Neighbourhood blue space, health and wellbeing: The mediating role of different types of physical activity

Modifying temperature-related cardiovascular mortality through green-blue space exposure

Green-blue spaces (GBS) are pivotal in mitigating thermal discomfort. However, their management lacks guidelines rooted in epidemiological evidence for specific planning and design. Here we show how various GBS types modify the link between non-optimal temperatures and cardiovascular mortality across different thermal extremes. We merged fine-scale population density and GBS data to create novel GBS exposure index. A case time series approach was employed to analyse temperature-cardiovascular mortality association and the effect modifications of type-specific GBSs across 1085 subdistricts in south-eastern China. Our findings indicate that both green and blue spaces may significantly reduce high-temperature-related cardiovascular mortality risks (e.g., for low (5%) vs. high (95%) level of overall green spaces at 99th vs. minimum mortality temperature (MMT), Ratio of relative risk (RRR) = 1.14 (95% CI: 1.07, 1.21); for overall blue spaces, RRR = 1.20 (95% CI: 1.12, 1.29)), while specific blue space types offer protection against cold temperatures (e.g., for the rivers at 1st vs MMT, RRR = 1.17 (95% CI: 1.07, 1.28)). Notably, forests, parks, nature reserves, street greenery, and lakes are linked with lower heat-related cardiovascular mortality, whereas rivers and coasts mitigate cold-related cardiovascular mortality. Blue spaces provide greater benefits than green spaces. The severity of temperature extremes further amplifies GBS's protective effects. This study enhances our understanding of how type-specific GBS influences health risks associated with non-optimal temperatures, offering valuable insights for integrating GBS into climate adaptation strategies for maximal health benefits.

Having a tree in front of one's home is associated with GREATER subjective wellbeing in adult residents in Melbourne, Australia, and Toronto, Canada

While urban trees can be important determinants of human health and wellbeing in world cities, the specific influence of nearby urban trees upon human wellbeing has not been adequately explored. While many studies have associated urban greenery abundance with wellbeing scores, many measures of urban greenery do not specify the type of vegetation or the impact of co-location. Here we fill this gap by associating self-reported measures of the presence of nearby trees (tree in front of one's home) with validated subjective wellbeing (SWB) scores. We also tested for the mediating role of what people thought about trees and nature, with a focus on the values people associate with urban trees and nature relatedness (NR). We used electronic panel survey data based on a demographic and geographical representative sample of more than 3400 residents living in Toronto, Canada, and Melbourne, Australia. We analysed these data using regression-based mediation and path analyses. We found that having a tree in front of one's home was strongly and positively associated with SWB scores in both cities with similar results (Melbourne, β = 0.17, p < 0.05; Toronto, β = 0.18, p < 0.05), while accounting for NR, values associated with urban trees, and demographics (e.g., age, education, home ownership). The mediating role of NR and values was small. The specific pathways of association between tree in front of one's home, SWB, NR, and values, varied by city, when accounting for demographics. We discuss how increasing the abundance of nearby urban trees in cities may also increase human wellbeing.

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.

Valuing the health benefits of nature-based recreational physical activity in England

Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease. Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose-response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers. In 2019, 22million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million). Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs.

Residence in coastal communities in adolescence and health in young adulthood: An 11-year follow-up of English UKHLS youth questionnaire respondents

We used the UK Household Longitudinal Study to examine whether community type (inland or coastal) in adolescence (10-15 years) was associated with five adult health outcomes assessed over 11 waves of follow-up (2009-22). When the analyses were stratified on area deprivation, four of the five health outcomes - self-rated, long-standing illness, psychological distress and mental functioning - showed worse health in increasingly more deprived communities, and to a greater extent in the most deprived communities that are coastal. For all but self-rated health, associations were robust to additional adjustment for adolescent gender, ethnicity, household income, tenure, and life satisfaction.

Exposure to blue space surroundings and depressive symptoms in young Chinese adults: The mediating role of sleep

OBJECTIVE

Existing evidence suggests that the natural environment can influence mental health. However, limited research has focused on the relationship between blue space and depressive symptoms in young adults. To investigate the association between blue space surroundings and depressive symptoms in young adults in China and explore the underlying mechanisms.

METHODS

The study was conducted between September and November 2019, including 2,743 young adults from China. We assessed the exposure to blue space around participants' living environments during June, July, and August 2019 using the Modified Normalized Difference Water Index (MNDWI). Blue indexes were calculated for 300 m, 1000 m, and 3000 m circular buffer zones near residential environments. Logistic regression models were employed to explore the associations between blue space exposures (quartiles) and depressive symptoms, exploring potential mechanisms through structural equation modeling (SEM), while accounting for potential confounders. Stratification analysis was used to identify sensitive populations.

