well-being of urban residents and to engage people to healthy urban public environments. In this respect, the research is directed by both qualitative and quantitative surveys in the public open spaces of Kermanshah, Iran. Firstly, the data are collected by Grounded Theory (GT) to identify significant environmental quality characteristics related to mental well-being by applying 24 semi-structured interviews. Secondly, the questionnaire survey based on Structural Equation Modeling (SEM) is applied to examine the association between each characteristic of the developed conceptual framework. The results reveal that the environmental quality characteristics of public open spaces, directly and indirectly, relate to users’ mental well-being. It should be noted that the public open spaces with unique functional and intrinsic features seem to have different impacts on mental well-being.

Green Logistics and Health in OBRI Economies: Does Social Marketing Matter?

In this study, our primary focus is to capture the impact of green logistics and social marketing on health outcomes in One Belt Road Initiative (OBRI) countries over the time period 2007–2019. Two estimation techniques, i.e., 2SLS and GMM, are employed to get the estimates of our variables. Findings of the 2SLS model confirmed the negative impact of green logistics on infant mortality in OBRI, European, MENA, and Asian countries. On the other side, the relationship between green logistics and life expectancy is positive in all the regions in 2SLS models. The other estimation technique also supports these findings, GMM, which confirmed the negative impact of green logistics on infant mortality and the positive impact of green logistics on life expectancy OBRI, European, MENA, and Asian economies. From these findings, we can conclude that green logistics helps to improve the health status of OBRI economies. Similarly, social marketing also improves the health status in OBRI and other regions in both models. Therefore, the governments and policymakers in respective economies should focus on the development of green infrastructure and logistics that, on one side, promote economic growth. However, on the other side, it helps improve environmental quality, which ultimately improves the OBRI economies' health status.

Systematic review of quantitative studies assessing the relationship between environment and mental health in rural areas

OBJECTIVE

Physical and natural environments might strongly influence mental health and well-being. Many studies have examined this relationship in urban environments, with fewer focused on rural settings. The aim of this systematic review was to synthesise quantitative evidence for the relationship between environmental factors (drought, climate and extreme weather events, land use/environmental degradation, green space/vegetation, engagement in natural resource management activities) and mental health or well-being in rural areas.

DESIGN

Following a systematic search of three databases (PsycINFO, MEDLINE and Web of Science), 4368 articles were identified, of which 28 met eligibility criteria for inclusion in the review.

RESULTS

Poorer mental health and well-being was typically found to have an association with extreme climate or weather events and environmental degradation. The observed relationships were largely assessed at area-wide or community levels.

CONCLUSIONS

Studies examining the relationship between the environmental condition of land and mental health at an individual level, particularly within farms, are lacking. Addressing this gap in research requires interdisciplinary expertise and diverse methodology. Few studies examined the effects of natural resource management practices/principles or biodiversity on mental health. While there is evidence that extreme climate or weather events have a negative impact on mental health in rural areas, there remain considerable gaps in our knowledge of how rural environments influence mental health and well-being.

Master-planned communities in the United States as novel contexts for individual and population-level research

It has long been known that social and physical environments can shape individual and population health, for better or worse. Master-planned communities (MPCs) in the US are custom-designed residential neighborhoods with defined boundaries planned and developed under a single, private owner or entity from their inception. Across the US, these vary greatly in scale ranging from 100 to over 50,000 homes, but broadly all provide residents with housing, infrastructure, landscaping, and purpose-built facilities to support socialization. Current research in the urban planning literature suggests that MPCs can influence the health of their residents. However, few studies have examined the use of MPCs as settings to conduct individual or population health research. In this paper, we examine the potential of MPCs as context for observational or intervention studies aimed at understanding individual and population-level health and well-being. We first summarize links between built and social environment and individual and population health research. Next, we describe the history of planned communities in the US. Then, we review specific features of MPCs related to governance, development, design, and social structure. We end by exploring how those specific features may lead to potential opportunities and challenges when using MPCs in health research. Through this discussion, we highlight MPCs as overlooked settings that may offer potential for collaborative, innovative, and socially engaged health research.

Research on Night Light Comfort of Pedestrian Space in Urban Park

The outdoor light environment significantly affects aspects of public psychological and physiological health. This study conducted experiments to quantify the effects of the light environment on visitor light comfort in urban park pedestrian space. Nine sets of lighting conditions with different average horizontal illuminance (2 lx, 6 lx, 10 lx) and colour temperatures (5600 K, 4300 K, 3000 K) were established virtual reality scenarios. Subjective light comfort was evaluated, and electroencephalogram (EEG) was measured on 18 subjects to comprehensively study the effects of different light environments on human light comfort. The results of the comprehensive evaluation showed that colour temperature had a very significant impact on subjective light comfort, with warm light being generally more favourable than cool light in enhancing human subjective light comfort. The results of the EEG analysis show that the average horizontal illuminance is an important factor in the level of physiological fatigue, and that physiological fatigue can be maintained in a superior state at an appropriate level of illuminance. Based on the results of both subjective and objective factors, a comprehensive analysis was carried out to propose a range of average horizontal illuminance (4.08 lx, 6.99 lx) and a range of colour temperature (3126 K, 4498 K) for the comprehensive light comfort zone in urban park pedestrian space.

