Nature-Based Strategies for Improving Urban Health and Safety

Community-Level Characteristics Associated With Resilience After Adversity: A Scoping Review of Research in Urban Locales

The objective of this study was to document the current knowledge on characteristics measured at the community level and their relationship to individual or community well-being. The review specifically focuses on studies in urban locations. The main aim was to describe and organize evidence-based community strengths using a multidimensional portfolio approach to resilience. A scoping review using PRISMA-ScR guidelines was performed through searches of English-language articles in PsycINFO and PubMed databases. Inclusion criteria encompassed strengths or deficit factors assessed at the community-level of analysis. Our initial searches produced a pool of 2,246 articles, with 87 meeting full criteria for this review. Community-level variables were often measured as deficits or risk factors. Most studies were conducted in North America. Relationships between community variables and individual well-being showed mixed results for social characteristics but, more consistently, positive associations for strengths-based measures of natural and built environments such as access to green spaces and walkability. Models of resilience, including those focused on individuals, should include environmental characteristics. Findings of the current study suggest foundational concepts for a community resilience portfolio model to complement the more individual-focused models currently in use.

Exploring Climate and Air Pollution Mitigating Benefits of Urban Parks in Sao Paulo Through a Pollution Sensor Network

Ambient air pollution is the most important environmental factor impacting human health. Urban landscapes present unique air quality challenges, which are compounded by climate change adaptation challenges, as air pollutants can also be affected by the urban heat island effect, amplifying the deleterious effects on health. Nature-based solutions have shown potential for alleviating environmental stressors, including air pollution and heat wave abatement. However, such solutions must be designed in order to maximize mitigation and not inadvertently increase pollutant exposure. This study aims to demonstrate potential applications of nature-based solutions in urban environments for climate stressors and air pollution mitigation by analyzing two distinct scenarios with and without green infrastructure. Utilizing low-cost sensors, we examine the relationship between green infrastructure and a series of environmental parameters. While previous studies have investigated green infrastructure and air quality mitigation, our study employs low-cost sensors in tropical urban environments. Through this novel approach, we are able to obtain highly localized data that demonstrates this mitigating relationship. In this study, as a part of the NERC-FAPESP-funded GreenCities project, four low-cost sensors were validated through laboratory testing and then deployed in two locations in São Paulo, Brazil: one large, heavily forested park (CIENTEC) and one small park surrounded by densely built areas (FSP). At each site, one sensor was located in a vegetated area (Park sensor) and one near the roadside (Road sensor). The locations selected allow for a comparison of built versus green and blue areas. Lidar data were used to characterize the profile of each site based on surrounding vegetation and building area. Distance and class of the closest roadways were also measured for each sensor location. These profiles are analyzed against the data obtained through the low-cost sensors, considering both meteorological (temperature, humidity and pressure) and particulate matter (PM1, PM2.5 and PM10) parameters. Particulate matter concentrations were lower for the sensors located within the forest site. At both sites, the road sensors showed higher concentrations during the daytime period. These results further reinforce the capabilities of green-blue-gray infrastructure (GBGI) tools to reduce exposure to air pollution and climate stressors, while also showing the importance of their design to ensure maximum benefits. The findings can inform decision-makers in designing more resilient cities, especially in low-and middle-income settings.

GBD 2021 US Burden of Disease Collaborators. The burden of diseases, injuries, and risk factors by state in the USA, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a comprehensive assessment of health and risk factor trends at global, regional, national, and subnational levels. This study aims to examine the burden of diseases, injuries, and risk factors in the USA and highlight the disparities in health outcomes across different states.

METHODS

GBD 2021 analysed trends in mortality, morbidity, and disability for 371 diseases and injuries and 88 risk factors in the USA between 1990 and 2021. We used several metrics to report sources of health and health loss related to specific diseases, injuries, and risk factors. GBD 2021 methods accounted for differences in data sources and biases. The analysis of levels and trends for causes and risk factors within the same computational framework enabled comparisons across states, years, age groups, and sex. GBD 2021 estimated years lived with disability (YLDs) and disability-adjusted life-years (DALYs; the sum of years of life lost to premature mortality and YLDs) for 371 diseases and injuries, years of life lost (YLLs) and mortality for 288 causes of death, and life expectancy and healthy life expectancy (HALE). We provided estimates for 88 risk factors in relation to 155 health outcomes for 631 risk-outcome pairs and produced risk-specific estimates of summary exposure value, relative health risk, population attributable fraction, and risk-attributable burden measured in DALYs and deaths. Estimates were produced by sex (male and female), age (25 age groups from birth to ≥95 years), and year (annually between 1990 and 2021). 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws (ie, 500 random samples from the estimate's distribution). Uncertainty was propagated at each step of the estimation process.

