Natural outdoor environments and mental and physical health: relationships and mechanisms

Effects of greenness in university campuses on test anxiety among Chinese university students during COVID-19 lockdowns: a correlational and mediation analysis

The purpose of this study is to investigate the correlations of greenness exposure with test anxiety among university students during COVID-19 lockdowns and to explore their mechanisms. We conducted a cross-sectional study with 2609 university students in Anhui and Shandong provinces, China. We assessed perceived campus greenness using a five-point Likert scale for quality, visibility, abundance, usage, and accessibility. Objective greenness was estimated via average normalised difference vegetation index (NDVI) in 1,000-, 1,500-, and 2,000-m radius zones around each of the campuses. A generalised linear mixed model examined the associations between greenness and test anxiety and to evaluate the mediation effects of physical activity, body mass index (BMI), and air pollution. Results showed that higher NDVI1500-m correlated with lower test anxiety (OR = 0.871; 95% CI: 0.851, 0.891), physical activity may partially mediate this association. Increased campus greenness may alleviate test anxiety among Chinese university students.

Impact of "blue-green diet" on human health and wellbeing: A systematic review of potential determinants in shaping the effectiveness of blue-green infrastructure (BGI) in urban settings

Discourses concerning the potential health benefits of blue-green infrastructure (BGI) have gained momentum, highlighting its positive influence on human health and wellbeing. While studies have explored the concept of "Nature Pyramid" and the role of exposure to natural environments in promoting health, the role of water elements remains underexplored. Rooted in this concept, this study proposed a notion of "blue-green diet" as a framework to understand the intricate mechanisms and determinants of optimal blue-green exposure. Understanding the relationship between these determinants and their health-related impacts can facilitate the enhancement of BGI design, leading to greater effectiveness in promoting health and wellbeing and supporting sustainable urban development strategies. To enhance the comprehension of the "blue-green diet", this study conducted a systematic literature review to grasp the underlying mechanisms behind its beneficial effects, focusing on two key determinants of "blue-green diet", which are also derived from the concept of the "Nature Pyramid": (1) the type of BGI and (2) the mode of interaction with and within BGIs. Under the search of BGI's overall health impacts, this study selected 54 journal publications concerning BGI's type and interaction mode from Web of Science and Scopus since 2010. The review revealed significant disparities in the health benefits provided by different types of BGI (in terms of artificial extent and scale) and between active and passive interaction modes. It examines how to balance natural and artificial elements for enhancing the benefits of BGI and discusses the attributes of BGI that encourage diverse and meaningful interaction patterns. These efforts collectively aim to optimize BGI design and planning, increase its capacity to promote health, and extend its benefits to a wider range of individuals. Future research should encompass a broader spectrum of determinants, such as diverse BGI settings, visit frequency and duration, and user's social-cultural backgrounds.

Quantitative evaluation of urban green exposure and its impact on human health: A case study on the 3-30-300 green space rule

BACKGROUND AND AIMS

Urban green spaces offer various health benefits, yet the impact of comprehensive green exposure criteria on multidimensional health remains unclear. The 3-30-300 green space rule represents the green exposure indicators with specific thresholds. This study aims to quantitatively evaluate urban green exposure in cities and can support investigation of its relationship with human health.

METHODS

We conducted a cross-sectional study based on 902 investigated individuals in 261 residential locations aged 11-95 years from Xiamen City, China. 3-30-300 green exposure was calculated using field surveys, GIS, and Baidu Maps Application Programming Interface (API). Physical health data was based on Occupational Stress Indicator (OSI)-2. Mental health was from the 12-item General Health Questionnaire (GHQ-12). Social health was from a self-constructed evaluation questionnaire. Statistical analyses were conducted using Geographically Weighted Regression and Geographically Weighted Logistic Regression for global and local effects on green exposure and multidimensional health.

RESULT

Among the investigated individuals, only 3.55 % (32/902) fully meet the 3-30-300 rule in Xiamen. Global results show that individuals achieved at least 30 % vegetation coverage (Yes) is associated with better physical (β: 0.76, p < 0.01) and social (β: 0.5, p < 0.01) health. GWLR global results indicate that individuals can "see at least 3 trees from home" meeting one (OR = 0.46, 95%CI: 0.25-0.86, p < 0.05) or two (OR = 0.41, 95%CI: 0.22,0.78, p < 0.01; OR = 0.24, 95%CI: 0.07-0.77, p < 0.05) 3-30-300 rule components are significantly associated with reduced medical visits and hospitalizations refer to not met these criterias. In the GWR local analysis, achieved 30 % vegetation cover is significantly related to improved social health at all locations. Meeting any two indicators also contribute to improved social health (n = 511, β: 0.46-0.51, P < 0.05).

CONCLUSION

Green exposure indicators based on the 3-30-300 rule guiding healthy urban green space development. We observed multidimensional health benefits when 1/3 or 2/3 of the indicators were met.

The association of access to green space with low mental distress and general health in older adults: a cross-sectional study

BACKGROUND

Access to green space is considered beneficial to mental and physical health, though the causal pathways are not completely clear. Accordingly, the objective of this study was to examine how access to green space was associated with low mental distress and general health among older adults.

METHODS

The data in our study stems from a survey from three Norwegian counties in 2015-16, n = 2937. The main exposure variable was self-reported access to green space, and the outcome variables were self-reported mental distress and general health. Logistic regression adjusted for sex, age, education, physical activity, functional disability, access to cultural/sports facilities and economic security was performed to assess the association between the exposure variable and the outcome variables.

RESULTS

Access to green space was associated with both higher odds of low mental distress (Odds Ratio = 3.85**, 95% CI 2.04-6.02) and good general health (OR = 8.20**, 95%CI 5.88-11.49) compared to no access. In models adjusted for sex, age, and education, the ORs were only slightly changed (OR = 4.03**, 95%CI 2.52-6.45) and (OR = 7.91**, 95%CI 5.63-11.13). However, adjusting for general health with low mental distress as outcome, the association was no longer statistically significant; (OR = 1.28 95%CI 0.74-2.21). Adjusting for low mental distress with general health as outcome, the association remained statistically significant; (OR = 3.43** 95%CI 2.34-5.03).

CONCLUSIONS

Our findings suggest that the association between access to green space and mental health may be mediated by general health. This implies that studies of associations between access to green space and mental health must take general health into consideration.

Time outdoors and residential greenness are associated with reduced systemic inflammation and allostatic load

Contacts with nature are linked with reduced morbidity and mortality. Hypothesized pathways include relaxation, physical activity, and improved immune function. This cross-sectional study of 320 adults in central North Carolina assessed health benefits of residential greenness using allostatic load (AL) and systemic inflammation (INFL) indices, composite biomarker-based measures of physiological dysregulation and inflammation, respectively. Distance-to-residence weighted tree cover and vegetated land cover measures were estimated within 500 m of each residence; 37 biomarkers of immune, neuroendocrine, cardiovascular, and metabolic functions were dichotomized at distribution or health-based cut-offs. AL was calculated as a sum of potentially unhealthy values of all biomarkers; INFL was based on a subset of 18 immune biomarkers. Regression analysis used generalized additive models for Poisson-distributed outcome. An interquartile range (IQR) increase in tree cover was associated with 0.89 (95 % Confidence Limits 0.82; 0.97) and 0.90 (0.79; 1.03)-fold change in AL and INFL, respectively. Greater daily outdoor time was associated with reduced AL and INFL, while leisure screen time, problems with sleeping, and common chronic infections were linked with increased AL and INFL. Among 138 individuals spending more than 1 h outdoors daily, an IQR increase in tree cover was associated with 0.76 (0.67; 0.86) and 0.81 (0.65; 1.02)-fold changes in AL and INFL, respectively. Among individuals with residential tree cover above the 50th percentile, spending more than 3 h outdoors daily was associated with 0.54 (0.37; 0.78) and 0.28 (0.15; 0.54)-fold changes in AL and INFL, respectively, compared to spending less than 30 min outdoors; there were no significant effects in the low tree cover stratum. Consistent but weaker effects were observed for vegetated land cover. Interaction effects of tree and vegetative cover and time spent outdoors on AL and INFL were statistically significant. This biomarker-based approach can help to assess public health benefits of green spaces.