RESULTS

Depressive symptoms were found in 148 (5.3%) of the 2,743 young adults in the study. We observed a negative correlation between depressive symptoms and average MNDWIs at participants' addresses (OR: 0.84; 95%CI: 0.72-0.98), within 300m (OR: 0.81; 95%CI: 0.70-0.95), 1000m (OR: 0.80; 95%CI: 0.69-0.93), and 3000m (OR:0.77; 95%CI: 0.66-0.89) buffer zones. Within the 1000m buffer zone, sleep was found to mediate 21% of the relationship between the presence of blue space and depressive symptoms. The stratified analysis revealed a stronger association between low MNDWI levels within the 1000m buffer zone and depressive symptoms in females (P < 0.05). Additionally, average MNDWI levels within the 3000m buffer zone were associated with depressive symptoms in both females and males.

CONCLUSIONS

Blue space could improve depressive symptoms, particularly in females, with sleep playing a mediating role. Incorporating blue spaces into environmental planning is important for improving mental health.

Anthropogenic impacts on urban blue space and its reciprocal effect on human and socio-ecological health

Quantifying anthropogenic impacts on blue space (BS) and its effect on human and socio-ecological health was least explored. The present study aimed to do this in reference to the urban BS transformation scenario of Eastern India. To measure BS transformation, Landsat image-based water indices were run from 1990 to 2021. Anthropogenic impact score (AIS) and 7 components scores of 78 selected BS on 70 parameters related data driven from the field. Total 345 respondents were taken for human and socio-ecological health assessment. For this, depression (DEP), anxiety (ANX), stress (STR), physical activities (PA), social capital (SC), therapeutic landscape (TL) and environment building (EB) parameters were taken. The result exhibited that BS was reduced. About 50% of urban core BS was reported highly impacted. Human and socio-ecological health was identified as good in proximity to BS, but it was observed better in the cases of larger peripheral BS. AIS on BS was found to be positively associated with mental health (0.47-0.63) and negatively associated with PA, SC, TL and EB (-0.50 to -0.90). Standard residual in ordinary least square was reported low (-1.5 to 1.5) in 95% BS. Therefore, BS health restoration and management is crucial for sustaining the living environment.

Exposure to residential green and blue space and the natural environment is associated with a lower incidence of psychiatric disorders in middle-aged and older adults: findings from the UK Biobank

BACKGROUND

There is increasing evidence for the role of environmental factors and exposure to the natural environment on a wide range of health outcomes. Whether exposure to green space, blue space, and the natural environment (GBN) is associated with risk of psychiatric disorders in middle-aged and older adults has not been prospectively examined.

METHODS

Longitudinal data from the UK biobank was used. At the study baseline (2006-2010), 363,047 participants (women: 53.4%; mean age 56.7 ± 8.1 years) who had not been previously diagnosed with any psychiatric disorder were included. Follow-up was achieved by collecting records from hospitals and death registers. Measurements of green and blue space modeled from land use data and natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazard models with adjustment for potential confounders were used to explore the longitudinal associations between GBN and any psychiatric disorder and then by specific psychiatric disorders (dementia, substance abuse, psychotic disorder, depression, and anxiety) in middle-aged and older adults.

RESULTS

During an average follow-up of 11.5 ± 2.8 years, 49,865 individuals were diagnosed with psychiatric disorders. Compared with the first tertile (lowest) of exposure, blue space at 300 m buffer [hazard ratio (HR): 0.973, 95% confidence interval (CI): 0.952-0.994] and natural environment at 300 m buffer (HR: 0.970, 95% CI: 0.948-0.992) and at 1000 m buffer (HR: 0.975, 95% CI: 0.952-0.999) in the third tertile (highest) were significantly associated with lower risk of incident psychiatric disorders, respectively. The risk of incident dementia was statistically decreased when exposed to the third tertile (highest) of green space and natural environment at 1000 m buffer. The third tertile (highest) of green space at 300 m and 1000 m buffer and natural environment at 300 m and 1000 m buffer was associated with a reduction of 30.0%, 31.8%, 21.7%, and 30.3% in the risk of developing a psychotic disorder, respectively. Subgroup analysis suggested that the elderly, men, and those living with some comorbid conditions may derive greater benefits associated with exposure to GBN.

CONCLUSIONS

This study suggests that GBN has significant benefits for lowering the risk of psychiatric disorders in middle-aged and older adults. Future studies are warranted to validate these findings and to understand the potential mechanistic pathways underpinning these novel findings.