FINDINGS

We found disparities in health outcomes and risk factors across US states. Our analysis of GBD 2021 highlighted the relative decline in life expectancy and HALE compared with other countries, as well as the impact of COVID-19 during the first 2 years of the pandemic. We found a decline in the USA's ranking of life expectancy from 1990 to 2021: in 1990, the USA ranked 35th of 204 countries and territories for males and 19th for females, but dropped to 46th for males and 47th for females in 2021. When comparing life expectancy in the best-performing and worst-performing US states against all 203 other countries and territories (excluding the USA as a whole), Hawaii (the best-ranked state in 1990 and 2021) dropped from sixth-highest life expectancy in the world for males and fourth for females in 1990 to 28th for males and 22nd for females in 2021. The worst-ranked state in 2021 ranked 107th for males (Mississippi) and 99th for females (West Virginia). 14 US states lost life expectancy over the study period, with West Virginia experiencing the greatest loss (2·7 years between 1990 and 2021). HALE ranking declines were even greater; in 1990, the USA was ranked 42nd for males and 32nd for females but dropped to 69th for males and 76th for females in 2021. When comparing HALE in the best-performing and worst-performing US states against all 203 other countries and territories, Hawaii ranked 14th highest HALE for males and fifth for females in 1990, dropping to 39th for males and 34th for females in 2021. In 2021, West Virginia-the lowest-ranked state that year-ranked 141st for males and 137th for females. Nationally, age-standardised mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischaemic heart disease (56·1% [95% UI 55·1-57·2] decline), lung cancer (41·9% [39·7-44·6]), and breast cancer (40·9% [38·7-43·7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878·0% [770·1-1015·5]), chronic kidney disease (158·3% [149·6-167·9]), and falls (89·7% [79·8-95·8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433·2 per 100 000 [380·6-493·4]) in 2021 and Mississippi having the highest (867·5 per 100 000 [772·6-975·7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40·7% decline [33·2-47·3]). Only six countries had age-standardised rates of YLDs higher than the USA in 2021: Afghanistan, Lesotho, Liberia, Mozambique, South Africa, and the Central African Republic, largely because the impact of musculoskeletal disorders, mental disorders, and substance use disorders on age-standardised disability rates in the USA is so large. At the state level, eight US states had higher age-standardised YLD rates than any country in the world: West Virginia, Kentucky, Oklahoma, Pennsylvania, New Mexico, Ohio, Tennessee, and Arizona. Low back pain was the leading cause of YLDs in the USA in 1990 and 2021, although the age-standardised rate declined by 7·9% (1·8-13·0) from 1990. Depressive disorders (56·0% increase [48·2-64·3]) and drug use disorders (287·6% [247·9-329·8]) were the second-leading and third-leading causes of age-standardised YLDs in 2021. For females, mental health disorders had the highest age-standardised YLD rate, with an increase of 59·8% (50·6-68·5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085·3 per 100 000 [9090·8-15 557·1]), whereas West Virginia had the highest (14 832·9 per 100 000 [11 226·9-18 882·5]). At the national level, the leading GBD Level 2 risk factors for death for all sexes combined in 2021 were high systolic blood pressure, high fasting plasma glucose, and tobacco use. From 1990 to 2021, the age-standardised mortality rates attributable to high systolic blood pressure decreased by 47·8% (43·4-52·5) and for tobacco use by 5·1% (48·3%-54·1%), but rates increased for high fasting plasma glucose by 9·3% (0·4-18·7). The burden attributable to risk factors varied by age and sex. For example, for ages 15-49 years, the leading risk factors for death were drug use, high alcohol use, and dietary risks. By comparison, for ages 50-69 years, tobacco was the leading risk factor for death, followed by dietary risks and high BMI.

INTERPRETATION

GBD 2021 provides valuable information for policy makers, health-care professionals, and researchers in the USA at the national and state levels to prioritise interventions, allocate resources effectively, and assess the effects of health policies and programmes. By addressing socioeconomic determinants, risk behaviours, environmental influences, and health disparities among minority populations, the USA can work towards improving health outcomes so that people can live longer and healthier lives.

FUNDING

Bill & Melinda Gates Foundation.

The Dynamic Relationship between Social Cohesion and Urban Green Space in Diverse Communities: Opportunities and Challenges to Public Health

Social cohesion is a key factor within social determinants of health and well-being. Urban green spaces can provide environments that potentially facilitate meaningful and positive social interactions that promote social cohesion, equity, human health, and well-being. However, the lack of integration of existing research on social cohesion, urban green spaces, and public health in diverse (e.g., racially and ethnically) communities limits culturally relevant strategies to address health disparities. In this manuscript, we synthesize research on the potential of urban green spaces to promote social cohesion and public health in historically excluded communities. Particularly, we explore the development of social cohesion as it relates to the social environment, built environment, leisure opportunities, green space maintenance, safety, and green gentrification. We highlight key factors and their application to meet opportunities and challenges to social and public health. A conceptual framework is presented to provide an overview and illustrate connections found in the literature.

Place-Based Strategies Addressing Neighborhood Environments to Improve Perinatal and Preterm Infant Outcomes

Preterm birth (defined as birth <37 weeks of gestation) is a significant health concern globally, with lasting implications for individuals, families, and society. In the United States, high preterm birth rates among Black and low-income populations likely result from differences in environmental exposures. Structural racism and economic disadvantage have led to unequal distribution of polluting industrial sites and roadways across society as well as differential access to health-promoting resources which contribute to preterm birth risk. Once born, preterm infants remain at risk for numerous environmentally responsive adverse health outcomes that affect growth and development throughout childhood and adulthood. In this commentary, we describe associations of neighborhood environments with pregnancy and preterm infant health outcomes and propose strategies to address harmful exposures that affect families across the lifespan.

In situ psycho-cognitive assessments support self-determined urban green exercise time

Prescribed nature walks frequently yield improvements to mood and cognition as observed in experimental studies. Research that uses real life settings such as self-determined time exercising outdoors for restorative health benefits may more accurately elicit effects than time-specified study protocols. This study examined in situ psycho-cognitive outcomes of routine walks in urban greenspace to test the concept that self-set exposure duration and not context alone is related to magnitude of psycho-cognitive benefit. Pre-post measurements taken on a diverse participant pool of individuals walking in urban parks and recruited on random days over a two-week period found significant associations between outdoor activity duration and cognitive and mood improvements. Greater outdoor walking duration linearly predicted stronger processing speeds but non-linearly in tests of other cognitive domains. Results of fixed effects model for mean mood change following green exercise show outdoor walking influenced mood change at highest levels of significance, even after accounting for individual level variability in duration. Mood improved for all durations of outdoor walking under a random effects model with high significance. Untethering fixed intervals of outdoor exercise from formal study design revealed briefer but more frequent nature engagement aligned with nature affinity. The influence of unmeasured factors, e.g., nature affinity or restorative conditioning, for prescriptive durations of urban green exercise merits further investigation toward designing wellbeing interventions directed at specific urban populations.

Green space exposure and colorectal cancer: A systematic review

Green space has been linked to colorectal cancer, but the evidence is still limited and inconclusive. This review aimed to investigate the relationship between green space and CRC. The studies were searched using three primary journal databases: PubMed, Scopus, and Web of Science. The retrieved citations were screened, and data from articles about GS exposure and CRC were extracted. The Newcastle-Ottawa Quality Assessment Form for Cohort Studies was used to evaluate the studies' quality. Five of the 1792 articles identified were eligible for the final review, which included five cohort studies published between 2017 and 2022. Each one article from the United States, the United Kingdom, France, Belgium, and Germany and All studies are of high quality. Four studies reported CRC incidence and one study reported CRC mortality from GS exposure. There was no significant association between GS attributes (Normalized Difference Vegetation Index (NDVI), surrounding greenness, surrounding green area, proximity to GS (agricultural lands, urban GSs, and forests), and count of recreational facilities and parks) with CRC. Only one study discovered that a healthier ecosystem was linked to a lower CRC risk. Although the evidence is still limited, the findings may indicate the presence of other factors in the relationship between GS and CRC. Future research should continue to focus on the variation of GS and the factors that influence it. Specific attention to the development of GS has the potential to produce benefits while mitigating cancer risk.