Association between neighborhood environments and suicidal ideation among Korean adults

BACKGROUND

The relationship between neighborhood environments and suicide has not been well studied. In the present study, relations between suicidal ideation and social and physical environments were investigated in Korean adults.

METHODS

This nationwide cross-sectional study was conducted using data from the 2013 Korea Community Health Survey. The final analysis included 221,038 individuals aged ≥ 19 years. A multivariate regression model was used to examine the independent effects of environments on suicidal ideation.

RESULTS

Approximately 9.4% of participants had experienced suicidal ideation. Stepwise multivariate regression analysis showed that trusting neighbors and all five physical environments were independently associated with suicidal ideation. As regards physical environments, relations with suicidal ideation varied across subgroups: satisfaction with overall safety was to be strongly and consistently related to less suicidal ideation.

LIMITATIONS

Causality and the impact of unmeasured confounders were not addressed.

CONCLUSION

Neighborhood environments may reduce suicidal ideation.

The level of formal support received by people with severe mental illness living in supported accommodation and participation: A systematic review

AIM

The review aimed to identify and explore the association of level of support received by people with severe mental illness in supported accommodation and participation.

METHOD

The authors conducted a systematic search in MEDLINE, PsychINFO, PsychARTICLES, CINAHL Plus and ASSIA. Searches were restricted to articles published in English and participants aged 18 years and over with severe mental illness. Articles were included based on level of support received in mental health supported accommodation, classified according to the Simple Taxonomy for Supported Accommodation, and three factors of participation: social participation, daily living functioning and personal empowerment. Studies of in-patient settings and nursing homes were excluded. The review protocol is registered on PROSPERO (registration number: CRD42019161808).

RESULTS

Six articles were included in the review from USA, Australia, Sweden and Taiwan. Factors of participation for people living in accommodation with moderate support and accommodation with high support were explored. Data indicated an association between level of support and participation showing that people living in accommodation with moderate support had increased participation compared to people living in accommodation with high support.

CONCLUSION

This review identified an association between level of formal support and participation. People with SMI living in accommodation with medium support participated in more community occupations, more activities and had a higher level of personal empowerment than people living in accommodation with high support.

Challenges and lessons learnt from conducting a health survey in an ethnically diverse population

Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% (n=209) and 22% (n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.

Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review

BACKGROUND

Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments.

METHODS

Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR).

RESULTS

Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear.

CONCLUSIONS

Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities.

TRIAL REGISTRATION

PROSPERO CRD42019158309.

Impact of COVID-19 containment zone built-environments on students' mental health and their coping mechanisms

The 2nd wave of COVID-19 in 2021 had put several higher educational institutions in India into complete lockdowns and some were converted into containment zones to prevent the further spread of infection. A study was conducted on a student population (N = 432) in one such institute campus across three different hostel complexes to understand the role of containment zone Built Environments in the prevalence of Anxiety and Depression. The results from the analysis revealed that students living in rooms which have access to qualitative Built Environment aspects such as quality window views overlooking greenery and sky in addition to presence of indoor plants and portrait/artworks, are at lower risk of depression and severity of anxiety. The linear regression results of Built Environment Variable (BEV) Score with CES-D and GAD-7 advocated for an inverted relationship. The multinomial logistic regression revealed that with each 1-unit increase in BEV Score there is a significant decrease of 1.3-unit of likelihood of Depression, 0.779, 0.712 and 0.614-unit decrease in the likelihood of mild, moderate and severe levels of anxiety respectively. For Adverse Effect on Productivity, a 1-unit increase in BEV Score increases the likelihood of No-effect on productivity by 1.277 units. In order to precisely predict the effect of individual aspects of University Campus Built environments on the mental health of students during such containment and quarantine situations, further multidisciplinary investigation is required on the spheres of Built Environment, Psychology, and Epidemiology.

Loneliness and mental health outcomes among South Asian older adult immigrants in the United States: a cross-sectional study

BACKGROUND

There is growing concern of mental health issues among South Asian immigrant populations, although limited disaggregated data on determinants of these issues exists. The aim of this study was to examine factors associated with mental health outcomes among South Asian older adult immigrants living in New York City (NYC).

METHODS

Data were sourced from a needs assessment among self-identified South Asians aged 60+ conducted by an NYC-based frontline agency and nonprofit organization. Variables assessed included the 9-item Patient Health Questionnaire, degree of difficulty experienced due to depression, loneliness, emotional distress, as well as sociodemographic, living situation, acculturation, general health, and financial related indicators.

RESULTS

Among the 682 responses, 9.4% of participants displayed symptoms of mild or moderate depression (16% of Caribbean-origin, 10% of Pakistani, 9% of Bangladeshi, and 8% of Indian participants). About a third of participants (29.9%) reported feeling lonely sometimes and 39.1% experienced any type of emotional distress. When compared to those with excellent or very good self-rated health, having fair, poor, or terrible self-rated health was associated with a greater adjusted odds ratio (AOR) of having mild or moderate depression (AOR: 8.42, 95% confidence interval [CI]: 22.09) and experiencing emotional distress (AOR: 3.03, 95% CI: 1.88-4.94). Those experiencing emotional distress were more likely to be younger (AOR: 0.97, 95% CI: 0.95-1.00) and live alone (AOR: 2.06, 95% CI: 1.21-3.53).