Assessing grassland cultural ecosystem services supply and demand for promoting the sustainable realization of grassland cultural values

Grasslands deliver essential provisioning and regulatory ecosystem services, concomitantly with indispensable cultural services that merit profound consideration. However, grassland cultural ecosystem services (GCES) face a conspicuous knowledge lacuna due to the lack of a unified research framework and quantitative methodology. This study endeavors to fill this gap by quantifying the potential supply and actual demand of GCES, concurrently scrutinizing spatial congruencies and disparities between GCES supply and demand in Inner Mongolia Autonomous Region (IMAR), China. To achieve this, we integrated social survey data, Point of Interest (POI) data, social media data, the Social Values for Ecosystem Services (SolVES) model and GIS Getis-Ord Gi* statistical analysis. Our analysis unveiled grid-scale spatial patterns of GCES supply and demand, furnishing a nuanced high-low ranking of GCES. It transpired that scenic travel holds the highest potential supply of GCES with a high-value area proportion of 46.0 %, while grassland recuperation ranks the lowest. Notably, road accessibility emerged as the most crucial factor influencing GCES patterns. Furthermore, we observed a substantial misalignment in the GCES supply-demand relationship, with 65.99 % of IMAR experiencing excess supply compared to demand and only 20.66 % achieving equilibrium. At a 95 % significance level, hot spots (excess supply) and cold spots (excess demand) accounted for 26.03 % and 22 %, respectively. We propose targeted suggestions that regions with oversupply of GCES should channel efforts toward augmenting road accessibility, whereas regions grappling with excess demand should prioritize the judicious allocation of resources to avert surpassing the environmental carrying capacity. Our study furnished insights for decision-makers to formulate sustainable development plans pertaining to grassland culture.

Neighborhood greenness and participation in specific types of recreational physical activities in the Sister Study

BACKGROUND

Urban green spaces have been consistently shown to have important human health benefits across a range of outcomes. These benefits are thought to be achieved, in part, because urban greenness provides opportunities for participation in recreational activity. However, the findings from studies that have assessed links between exposure to greenness and physical activity have been mixed. To date, few studies have examined association between greenness and specific types of recreational physical activities.

OBJECTIVE

We evaluated associations between measures of greenness and specific types of recreational physical activities. Moreover, we explored the extent to which these associations were modified by socioeconomic conditions, and regionally.

METHODS

We analyzed cross-sectional data from 49,649 women in the Sister Study and assigned three residentially-based measures of greenness based on national land cover data at buffer distances of 250 m and 500 m. Data on participation in up to ten specific recreational physical activities, including time spent in each activity were collected. Logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) controlling for confounders.

RESULTS

Compared to those in the lowest tertile of greenness, participants in the upper tertile of greenness within a 500 m buffer, were more likely to garden (OR = 1.46, 95% CI = 1.25,1.69), participate in sports (OR = 1.28, 95% CI = 1.19,1.38), run (OR = 1.15, 95% CI = 1.04,1.27), walk (OR = 1.11, 95% CI = 1.06,1.16), and engage in conditioning exercises (OR = 1.10, 95% CI = 1.05,1.16) at least once a week for at least one month over the past year. These associations were modified by household income and US region.

DISCUSSION

Our findings suggest a beneficial effect of greenness on physical activity and provide additional information to inform planning of green environments that contribute to better health and wellbeing.

Moderating Effects of Individual Traits on the Association Between Nature and Patient Wait Experiences

OBJECTIVES

We empirically investigated to what extent plants in the emergency department (ED) waiting areas influence patient wait experiences (i.e., anxiety, perceived service quality, and perception of wait time) depending on individual differences in cognitive thinking styles and one's bonds with the natural world.

BACKGROUND

Positive effects of nature on patient experiences in healthcare environments are well established by empirical research findings. However, evidence is scarce on the impact of nature on patient wait experiences and the roles of patient traits often related to their backgrounds.

METHODS

A within-subjects study was conducted (N = 116) with two virtually built ED waiting rooms: with versus without indoor and outdoor plants.

RESULTS

Findings confirmed that plants lower anxiety and improve perceptions of service quality and wait time. Cognitive thinking style significantly moderated how plants affected patient wait experiences. Although participants with higher connectedness to nature showed more positive responses to the nature condition, connectedness to nature did not significantly affect the association between nature and wait experiences.

CONCLUSIONS

This study contributes to the existing body of knowledge on nature's effects in healthcare environments by examining the roles of individual differences in patients' and visitors' cognitive styles and connectedness to nature. Results highlighted the impact of these differences in patient experiences for effective implications of nature in waiting areas of healthcare facilities.

Knee Angle Estimation with Dynamic Calibration Using Inertial Measurement Units for Running

The knee flexion angle is an important measurement for studies of the human gait. Running is a common activity with a high risk of knee injury. Studying the running gait in realistic situations is challenging because accurate joint angle measurements typically come from optical motion-capture systems constrained to laboratory settings. This study considers the use of shank and thigh inertial sensors within three different filtering algorithms to estimate the knee flexion angle for running without requiring sensor-to-segment mounting assumptions, body measurements, specific calibration poses, or magnetometers. The objective of this study is to determine the knee flexion angle within running applications using accelerometer and gyroscope information only. Data were collected for a single test participant (21-year-old female) at four different treadmill speeds and used to validate the estimation results for three filter variations with respect to a Vicon optical motion-capture system. The knee flexion angle filtering algorithms resulted in root-mean-square errors of approximately three degrees. The results of this study indicate estimation results that are within acceptable limits of five degrees for clinical gait analysis. Specifically, a complementary filter approach is effective for knee flexion angle estimation in running applications.

Young children's use of blue spaces and the impact on their health, development and environmental awareness: A qualitative study from parents' perspectives

ISSUE ADDRESSED

This study examined how families with young children access and use different types of blue spaces and the health and development benefits, and potential negative effects.

METHODS

Parents(n = 25) of young children across four coastal communities in Western Australia were recruited via purposive sampling to participate in interviews. A generic qualitative study design grounded in the pragmatism paradigm was utilised.

RESULTS

Beaches were the most frequently used blue space for families all year around, however families did not necessarily attend their closest beach. This appears due to certain beach features making them more or less attractive for use regardless of the distance from home. Parents perceived blue spaces as health promoting due to the increased physical activity children did in and around these spaces. They also reported blue spaces could be positive for child development, contributing to the development of identity. Blue spaces were also perceived to promote children's environmental awareness and environmentally friendly behaviours. However, blue spaces could also be potentially risky environments for families with young children.

CONCLUSIONS

The findings highlight blue spaces are an important setting for supporting children's health, development and environmental consciousness. SO WHAT?: It is important to protect natural outdoor environments such as blue spaces for future generations. The findings can be used by governments and policy makers to improve the quality (features and amenities) of blue spaces and positively impact how often families (including those with dogs) use blue spaces and the benefits they experience.

Nature-based interventions to support mental health and well-being of young women in pregnancy: exploratory work for future feasibility RCT

Background

The prevalence of mental health and well-being issues among young women is increasing. Pregnancy is a time when new mental health challenges may arise, or existing conditions can be exacerbated. This project presents preparatory work on how nature-based interventions may help to support the mental health and well-being of young pregnant women (aged 16-24 years) in a future study.

Methods

This project was formed of three main phases conducted from March to August 2022: (1) mapping nature activities available across the East Midlands region and two focus groups with providers of nature activities (n = 6); (2) public participation and involvement work to inform future research. This included four focus groups with young women (n = 11), leading to the formation of a new young women's panel (Research Influencers Group). Networking and stakeholder engagement to support future research.

Results

The mapping survey identified 68 nature-based organisations/projects operating in the region, many of whom expressed interest in being involved in future research. The young women's focus groups confirmed the importance of the topic and generated a wealth of information to support the intervention design. A Research Influencer Group of five young women was established from the focus group participants. The Research Influencer Group chose the nature-based intervention and had input into all aspects of the study design. This group will continue into future projects. Focus groups with providers of nature activities have further advanced the study design. The project team have developed relationships with relevant stakeholders and networks that will inform the future trial.

Conclusion

This preparatory co-design work suggested that a nature-based intervention may be acceptable to young women, and providers of such interventions felt it was feasible to offer these activities to young pregnant women. This preparatory work has led to an outline research plan which has been co-produced with public contributors and stakeholders throughout.