The impact of outdoor blue spaces on the health of the elderly: A systematic review

Research on natural health has identified the potential benefit of outdoor blue spaces for human health and wellbeing. However, the existing evidence has relatively limited attention to the elderly. This study aims to review the available evidence on outdoor blue spaces and health outcomes among older individuals and identify knowledge gaps. In accordance with the PRISMA guidelines, specific keywords were used to search for articles published in English from inception to October 2023. Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched, and 22 studies were identified in this review. We classified articles based on elderly health as general health (e.g., self-reported, perceived health and wellbeing), physical health (e.g., physical activity, physical function index), and mental health and wellbeing (e.g., depression). The findings indicated a positive correlation between outdoor blue space and the health of the elderly. In terms of the characteristics of exposure to outdoor blue spaces, direct contact (e.g., sensory-based) has not been well documented compared to indirect contact (e.g., distance, percentage, region-based). Although encouraging, the available body of evidence is limited and lacks consistency. Future research is needed to provide complementary evidence between outdoor blue spaces and elderly health.

Urban green and blue spaces and general and mental health among older adults in Washington state: Analysis of BRFSS data between 2011-2019

A growing body of evidence highlights the significant effect of built environment features on mental and general health. This study examined the association between distance to and percentage of green and blue space measures and serious psychological distress, general health, and frequent mental distress among older adults living in urban ZIP codes in Washington state. Percentage of green space, particularly tree canopy and forest space, was significantly associated with better self-rated general health and reduced odds of serious psychological distress. Closer distance to blue space was associated with better self-rated general health. Programs which incentivize exposure to green and blue spaces for urban-dwelling, older adults may improve health outcomes.

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.

A large clinical trial to improve well-being during the transition to college using wearables: The lived experiences measured using rings study

INTRODUCTION

The transition to college is a period of elevated risk for a range of mental health conditions. Although colleges and universities strive to provide mental health support to their students, the high demand for these services makes it difficult to provide scalable, cost-effective solutions.

OBJECTIVE

To address these issues, the present study aims to compare the efficacy of three different treatments using a large cohort of 600 students transitioning to college. Interventions were selected based on their potential for generalizability and cost-effectiveness on college campuses.

METHODS

The study is a Phase II parallel-group, four-arm, randomized controlled trial with 1:1 allocation that will assign 600 participants to one (n = 150 per condition) of four arms: 1) group-based therapy, 2) physical activity program, 3) nature experiences, or 4) weekly assessment condition as a control group. Physiological data will be collected from all participants using a wearable device to develop algorithmic mental and physical health functioning predictions. Once recruitment is complete, modeling strategies will be used to evaluate the outcomes and effectiveness of each intervention.

DISCUSSION

The findings of this study will provide evidence as to the benefits of implementing scalable and proactive interventions using technology with the goal of improving the well-being and success of new college students.

Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries

The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults. Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics. Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities. The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention.

Association of greenness with the disease burden of lower respiratory infections and mediation effects of air pollution and heat: a global ecological study

Exposure to greenness is increasingly linked to beneficial health outcomes, but the associations between greenness and the disease burden of lower respiratory infections (LRIs) are unclear. We used the normalized difference vegetation index (NDVI) and the leaf area index (LAI) to measure greenness and incidence, death, and disability-adjusted life years (DALYs) due to LRIs to represent the disease burden of LRIs. We applied a generalized linear mixed model to evaluate the association between greenness and LRI disease burden and performed a stratified analysis, after adjusting for covariates. Additionally, we assessed the potential mediating effects of fine particulate matter (PM2.5), ozone (O3), nitrogen dioxide (NO2), and heat on the association between greenness and the disease burden of LRIs. In the adjusted model, one 0.1 unit increase of NDVI and 0.5 increase in LAI were significantly inversely associated with incidence, death, and DALYs due to LRIs, respectively. Greenness was negatively correlated with the disease burden of LRIs across 15-65 age group, both sexes, and low SDI groups. PM2.5, O3, and heat mediated the effects of greenness on the disease burden of LRIs. Greenness was significantly negatively associated with the disease burden of LRIs, possibly by reducing exposure to air pollution and heat.

Blue prescription: A pilot study of health benefits for oncological patients of a short program of activities involving the sea

Performing outdoor activities in blue spaces can help improve human health and mental well-being by reducing stress and promoting social relationships. The number of people surviving cancer has increased globally to experience this disease as a life-changing and chronic condition with physical and psychosocial symptoms that have negative impacts on their quality of life. While there has been a growth of programs in green spaces to meet the needs of cancer patients, such as follow-up post-treatment care, support groups and physical activity programs, very few studies have examined the effects of activities involving the sea for the health and well-being of oncology patients. This is the first study to evaluate whether different outdoor activities in blue spaces can benefit oncological patients' physical and mental health using smartwatches, sphygmomanometers and Profile of Mood States (POMS) questionnaires. We assessed changes in blood pressure, heart rate, sleep quality and mental health of 16 patients after twelve sessions of three different activities (walking, beach and snorkelling) and four sessions of a control activity. While no significant differences between activities were observed in terms of the data gathered by the smartwatches, a gradient of positive results for human mental health was observed towards exposure to a blue space, assessed through POMS questionnaires. Results show that exposure to blue spaces contributes to tension and anger reduction and improves the vigour mood state of oncology patients. No significant increases in patients' heart rate were recorded after the beach and snorkelling activities, with results similar to the control activity, suggesting that the contribution may be to participants' relaxation.