DISCUSSION

Findings support the need for tailored mental health interventions targeting concerns, such as poor self-rated health, among South Asian older adult immigrants, as well as specific subpopulations such as Indo-Caribbeans who may be experiencing a disproportionate burden.

A multi-scalar perspective on health and urban housing: an umbrella review

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

Toward a High Spatial Resolution Aerial Monitoring Network for Nature Conservation—How Can Remote Sensing Help Protect Natural Areas?

Aerial surveys have always significantly contributed to the accurate mapping of certain geographical phenomena. Remote sensing opened up new perspectives in nature monitoring with state-of-the-art technical solutions using modern onboard recording equipment. We developed the technical background and the methodology that supports detailed and cost-effective monitoring of a network of natural areas, thereby detecting temporal changes in the spatial pattern of land cover, species, biodiversity, and other natural features. In this article, we share our experiences of the technical background, geometric accuracy and results of comparisons with selected Copernicus Land Monitoring products and an Ecosystem Map based on the testing of our methodology at 25 sites in Hungary. We combined a high-spatial-resolution aerial remote sensing service with field studies to support an efficient nature conservation monitoring network at 25 permanent sites. By analyzing annually (or more frequently) orthophotos taken with a range of 0.5–5 cm spatial resolution and 3D surface models of aerial surveys, it is possible to map the upper canopy of vegetation species. Furthermore, it allows us to accurately follow the changes in the dynamics at the forest edge and upper canopy, or the changes in species’ dominance in meadows. Additionally, spatial data obtained from aerial surveys and field studies can expand the knowledge base of the High-Resolution Aerial Monitoring Network (HRAMN) and support conservation and restoration management. A well-conducted high-resolution survey can reveal the impacts of land interventions and habitat regeneration. By building the HRAMN network, nature conservation could have an up-to-date database that could prompt legal processes, establish protection designation procedures and make environmental habitat management more cost-effective. Landscape protection could also utilize the services of HRAMN in planning and risk reduction interventions through more reliable inputs to environmental models.

Exploring Intraindividual Profiles for Home Buildings Based on Architectural Compositional Elements and Psychological Health Factors: A Transdisciplinary Approach

Based on the transactional and salutogenic perspectives, we explored individual profiles that integrate psychosocial factors and compositional elements of the built home environment. Adults with different socio-demographic characteristics completed several self-report measures on psychological factors (personality traits, self-efficacy, mental health, and happiness) and architectural elements constituting the ideal home environment. Adopting an individual-centered perspective, three distinct intra-individual psycho-architectural (person-environment) profiles were found with different compositional preferences and psychosocial characteristics in terms of functioning, health, and well-being: endopathic (characterized by higher levels of psychosocial resources and well-being indicating a highly adapted and successful profile, and architectural preferences corresponding to their identities and experiences—expression through spaces), assimilative (characterized by average levels in all regulatory parameters indicating moderately adaptive individuals, and architectural preferences of spaces created in interactive processes—introjection of spaces), and additive individuals (characterized by a comparatively dysfunctional, poorer psychosocial profile, and architectural preferences in line with provoking a restorative effect—change with spaces). An awareness of the psychosocial features of the users for whom the homes are built can help in designing spaces to inhabit that are adapted to them for an enhancement of their overall well-being. Therefore, a better understanding of the interconnections between psychology and architecture will help in designing healthy spaces.

The School as an Arena for Co-Creating Participation, Equity, and Well-Being-A Photovoice Study from Norway

Schools may play an essential role as an arena for co-creating community activities that enhance well-being, equity, and citizenship. Still, there is limited knowledge about physical and non-physical factors that contribute to well-being within such approaches. The aim of this study was to identify important factors for well-being as perceived by pupils, school employees, and parents in a community school in Norway. The participatory method photovoice was used, and seven pupils, six employees, and four parents participated by taking photos used as the basis for six focus group discussions. Transcripts of the discussions were analyzed using Systematic Text Condensation. The analysis showed that the participants experienced that the school’s built and natural environment, the activities happening there, and the human resources and organization at the school facilitated perceptions of safety, inclusion, and cohesion, which in turn contributed to well-being. Furthermore, the results showed that co-creating schools as a community arena could be an innovative way of ensuring participation, equity, and well-being in the community. Such an approach might be especially important in deprived areas or in multi-ethnic communities. An important prerequisite to succeed is the openness of the school’s staff to engage in co-creation with other stakeholders in the community.