Limitations

This preparatory work is limited by small focus group samples, and the possibility that not all providers were reached through the snowballing approach to the mapping survey.

Future work

Future research is needed to test the nature-based intervention; this would be in the form of a feasibility randomised controlled trial of nature-based interventions to promote the mental health and well-being of young pregnant women.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135167.

Sustainable poverty alleviation through forests: Pathways and strategies

Forests are the most productive terrestrial ecosystems across the world. They can play both a direct and indirect role in global poverty alleviation through their social, economic and environmental functions. However, the potential of forests in poverty alleviation is underestimated to a great extent. Sustainability, the most essential advantage and characteristic of forests for poverty alleviation, has not been fully recognized. To that end, we propose the concept of sustainable poverty alleviation through forests (SPAF). This concept shifts the vision of poverty alleviation through forests from a narrow focus on subsistence and livelihood to a sustainable poverty alleviation that promotes all dimensions of human development. There is abundant evidence that forests can at least contribute to sustainable poverty alleviation through a synergy of seven pathways: subsistence materials, health, income, employment, women's empowerment, climate change mitigation and biodiversity, which are highly consistent with the United Nations Sustainable Development Goals. SPAF also faces enormous implementation challenges, so a sustainable global strategy is urgently needed to provide direction for worldwide poverty alleviation at the crossroads of nature and humanity.

Two- and three-dimensional indicators of green and grey space exposure and psychiatric conditions and medicine use: A longitudinal study in a large population-based Italian cohort

BACKGROUND

Evidence available on the associations between urban greenness and mental health is mainly based on cross-sectional studies and has relied on 2D indicators of greenness. This longitudinal study aimed at investigating the association between 2D and 3D indicators of green and grey spaces and incident mental health-related outcomes in a large population-based cohort.

METHODS

Our study used data from 593,894 Italian adults (≥30 years) from the Rome Longitudinal Study. Mental health outcomes were defined using either drug prescriptions (antidepressants, antipsychotics, lithium and other mood stabilisers, and anxiolytics, hypnotics and sedatives), or hospitalisation records (for schizophrenia spectrum disorder, depression, anxiety, stress-related and somatoform, or substance use disorders). We obtained 2D and 3D indicators of green and grey exposures including Normalized Difference Vegetation Index (NDVI), green volume, grey volume, number of trees, and Normalized Difference Green-Grey Volume Index around participants' homes. Cox proportional hazards regression models were developed to estimate the association of green and grey space exposure and psychiatric conditions and medicine use, adjusted for relevant covariates.

RESULTS

We found beneficial associations of NDVI and the number of trees with antipsychotic and lithium and other mood stabiliser drugs. We also observed detrimental associations between grey volume and lithium and other mood stabilisers and anxiolytic, hypnotic and sedative drugs. Finally, we found a protective association of the NDGG with lithium and other mood stabilisers (HR: 0.977; 95% CI: 0.965-0.990) and anxiolytic, hypnotic and sedative drugs (HR: 0.851; 95% CI: 0.762-0.950). The associations for hospitalisation for psychiatric conditions were less consistent and generally not statistically significant.

CONCLUSIONS

Findings suggested that higher greenness areas around residential addresses are associated with reduced use of drugs for psychiatric conditions, while the opposite is true for higher grey space exposure. The study highlights the importance of accurately characterising green and grey spaces, using novel exposure indicators.

Changes in neighborhood physical and social environments matter for change in mental health: Longitudinal evidence from Dutch panel data

Numerous neighborhood environments have been recognized to affect mental health, but only a few longitudinal studies investigated these associations jointly and whether different population groups are affected differently. We used three-wave panel data of 2699 adults between 2010 and 2016 in the Netherlands to assess the associations between changes in neighborhood physical and social environments and mental health changes. Further, we assessed possible effect modification of gender and income. Mental health was measured using the Mental Health Inventory. Time-varying exposure to green space, blue space, population density, air pollution, socioeconomic deprivation, and social fragmentation were assigned based on individuals' neighborhood histories. Fixed-effect regressions were conducted to assess within-person associations between single and multiple exposures on mental health for the entire sample and stratified by gender and income. Our single-exposure models showed that increases in blue space were significantly associated with mental health improvements, while increases in fine particulate matter (PM2.5) resulted in declines in mental health. These associations were not attenuated in the multi-exposure model. We observed no significant associations for the remaining environments. Stratification analyses showed that females' mental health further declined as PM2.5 concentrations increased compared to males. Increasing levels of socioeconomic deprivation were associated with further declines in mental health among the less well-off compared with higher-income earners. Our longitudinal findings suggested that neighborhood physical and social environment changes were associated with mental health changes. Future research is required to establish the underlying pathways.

The health perception of urban green spaces and its emotional impact on young adults: an empirical study from three cities in China

Introduction

Exposure to green space can bring many benefits to physical and mental health, but in China, the attractiveness of green space to youth groups seems to be not significant. The question of how to encourage young people to go out of the house to better perceive green space, enjoy nature, and promote physical and mental health is on our minds.

Methods

This study combines young people's green space perception, green space use, and purpose of visit to explore its impact on the emotional health of youth groups, combined with the PANAS psychological data scale, an online questionnaire survey of 426 residents (18-35  years old) in three Chinese cities, and was used to construct a multiple regression model and AMOS structural equations.

Results and discussion

The results of the study showed that, firstly, environmental attractiveness, environmental odor, and number of facilities were the key factors influencing adolescents' landscape perception evaluation, while activity space, environmental odor, and environmental attractiveness had a greater impact on adolescents' emotional well-being. Second, among adolescents' visit purposes, socializing and fitness were more likely to help them generate positive emotions while resting and viewing activities were effective in helping them alleviate negative emotions. In addition, in terms of usage, residents who took public transportation as well as those who arrived on foot were the most emotionally healthy. The findings of this paper provide insights for public policymakers, urban planners, and landscape architects to better encourage youth participation in green spaces when they are installed.

Health effects of green prescription: A systematic review of randomized controlled trials

An increasing number of studies have examined the effects of green prescription on various health outcomes. The aim of this study was to systematically review published randomized controlled trial studies on the health benefits of green prescriptions. We searched PubMed, Scopus, and Web of Science for the relevant original articles published in English until June 30, 2023. Our search initially retrieved 26176 articles, of which 31 studies were included in our review after removing the duplicates and excluding ineligible articles based on their titles, abstracts, and full-text review. Consistent positive health benefits of green prescription were reported for psychological health and wellbeing (16 out of 24 studies), cardiometabolic health (five out of nine studies), physical activity (eight out of nine studies), and inflammation (two out of two studies). The reviewed studies did not report any significant benefits in orthopedic conditions, pain, and recovery from exhaustion disorder due to their implemented green prescriptions; however, the number of studies was too small to generalize the effect of green prescriptions on these outcomes. The quality of these studies was generally acceptable, with 28 studies having some concerns regarding their overall risk of bias and only three studies with a high risk of bias. All in all, this systematic review suggests that green prescriptions can be effective in improving various health outcomes, but further studies with larger sample sizes and objective measures are needed.

Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data

Background

Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited.

Objectives

To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use.

Design

A retrospective, dynamic longitudinal panel study.

Setting

Wales, UK.

Participants

An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces.

Main outcome measures

Common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale.

Data sources

Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank.

Methods

Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders.

Results and conclusions

Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower.

Limitations

Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets.

Future work

Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.