Inequalities in urban greenness and epigenetic aging: Different associations by race and neighborhood socioeconomic status

Slower epigenetic aging is associated with exposure to green space (greenness); however, the longitudinal relationship has not been well studied, particularly in minority groups. We investigated the association between 20-year exposure to greenness [Normalized Difference Vegetation Index (NDVI)] and epigenetic aging in a large, biracial (Black/white), U.S. urban cohort. Using generalized estimating equations adjusted for individual and neighborhood socioeconomic characteristics, greater greenness was associated with slower epigenetic aging. Black participants had less surrounding greenness and an attenuated association between greenness and epigenetic aging [βNDVI5km: -0.80, 95% confidence interval (CI): -4.75, 3.13 versus βNDVI5km: -3.03, 95% CI: -5.63, -0.43 in white participants]. Participants in disadvantaged neighborhoods showed a stronger association between greenness and epigenetic aging (βNDVI5km: -3.36, 95% CI: -6.65, -0.08 versus βNDVI5km: -1.57, 95% CI: -4.12, 0.96 in less disadvantaged). In conclusion, we found a relationship between greenness and slower epigenetic aging, and different associations by social determinants of health such as race and neighborhood socioeconomic status.

Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales

Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index β =  - 1.84, 95% confidence interval (CI) - 3.63, - 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none β = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14-70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries

The effects of 'nature' on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

COVID-19 Spotlights Connections between Disease and Multiple Lifestyle Factors

The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2), and the disease it causes (COVID-19), have had a profound impact on global human society and threaten to continue to have such an impact with newly emerging variants. Because of the widespread effects of SARS-CoV-2, understanding how lifestyle choices impact the severity of disease is imperative. This review summarizes evidence for an involvement of chronic, non-resolving inflammation, gut microbiome disruption (dysbiosis with loss of beneficial microorganisms), and impaired viral defenses, all of which are associated with an imbalanced lifestyle, in severe disease manifestations and post-acute sequelae of SARS-CoV-2 (PASC). Humans' physiological propensity for uncontrolled inflammation and severe COVID-19 are briefly contrasted with bats' low propensity for inflammation and their resistance to viral disease. This insight is used to identify positive lifestyle factors with the potential to act in synergy for restoring balance to the immune response and gut microbiome, and thereby protect individuals against severe COVID-19 and PASC. It is proposed that clinicians should consider recommending lifestyle factors, such as stress management, balanced nutrition and physical activity, as preventative measures against severe viral disease and PASC.

Cross-sectional associations of different types of nature exposure with psychotropic, antihypertensive and asthma medication

BACKGROUND

Exposure to natural environments is thought to be beneficial for human health, but the evidence is inconsistent.

OBJECTIVE

To examine whether exposure to green and blue spaces in urban environments is associated with mental and physical health in Finland.

METHODS

The Helsinki Capital Region Environmental Health Survey was conducted in 2015-2016 in Helsinki, Espoo and Vantaa in Finland (n=7321). Cross-sectional associations of the amounts of residential green and blue spaces within 1 km radius around the respondent's home (based on the Urban Atlas 2012), green and blue views from home and green space visits with self-reported use of psychotropic (anxiolytics, hypnotics and antidepressants), antihypertensive and asthma medication were examined using logistic regression models. Indicators of health behaviour, traffic-related outdoor air pollution and noise and socioeconomic status (SES) were used as covariates, the last of these also as a potential effect modifier.

RESULTS

Amounts of residential green and blue spaces or green and blue views from home were not associated with medications. However, the frequency of green space visits was associated with lower odds of using psychotropic medication (OR=0.67, 95% CI 0.55 to 0.82 for 3-4 times/week; 0.78, 0.63 to 0.96 for ≥5 times/week) and antihypertensive (0.64, 0.52 to 0.78; 0.59, 0.48 to 0.74, respectively) and asthma (0.74, 0.58 to 0.94; 0.76, 0.59 to 0.99, respectively) medication use. The observed associations were attenuated by body mass index, but no consistent interactions with SES indicators were observed.

CONCLUSIONS

Frequent green space visits, but not the amounts of residential green or blue spaces, or green and blue views from home, were associated with less frequent use of psychotropic, antihypertensive and asthma medication in urban environments.