Bibliometric Analysis of Nature-Based Therapy Research

Unrestrained urbanisation and natural space loss are reducing contact with nature in today's society, producing negative consequences for people's mental and physical health and wellbeing. Nature-based therapies, such as physical activity in natural settings, forest bathing, therapeutic hiking, or experiential learning, reduce anxiety and depressive symptoms and improve the quality of life in both general and specific populations. A bibliometric analysis of research on nature-based therapies was performed by applying the traditional laws of bibliometrics (exponential growth law, Bradford's concentration law, Lotka's law, Zipf's law, etc.) to documents published in journals indexed in the Core Collection of the Web of Science (WoS). Graphical visualisation was performed using the VOSviewer software. Annual publications between 2006 and 2021 presented an exponential growth trend (R² = 91%). The International Journal of Environmental Research and Public Health (MDPI) and Urban Forestry & Urban Greening (Elsevier) were the most productive and cited journals. Ikei, Miyazaki, and Song are the most cited prolific authors. The USA and South Korea were the countries with the highest scientific production. In recent years, there has been a growing interest in adventure, nature, and forest therapies among researchers. Nature-based therapies have experienced a growing interest in recent years. Positive effects on mental, physical, and emotional health have been found in different populations and research lines, although more studies with different designs and populations are needed.

Green Spaces with Fewer People Improve Self-Reported Affective Experience and Mood

Calm and quiet green spaces provide health benefits for urban residents. Yet as cities become more densely populated, increasing public users to green spaces may reduce or moderate these benefits. We examine how increased pedestrian density in a green street changes self-reported wellbeing. We use a between subject experimental design that added public users as confederates in randomly selected periods over three weeks. We collect data on mood and affective response from pedestrians moving through the green street (n = 504), with and without our public user treatment in randomly selected periods. Mood and affective response are improved when experiencing the green street with fewer people. We find that an increased number of public users in the green space has a negative effect on mood, especially among women. We provide experimental evidence that self-reported wellbeing in urban green spaces depends on social context, and that there are gender inequities associated with changes in affective response. Although we only measure immediate impacts, our results imply that the health benefits of green spaces may be limited by the total number of users. This research contributes additional evidence that greener cities are also healthier cities, but that the benefits may not be equally shared between women and men and will depend on the social context of use.

Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program

Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.

Usage behavior and health benefit perception of youth in urban parks: A case study from Qingdao, China

With the development of the urban park, people's cognition of the relationship between the environment and public health has been improved, and higher requirements for the living environment have been put forward. As an important group of park users, youths often have different needs regarding the health benefits brought by urban parks. To explore the potential relationship among youth's satisfaction with urban parks, their usage behavior, and health benefit perception, this article presents some constructive suggestions for the development of healthy landscapes in urban parks. Researchers have selected five typical urban parks from different areas in Qingdao, China. Furthermore, we have used the survey method by combining the practices of “issuing questionnaires, observing and interviewing” with the goal of collecting data on 500 park visitors in autumn, including information on social demography, the satisfaction of park landscape variables, and usage behavior and health perception. A linear regression model has been used to analyze the correlation among “landscape variables,” “usage behavior,” and “health benefit perception.” Results have shown that urban green landscapes and waterscapes can significantly affect youth's social health perception and static behavior. Moreover, static behaviors such as relaxation have a great impact on mental health perception. The results of this study will be beneficial in understanding youth's needs for landscapes when using urban parks. In addition, it will provide insight for the urban planners and landscape designers to design urban parks from the perspective of youth.

Towards healthy school neighbourhoods: A baseline analysis in Greater London

Creating healthy environments around schools is important to promote healthy childhood development and is a critical component of public health. In this paper we present a tool to characterize exposure to multiple urban environment features within 400 m (5-10 min walking distance) of schools in Greater London. We modelled joint exposure to air pollution (NO₂ and PM_2.5), access to public greenspace, food environment, and road safety for 2,929 schools, employing a Bayesian non-parametric approach based on the Dirichlet Process Mixture modelling. We identified 12 latent clusters of schools with similar exposure profiles and observed some spatial clustering patterns. Socioeconomic and ethnicity disparities were manifested with respect to exposure profiles. Specifically, three clusters (containing 645 schools) showed the highest joint exposure to air pollution, poor food environment, and unsafe roads and were characterized with high deprivation. The neighbourhood of the most deprived cluster of schools had a median of 2.5 ha greenspace, 29.0 µg/m³ of NO₂, 19.3 µg/m³ of PM_2.5, 20 fast food retailers, and five child pedestrian crashes over a three-year period. The neighbourhood of the least deprived cluster of schools had a median of 21.8 ha greenspace, 15.6 µg/m³ of NO₂, 15.1 µg/m³ of PM_2.5, 2 fast food retailers, and one child pedestrian crash over a three-year period. To have a school-level understanding of exposure levels, we then benchmarked schools based on the probability of exceeding the median exposure to various features of interest. Our study accounts for multiple exposures, enabling us to highlight spatial distribution of exposure profile clusters, and to identify predominant exposure to urban environment features for each cluster of schools. Our findings can help relevant stakeholders, such as schools and public health authorities, to compare schools based on their exposure levels, prioritize interventions, and design local policies that target the schools most in need.

Effects of tree canopy on psychological distress: A repeated cross-sectional study before and during the COVID-19 epidemic

BACKGROUND

During the COVID-19 epidemic period, people showed a stronger connection to the environment within their communities. Although tree canopy in residential areas has been shown to positively affect psychological distress, it is not clear whether the COVID-19 epidemic played a role in this process. Elucidation of the relationship between tree canopy and the impact on psychological distress during the COVID-19 epidemic could provide valuable information as to the best methods to help individuals cope with urban mental stress events.