Residential greenspace and anxiety symptoms among Australian women living in major cities: A longitudinal analysis

Despite an increasing number of studies demonstrating the potential mental health benefits of greenspace, few longitudinal studies have been reported. We aimed to assess associations between two metrics of residential greenspace exposure and anxiety symptoms in a cohort of Australian women living in major cities. Our study comprised 3,938 women, born between 1973 and 78. Anxiety symptoms in the previous month were assessed at follow-up every three years during 2003-2018, using the anxiety subscale of the Goldberg Anxiety and Depression Scale. The three-month seasonal average normalized difference vegetation index (NDVI) was estimated from 30 m Landsat satellite images in a 500 m buffer (NDVI500m) around participants' address at each survey (higher NDVI indicates more green vegetation). The annual fractional cover of non-photosynthesising vegetation was estimated (fNPV500m, with higher values indicating greater levels of dead leaf litter or dry grass). A generalised estimating equation assessed associations between greenspace measures and anxiety symptoms (as odds ratios [ORs]), adjusting for repeated outcomes and individual-level covariates. Additional analyses focused on women experiencing substantial changes in between-survey exposure due to moving, and adjusting for nitrogen dioxide (NO2) and fine particulate matter (PM2.5) exposure, among others. A standard deviation (SD) (0.12 units) increase in NDVI500m was significantly associated with lower odds of anxiety symptoms (OR: 0.96, 95% CI: 0.93-0.99) in the adjusted model. An SD (5.2%) increase in annual fNPV500m was consistent with the direction expected for that exposure, but not significant in the adjusted model (OR: 1.03, 95% CI: 0.99-1.07). NDVI500m was modestly attenuated when air pollutants were adjusted for, while fNPV500m only became significant when PM2.5 was adjusted for. Between-survey contrasts had no clear effect for NDVI500m. Moving to a higher fNPV500m area, compared with a similar fNPV500m area, was consistently associated with anxiety symptoms (OR: 1.15, 95% CI: 1.02-1.31). NDVI500m was generally associated with lower odds of anxiety symptoms, while fNPV500m was generally associated with higher odds of anxiety, depending on the covariates considered.

Mechanism and implications of pro-nature physical activity in antagonizing psychological stress: the key role of microbial-gut-brain axis

Appropriate physical activities and a biodiversity-rich environment are conducive to the relief of psychological stress, and pro-nature physical activities are a combination of the two, which has good application potential in antagonizing psychological stress, but the intervention mechanism is still unclear. The microbiota-gut-brain axis is cyclically associated with psychological stress, and psychological stress can affect the microbiota through the gut-brain pathway, and conversely, the microbiota can also affect the psychological stress-induced symptoms. It is suggested that the microbe-gut-brain axis may provide a new perspective and target for the treatment of psychological stress-related diseases. Pro-nature physical activity can improve the number of Firmicutes, short-chain fatty acids, Akkermansia bacteria, and the gut-brain barrier and further affect the HPA axis, BDNF, and serotonin pathways of gut-brain two-way communication, thereby maintaining the body's homeostasis and reducing antagonistic psychological stress. According to the comprehensive influence of physical activities on the microbiota-gut-brain axis, a "green + exercise prescription hypothesis" in line with the holistic medical concept is revealed, which is expected to be effective in the prevention, alleviation, and treatment of irritable bowel syndrome and neurodegenerative diseases. It provides new means for treating psychological stress-related diseases such as mental disorders and mood disorders. In addition, it enlightens the construction of green infrastructure that is conducive to the diversified contact of microorganisms in outdoor physical activities venues and induces healthy interaction between the human body and the microbial population in the natural ecology. However, the current research is still in its early stages, and the intervention effect and mechanism of pro-nature physical activities need further demonstration in the future.

Predicting self-perceived general health status using machine learning: an external exposome study

BACKGROUND

Self-perceived general health (SPGH) is a general health indicator commonly used in epidemiological research and is associated with a wide range of exposures from different domains. However, most studies on SPGH only investigated a limited set of exposures and did not take the entire external exposome into account. We aimed to develop predictive models for SPGH based on exposome datasets using machine learning techniques and identify the most important predictors of poor SPGH status.

METHODS

Random forest (RF) was used on two datasets based on personal characteristics from the 2012 and 2016 editions of the Dutch national health survey, enriched with environmental and neighborhood characteristics. Model performance was determined using the area under the curve (AUC) score. The most important predictors were identified using a variable importance procedure and individual effects of exposures using partial dependence and accumulated local effect plots. The final 2012 dataset contained information on 199,840 individuals and 81 variables, whereas the final 2016 dataset had 244,557 individuals with 91 variables.

RESULTS

Our RF models had overall good predictive performance (2012: AUC = 0.864 (CI: 0.852-0.876); 2016: AUC = 0.890 (CI: 0.883-0.896)) and the most important predictors were "Control of own life", "Physical activity", "Loneliness" and "Making ends meet". Subjects who felt insufficiently in control of their own life, scored high on the De Jong-Gierveld loneliness scale or had difficulty in making ends meet were more likely to have poor SPGH status, whereas increased physical activity per week reduced the probability of poor SPGH. We observed associations between some neighborhood and environmental characteristics, but these variables did not contribute to the overall predictive strength of the models.

CONCLUSIONS

This study identified that within an external exposome dataset, the most important predictors for SPGH status are related to mental wellbeing, physical exercise, loneliness, and financial status.

The effect of simulated natural environments in virtual reality and 2D video to reduce stress

Stress is a common problem associated with poor physical and psychological health. Exposure to the natural environment is one method for reducing stress. The real and simulated natural environments have a restorative effect on stress reduction. In contrast to the real environment, simulated natural environments, such as virtual reality and 2D video, provide safer and more controllable exposure. Several studies on the restorative effects of the natural environment in virtual reality and 2D video have been conducted. However, the difference between the two in reducing stress must be clarified. This study was conducted to determine the effect of the simulated natural environments in virtual reality and 2D video and their differences in reducing stress. This study hypothesizes that both simulated natural environments in virtual reality and 2D video can reduce stress, but there is a difference between them in reducing stress. Fifty-three subjects were divided into two experimental groups: 2D video (n = 28) and virtual reality (n = 25). The results indicated that simulated natural environments in virtual reality and 2D video reduced stress. However, there was no difference between the two groups regarding stress reduction.

Joint associations and pathways from greenspace, traffic-related air pollution, and noise to poor self-rated general health: A population-based study in Sofia, Bulgaria

BACKGROUND

Little is still known of how multiple urban exposures interact as health determinants. This study investigated various ways in which greenspace, traffic-related air pollution, and noise could operate together, influencing general health status.

METHODS

In 2022, a cross-sectional population-based survey was conducted in Sofia, Bulgaria. Included were 917 long-term adult residents who completed questionnaires on poor self-rated health (PSRH), total time spent in physical activity (PA), home garden presence, time spent in urban greenspace and nature, and sociodemographics. Residential greenspace was operationalized using the normalized difference vegetation index (NDVI), tree cover density, number of trees, and access to local greenspace and parks. Nitrogen dioxide (NO₂) was modeled for the study area. Road traffic, railway, and aircraft day-evening-night sound levels (L_den) were extracted from EU noise maps. Area-level income and urbanicity were considered. Analyses included multivariate ordinal regressions, interactions, and structural equation modeling (SEM).

RESULTS

Associations with PSRH were per 0.10 NDVI _300 m: OR = 0.65 (0.42-1.01), home garden: OR = 0.72 (0.49-1.07), per 5 μg/m³ NO₂: OR = 1.57 (1.00-2.48), per 5 dB(A) L_den road traffic: OR = 1.06 (0.91-1.23), railway: OR = 1.11 (1.03-1.20), and aircraft: OR = 1.22 (1.11-1.34). Spending >30 min/week in nature related to better health. In multi-exposure models, only associations with aircraft and railway L_den persisted. People with lower education and financial difficulties or living in poorer districts experienced some exposures stronger. In SEM, time spent in nature and PA mediated the effect of greenspace.

CONCLUSIONS

Greenspace was associated with better general health, with time spent in nature and PA emerging as intermediate pathways. NO₂, railway, and aircraft noise were associated with poorer general health. These results could inform decision-makers, urban planners, and civil society organizations facing urban development problems. Mitigation and abatement policies and measures should target socioeconomically disadvantaged citizens.

Knowledge, attitudes, and practices for tick bite prevention and tick control among residents of Long Island, New York, USA

In the United States, tick-borne diseases (TBDs) are a major public health concern and a source of significant morbidity. To reduce tick-borne disease incidence, understanding factors associated with increased risk in humans for tick bites is necessary. These risk factors can include TBD knowledge, attitudes about prevention and care, and associated practices of individuals and their communities, including paying for preventive services. Our study focused on Long Island, New York, a region with high endemicity of ticks and TBDs. The purpose of our study was to identify gaps in the knowledge, attitudes, and practices regarding TBDs in residents of this region to inform priorities for TBD interventions. To this end, we performed a knowledge, attitudes, and practices (KAP) survey and collected 803 responses from Long Island residents. Our survey results demonstrated that Long Island residents had a low to moderate level of knowledge regarding ticks and TBDs. Still, residents expressed concern regarding TBDs, with increased levels of concern associated with increased likelihood of paying for tick control and for practicing tick bite prevention strategies. Individuals with pets were more likely to practice these tick bite prevention strategies. Residents with more frequent exposure to ticks, with a history of TBD in their household, and with higher general concern over ticks were also more likely to pay for tick control services. These findings highlight gaps in resident knowledge, differences in attitudes towards tick preventative behavior, and potential factors affecting motivation towards implementing tick control measures, which can inform future public health messaging regarding tick bite prevention.

Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix

During the last years the need to integrate sex and gender in health-related research for better and fairer science became increasingly apparent. Various guidelines and checklists were developed to encourage and support researchers in considering the entangled dimensions of sex/gender in their research. However, a tool for the assessment of sex/gender consideration and its visualization is still missing. We aim to fill this gap by introducing an assessment matrix that can be used as a flexible instrument for comprehensively evaluating the sex/gender consideration in quantitative health-related research. The matrix was developed through an iterative and open process based on the interdisciplinary expertise represented in our research team and currently published guidelines. The final matrix consists of 14 different items covering the whole research process and the publication of results. Additionally, we introduced a method to graphically display this evaluation. By developing the matrix, we aim to provide users with a tool to systematically compare sex/gender consideration qualitatively between different publications and even different fields of study. This way, the assessment matrix represents a tool to identify research gaps and a basis for future research. In the long term, the implementation of this tool to evaluate the consideration of sex/gender should contribute to more sex/gender equitable health-related research.

An urban green space intervention with benefits for mental health: A health impact assessment of the Barcelona "Eixos Verds" Plan

BACKGROUND

Mental health disorders account for over 30% of the global burden of disease. There is a positive association between green space exposure and better mental health, and therefore urban greening can be an effective public health tool. Barcelona is a compact city with one of the highest population and traffic densities in Europe, with limited green spaces. Under the umbrella of the Superblock model, the Barcelona City council is implementing the Eixos Verds Plan for extensive street greening. We estimated the potential mental health benefits of this plan.

METHODS

We performed a quantitative health impact assessment at the Barcelona grid-cell level (n = 1,096). We compared the baseline green space situation (2015) with the proposed plan and translated the increase in green space into a) percentage of green area (%GA) and b) NDVI. We combined exposure data with Barcelona-specific mental health risk estimates, adult population (n = 1,235,375), and mental health data, and calculated preventable cases.

FINDINGS

Under the Eixos Verds Plan, we estimated an average increase of 5·67 %GA (range: 0·00% - 15·77%) and 0·059 NDVI (range: 0·000 - 0·312). We estimated that with the Eixos Verds Plan implementation, 31,353 (95%CI: 18,126-42,882) cases of self-perceived poor mental health (14·03% of total), 16,800 (95%CI: 6828-25,700) visits to mental health specialists (13·37% of total), 13,375 (95%CI: 6107-19,184) cases of antidepressant use (13·37% of total), and 9476 (95%CI: 802-16,391) cases of tranquilliser/ sedative use (8·11% of total) could be prevented annually, along corresponding to over 45 M € annual savings in mental health costs annually.

INTERPRETATION

Our results highlight the importance of urban greening as a public health tool to improve mental health in cities. Similar results for green interventions in other cities could be expected.

Do Multiple Sex/Gender Dimensions Play a Role in the Association of Green Space and Self-Rated Health? Model-Based Recursive Partitioning Results from the KORA INGER Study

Exposure to green space has a positive impact on health. Whether sex/gender modifies the green space-health association has so far only been studied through the use of a binary sex/gender category; however, sex/gender should be considered more comprehensively as a multidimensional concept based on theoretical approaches. We therefore explored whether sex/gender, operationalized through multiple sex/gender- and intersectionality-related covariates, modifies the green space-self-rated health association. We collected data from participants involved in the German KORA study (Cooperative Health Research in the Region of Augsburg) in 2019. Self-rated health was assessed as a one-question item. The availability of green spaces was measured subjectively as well as objectively. The multiple sex/gender- and intersectionality-related covariates were measured via self-assessment. To analyze the data, we used model-based recursive partitioning, a decision tree method that can handle complex data, considering both multiple covariates and their possible interactions. We showed that none of the covariates operationalizing an individual sex/gender self-concept led to subgroups with heterogeneous effects in the model-based tree analyses; however, we found effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective, although they did not show the intersectional structuring of sex/gender dimensions. In one identified subgroup, those with a lower education level or a feeling of discrimination based on social position showed a positive green space-self-rated health association, while participants with a higher education level or no feeling of discrimination based on social position had a high level of self-rated health regardless of the availability of green spaces. Model-based recursive partitioning has the potential to detect subgroups exhibiting different exposure-outcome associations, with the possibility of integrating multiple sex/gender- and intersectionality-related covariates as potential effect modifiers. A comprehensive assessment of the relevance of sex/gender showed effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective.

Evaluation of Satisfaction with the Built Environment of University Buildings under the Epidemic and Its Impact on Student Anxiety

Anxiety on college campuses has increased due to the COVID-19 epidemic's profound effects on society. Much research has been conducted on how the built environment influences mental health; however, little has been undertaken on how it affects student mental health in the context of the epidemic from the architectural scale perspective of academic buildings. Based on online survey data, this study develops multiple linear regression and binary logistic regression models to investigate students' satisfaction ratings of the academic buildings' physical environments during the epidemic and how these satisfaction ratings affect students' anxiety tendencies. According to the study's findings regarding the natural exposure perspective, students who perceived the academic building's poor semi-open space view (p = 0.004, OR = 3.22) as unsatisfactory factors were more likely to show anxiety tendencies. In terms of the physical conditions, students who were dissatisfied with the noise level in the classroom (p = 0.038, OR = 0.616) and the summer heat in semi-open spaces (p = 0.031, OR = 2.38) were more likely to exhibit anxiety tendencies. Additionally, even after controlling for confusing distractions, the general satisfaction rating of the academic building's physical environments (p = 0.047, OR = 0.572) was still able to significantly and negatively affect students' anxiety tendencies. The study's findings can be used in the architectural and environmental planning of academic buildings focusing on mental health.

Does physical activity mediate the associations between blue space and mental health? A cross-sectional study in Australia

BACKGROUND

Research has begun to examine whether blue space is beneficial to mental health. While results are promising, it is difficult to know which aspects of mental health or mental ill-health may benefit most. Physical activity has been proposed as one potential mechanism via which blue space may be associated with better mental health. However, very few studies have examined mechanisms. We examined associations between blue space proximity and a range of mental health outcomes and examined which of these associations were mediated by physical activity.

METHODS

350 participants (M = 38.74, SD = 14.92, 70% female) self-reported their weekly physical activity and completed measures of depression, anxiety, and psychological wellbeing. We then used GIS software to calculate blue space proximity (i.e., coastal and inland), and structural equation modelling with mediation paths to determine the role of physical activity in the associations between bluespace and mental health.

RESULTS

Physical activity partially mediated the associations between coastal proximity and depression (β = 0.02, 95% CI = 0.001, 0.05), anxiety (β = 0.03, 95% CI = 0.01, 0.06), and wellbeing (β = - 0.03, 95% CI = - 0.08, - 0.01), and fully mediated the associations between inland water proximity and depression (β = 0.02, 95% CI = 0.003, 0.05), anxiety (β = 0.03, 95% CI = 0.01, 0.07), and wellbeing (β = - 0.03, 95% CI = - 0.07, - 0.01).

CONCLUSION

While physical activity appears to explain associations between inland blue space and mental health outcomes, it only partially explains the association between coastal blue space and mental health, suggesting other mechanisms may play a role and even inactive exposure may be beneficial.

Comparison of static and dynamic exposures to air pollution, noise, and greenness among seniors living in compact-city environments

GPS technology and tracking study designs have gained popularity as a tool to go beyond the limitations of static exposure assessments based on the subject's residence. These dynamic exposure assessment methods offer high potential upside in terms of accuracy but also disadvantages in terms of cost, sample sizes, and types of data generated. Because of that, with our study we aim to understand in which cases researchers need to use GPS-based methods to guarantee the necessary accuracy in exposure assessment. With a sample of 113 seniors living in Barcelona (Spain) we compare their estimated daily exposures to air pollution (PM2.5, PM10, NO2), noise (dB), and greenness (NDVI) using static and dynamic exposure assessment techniques. Results indicate that significant differences between static and dynamic exposure assessments are only present in selected exposures, and would thus suggest that static assessments using the place of residence would provide accurate-enough values across a number of exposures in the case of seniors. Our models for Barcelona's seniors suggest that dynamic exposure would only be required in the case of exposure to smaller particulate matter (PM2.5) and exposure to noise levels. The study signals to the need to consider both the mobility patterns and the built environment context when deciding between static or dynamic measures of exposure assessment.