Envisioning Happy Places for All: A Systematic Review of the Impact of Transformations in the Urban Environment on the Wellbeing of Vulnerable Groups

Urban planning and design can impact mental health, but it is unclear how ever-growing and changing cities can sustain the psychological wellbeing of vulnerable groups, who are among the most mentally sensitive to spatial inequalities. This systematic review synthesised quantitative and qualitative studies on urban design interventions and their impact on wellbeing in vulnerable groups. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched five online databases from inception to May 2020. A total of 10 papers were included. We found mixed evidence of benefits for wellbeing linked to urban regeneration projects or focused interventions (green spaces, transport, security). Interventions that were centred around participation, sustainable living, and quality of design (e.g., perceived sense of safety) were associated with increased residential satisfaction and wellbeing, particularly among low-income communities and women. Risk of bias was low to medium, but there was high methodological heterogeneity; studies were mainly from Western countries, and none of the included studies investigated the experiences of people with disabilities, migrants, or racial minorities. This review highlights the importance of inclusive and sustainable design interventions to create happy places for all strata of society, although further investigation is warranted.

Experiences of place attachment and mental wellbeing in the context of urban regeneration

Urban regeneration is an important policy focus across the European Union, with initiatives seeking to address inequalities in public health. Although theoretically such initiatives should produce benefits for mental wellbeing, this lacks strong supporting evidence. The current research addressed a prior overreliance on quantitative methods and underappreciation of the psychological significance of place, through the adoption of qualitative interviews with residents, as part of an independent review of a £650m regeneration project. Interpretative phenomenological analysis was utilised to explore the processes involved in residents' mental wellbeing and place attachment. Analysis developed three super-ordinate themes: 'feelings of control', 'social and community relations', and 'understandings and definitions of place'. These highlight issues relating to physical health, social isolation, community cohesion, as well as the potential for regeneration activities to undermine various elements of the people-place relationship.

Mental Well-Being and the Influence of Place: Conceptual Approaches for the Built Environment for Planning Healthy and Walkable Cities

Promotion of healthy cities has prompted urban planners and designers to build new conceptual frameworks to improve the design of public spaces, in which mental well-being emerges as a fundamental concept. Mental well-being is related to spatial design, with increasing attention being paid to the built environment as an important predictor of mental well-being. The objective of this article is to advance and contribute new knowledge about the characteristics of the built environment and its potential benefits for mental well-being. A meta-analysis is carried out on various empirical and theoretical approaches from the literature. Using a WOS database as a case study, a methodology based on a bibliometric analysis is proposed to examine which elements of the built environment impact mental well-being in research between 1975 and 2020, using the HistCites and VOSviewer tools. The results show that there are six thematic axes related to the built environment that would favor greater mental well-being in public spaces: walkability, density, spatial design, environmental noise, green areas and social interaction. The six thematic axes are critically analyzed and integrated into a conceptual framework to address the impacts of the built environment on mental well-being in the planning of cities. It concludes with a discussion on the implications of these concepts for urban public policy and the promotion of healthier and more sustainable and walkable environments in Latin American cities.

Longitudinal associations between neighbourhood physical environments and depressive symptoms of older adults in Hong Kong: The moderating effects of terrain slope and declining functional abilities

Little is known about the accumulative impacts of neighbourhood physical environments on older adults' depressive symptoms over time. Based on a cohort study of 2081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults, with a particular focus on the moderating effects of terrain slope and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the terrain slope types. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. This study has implications for the Ecological Theory of Ageing by identifying the dynamic interplay of environment demands and individual functional ability. Planning policies for building age-friendly neighbourhoods are discussed.

Perceived built environment, health-related quality of life and health care utilization

Previous research has shown that the built environment plays a crucial role for health-related quality of life (HRQoL) and health care utilization. But, there is limited evidence on the independence of this association from lifestyle and social environment. The objective of this cross-sectional study was to investigate these associations, independent of the social environment, physical activity and body mass index (BMI). We used data from the third follow-up of the Swiss study on Air Pollution and Lung and Heart diseases In Adults (SAPALDIA), a population based cohort with associated biobank. Covariate adjusted multiple quantile and polytomous logistic regressions were performed to test associations of variables describing the perceived built environment with HRQoL and health care utilization. Higher HRQoL and less health care utilization were associated with less reported transportation noise annoyance. Higher HRQoL was also associated with greater satisfaction with the living environment and more perceived access to greenspaces. These results were independent of the social environment (living alone and social engagement) and lifestyle (physical activity level and BMI). This study provides further evidence that the built environment should be designed to integrate living and green spaces but separate living and traffic spaces in order to improve health and wellbeing and potentially save health care costs.

The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness

Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium).Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data.Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found.Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.

Incorporating space and time into random forest models for analyzing geospatial patterns of drug-related crime incidents in a major U.S. metropolitan area

The opioid crisis has hit American cities hard, and research on spatial and temporal patterns of drug-related activities including detecting and predicting clusters of crime incidents involving particular types of drugs is useful for distinguishing hot zones where drugs are present that in turn can further provide a basis for assessing and providing related treatment services. In this study, we investigated spatiotemporal patterns of more than 52,000 reported incidents of drug-related crime at block group granularity in Chicago, IL between 2016 and 2019. We applied a space-time analysis framework and machine learning approaches to build a model using training data that identified whether certain locations and built environment and sociodemographic factors were correlated with drug-related crime incident patterns, and establish the top contributing factors that underlaid the trends. Space and time, together with multiple driving factors, were incorporated into a random forest model to analyze these changing patterns. We accommodated both spatial and temporal autocorrelation in the model learning process to assist with capturing the changes over time and tested the capabilities of the space-time random forest model by predicting drug-related activity hot zones. We focused particularly on crime incidents that involved heroin and synthetic drugs as these have been key drug types that have highly impacted cities during the opioid crisis in the U.S.