Do neighbourhood traffic-related air pollution and socio-economic status moderate the associations of the neighbourhood physical environment with cognitive function? Findings from the AusDiab study

Characteristics of the neighbourhood environment, including the built and natural environment, area-level socio-economic status (SES) and air pollution, have been linked to cognitive health. However, most studies have focused on single neighbourhood characteristics and have not considered the extent to which the effects of environmental factors may interact. We examined the associations of measures of the neighbourhood built and natural environment, area-level SES and traffic-related air pollution (TRAP) with two cognitive function domains (memory and processing speed), and the extent to which area-level SES and TRAP moderated the associations. We used cross-sectional data from the AusDiab3 study, an Australian cohort study of adults (mean age: 61 years) in 2011-12 (N = 4141) for which geocoded residential addresses were available. Spatial data were used to create composite indices of built environment complexity (population density, intersection density, non-commercial land use mix, commercial land use) and natural environment (parkland and blue spaces). Area-level SES was obtained from national census indices and TRAP was based on estimates of annual average levels of nitrogen dioxide (NO2). Confounder-adjusted generalised additive mixed models were used to estimate the independent associations of the environmental measures with cognitive function and the moderating effects of area-level SES and TRAP. The positive associations between built environment complexity and memory were stronger in those living in areas with higher SES and lower NO2 concentrations. A positive association between the natural environment and memory was found only in those living in areas with lower NO2 concentrations and average or below-average SES. Built environment complexity and the natural environment were positively related to processing speed. Complex urban environments and access to nature may benefit cognitive health in ageing populations. For higher-order cognitive abilities, such as memory, these positive effects may be stronger in areas with lower levels of TRAP.

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.

COVID-19: Reducing the risk via diet and lifestyle

This review shows that relatively simple changes to diet and lifestyle can significantly, and rapidly, reduce the risks associated with coronavirus disease 2019 (COVID-19) in terms of infection risk, severity of disease, and even disease-related mortality. A wide range of interventions including regular exercise, adequate sleep, plant-based diets, maintenance of healthy weight, dietary supplementation, and time in nature have each been shown to have beneficial effects for supporting more positive health outcomes with COVID-19, in addition to promoting better overall health. This paper brings together literature from these areas and presents the argument that non-pharmaceutical approaches should not be overlooked in our response to COVID-19. It is noted that, in several cases, interventions discussed result in risk reductions equivalent to, or even greater than, those associated with currently available vaccines. Where the balance of evidence suggests benefits, and the risk is minimal to none, it is suggested that communicating the power of individual actions to the public becomes morally imperative. Further, many lives could be saved, and many harms from the vaccine mandates avoided, if we were willing to embrace this lifestyle-centred approach in our efforts to deal with COVID-19.

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.

Inland Waterways and Population Health and Wellbeing: A Cross-Sectional Study of Waterway Users in the UK

Natural environments, such as inland waterways (IWs), have been identified as a potential means to increase physical activity and promote health and wellbeing. However, further information on predictors of IW usage and their relationship with health and wellbeing outcomes is needed. Data were taken from the cross-sectional UK Waterways Engagement Monitor survey of waterway users (n = 21,537) in 2019/2020. Health outcome measures were life satisfaction, physical activity, and mental wellbeing. Visit frequency was an additional outcome measure. Both bivariate and multivariable associations between outcome measures and features of IWs were explored. The travel-cost method was used to estimate users' demand, expressed by travel costs to waterways. Multivariable models showed positive associations of frequent visits and use for recreational/leisure purposes with life satisfaction and physical activity. Rural visits were associated with higher life satisfaction than urban ones. Lower visit satisfaction negatively impacted life satisfaction and mental wellbeing. Visit frequency was influenced by individual characteristics and purpose of visit, including visits for exercise. Waterway visits were inversely associated with travel costs (IRR = 0.99, p-value ≤ 0.001), and there was greater demand elasticity for short distances (≤5 miles). Socioeconomic-related inequalities were present. Future policies could enhance frequent use of waterways and alleviate accessibility-related inequalities to improve population health outcomes.

Blue sky as a protective factor for cardiovascular disease

Objective

Blue sky has been considered to boost outdoor physical activity and social interaction, ameliorate work pressure and life stress, and enhance people's sense of happiness. However, the direct association between blue sky exposure and cardiovascular disease (CVD) still lacks epidemiological evidence. In this study, we aimed to quantify their relationship via a nationwide prospective cohort in China.

Method

We extracted the baseline data from the China Hypertension Survey (CHS), by enrolling 22,702 participants aged ≥ 35 years without self-reported medical history of CVD from 14 provinces of China between 2012 and 2015 and followed up from 2018 to 2019. A blue day was marked out with no rain, low cloud cover ≤ climatological mean at each station, and visibility at 2 pm ≥ 21.52 km. We calculated the number of blue days at baseline survey year to evaluate the chronic individual blue day exposure. Cox proportional hazards models were employed to calculate the multivariable-adjusted hazard ratio (HR). We implemented subgroup analyses as well to identify potential effect modifications.