Global Trends in Green Space and Senior Mental Health Studies: Bibliometric Review

The Sustainable Development Goals and the World Health Organization have prioritized senior mental health as an important goal. Senior mental health is a critical issue within the global public health sphere. Notably, green spaces are a useful alternative for improving senior mental health. Many studies have focused on green space and senior mental health, especially on their connection and relationship. However, this research topic lacks a comprehensive and systematic review. Owing to the lack of critical reviews, this study clarified the trend, progress, status, and focus of studies on green spaces and senior mental health using bibliometric analysis of literature within the Web of Science database. The literature analysis within this study specifically focused on the following, including the country/region contribution analysis, institution contribution analysis, keyword analysis, and highly productive journal analysis. Furthermore, this study systematically recorded the content of green space and senior mental health, identified the gap that exists, and provided future frontier directions or issues for research. These contribute toward comprehending the progress and content of this research topic and further provide a guide, reference, and inspiration for possible future research.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

How the natural environment in downtown neighborhood affects physical activity and sentiment: Using social media data and machine learning

BACKGROUND

Natural environment might encourage physical exercise, hence enhancing human health and wellbeing. Social media offers an extensive repository of spatiotemporal data, containing details on the feelings and behaviors of individuals. However, investigations on physical activity and public sentiment in the natural environment of the downtown neighborhood are lacking in the existing literature.

METHODS

To extract environmental and behavioral information from social media data and other multi-source data, natural language processing, semantic segmentation, instance segmentation, and fully convolutional neural networks are employed. The research examines how neighborhood blue-green spaces and other health-promoting facilities affect physical activity and public sentiment.

RESULTS

The results reveal that blue space visibility, activity facilities, street furniture, and safety all have a favorable influence on physical activity with a social gradient. Amenities, perceived street safety and beauty positively correlated to public sentiment. The findings from social media about the environment and physical activity are consistent with traditional surveys from the same time period with a 0.588 kappa value.

CONCLUSION

According to our findings, social media data might be utilized to learn more about how urban environments influence people's physical activity patterns. Also, the health-promoting effects of blue space require more investigation.

Integrating justice in Nature-Based Solutions to avoid nature-enabled dispossession

Heavily featured over the last few years in global research and policy agreements, Nature-Based Solutions (NBS) remain however exposed to much debate over the ways their current design and ability to achieve both environmental goals and social needs. As they become mainstream climate mitigation and adaptation options, their capacity to deliver expected benefits, especially when contemplating equity and justice, is at least uncertain. Through a critical review of existing debates and perspectives on NBS, this paper questions their uptake and points at the frequent embeddedness of NBS in speculative and elite-based development paths in both urban and rural areas. We present an alternative, justice-oriented approach to NBS so that projects can avoid nature-enable dispossession and instead build nature-inspired justice that prioritizes the needs, identities, and livelihoods of the most ecologically and socially vulnerable residents.

What is the impact of nature on human health? A scoping review of the literature

Background

The burden of non-communicable diseases (including poor mental health) is increasing, and some practitioners are turning to nature to provide the solution. Nature-based interventions (NBIs) could offer cost-effective solutions by reconnecting individuals with nature, but the success of these interventions depends partially on the way in which people engage with blue and green spaces.

Methods

We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Cochrane guidelines to establish the evidence base for treating poor mental and physical health with NBIs. We searched five databases and the grey literature. Exposure was the active engagement with natural environments. The primary outcome was mental health and the secondary outcome was physical health defined using established metrics. All data were extracted to a charting table and reported as a narrative synthesis.

Results

952 studies were identified, of which 39 met the inclusion criteria. 92% demonstrated consistent improvements across any health outcome where individuals engaged with natural outdoor environments. Mental health outcomes improved across 98% of studies while physical and cognitive health outcomes showed improvement across 83% and 75% of studies respectively. Additionally, we identified 153 factors affecting engagement with nature, 78% of which facilitated engagement compared with 22% that reduced engagement. Aspects such as the sense of wilderness, accessibility, opportunities for physical activity and the absence of noise/ air pollution all increased engagement.

Conclusions

Further research (accompanied by a global improvement in study design) is needed to establish the magnitude and relative effect of nature-based interventions, and to quantify the compounding effect of factors that improve engagement with green and blue spaces. Nevertheless, this review has documented the increasing body of evidence in support of NBIs as effective tools to improve mental, physical, and cognitive health outcomes, and highlighted key factors that improve engagement with the natural world.

Registration

Open Science Framework: https://doi.org/10.17605/OSF.IO/8J5Q3.

Exploring the Association between Neighborhood Blue Space and Self-Rated Health among Elderly Adults: Evidence from Guangzhou, China

Blue spaces is associated with self-rated health (SRH), but little is known about the pathways underlying this association among Chinese urban elderly individuals. Based on neighborhood effect theory, this study examined the relationship between neighborhood blue spaces and SRH among elderly individuals using data from a questionnaire survey conducted in Guangzhou, remote sensing images, street views, and environmental information in the context of a Chinese megacity. In addition, multilevel linear model and mediating effect model empirical analyses were performed. Results showed that first, the SRH of the elderly was associated with individual- and neighborhood-level factors. Second, the multilevel mediation model revealed that multiple biopsychosocial pathways existed between neighborhood blue spaces and the SRH of the elderly, specifically, the blue space characteristics related to the SRH of the elderly via the mediating effect of stress. Third, owing to demographic characteristics and socioeconomic status, the stratified analyses also indicated a strong association between neighborhood blue spaces and SRH outcomes in the older and low-income groups. The mediating effect of stress in the age and income groups was also observed, and the mediation pathways and group differences were confirmed in the context of Chinese cities. This research enriches the empirical literature on blue spaces and elderly health from a multidisciplinary perspective and suggests the need for "healthy neighborhood" and "health-aging" planning in Chinese settings.

Impacts of Urban Blue-Green Space on Residents' Health: A Bibliometric Review

Urban blue-green space (UBGS), as an important component of the urban environment, is found to closely relate to human health. An extensive understanding of the effects of UBGS on human health is necessary for urban planning and intervention schemes towards healthy city development. However, a comprehensive review and discussion of relevant studies using bibliometric methods is still lacking. This paper adopted the bibliometric method and knowledge graph visualization technology to analyze the research on the impact of UBGS on residents' health, including the number of published papers, international influence, and network characteristics of keyword hotspots. The key findings include: (1) The number of articles published between 2001 and 2021 shows an increasing trend. Among the articles collected from WoS and CNKI, 38.74% and 32.65% of the articles focus on physical health, 38.32% and 30.61% on mental health, and 17.06% and 30.61% on public health, respectively. (2) From the analysis of international partnerships, countries with high levels of economic development and urbanization have closer cooperation than other countries. (3) UBGS has proven positive effects on residents' physical, mental, and public health. However, the mediating effects of UBGS on health and the differences in the health effects of UBGS on different ages and social classes are less studied. Therefore, this study proposes several future research directions. First, the mediating effect of UBGS on health impacts should be further examined. Furthermore, the interactive effects of residents' behaviors and the UBGS environment should be emphasized. Moreover, multidisciplinary integration should be strengthened. The coupling mechanism between human behavior and the environment should also be studied in depth with the help of social perception big data, wearable devices, and human-computer interactive simulation. Finally, this study calls for developing health risk monitoring and early warning systems, and integrating health impact assessment into urban planning, so as to improve residents' health and urban sustainability.