Effects of an urban regeneration program on related social determinants of health in Chile: A pre-post intervention study

Urban regeneration programs, such as "Programa Quiero mi Barrio" (PQMB) that is carried out in neighborhoods with greater deprivation across Chile, can improve health and quality of life in socio-economically deprived neighborhoods. The aim of this study was to analyze the effects of this program on the physical, social, and safety environments of neighborhoods intervened between 2011 and 2018, according to gender and socioeconomic position. Four indices and six sub-indices were constructed to measure physical, social, and safety environments of the neighborhoods. We conducted a pre- and post-intervention analysis with 2095 people using linear models adjusted for repeated measurements. After the intervention, participants had an improved perception of physical, social, and safety environments, as well as the use of spaces, particularly among women and people with higher levels of education. Therefore, the PQMB program is a form of public policy that can improve the quality of life and health of people living in underprivileged areas.

Does variety of social interactions associate with frequency of laughter among older people? The JAGES cross-sectional study

OBJECTIVE

Several studies have reported that laughter is associated with health benefits. In addition, social interactions, such as social relationships, social participation and so forth, have shown the association with not only health but also individual emotion. In this study, we conducted a cross-sectional study to examine the association between variety of social interactions and the frequency of laughter.

DESIGN

Cross-sectional study.

SETTING

Sampled from 30 municipalities in Japan.

PARTICIPANTS

Non-disabled Japanese men (n=11 439) and women (n=13 159) aged ≥65 years using data from the Japan Gerontological Evaluation Study, which was conducted during October to December in 2013.

PRIMARY OUTCOME MEASURES

Laughing almost every day by self-reported questionnaire.

RESULTS

Poisson regression analysis with robust error variance was used to calculate prevalence ratios (PRs) for laughing almost every day according to each social relationship and its potential community-level environmental determinants. The prevalence of laughing almost every day tended to increase with increased variety in each social interaction after adjusting, instrumental activities of daily living, number of living together, working status, depression, self-reported economic status and residence year. Among men and women, multivariate-adjusted PRs (95% CIs) by comparing participants with the highest and lowest categories were 1.18 (1.04 to 1.35) and 1.16 (1.04 to 1.29) in positive life events; 1.26 (1.10 to 1.45) and 1.09 (0.96 to 1.24) in perceived positive changes in the area; 1.15 (1.04 to 1.28) and 1.17 (1.07 to 1.28) in social participations; 2.23 (1.57 to 3.16) and 1.47 (1.02 to 2.12) in social relationships and 1.25 (1.08 to 1.45) and 1.29 (1.15 to 1.45) in positive built environments. These associations were also preserved after the restriction of participants who were not in depression.

CONCLUSIONS

This study shows that a greater variety of each social relationships and the potential community-level environmental determinants are associated with higher frequencies of laughter in Japan.

The health effect of perceived built environment on depression of elderly people in rural China: Moderation by income

This study explored the health effect of perceived built environment on depression of the Chinese elderly people in rural areas. A multifaceted approach in examining perceived built environment was used. A sample of 670 older residents in rural area of China were interviewed, and data were collected mainly for exploratory factor analysis, confirmatory factor analysis and moderation analysis. Results showed a reliable construct of perceived built environment which was developed by this study. A significant moderating role of personal income per month in the significantly negative relationship between perceived built environment and depression was confirmed. That is, the health effect of perceived built environment on depression became weakened among people of higher income levels. This study added evidence for the health effect of perceived built environment on depression among Chinese elderly people. Additionally, individual income was identified as an important influencing factor in such effect. Discussion on the negative relationship between perceived built environment and depression, as well as the moderating effect of personal income in such relationship were presented.

Relationship Among Physical Literacy, Mental Health, and Resilience in College Students

Objectives: The objective of the study is to examine the relationship among physical literacy, mental health, and resilience in college students. Methods: The study is a cross-sectional study. Participants (N = 5,265; 46.6% males) completed perceived physical literacy instruments, mental health continuum short forms, and the 12-item child and youth resilience measures. Mediation models were applied to explore the association among three concepts. Results: Physical literacy, resilience, and mental health were significantly linked with each other. In the mediation model, the direct effect of physical literacy on mental health was 0.49. The indirect effect of physical literacy on mental health through the mediation of resilience was 0.97. The mediating effect of resilience accounts for 66.30% of the total effect, indicating the partial mediating effect of resilience in the relationship between physical literacy and mental health. In more detailed models, resilience was found to mediate the relationship between physical literacy and social and psychological wellbeing, accounting for 61.02% and 56.92% of the total effect, respectively. In addition, resilience acted as full mediator in the relationship between physical literacy and emotional wellbeing (>100%). These findings suggest that physical literacy increases mental health by improving resilience. Conclusions: This is the first time to connect physical literacy with mind factors. The mediating effect of resilience on the relationship between physical literacy and mental health was found. Our findings support the development of physical literacy in universities as part of a holistic approach to supporting the wellbeing and mental health of undergraduates. This study provides a new perspective for the development of large-scale interventions in the health of body and mind in college students.