Results

A total of 1,096, 993, and 597 incident cases of all-cause mortality, fatal or nonfatal CVD, and stroke occurred during a median follow-up around 5 years, respectively. A 10-day increase in annual blue day exposure was associated with a 3% (95% confidence interval [CI]: 1-6%) and 7% (95% CI: 5-10%) decreased risk of fatal or nonfatal CVD and stroke, respectively. Compared with those exposed to the worst tertile of blue days at baseline, subjects who exposed to the best tertile had a 32% (95% CI: 19-43%) and 43% (95% CI: 29-55%) lower likelihood of developing fatal or nonfatal CVD and stroke, respectively. Negative consistent exposure-response relationships were generally observed between them in the restricted cubic spline model. In the stratified analyses, the cardioprotective effects of blue sky were stronger for females, rural residents, and individuals residing in heavily contaminated areas.

Conclusion

This study indicates that blue sky may serve as an independent environmental protective factor against CVD, and informs future policies on fighting air pollution and protecting the blue sky in China.

Relationship between "Blue Space" Proximity and Children's Weight Status, Health Behaviors, and Health-Related Quality of Life among a Sample of Regional Victorian Primary School Children

Background: Access to green space (e.g., parks and gardens) has been associated with child health and wellbeing, whereas blue space (e.g., coasts, lakes, and rivers) is understudied. Our aim was to determine whether proximity to the coast was associated with primary school children's weight status, modifiable health-related behaviors, and health-related quality of life (HRQoL). Methods: Exploratory cross-sectional analysis of baseline data from the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHOSTOPS) study, to estimate gender-specific differences in weight and behaviors across four bands of distance from the coast (<5 km, 5 to <25 km, 25 to <50 km, ≥50 km). Linear and logistic models, with robust standard errors, adjusted for school year level, area-level socioeconomic position and rurality, and allowing for distance by gender interaction were fitted on data from 1216 children (aged 8.5-13 years). Main outcomes were weight status (categorical), physical activity (PA) (categorical), and global HRQoL score (continuous). Results: Compared with girls living in towns ≥50 km from the coast, those living within 5 km had lower odds for overweight/obesity [odds ratio (OR) = 0.50; 95% confidence interval (CI): 0.37-0.67] and higher mean moderate-to-vigorous PA minutes (accelerometry) (β = 8.7; 95% CI: 2.0-15.5) and global HRQoL (β = 3.2; 95% CI: 1.4-5.0). Compared with boys living ≥50 km from the coast, those living within 5 km had higher odds of meeting self-reported PA guidelines (≥60 minutes/day) for ≥5 days (OR = 2.33; 95% CI: 1.75-3.10), and higher mean global HRQoL scores (β = 5.6; 95% CI: 1.9-9.3). Conclusions: Living close to the coast was associated with some favorable health outcomes and behaviors, which differed between girls and boys.

Effect modifications of green space and blue space on heat-mortality association in Hong Kong, 2008-2017

BACKGROUND

Despite emerging recognition of the benefits of green and blue spaces on human health, evidence for their effect modifications on heat-mortality associations is limited. We aimed to investigate the effect modifications of green and blue spaces on heat-mortality associations among different age and sex groups and at different heat levels.

METHODS

Daily mortality and meteorological data from 2008 to 2017 in Hong Kong, China were collected. The Normalized Difference Vegetation Index and distance to coast were used as proxies for green and blue space exposure, respectively. Time-series analyses was performed using fitting generalized linear mixed models with an interaction term between heat and levels of exposure to either green or blue space. Age-, sex-, and heat level-stratified analyses were also conducted.

RESULTS

With a 1 °C increase in temperature above the 90th percentile (29.61 °C), mortality increased by 5.7% (95% confidence interval [CI]: 1.6, 10.1%), 5.4% (1.4, 9.5%), and 4.6% (0.8, 8.9%) for low, medium and high levels of green space exposure, respectively, and by 7.5% (3.9, 11.2%) and 3.5% (0.3, 6.8%) for low and high levels of blue space exposure, respectively. Significant effect modifications of green and blue spaces were not observed for the whole population or any specific age and sex group, either at a moderate heat level or a heat level (Ps > 0.05).

CONCLUSIONS

No significant effect modifications of green and blue spaces on heat-related mortality risk were observed in Hong Kong. These findings challenge the existing evidence on the prominent protective role of green and blue spaces in mitigating heat-related mortality risks.