METHODS

A total of 15 randomly selected residential areas of Beijing were enrolled in this repeated cross-sectional study. A total of 900 residents were included in the two-waves of the investigation (450 residents per wave) before and during the COVID-19 epidemic (i.e., May 2019 and May 2020). Psychological distress was estimated using the 12-question General Health Questionnaire (GHQ-12). Tree canopy coverage (TCC) was measured through visual interpretation based on the 2013 data sources (World View 2 satellite imagery of Beijing urban areas with a resolution of 0.5 m). The demographic characteristics, distance to the nearest surrounding green or blue space, residential area house price, household density, and construction year were also collected in this study. A multivariate logistic regression, relative risk due to interaction (RERI), and synergy index (SI) were used to explore the relationships among tree canopy, COVID-19, and psychological distress.

RESULTS

The negative impact of the COVID-19 epidemic on mental health was significant, with the prevalence of psychological distress increased 7.84 times (aOR = 7.84, 95% CI = 4.67-13.95) during the COVID-19 epidemic period. Tree canopy coverage in the group without psychological distress was significantly higher than that of the psychologically distressed group (31.07 ± 11.38% vs. 27.87 ± 12.97%, P = 0.005). An increase in 1% of TCC, was related to a 5% decrease in the prevalence of psychological distress (aOR = 0.95, 95% CI = 0.93-0.98). An antagonism joint action between tree canopy and the COVID-19 epidemic existed (RERI = 1.09, 95% CI = 0.72-1.47; SI = 0.16, 95% CI = 0.05-0.52), and persisted enhancing only in medium (26.45%-33.21%) and above TCC level. Correlation of GHQ items and TCC significantly differed between the COVID-19 non-epidemic and epidemic periods, with the effects of tree canopy on GHQ-12 items covering topics, such as social function and depression, presumably absent because of epidemic limitations.

CONCLUSIONS

This study indicates that the COVID-19 epidemic harmed mental health and verified the positive effects of residential tree canopy on psychological distress in Beijing. We suggest paying more attention to residents in areas of low TCC and dealing with psychological distress caused by public health stress events based on tree canopy strategies.

Community-Based Participatory Research to Improve Cardiovascular Health Among US Racial and Ethnic Minority Groups

Purpose of Review

This review aims to assess the contemporary community-based participatory research (CBPR) literature seeking to improve the cardiovascular health of racial and ethnic minority groups in the USA with a higher burden of cardiovascular risk factors and social determinants of health. It summarizes recent CBPR studies based on the American Heart Association Life's Simple 7 (LS7) framework, delineating seven modifiable health behaviors and clinical factors to promote cardiovascular health.

Recent Findings

Although limited in quantity, studies demonstrated preliminary effectiveness in improving individual and a composite of LS7 indicators by employing strategies centered around fortifying social networks, integrating group activities, leveraging technology, incorporating faith-based and spiritual practices, and implementing changes to the built environment.

Summary

Future directions for investigators engaged in CBPR include building on the existing body of evidence through more comprehensive studies, scaling effective interventions, and translating CBPR findings to influence health policy to better address health disparities.

A life course approach to understanding associations between natural environments and mental well-being for the Danish blood donor cohort

Natural environments have been associated with mental health benefits, but globally access to these benefits is threatened by urban development and densification. However, it remains unclear how natural environments relate to mental health and how consistent the association is across populations. Here we use a life-course approach with a population consisting of 66 194 individuals from the Danish Blood Donor Study (DBDS) to investigate the association between green and blue space (e.g. parks and lakes) and self-evaluated mental well-being. Green and blue space was identified from remotely-sensed images from the Landsat program, while mental well-being was based on the mental component score (MCS) calculated using the 12-item short form health survey. We use multivariate linear regression models and logistic regression models to quantify the associations. We adjust for additional environmental (urbanization, and air pollution) and lifestyle factors (smoking, body mass index, socioeconomic status, and physical activity) and specifically evaluate the role of physical activity and air pollution as possible mediating factors. We found a positive association between the MCS and current and childhood green space, and a non-significant association for current and childhood blue space. Adjusting for environmental and the other factors attenuated the effect sizes indicating that a broad range of factors determine mental well-being. Physical activity and air pollution were both associated with the MCS as possible mediators of green space associations. In addition, the odds for successfully completing tasks', seeing others, and feeling less downhearted increased with higher levels of green space, and the odds of feeling calm increased with higher levels of blue space. In conclusion, we found support for an association between green and, to less degree, blue space and mental well-being throughout different life stages. In addition, we found a positive association with individual indicators of mental well-being such as being productive, feeling less downhearted and calmer, and being social. The healthy blood donor effect and the bias towards urban residency may explain why we found smaller effect sizes between green and blue space and mental well-being for this generally healthy and resourceful cohort compared to previous studies.

Associations of Vigorous Gardening With Cardiometabolic Risk Markers for Middle-Aged and Older Adults

This study investigates the associations of vigorous-intensity gardening time with cardiometabolic health risk markers. This cross-sectional study (AusDiab) analyzed 2011-2012 data of 3,664 adults (55% women, mean [range], age = 59.3 [34-94] years) in Australia. Multiple linear regression models examined associations of time spent participating in vigorous gardening (0, <150 min/week, ≥150 min/week) with a clustered cardiometabolic risk (CMR) score and its components, for the whole sample and stratified by age and gender. Of participants, 61% did no vigorous gardening, 23% reported <150 min/week, and 16% reported ≥150 min/week. In the whole sample, spending ≥150 min/week in vigorous gardening was associated with lower CMR (lower CMR score, waist circumference, diastolic blood pressure, and triglycerides) compared with no vigorous gardening. Stratified analyses suggested that these associations were almost exclusively observed for older adults and women. These findings suggest the public health potential of vigorous-intensity gardening in reducing CMR.

Conceptualizing multilevel research designs of resilience

Resilience is a broad concept allowing us to understand health and well-being as a multidimensional process that continually grapples with a multitude of stressors. Currently, there are efforts across disciplines and scales to develop this concept of resilience. Unfortunately, individual and community resilience efforts tend to only abstractly conceptualize macroscale dynamics while social-ecological efforts tend to treat individuals and communities as nonindependent components of these macroscale dynamics. Combining these efforts is needed to create a robust dialog around resilience. This paper reviews and synthesizes social-ecological, community, and individual resilience literature by proposing longitudinal, multilevel models of resilience. In developing these models, some of the issues that have prevented synthesizing these literatures are resolved, including generalizability issues, within system variation, and the operationalization of social and natural and micro- and macroscale factors. Three brief examples are presented to elaborate on the utility of the multilevel model of resilience.