Moving to greener pastures: Health selection into neighborhood green space among a highly mobile and diverse population in California

Global urbanization has sparked substantial environmental, public health, and social science research on the importance of conserving and propagating natural environments. A large subset of this work focuses on the benefits of green space for health. An often-overlooked methodological concern when examining relations between green space and health, however, involves residential self-selection. The selective movement of individuals into greener neighborhoods on the basis of preexisting health and correlated social factors may bias associations, particularly in cross-sectional studies, which predominate existing green space/health research. To quantify the extent of residential self-selection bias, this study used a longitudinal sibling comparison design with repeated individual and neighborhood measures to estimate associations between pre-move health factors, including maternal body mass index (BMI) and infant birthweight, and post-move neighborhood green space in a residentially mobile sample of mothers in California, 2007 to 2015 (n = 288,333). Results show that better health before moving predicted higher levels of neighborhood green space after moving, providing evidence of health selection. Findings also indicate some support for differential health selection into neighborhood green space by race/ethnicity, including that evidence of selection emerges for white and Hispanic, but not Black, mothers. However, weak relations between pre-move individual factors and post-move neighborhood green space across analyses suggest that potential bias due to residential self-selection appears relatively minimal in a large, diverse, and highly mobile sample of families in California. Findings support calls to increase green space in historically marginalized neighborhoods as a means to promote environmental and health equity.

The evaluation of the 3-30-300 green space rule and mental health

BACKGROUND AND AIMS

Urban green space has many health benefits, but it is still unclear how much actually is needed for better health. Recently a new 3-30-300 rule of thumb for urban forestry and urban greening has been proposed, but this rule has not been evaluated for benefits on health. The rule requires that every citizen should be able to see at least three trees from their home, have 30 percent tree canopy cover in their neighbourhood and not live more than 300 m away from the nearest park or green space. The aim of this study was to evaluate the relationship between the 3-30-300 green space rule and its components in relation to mental health.

METHODS

We conducted a cross-sectional study based on a population-based sample of 3145 individuals aged 15-97 years from in Barcelona, Spain who participated in the Barcelona Health Survey (2016-2017). We created 3-30-300 green space indicators using questionnaire data, GIS, remote sensing and land cover maps. Mental health status was assessed with the 12-item General Health Questionnaire (GHQ-12) and also the use of tranquilizer/sedatives or antidepressants and psychiatrist or psychologist visits. Analyses were conducted using mixed effects logistic regression models with districts as the random effect, adjusted for relevant covariates.

RESULTS

We found that people in Barcelona had relatively little exposure to green space, whether through window view, living in an area with sufficient greenness, or access to a major green space, and only 4.7% met a surrogate 3-30-300 green space rule. Residential surrounding greenness, but not tree window view or access to major green space, was significantly associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits. Meeting the full surrogate 3-30-300 green space rule was associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits, but only for the latter combined the association was statistically significant (Odds ratio = 0.31, 95% CI: 0.11, 0.91).

CONCLUSION

Few people achieved the 3-30-300 green space in Barcelona and we used a surrogate measure. We observed health benefits when the full surrogate rule was met.

Environmental stress, minority status, and local poverty: risk factors for mental health in Berlin's inner city

This study examines whether climate change-associated environmental stressors, including air and noise pollution, local heat levels, as well as a lack of surrounding greenspace, mediate the effects of local poverty on mental health, using the 28-item General Health Questionnaire. We recruited 478 adults who were representative of eleven of Berlin's inner-city neighborhoods. The relationship of individual-level variables, neighborhood-level sociodemographic and environmental data from the Berlin Senate (Department for Urban Development, Building and Housing) to mental health was assessed in a multilevel model using SPSS. We found that neither local exposure to environmental stressors, nor available greenspace as a protective factor, mediated the effects of local poverty on variance in mental health (all p values > 0.2). However, surrounding greenspace (r = -0.24, p < 0.001), nitrogen dioxide levels (r = 0.10, p < 0.05), noise pollution (rho = 0.15, p < 0.01), and particle pollution (r = 0.12, p < 0.001) were associated with local poverty, which, more strongly than individual factors, accounted for variance in mental health (β = 0.47, p < 0.001). Our analysis indicates that the effects of local poverty on mental health are not mediated by environmental factors. Instead, local poverty was associated with both an increased mental health burden and the exposure to climate-related environmental stressors.

Integrated analysis of doubly disadvantaged neighborhoods by considering both green space and blue space accessibility and COVID-19 infection risk

The ongoing COVID-19 pandemic has taken a heavy toll on the physical and mental health of the public. Nevertheless, the presence of green and blue spaces has been shown to be able to encourage physical activities and alleviate the mental distress caused by COVID-19. However, just as the impact of COVID-19 varies by geographical region and area, the distribution of green and blue spaces is also different across different neighborhoods and areas. By using Hong Kong as the study area, we determine the local neighborhoods that suffer from both high COVID-19 infection risk as well as low green and blue space accessibility. The results show that some of the poorest neighborhoods in the territory such as Sham Shui Po, Kwun Tong and Wong Tai Sin are also among the most doubly disadvantaged in terms of COVID-19 infection risk as well as green and blue space accessibility.

Mapping seasonal sentiments of people visiting blue spaces in urban wetlands: A pilot study on inland cities of China

To evoke positive human emotions is a critical goal of blue spaces in urban wetland parks. However, information is still scarce on how people self-express across the spatiotemporal spectrum when they come across wetlands which include varying levels of elevation in a single landscape and microclimate. In this study, 30 urban wetland parks were selected from 17 cities in Central China, where a total of 1,184 portrait photos of visitors were obtained from a social media platform (Sina Weibo) to analyze their expressed sentiments by rating facial expression scores of happy and sad emotions and net positive emotion index (NPE; happy-score minus sad-score) in 2020. Landscape metrics were remotely evaluated for every wetland park, and microclimatic factors were obtained for the days when the photos were taken. Based on regressions of park-level data, blue-space areas could be perceived as a positive driver to trigger happiness in spring (regression coefficient [RC] of 0.20), but it triggered negative emotions in autumn (RC of −2.98). The higher elevation areas triggered positive emotions in summer and autumn (RC of 1.35 × 10−3), but extreme daily temperature, air humidity, and wind velocity together triggered sadness (RC of 0.11, 0.03, and 0.51, respectively). Mapped distribution of the area and corresponding emotions showed that visiting blue space evoked more smiles in wetland parks of northern Hunan, southern Hubei, and eastern Anhui in spring. Blue spaces in Shanxi and northwestern Hebei evoked better moods in autumn. Smaller blue spaces in wetlands located at higher elevations were recommended for nature enthusiasts in warm seasons to overcome the prevalent sadness characteristic of that time of the year and location.

Trends and inequalities in distance to and use of nearest natural space in the context of the 20-min neighbourhood: A 4-wave national repeat cross-sectional study, 2013 to 2019

The 20-min neighbourhood is a policy priority for governments worldwide; a key feature of this policy is providing access to natural space (NS) within 800 m of home. The study aims were to (1) examine the association between distance to nearest NS and frequent use over time and (2) examine whether frequent use and changes in use were patterned by income and housing tenure over time. Bi-annual Scottish Household Survey data were obtained for 2013 to 2019 (n:42128 aged 16+). Adults were asked the walking distance to their nearest NS, the frequency of visits to this space and their housing tenure, as well as age, sex and income. We examined the association between distance from home of nearest NS, housing tenure, and the likelihood of frequent NS use (visited once a week or more). Two-way interaction terms were further applied to explore variation in the association between tenure and frequent NS use over time. We found that 87% of respondents lived within 10 min walk of a NS, meeting the policy specification for a 20-min neighbourhood. Greater proximity to NS was associated with increased use; individuals living a 6-10 min walk and over 10 min walk were respectively 53% and 78% less likely to report frequent NS use than those living within a 5 min walk. Housing tenure was an important predictor of frequent NS use; private renters and homeowners were more likely to report frequent NS use than social renters. Our findings provide evidence that proximity to NS is a strong predictor of frequent use. Our study provides important evidence that time-based access measures alone do not consider deep-rooted socioeconomic variation in use of NS. Policy makers should ensure a nuanced lens is applied to operationalising and monitoring the 20-min neighbourhood to safeguard against exacerbating existing inequalities.