Exploring how the urban neighborhood environment influences mental well-being using walking interviews

Mental well-being in cities is being challenged worldwide and a more detailed understanding of how urban environments influence mental well-being is needed. This qualitative study explores neighborhood factors and their interactions in relation to mental well-being. Individual semi-structured walking interviews were conducted with 28 adults living in the Brussels-Capital Region. This paper provides a detailed description of physical neighborhood factors (green-blue spaces, services, design and maintenance, traffic, cellphone towers) and social neighborhood factors (neighbor ties, neighbor diversity, social security) that link to mental well-being. A socio-ecological framework is presented to explain interactions among those neighborhood factors, and personal and institutional factors, in relation to mental well-being. The findings are linked to existing concepts and theories to better understand the mechanisms underlying the associations between the urban neighborhood environment and mental well-being. Finally, implications of the walking interview method are discussed.

Gender Disparity in Perceived Urban Green Space and Subjective Health and Well-Being in China: Implications for Sustainable Urban Greening

It is generally agreed that green space has a positive effect on the health and well-being of urban residents. A number of papers have studied the relationship between green space and various sociodemographic characteristics; however, little is known about how perceptions of green space affect health and well-being differently between men and women. Such knowledge is significant for informing policy makers in designing urban green space to benefit the health and well-being of all people. In addition, urban greening has rarely been studied in the context of the UN 2030 Agenda and the UN New Urban Agenda. This study examines gender disparities in perceived green space and health and well-being, the effect of perceived green space, personal, and family variables on subjective health and well-being, and the interactive effects of perceived green space, personal, and family variables on health and well-being. The analyses were based on a survey of 9325 participants in 40 Chinese cities, using the Geographical Detector method. The results suggest that men tend to have a higher perception of green space but lower subjective health and well-being than women. Compared to health, well-being is more affected by perception of urban green space and personal and family factors. Perception of urban green space has a higher effect on men’s health and well-being than women’s. Women’s health and well-being tends to be more affected by personal and family factors than men’s. There are clear interactive effects of perceived green space, personal, and family variables on health and well-being. The combined effect is greater than the sum of individual effects on health and well-being, suggesting complexity in sustainable urban green space development with attention to gender equality in the context of the UN Agendas for sustainable development.

Active design of built environments for increasing levels of physical activity in adults: the ENABLE London natural experiment study

Background

Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited.

Objectives

The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined.

Design

The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment.

Setting

East Village, London, UK.

Participants

A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years.

Intervention

The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport.

Main outcome measure

Change in objectively measured daily steps from baseline to follow-up.

Methods

Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village.

Results

A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity.

Conclusions

Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).

Developing an evidence-informed framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries: a protocol for realist synthesis

BACKGROUND

Mobility, one of the basic daily activities, helps in carrying out routine work, which contributes to people's well-being. A lack of friendly and accessible infrastructure may act as a barrier, which limits older adults' contributions and participation in society. Hence, it is important to have an enabling environment for older adults to carry out their activities independently at ease. There is ample research evidence about effective interventions on urban mobility infrastructures, but there is a lack of evidence regarding what works, for whom, and in what circumstances. Hence, there is a need to identify the contextual factors for different regions to design region-specific interventions. The aim of this realist synthesis is to develop an evidence-informed framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries.

METHODS

A realist review will be undertaken using the following process: (1) development of a program theory, (2) search strategy and information sources, (3) study selection and appraisal, (4) data extraction, and (5) data synthesis. In addition to searching grey literature and contacting authors, we will search (since inception) multiple electronic databases such as PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Studies will be included based on their ability to provide data that evaluates some aspect of the program theory. Two independent reviewers will screen and extract data from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome that explains how safe and accessible urban mobility infrastructures for older adults implemented in low- and middle-income countries translate to better health outcomes. The findings will be reported according to Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidelines.

DISCUSSION

This realist review will help to develop a framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries. The results of this study will support evidence-based decision-making on urban mobility systems and will be of interest to various stakeholders. Dissemination will be done through conference presentations, policy briefs, media, and peer-reviewed journals. Implications for future research will be discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020168020.

Evaluating the effect of change in the built environment on mental health and subjective well-being: a natural experiment

BACKGROUND

Neighbourhood characteristics may affect mental health and well-being, but longitudinal evidence is limited. We examined the effect of relocating to East Village (the former London 2012 Olympic Athletes' Village), repurposed to encourage healthy active living, on mental health and well-being.

METHODS

1278 adults seeking different housing tenures in East village were recruited and examined during 2013-2015. 877 (69%) were followed-up after 2  years; 50% had moved to East Village. Analysis examined change in objective measures of the built environment, neighbourhood perceptions (scored from low to high; quality -12 to 12, safety -10 to 10 units), self-reported mental health (depression and anxiety) and well-being (life satisfaction, life being worthwhile and happiness) among East Village participants compared with controls who did not move to East Village. Follow-up measures were regressed on baseline for each outcome with group status as a binary variable, adjusted for age, sex, ethnicity, housing tenure and household clustering (random effect).