Freshwater Wild Swimming, Health and Well-Being: Understanding the Importance of Place and Risk

Spending time in or around bodies of water or ‘blue spaces’ can benefit human health and well-being. A growing body of evidence suggests immersion in blue space, e.g., participating in ‘wild’ swimming, can be particularly beneficial for both physical and mental health. To date, wild swimming and health research has primarily focused on the experience of individuals who swim in the sea. Empirical studies of the health-promoting potential of swimming in freshwater environments, such as lochs and lakes, are lacking, despite the popularity of this practice in many countries and the vastly different physical and hydrological properties of freshwater and coastal environments. The aim of this study was to explore the relationship between loch (lake) swimming and health and well-being for adults living in Scotland and determine the importance of perceptions of place and risk in this relationship. Semi-structured interviews were conducted with twelve wild swimmers who regularly swim in lochs in Scotland. Interview data were analysed thematically using Nvivo. The findings suggest loch swimming has a variety of health and well-being benefits that can be categorised over three domains of health: physical, mental and social. Of these domains, mental health benefits e.g., mindfulness promotion, resilience building and increasing one’s ability to listen to their body, were particularly prominent. Our findings also highlight important physical and hydrological characteristics of loch environments, e.g., calm water conditions (relative to the sea), which contribute to positive wild swimming experiences. Finally, the perceived risks of loch swimming and mitigation strategies for these risks are established. Collectively, our findings further support the notion that wild swimming is a unique health-promoting practice. Our findings also highlight differences (in terms of experience and perceived risk) between swimming in freshwater and coastal environments, which can inform public health and water management policy.

Beneficial Use Impairments, Degradation of Aesthetics, and Human Health: A Review

In environmental programs and blue/green space development, improving aesthetics is a common goal. There is broad interest in understanding the relationship between ecologically sound environments that people find aesthetically pleasing and human health. However, to date, few studies have adequately assessed this relationship, and no summaries or reviews of this line of research exist. Therefore, we undertook a systematic literature review to determine the state of science and identify critical needs to advance the field. Keywords identified from both aesthetics and loss of habitat literature were searched in PubMed and Web of Science databases. After full text screening, 19 studies were included in the review. Most of these studies examined some measure of greenspace/bluespace, primarily proximity. Only one study investigated the impacts of making space quality changes on a health metric. The studies identified for this review continue to support links between green space and various metrics of health, with additional evidence for blue space benefits on health. No studies to date adequately address questions surrounding the beneficial use impairment degradation of aesthetics and how improving either environmental quality (remediation) or ecological health (restoration) efforts have impacted the health of those communities.

Experiencing Urban Green and Blue Spaces in Urban Wetlands as a Nature-Based Solution to Promote Positive Emotions

Green and blue spaces are nature-based solutions (NBSs) that evoke positive emotions of experiencers therein. There is an impetus to optimize wetland forest landscapes by planning the geographical arrangement of metrics that promote positive emotion. The facial expressions of nature experiencers in photos, downloaded from social media databases with landscape metrics, were evaluated for emotions and given scores. Happy and sad scores were rated by FireFACE v1.0 software and positive response index (PRI) was calculated as happy score minus sad score. Spatial areas and tree height were evaluated from Landsat 8 images and digital model maps, respectively. Visitors at middle and senior ages smiled more frequently in southern parts than in northern parts, and females had higher happy scores and PRI than males. Both green- and blue-space areas had positive relationships with PRI scores, while blue spaces and their area to park area ratios had positive contributions to happy scores and PRI scores in multivariate linear regression models. Elevation had a negative relationship with positive facial emotion. Overall, based on spatial distributions of blue-space area and elevation, regional landscape was optimized so people perceived more happiness in wetlands around Zhejiang and Shanghai, while people in wetlands of Jiangxi and Hubei showed more net emotional expressions.

Amount of and proximity to blue spaces and general health among older Chinese adults in private and public housing: A national population study

A growing body of research indicates that exposure to outdoor blue spaces is associated with better physical and mental health. However, few studies have explored the associations between different blue space indicators (e.g., amount of and proximity to freshwater and seawater) and general health. Moreover, research has rarely attempted to address the residential selection bias associated with the salutogenic effect of access to blue spaces. Therefore, this study explores the associations between the amount (percentage of blue space within a 1 km circular buffer) of and proximity (Euclidean distance to the edge of the nearest blue space) to blue space and older adults' general health across the entire country of China using the micro-data sample of one-percent national population sample survey in 2015. It adds to the existing literature by taking into account the neighbourhood selection mechanism for different housing tenures and examining the salutogenic effect of blue spaces separately for public housing residents and private housing residents. The results indicated that greater neighbourhood seawater coverage and living near a coastline were associated with better general health among older adults in both private and public housing, while the percentage of freshwater blue spaces within neighbourhoods and the distance to freshwater blue spaces were associated with better general health among private housing residents only. The blue spaces-general health associations were stronger among urban participants, participants in deprived neighbourhoods, males, participants aged under 80 years, and low- and medium-educated participants. Our findings indicated that living near the coast was beneficial to older adults' health, and residential selection bias confounded the association between freshwater blue spaces and health.