Nature's Role in Outdoor Therapies: An Umbrella Review

Objective: To report on the role of nature in outdoor therapies through review and summary of existing systematic and meta-analytic reviews in an effort to articulate a theoretical framework for practice. Materials and methods: An umbrella review was conducted following systematic protocols PRISMA guidelines. Results: Fourteen studies met the inclusion criteria and represented five self-identified approaches: nature-based therapies, forest therapy, horticultural therapy, wilderness therapy, and adventure therapy. Clear and comprehensive descriptions of theory, program structure, and activity details with causal links to outcomes were mostly absent. Conclusions: A rigorous and determined program of research is required in order to explicit in-depth theories of change in outdoor therapies. Conversely, or maybe concurrently, a holistic theory of integrated relatedness may be developed as a parallel expression of support for nature in therapy while the explanatory science catches up.

Growing Together: Community Coalescence and the Social Dimensions of Urban Sustainability

Urban sustainability is most often measured using a series of social, economic, and ecological indicators. Assessment methods for urban sustainability typically factor in the ecological dimensions of greenspace, such as biodiversity maintenance, stormwater management, and/or air quality—yet indicator schemas that consider only the ecological dimensions largely overlook the social benefits of some types of urban greenspace, particularly community gardens and orchards. This article makes the case that the process of community formation and strengthening that occurs in shared growing spaces is an important element of urban sustainability in its own right. Based on 55 interviews of community garden advocates, policy-makers, and development professionals involved in urban agriculture planning, this article traces the widespread understanding among practitioners that shared growing spaces strengthen social as well as environmental sustainability, though the social benefits are often difficult to measure. The latter concern was most frequently expressed by urban agriculture advocates who, after involvement in the political process, perceived the need for such metrics in order to communicate persuasively with planners and policy makers. The social values of shared growing spaces, at once self-evident to garden advocates and difficult for them to demonstrate with quantitative data, may be theorized by drawing on insights from sociology: A truly sustainable city requires community coalescence among diverse citizens, and such community is fostered particularly well in shared growing spaces.

Connections-between Daily Greenness Exposure and Health Outcomes

A compelling body of research demonstrates that exposure to nature, especially trees, is beneficial to human health. We know little, however, about the extent to which understory vegetation that does not reach the height of trees, impacts human health. An additional gap in our knowledge concerns the extent to which daily variations in exposure to various forms of vegetation are related to human health outcomes. Many previous findings describing such connections were achieved in laboratory settings or through semi-controlled experiments, which do not reflect the dynamic variations of people's daily exposure to nature. Thus, we conducted an online survey to address these questions. We used the National Land Cover Dataset 2011 and Google Street View images to estimate participants' daily exposure to nature, and two standard questionnaires (General Health SF-12 and the Perceived Stress Scale) to assess health. Results show that greater exposure to trees in daily life is associated with better health outcomes. Specifically, higher neighborhood concentrations of tree canopy are related to better physical health, overall health and an increased capacity to control stress. In contrast, the results exploring the health associations of understory vegetation were inconsistent. In most cases, understory vegetation had a negative relationship with stress and mental health measures.

Evidence-Informed strategies for promoting equitability in brownfields redevelopment

Brownfields redevelopment creates opportunities for enhanced environmental conditions, improved physical and mental health, community cohesion, and economic prosperity. However, brownfields cleanup and recycling projects sometimes fail due to a lack of community engagement. Recent research suggests that such failures can stem from a lack of equitability in the planning process, especially when it comes to decision making. This paper examines issues of equitability in a recent brownfields redevelopment project in Tampa, Florida funded by the U.S. Environmental Protection Agency. The project focused on an underserved and under-resourced community with long-term environmental burdens and health disparities. Our ethnographic research shows that, while the project engaged in multiple and intersecting efforts to include a diversity of community voices in the decision-making process, ultimately structural and organizational power imbalances in sustainability transitions influenced participation in redevelopment initiatives. This study suggests that attending to issues of power articulated through expressions of local and authoritative knowledge about environmental cleanup and redevelopment can lead to deeper levels of community engagement.

Momentary mood response to natural outdoor environments in four European cities

Exposure to natural outdoor environments (NOE) has been shown in population-level studies to reduce anxiety and psychological distress. This study investigated how exposure to one's everyday natural outdoor environments over one week influenced mood among residents of four European cities including Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands) and Kaunas (Lithuania). Participants (n = 368) wore a smartphone equipped with software applications to track location and mood (using mobile ecological momentary assessment (EMA) software), for seven consecutive days. We estimated random-effects ordered logistic regression models to examine the association between mood (positive and negative affect), and exposure to green space, represented by two binary variables indicating exposure versus no exposure to NOE using GPS tracking and satellite and aerial imagery, 10 and 30 min prior to participants' completing the EMA. Models were adjusted for home city, day of the week, hour of the day, EMA survey type, residential NOE exposure, and sex, age, education level, mental health status and neighbourhood socioeconomic status. In addition, we tested for heterogeneity of effect by city, sex, age, residential NOE exposure and mental health status. Within 10 min of NOE exposure, compared to non-exposure, we found that overall there was a positive relationship with positive affect (OR: 1.39, 95% CI: 1.06, 1.81) of EMA surveys, and non-significant negative association with negative affect (OR: 0.80, 95% CI: 0.58, 1.10). When stratifying, associations were consistently found for Stoke-on-Trent inhabitants and men, while findings by age group were inconsistent. Weaker and less consistent associations were found for exposure 30 min prior to EMA. Our findings support increasing evidence of psychological and mental health benefits of exposure to natural outdoor environments, especially among urban populations such as those included in our study.