RESULTS

Participants who moved to East Village lived closer to their nearest park (528 m, 95% CI 482 to 575 m), in more walkable areas, and had better access to public transport, compared with controls. Living in East Village was associated with marked improvements in neighbourhood perceptions (quality 5.0, 95% CI 4.5 to 5.4 units; safety 3.4, 95% CI 2.9 to 3.9 units), but there was no overall effect on mental health and well-being outcomes.

CONCLUSION

Despite large improvements in the built environment, there was no evidence that moving to East Village improved mental health and well-being. Changes in the built environment alone are insufficient to improve mental health and well-being.

Designing Urban Green Space (UGS) to Enhance Health: A Methodology

Policymakers and urban designers strive to implement the increasing evidence about the positive association between urban green space (UGS) and health in policy. In Almere, The Netherlands, the Regenboogbuurt ("Rainbow Quarter") neighbourhood is currently being revitalized. The research team was asked to deliver design principles for the improvement of UGS in this neighbourhood to benefit the health of its residents. However, robust studies that demonstrate what UGS criteria offer what particular benefit for what target group are scarce. This paper contributes to the need for more evidence-based UGS design by presenting the approach we used to develop UGS design principles for Regenboogbuurt. Demographic information, health statistics, residents' opinions, and data about the current use of UGS were analysed to choose target groups and to formulate health benefit goals. We also developed a model for assessing the health benefits of UGS. For two age groups (those aged 10-24 and 40-60), stimulating physical health and social cohesion, respectively, were determined to be the goals of improving UGS. UGS design principles were then assessed based on the existing literature. These principles will be taken into account when this area is revitalized in 2021. Thus, there will be an opportunity to measure whether these design principles did indeed contribute to residents' health.

The impact of social capital, demographic factors, and coping strategies on community adaptation in supporting people with severe mental illness

Background: People with severe mental illness have the ability to live a satisfactory and independent life with the help of the community. Their adaptation to life’s challenges is a dynamic process, and the community plays an important role. This research, therefore, aims to address the question of how social capital, demographic factors, and coping strategies affect the community’s ability to adapt to people with severe mental illness.

Design and methods: The multi-stage random sampling was used to obtain data from 137 respondents from rural society using an analytic observational design and cross-sectional approach. In addition, the Somers’ D test was used to measure the effect of social capital, demographic factors, and coping strategies on community adaptation.

Results: The results showed a significant effect of social capital, demographic factors, and the coping strategy of community adaptation (P<0.05). Based on empirical research, access to social capital is critical in fostering community adaptation through its social participation, network, trust, coping strategies, and cooperation.

Conclusions: In conclusion, social capital, demographic factors, and coping strategies are significant factors in developing community adaptation of people with severe mental illness.

The effects of park-based interventions on health: a systematic review protocol

BACKGROUND

Public parks serve as spaces within neighborhoods for encouraging a variety of physical and mental health-related behaviors. Over the past decade, there have been a number of interventions conducted in public parks, often aimed at improving an aspect of mental or physical health. A common type of park-based interventions is aimed at increasing physical activity among adults and children.

METHODS

We will conduct a systematic review of peer-reviewed articles on the effects of park-based interventions on physical and mental health outcomes of adults and youth (children and adolescents). An electronic search will be conducted in four electronic databases: Web of Science, PubMed/MEDLINE, Cochrane Library, and Scopus. Manual hand-searching of reference lists from studies identified as relevant by experts and of systematic reviews resulting from the search strategy will be conducted to further identify articles of interest. Inclusion criteria are peer-reviewed, quantitative studies, studies detailing an intervention conducted in a park setting, which was at the person-level or place-level, and studies published in English or Spanish. A three-stage approach will be used to screen title and abstracts and full-text articles against the inclusion and exclusion criteria and, lastly, extract data from eligible studies. Study quality will be assessed by the Cochrane Risk of Bias and the Community Guide's Guide to Community Preventive Services tools. Extracted data will be summarized narratively and meta-analysis will be conducted, if appropriate.

DISCUSSION

We aim to find relevant studies proving evidence for park-based intervention studies and their effects on health-related outcomes for youth and adults. The evidence obtained from the included studies will help guide future studies on park-based interventions. The study results will be submitted to a peer-reviewed journal for electronic dissemination.

SYSTEMATIC REVIEW REGISTRATION

Systematic review registration: PROSPERO CRD42018109165.

Environmental determinants of population health in urban settings. A systematic review

Background

Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies.

Methods

A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts. Health determinants, dimensions and indicators researched in the selected studies were synthetized, and associations analyzed. An independent assessment of quality of the studies was performed. Key conclusions and policy recommendations were extracted to build a framework to analyze environment related population health and policies in urban settings.

Results

Ninety four studies of varied methodological approaches and quality met the inclusion criteria. The review identified positive associations between all environmental determinants -socioeconomic, built environment, natural environment, healthcare, behaviors, and health outcomes - overall mortality and morbidity, in urban settings. Improvements in income, education, air quality, occupation status, mobility and smoking habits indicators have positive impact in overall mortality and chronic diseases morbidity indicators. Initiatives to improve population health in which policymakers can be more evidence-informed include socioeconomic, natural environment and built environment determinants.