The built environment and mental health among older adults in Dalian: The mediating role of perceived environmental attributes

The basic attributes of the urban built environment are an important factor affecting mental health. However, research has rarely distinguished objective and perceived built environment characteristics to explore the associations with older adults' mental health. Based on data of 879 respondents aged 60 or older in Dalian, China, we explored the mediating roles of perceived built environmental attributes in the relationship between objective built environmental characteristics and mental wellbeing by structural equation modelling. Furthermore, to control for residential self-selection, the model was further tested by excluding the participants who self-selected their residences. The results showed that accessibility to daily living service facilities was positively associated with older adults' mental wellbeing through an indirect role of perceived built environmental attributes. The positive direct effect of aggregation of daily living service facilities on mental wellbeing was offset by the negative indirect effects of perceived built environmental attributes. In addition, the street interface density was negatively related to mental wellbeing through indirect effects. The diverse leisure, exercise and landscape facilities, underground parking and presence of elevators within neighborhoods were all positively associated with older adults' mental wellbeing through direct and/or indirect effects. The results were verified after excluding residential self-selection samples. These findings are helpful for evidence-based planning strategies and can provide guidelines on designing neighborhood landscapes and facilities which can further contribute to aging in place policies.

GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative

Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.

Daily space-time activities, multiple environmental exposures, and anxiety symptoms: A cross-sectional mobile phone-based sensing study

BACKGROUND

Few mobility-based studies have investigated the associations between multiple environmental exposures, including social exposures, and mental health.

OBJECTIVE

To assess how exposure to green space, blue space, noise, air pollution, and crowdedness along people's daily mobility paths are associated with anxiety symptoms.

METHODS

358 participants were cross-sectionally tracked with Global Positioning System (GPS)-enabled mobile phones. Anxiety symptoms were measured at baseline using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire. Green space, blue space, noise, and air pollution were assessed based on concentric buffers of 50 m and 100 m around each GPS point. Crowdedness was measured by the number of nearby Bluetooth-enabled devices detected along the mobility paths. Multiple linear regressions with full covariate adjustment were fitted to examine anxiety-environmental exposures associations. Random forest models were applied to explore possible nonlinear associations and exposure interactions.

RESULTS

Regression results showed null linear associations between GAD-7 scores and environmental exposures. Random forest models indicated that GAD-7-environment associations varied nonlinearly with exposure levels. We found a negative association between green space and GAD-7 scores only for participants with moderate green space exposure. We observed a positive association between GAD-7 scores and noise levels above 60 dB and air pollution concentrations above 17.2 μg m^-3. Crowdedness was positively associated with GAD-7 scores, but exposure-response functions flattened out with pronounced crowdedness of >7.5. Blue space tended to be positively associated with GAD-7 scores. Random forest models ranked environmental exposures as more important to explain GAD-7 scores than linear models.

CONCLUSIONS

Our findings indicate possible nonlinear associations between mobility-based environmental exposures and anxiety symptoms. More studies are needed to obtain an in-depth understanding of underlying anxiety-environment mechanisms during daily life.

Primary Exploration of Leisure Path Design along Songhua River by a Small Number of Sample Experiment, Considering Several Multiple Indexes

The waterfront park in northern China always has two parallel leisure pathways, a sunshine pathway and a tree-shaded pathway, which is attributed to the seasonal variations in water level. To provide some design suggestions according to the local characteristics of the waterfront park in northern China, this study selected six young volunteers to take part in an outdoor field experiment and a questionnaire survey in Stalin Park of Songhua River in Harbin, China. During the experiment, the volunteers’ local skin temperature and core temperature were recorded, with their subjective responses recorded every 5 min, including thermal comfort, thermal sensation, thermal pleasure, and fatigue scale vote. This study found that, compared with the sunshine pathway, the tree-shaded pathway not only optimized people’s outdoor thermal comfort and thermal pleasure, but also improved their fatigue scale vote experience. Some evidence showed that people’s subjective response to the outdoor thermal environment might be influenced by physical factors (temperature, velocity, humidity, radiation, etc.) and may also be influenced by the surrounding landscape view (water, square, lawn, tree, etc.). The first piece of evidence is that, during the first 10 min, people’s thermal sensation in the sunshine pathway group was high, but they kept voting for high thermal comfort, which may be due to the influence of the waterfront view on people’s subjective response to thermal comfort. The second piece of evidence shows that people’s overall thermal sensation was calculated by their local thermal sensation, looking at former research, with the voting results very different to the calculated results, which could be attributed to the influence of diversity landscape elements on people’s subjective response to thermal sensation. Based on these results, some suggestions for the leisure pathway design along Stalin Park of Songhua River in Harbin, China, were given. The shaded device of the sunshine pathway should be designed in 15-min-walk intervals and accessible ways to the tree-shaded pathway should be added. The other facilities should be designed with 30 min walking distance on the tree-shaded pathway and 20 min walking distance to the sunshine pathway. Diversified landscapes should be designed for both the tree-shaded pathway and sunshine pathway, which could improve people’s outdoor thermal comfort and the general subjective response to the environment. It is worth noting that the sample size of this study was small (6), and the participants were all homogenous young people (age, height, weight); thus, this study could be considered a preliminary work and the results and applicability have limitations.

The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil

BACKGROUND

Currently, more than half of the global population lives in cities. Contemporary urban planning practices result in environmental risk factors (e.g. air pollution, noise, lack of green space, excess heat) that put health and well-being of city dwellers at risk and contribute to chronic diseases and premature death. Despite a growing body of evidence on adverse health impacts related to current urban and transport planning practices, especially for cities in the Global North, not much is known about associated health impacts in South American cities. Therefore, we estimated the mortality burden attributable to breaching internationally-recommended or locally-preferable exposure levels of urban planning related environmental exposures in Sao Paulo, Brazil.

METHODS

We carried out a health impact assessment study, following the comparative risk assessment framework, to assess preventable mortality impacts of breaching exposure recommendations for air pollution, green spaces and temperature at the census tract (CT) level (n = 18,363). We also assessed the distribution thereof by socioeconomic vulnerability.

RESULTS

We estimated that annually 11,372 (95% CI: 7921; 15,910) attributable deaths could be prevented by complying with recommended exposure levels. The largest proportion of preventable mortality was due to breaching air pollution limits (i.e. 8409 attributable deaths), followed by insufficient green space (i.e. 2593), and excess heat (i.e. 370). Adverse health impacts were larger in CTs of lower socioeconomic vulnerability, due to demographic profile, traffic density and residential area configurations.

DISCUSSION

Not complying with the health limits for air pollution, green space and temperature exposures resulted in a considerable preventable mortality burden (i.e. 17% of total expected deaths) in Sao Paulo. This burden can be reduced by improving current urban and transport planning practices.

Home and nearby nature: Uncovering relational flows between domestic and natural spaces in three countries during COVID-19

This paper addresses the role of living spaces, neighborhood environments, and access to nearby nature in shaping individual experiences of health and well-being during the first wave of the COVID-19 pandemic. Key data is drawn from the GreenCOVID study across Spain, England and Ireland. The survey gathered contextual information about home environments, neighborhood spaces, and access to nature elements, and standardized measures of health and wellbeing between April and July 2020 (n = 3,127). The paper used qualitative data from the survey to document flows between home and nearby nature. These were framed as barriers/mediators with specific focus on differing interpretations of home as both trap and refuge, with additional dimensions of loss, disruption and interruption shaping the broad responses to the pandemic. By contrast nearby nature was an enabler/moderator of health and wellbeing, offering healthy flows between home and nature as well as respite and additional health-enabling factors. Differences were identified between the three countries but important commonalities emerged too, recognising the role nature plays as an asset both within and immediately beyond the home. The use of flow as metaphor also recognises the importance of embodiment and the elastic nature of connections between home and nearby nature for wellbeing. More broadly, flow provides a valuable way to trace affective relational geographers to develop a wider understanding of assemblages of health during pandemics.

Campus Green Spaces, Academic Achievement and Mental Health of College Students

Mental health concerns have become a common problem among college students. Studies have shown that college students have a higher depression rate than the general population. The effect of campus green spaces on college students’ mental health has been widely studied. However, the internal mechanism of campus green spaces affecting college students’ mental health is not fully discussed. The data came from a cross-sectional survey of 45 Chinese universities. This paper discussed the relationship between campus green spaces, academic achievement, and college students’ mental health. Depending on gender, college students displayed different levels of mental health. The prevalence of depression among female students was higher than among male students. The effect of campus green spaces on mental health was higher in males than females, while the effect of campus green spaces on academic achievement had little gender difference. We call for the construction, improvement, and renewal of campus green spaces in the future not only to meet the needs of different gender groups, but also to pay more attention to the needs of female college students and improve the differences in mental health, so as to improve the mental health of the whole college student population.