Greening Blocks: A Conceptual Typology of Practical Design Interventions to Integrate Health and Climate Resilience Co-Benefits

It is increasingly evident that exposure to green landscape elements benefits human health. Urban green space in cities is also recognized as a crucial adaptation response to changes in climate and its subsequent effects. The exploration of conceptual and practical intersections between human health, green spaces, and climate action is needed. Evidence-based guidance is needed for stakeholders, practitioners, designers, and citizens in order to assess and manage urban green spaces that maximize co-benefits for both human health and climate resilience. This paper proposes interventions that provide strategic green space enhancement at the neighborhood and block scale. We propose eight tangible green space interventions and associated metrics to integrate climate resilience and population health co-benefits into urban green space design and planning: View from within, Plant entrances, Bring nature nearby, Retain the mature, Generate diversity, Create refuge, Connect experiences, and Optimize green infrastructure. These interventions represent a hierarchy of functional design concepts that respond to experiential qualities and physical/psychological dimensions of health, and which enhance resilience at a range of social scales from the individual to the neighborhood. The interventions also reveal additional research needs in green space design, particularly in neighborhood-level contexts.

Structural Characteristics of Tree Cover and the Association with Cardiovascular and Respiratory Health in Tampa, FL

Urban tree cover can provide several ecological and public health benefits. Secondary datasets for Tampa, FL, including sociodemographic variables (e.g., race/ethnicity), health data, and interpolated values for features of tree cover (e.g., percent canopy and leaf area index) were analyzed using correlation and regression. Percent canopy cover and leaf area index were inversely correlated to respiratory and cardiovascular outcomes, yet only leaf area index displayed a significant association with respiratory conditions in the logistic regression model. Percent racial/ethnic minority residents at the block group level was significantly negatively correlated with median income and tree density. Leaf area index was also significantly lower in block groups with more African-American residents. The percentage of African Americans (p = 0.101) and Hispanics (p < 0.001) were positively associated with respiratory outcomes while population density (p < 0.001), percent canopy (p < 0.01), and leaf area index (p < 0.01) were negatively associated. In multivariate models, higher tree density, leaf area index, and median income were significantly negatively associated with respiratory cases. Block groups with a higher proportion of African Americans had a higher odds of displaying respiratory admissions above the median rate. Tree density and median income were also negatively associated with cardiovascular cases. Home ownership and tree condition were significantly positively associated with cardiovascular cases.

Neighborhood Parks and Recreationists' Exposure to Ozone: A Comparison of Disadvantaged and Affluent Communities in Los Angeles, California

Urban parks are valued for their benefits to ecological and human systems, likely to increase in importance as climate change effects continue to unfold. However, the ability of parks to provide those myriad benefits hinges on equitable provision of and access to green spaces and their environmental quality. A social-ecological approach was adopted in a study of urban park use by recreationists in the City of Los Angeles, contrasting two affluent and two disadvantaged communities situated in coastal and inland zones. Twenty-four days of observations distributed across morning and afternoon time blocks were gathered, with observations in each day drawn from a pair of affluent and disadvantaged community parks. Observers noted location, gender, age, ethnicity/race, and level of physical activity of each visitor encountered during four scheduled observation sweeps on each day of field work. In addition, ozone dose exposure was measured through passive monitoring. Ozone dose exposure was calculated using average hourly ozone in ppb multiplied by METS (metabolic expenditures). Dose exposure was significantly higher in the disadvantaged community parks (with majority Latino use). Findings suggest that additional monitoring in disadvantaged communities, especially inland, may be prudent to facilitate community-based information as well as to assess the degree of potential impact over time. Additionally, mitigative strategies placed in urban parks, such as increased tree canopy may help to reduce the degree of risk and improve community resilience. Future research examining the positive outcomes from physically active use of urban parks may benefit from adopting a nuanced approach in light of the present findings.

The Relationship between Social Cohesion and Urban Green Space: An Avenue for Health Promotion

Social cohesion involves the interpersonal dynamics and sense of connection among people. Increased social cohesion can be associated with various physical and psychological health benefits. The presence of urban green spaces can encourage positive social interactions that cultivate social cohesion in ways that enhance health and well-being. Urban green spaces have also been linked to positive health behaviors and outcomes including increased physical activity and social engagement. Understanding the relationship between social cohesion and urban green space is important for informing holistic approaches to health. In this article, we discuss how positive interactions in urban green space can catalyze social cohesion, social capital and critical health-promoting behaviors that may enhance psychological health and well-being. We also summarize the strengths and limitations of previous studies and suggest directions for future research.

Making the Case for "Whole System" Approaches: Integrating Public Health and Housing

Housing conditions have been an enduring focus for public health activity throughout the modern public health era. However, the nature of the housing and health challenge has changed in response to an evolution in the understanding of the diverse factors influencing public health. Today, the traditional public health emphasis on the type and quality of housing merges with other wider determinants of health. These include the neighbourhood, community, and "place" where a house is located, but also the policies which make access to a healthy house possible and affordable for everyone. Encouragingly, these approaches to policy and action on housing have the potential to contribute to the "triple win" of health and well-being, equity, and environmental sustainability. However, more effective housing policies (and in public health in general) that adopt more systemic approaches to addressing the complex interactions between health, housing, and wider environment are needed. This paper illustrates some of the key components of the housing and health challenge in developed countries, and presents a conceptual model to co-ordinate activities that can deliver the "triple win." This is achieved by offering a perspective on how to navigate more effectively, inclusively and across sectors when identifying sustainable housing interventions.

Effect of Greening Vacant Land on Mental Health of Community-Dwelling Adults: A Cluster Randomized Trial

IMPORTANCE

Neighborhood physical conditions have been associated with mental illness and may partially explain persistent socioeconomic disparities in the prevalence of poor mental health.

OBJECTIVE

To evaluate whether interventions to green vacant urban land can improve self-reported mental health.

DESIGN, SETTING, AND PARTICIPANTS

This citywide cluster randomized trial examined 442 community-dwelling sampled adults living in Philadelphia, Pennsylvania, within 110 vacant lot clusters randomly assigned to 3 study groups. Participants were followed up for 18 months preintervention and postintervention. This trial was conducted from October 1, 2011, to November 30, 2014. Data were analyzed from July 1, 2015, to April 16, 2017.

INTERVENTIONS

The greening intervention involved removing trash, grading the land, planting new grass and a small number of trees, installing a low wooden perimeter fence, and performing regular monthly maintenance. The trash cleanup intervention involved removal of trash, limited grass mowing where possible, and regular monthly maintenance. The control group received no intervention.