Conclusions

There is scope and need to further explore which environmental determinants and dimensions most contribute to population health to create a series of robust evidence-based measures to better inform urban planning policies.

Overview of "Systematic Reviews" of the Built Environment's Effects on Mental Health

Good mental health is related to mental and psychological well-being, and there is growing interest in the potential role of the built environment on mental health, yet the evidence base underpinning the direct or indirect effects of the built environment is not fully clear. The aim of this overview is to assess the effect of the built environment on mental health-related outcomes. Methods. This study provides an overview of published systematic reviews (SRs) that assess the effect of the built environment on mental health. We reported the overview according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched until November 2019 included the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE (OVID 1946 to present), LILACS, and PsycINFO. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using the Assessing Methodological Quality of Systematic Reviews-2 (AMSTAR-2). Results. In total, 357 records were identified from a structured search of five databases combined with the references of the included studies, and eleven SRs were included in the narrative synthesis. Outcomes included mental health and well-being, depression and stress, and psychological distress. According to AMSTAR-2 scores, the quality assessment of the included SRs was categorized as "high" in two SRs and as "critically low" in nine SRs. According to the conclusions of the SRs reported by the authors, only one SR reported a "beneficial" effect on mental health and well-being outcomes. Conclusion. There was insufficient evidence to make firm conclusions on the effects of built environment interventions on mental health outcomes (well-being, depression and stress, and psychological distress). The evidence collected reported high heterogeneity (outcomes and measures) and a moderate- to low-quality assessment among the included SRs.

Influence of Individual and Contextual Perceptions and of Multiple Neighborhoods on Depression

The risk of depression is related to multiple various determinants. The consideration of multiple neighborhoods daily frequented by individuals has led to increased interest in analyzing socio-territorial inequalities in health. In this context, the main objective of this study was (i) to describe and analyze the spatial distribution of depression and (ii) to investigate the role of the perception of the different frequented spaces in the risk of depression in the overall population and in the population stratified by gender. Data were extracted from the 2010 SIRS (a French acronym for "health, inequalities and social ruptures") cohort survey. In addition to the classic individual characteristics, the participants reported their residential neighborhoods, their workplace neighborhoods and a third one: a daily frequented neighborhood. A new approach was developed to simultaneously consider the three reported neighborhoods to better quantify the level of neighborhood socioeconomic deprivation. Multiple simple and cross-classified multilevel logistic regression models were used to analyze the data. Depression was reported more frequently in low-income (OR = 1.89; CI = [1.07-3.35]) or middle-income (OR = 1.91; CI = [1.09-3.36]) neighborhoods and those with cumulative poverty (OR = 1.64; CI = [1.10-2.45]). In conclusion, a cumulative exposure score, such as the one presented here, may be an appropriate innovative approach to analyzing their effects in the investigation of socio-territorial inequalities in health.

Global variation in the prevalence of bullying victimisation amongst adolescents: Role of peer and parental supports

BACKGROUND

Bullying victimisation is a global public health problem that has been predominantly studied in high income countries. This study aimed to estimate the population level prevalence of bullying victimisation and its association with peer and parental supports amongst adolescents across low and middle income to high income countries (LMIC-HICs).

METHODS

Data were drawn from the Global School-based Student Health Survey of school children aged 12-17 years, between 2003 and 2015, in 83 LMIC-HICs in the six World Health Organization (WHO) regions. We estimated the weighted prevalence of bullying victimisation at country, region and global level. We used multiple binary logistic regression models to estimate the adjusted association of age, gender, socioeconomic status, and parental support and peer support, and country level variables (GDP and government expenditure on education) with adolescent bullying victimisation.

FINDINGS

Of the 317,869 adolescents studied, 151,036 (48%) were males, and 166,833 (52%) females. The pooled prevalence of bullying victimisation on one or more days in the past 30 days amongst adolescents aged 12-17 years was 30·5% (95% CI: 30·2-31·0%). The highest prevalence was observed in the Eastern Mediterranean Region (45·1%, 44·3-46·0%) and African region (43·5%, 43·0-44·3%), and the lowest in Europe (8·4%, 8·0-9·0%). Bullying victimisation was associated with male gender (OR: 1·21; 1·11-1·32), below average socio-economic status (OR: 1·47, 1·35-1·61), and younger age (OR: 1·11, 1·0-1·24). Higher levels of peer support (0·51, 0·46-0·57), higher levels of parental support (e.g., understanding children's problems (OR: 0·85, 0·77-0·95), and knowing the importance of free time spent with children (OR: 0·77, 0·70-0·85)), were significantly associated with a reduced risk of bullying victimisation.

INTERPRETATIONS

Bullying victimisation is prevalent amongst adolescents globally, particularly in the Eastern Mediterranean and African regions. Parental and peer supports are protective factors against bullying victimisation. A reduction in bullying victimisation may be facilitated by family and peer based interventions aimed at increasing social connectedness of adolescents.