MAIN OUTCOMES AND MEASURES

Self-reported mental health measured by the Kessler-6 Psychological Distress Scale and the components of this scale.

RESULTS

A total of 110 clusters containing 541 vacant lots were enrolled in the trial and randomly allocated to the following 1 of 3 study groups: the greening intervention (37 clusters [33.6%]), the trash cleanup intervention (36 clusters [32.7%]), or no intervention (37 clusters [33.6%]). Of the 442 participants, the mean (SD) age was 44.6 (15.1) years, 264 (59.7%) were female, and 194 (43.9%) had a family income less than $25 000. A total of 342 participants (77.4%) had follow-up data and were included in the analysis. Of these, 117 (34.2%) received the greening intervention, 107 (31.3%) the trash cleanup intervention, and 118 (34.5%) no intervention. Intention-to-treat analysis of the greening intervention compared with no intervention demonstrated a significant decrease in participants who were feeling depressed (-41.5%; 95% CI, -63.6% to -5.9%; P = .03) and worthless (-50.9%; 95% CI, -74.7% to -4.7%; P = .04), as well as a nonsignificant reduction in overall self-reported poor mental health (-62.8%; 95% CI, -86.2% to 0.4%; P = .051). For participants living in neighborhoods below the poverty line, the greening intervention demonstrated a significant decrease in feeling depressed (-68.7%; 95% CI, -86.5% to -27.5%; P = .007). Intention-to-treat analysis of those living near the trash cleanup intervention compared with no intervention showed no significant changes in self-reported poor mental health.

CONCLUSIONS AND RELEVANCE

Among community-dwelling adults, self-reported feelings of depression and worthlessness were significantly decreased, and self-reported poor mental health was nonsignificantly reduced for those living near greened vacant land. The treatment of blighted physical environments, particularly in resource-limited urban settings, can be an important treatment for mental health problems alongside other patient-level treatments.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN92582209.

Climate change, urban health, and the promotion of health equity

Jerald Fagliano and Ana Diez Roux discuss the challenges of climate change in an urban environment, but also opportunities for healthier lifestyles and green spaces.

Urban Green Space and Its Impact on Human Health

Background: Over half of the world's population now lives in urban areas, and this proportion is expected to increase. While there have been numerous reviews of empirical studies on the link between nature and human health, very few have focused on the urban context, and most have examined almost exclusively cross-sectional research. This review is a first step toward assessing the possibility of causal relationships between nature and health in urban settings. Methods: Through systematic review of published literature, we explored the association between urban green space and human health. Results: We found consistent negative association between urban green space exposure and mortality, heart rate, and violence, and positive association with attention, mood, and physical activity. Results were mixed, or no association was found, in studies of urban green space exposure and general health, weight status, depression, and stress (via cortisol concentration). The number of studies was too low to generalize about birth outcomes, blood pressure, heart rate variability, cancer, diabetes, or respiratory symptoms. Conclusions: More studies using rigorous study design are needed to make generalizations, and meta-analyses, of these and other health outcomes possible. These findings may assist urban managers, organizations, and communities in their efforts to increase new or preserve existing green space.

Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear

Blighted and vacant urban land is a widespread and potentially risky environmental condition encountered by millions of people every day. About 15% of the land in US cities is deemed vacant or abandoned, translating into an area roughly the size of Switzerland: over 3 million hectares of otherwise beneficial spaces remain neglected. Urban residents, especially in low-income neighborhoods, point to these spaces as primary threats to their health and safety. Cities continue to seek meaningful, evidence-based interventions for remediating vacant land. Standardized processes for the restoration of vacant urban land were experimentally tested on a citywide scale and found to significantly reduce gun violence, crime, and fear.

Vacant and blighted urban land is a widespread and potentially risky environmental condition encountered by millions of people on a daily basis. About 15% of the land in US cities is deemed vacant or abandoned, an area roughly the size of Switzerland. In a citywide cluster randomized controlled trial, we investigated the effects of standardized, reproducible interventions that restore vacant land on the commission of violence, crime, and the perceptions of fear and safety. Quantitative and ethnographic analyses were included in a mixed-methods approach to more fully test and explicate our findings. A total of 541 randomly sampled vacant lots were randomly assigned into treatment and control study arms; outcomes from police and 445 randomly sampled participants were analyzed over a 38-month study period. Participants living near treated vacant lots reported significantly reduced perceptions of crime (−36.8%, P < 0.05), vandalism (−39.3%, P < 0.05), and safety concerns when going outside their homes (−57.8%, P < 0.05), as well as significantly increased use of outside spaces for relaxing and socializing (75.7%, P < 0.01). Significant reductions in crime overall (−13.3%, P < 0.01), gun violence (−29.1%, P < 0.001), burglary (−21.9%, P < 0.001), and nuisances (−30.3%, P < 0.05) were also found after the treatment of vacant lots in neighborhoods below the poverty line. Blighted and vacant urban land affects people’s perceptions of safety, and their actual, physical safety. Restoration of this land can be an effective and scalable infrastructure intervention for gun violence, crime, and fear in urban neighborhoods.

Urban Green Space and the Pursuit of Health Equity in Parts of the United States

Research has demonstrated that inequitable access to green space can relate to health disparities or inequalities. This commentary aims to shift the dialogue to initiatives that have integrated green spaces in projects that may promote health equity in the United States. Specifically, we connect this topic to factors such as community revitalization, affordable housing, neighborhood walkability, food security, job creation, and youth engagement. We provide a synopsis of locations and initiatives in different phases of development along with characteristics to support effectiveness and strategies to overcome challenges. The projects cover locations such as Atlanta (GA), Los Angeles (CA), the District of Columbia (Washington D.C.), South Bronx (NY), and Utica (NY). Such insight can develop our understanding of green space projects that support health equity and inform the dialogue on this topic in ways that advance research and advocacy.

Each meal matters in the exposome: Biological and community considerations in fast-food-socioeconomic associations

Advances in omics and microbiome technology have transformed the ways in which the biological consequences of life in the 'ecological theatre' can be visualized. Exposome science examines the total accumulated environmental exposures (both detrimental and beneficial) as a means to understand the response of the 'total organism to the total environment' over time. The repetitive stimulation of compensatory physiological responses (immune, cardiovascular, neuroendocrine) in response to stress - including sources of stress highly relevant to socioeconomic disadvantage - may lead to metabolic dysregulation and cellular damage, ultimately influencing behavior and disease. The collective toll of physiological wear and tear, known as allostatic load, is not paid equally throughout developed societies. It is paid in excess by the disadvantaged. In the context of fast-food, human and experimental research demonstrates that the biological response to a single fast-food-style meal - especially as mediated by the microbiome- is a product of the person's total lived experience, including the ability to buffer the fast-food meal-induced promotion of inflammation and oxidative stress. Emerging research indicates that each meal and its nutritional context matters. As we discuss, equal weekly visits to major fast-food outlets by the affluent and deprived do not translate into biological equivalency. Hence, debate concerning reducing fast-food outlets through policy - especially in disadvantaged neighborhoods where they are prevalent - requires a biological context. The fast-food establishment and fast-food meal - as they represent matters of food justice and press upon non-communicable disease risk - are far more than physical structures and collections of carbohydrate, fat, sugar and sodium.

Nature Contact and Human Health: A Research Agenda

BACKGROUND

At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding.

OBJECTIVES

We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions.

DISCUSSION

We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science.

CONCLUSIONS

Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights. https://doi.org/10.1289/EHP1663.

Effects of greening and community reuse of vacant lots on crime

The Youngstown Neighborhood Development Corporation initiated a 'Lots of Green' programme to reuse vacant land in 2010. We performed a difference-in-differences analysis of the effects of this programme on crime in and around newly treated lots, in comparison to crimes in and around randomly selected and matched, untreated vacant lot controls. The effects of two types of vacant lot treatments on crime were tested: a cleaning and greening 'stabilisation' treatment and a 'community reuse' treatment mostly involving community gardens. The combined effects of both types of vacant lot treatments were also tested. After adjustment for various sociodemographic factors, linear and Poisson regression models demonstrated statistically significant reductions in all crime classes for at least one lot treatment type. Regression models adjusted for spatial autocorrelation found the most consistent significant reductions in burglaries around stabilisation lots, and in assaults around community reuse lots. Spill-over crime reduction effects were found in contiguous areas around newly treated lots. Significant increases in motor vehicle thefts around both types of lots were also found after they had been greened. Community-initiated vacant lot greening may have a greater impact on reducing more serious, violent crimes.

Finding Common Ground: Environmental Ethics, Social Justice, and a Sustainable Path for Nature-Based Health Promotion

Decades of research have documented continuous tension between anthropocentric needs and the environment’s capacity to accommodate those needs and support basic human welfare. The way in which society perceives, manages, and ultimately utilizes natural resources can be influenced by underlying environmental ethics, or the moral relationship that humans share with the natural world. This discourse often centers on the complex interplay between the tangible and intangible benefits associated with nonhuman nature (e.g., green space), both of which are relevant to public health. When ecosystem degradation is coupled with socio-demographic transitions, additional concerns related to distributional equity and justice can arise. In this commentary, we explore how environmental ethics can inform the connection between the ecosystem services from green space and socially just strategies of health promotion.

Modifiable Neighborhood Features Associated With Adolescent Homicide

IMPORTANCE

Homicide is a leading cause of adolescent mortality. To our knowledge, relatively little has been studied in terms of the association between environmental neighborhood features, such as streets, buildings, and natural surroundings, and severe violent injury among youth.

OBJECTIVE

To assess associations between environmental neighborhood features and adolescent homicide in order to identify targets for future place-based interventions.

DESIGN, SETTING, AND PARTICIPANTS

Population-based case-control study conducted in Philadelphia, Pennsylvania, from April 15, 2008, to March 31, 2014. We identified adolescents who died by homicide at 13 to 20 years of age from 2010 to 2012 while residing in Philadelphia. We used incidence-density sampling and random-digit dialing to recruit control participants ages 13 to 20 years matched on sex and indoor-outdoor location at the time of each index case participant's homicide.

EXPOSURES

To obtain environmental data about modifiable features that were present in the immediate surroundings of our case and control participants, blinded field researchers used standardized techniques to photograph case and control participant outdoor locations. Photographic data were stitched together to create 360° panoramic images that were coded for 60 elements of the visible environment.

MAIN OUTCOME AND MEASURE

Adolescent homicide.

RESULTS

We enrolled 143 homicide case participants (mean [SD] age, 18.4 [1.5] years) and 155 matched control participants (mean [SD] age, 17.2 [2.1] years) who were both outdoors at the time of the homicide. In adjusted analyses, multiple features of Philadelphia streets, buildings, and natural surroundings were associated with adolescent homicide. The presence of street lighting (odds ratio [OR], 0.24; 95% CI, 0.09-0.70), illuminated walk/don't walk signs (OR, 0.16; 95% CI, 0.03-0.92), painted marked crosswalks (OR, 0.17; 95% CI, 0.04-0.63), public transportation (OR, 0.13; 95% CI, 0.03-0.49), parks (OR, 0.09; 95% CI, 0.01-0.88), and maintained vacant lots (OR, 0.17; 95% CI, 0.03-0.81) were significantly associated with decreased odds of homicide. The odds of homicide were significantly higher in locations with stop signs (OR, 4.34; 95% CI, 1.40-13.45), security bars/gratings on houses (OR, 9.23; 95% CI, 2.45-34.80), and private bushes/plantings (OR, 3.44; 95% CI, 1.18-10.01).

CONCLUSIONS AND RELEVANCE

Using a population-based case-control design, we identified multiple modifiable environmental features that might be targeted in future randomized intervention trials designed to reduce youth violence by improving neighborhood context.

Advancing Sustainability through Urban Green Space: Cultural Ecosystem Services, Equity, and Social Determinants of Health

Urban green spaces provide an array of benefits, or ecosystem services, that support our physical, psychological, and social health. In many cases, however, these benefits are not equitably distributed across diverse urban populations. In this paper, we explore relationships between cultural ecosystem services provided by urban green space and the social determinants of health outlined in the United States Healthy People 2020 initiative. Specifically, we: (1) explore connections between cultural ecosystem services and social determinants of health; (2) examine cultural ecosystem services as nature-based health amenities to promote social equity; and (3) recommend areas for future research examining links between urban green space and public health within the context of environmental justice.