Association of Residential Proximity to the Coast With Incident Myocardial Infarction: A Prospective Cohort Study

Background

Little is known about how the residential distance to the coast is associated with incident myocardial infarction (MI) and which mechanisms may explain the association. We aim to explore this association using data from a prospective, population-based cohort with unprecedented sample size, and broad geographical coverage.

Methods

In this study, 377,340 participants from the UK Biobank were included.

Results

It was shown that 4,059 MI occurred during a median 8.0 years follow-up. Using group (<1 km) as reference, group (20–50 km) was associated with a lower risk of MI (hazard ratio, HR 0.79, 95% CI 0.64–0.98) and a U-shaped relation between distance to the coast and MI was shown with the low-risk interval between 32 and 64 km (p_non−linear = 0.0012). Using participants of the intermediate region (32–64 km) as a reference, participants of the offshore region (<32 km) and inland region (>64 km) were both associated with a higher risk of incident MI (HR 1.12, 95% CI 1.04–1.21 and HR 1.09, 95% CI 1.01–1.18, respectively). HR for offshore region (<32 km) was larger in subgroup with low total physical activity (<24 h/week) (HR 1.24, 95% CI 1.09–1.42, p_interaction = 0.043). HR for inland region (>64 km) was larger in subgroup in urban area (HR 1.12, 95% CI 1.03–1.22, p_interaction = 0.065) and in subgroup of high nitrogen dioxide (NO₂) air pollution (HR 1.29, 95% CI 1.11–1.50, p_interaction = 0.021).

Conclusion

We found a U-shaped association between residential distance to the coast and incident MI, and the association was modified by physical activity, population density, and air pollution.

Urban Neighbourhood Environments, Cardiometabolic Health and Cognitive Function: A National Cross-Sectional Study of Middle-Aged and Older Adults in Australia

Population ageing and urbanisation are global phenomena that call for an understanding of the impacts of features of the urban environment on older adults' cognitive function. Because neighbourhood characteristics that can potentially have opposite effects on cognitive function are interdependent, they need to be considered in conjunction. Using data from an Australian national sample of 4141 adult urban dwellers, we examined the extent to which the associations of interrelated built and natural environment features and ambient air pollution with cognitive function are explained by cardiometabolic risk factors relevant to cognitive health. All examined environmental features were directly and/or indirectly related to cognitive function via other environmental features and/or cardiometabolic risk factors. Findings suggest that dense, interconnected urban environments with access to parks, blue spaces and low levels of air pollution may benefit cognitive health through cardiometabolic risk factors and other mechanisms not captured in this study. This study also highlights the need for a particularly fine-grained characterisation of the built environment in research on cognitive function, which would enable the differentiation of the positive effects of destination-rich neighbourhoods on cognition via participation in cognition-enhancing activities from the negative effects of air pollutants typically present in dense, destination-rich urban areas.

Perceived Impact of Outdoor Swimming on Health: Web-Based Survey

Background

Outdoor swimming in lakes, lidos (outdoor pools), rivers, and the sea has grown in popularity in many countries, including the United Kingdom. Many anecdotal accounts indicate improvements in medical conditions, which are considered a consequence of outdoor swimming.

Objective

The aim of this study is to better understand outdoor swimmers’ perceptions of their health and the extent to which participation impacted their existing self-reported symptoms.

Methods

A survey was conducted to investigate outdoor swimming behaviors and reports of any diagnosed medical conditions. Medical conditions were coded into categories, and descriptive statistics were generated regarding the outdoor swimmers’ behaviors and the effect that outdoor swimming had on their medical symptoms if any. The medical categories were clustered into five larger categories based on their prevalence in the current sample: mental health; musculoskeletal and injury; neurological; cardiovascular and blood disease; and other, which comprises inflammatory, immune, endocrine, and respiratory conditions.

Results

In total, 722 outdoor swimmers responded, of whom 498 (68.9%) were female. The probability of outdoor swimming having some positive impact on health across all medical categories was 3.57 times higher compared with no impact (B=1.28, 95% CI 0.63-1.91; P<.001), 44.32 times higher for the mental health category (B=3.79, 95% CI 2.28-5.30; P<.001), 5.25 times higher for musculoskeletal and injury category (B=1.66, 95% CI 0.52-2.79; P=.004), and 4.02 times higher for the other category (B=1.39, 95% CI 0.27-2.51; P=.02). Overall, outdoor swimming was associated with perceived reductions in symptoms of poor mental health (χ²₂=25.1; P<.001), musculoskeletal and injury (χ²₂=8.2; P=.04), cardiovascular and blood (χ²₂=14.7; P=.006), and other conditions (χ²₂=18.2; P<.001).

Conclusions

Physical activity in the form of outdoor swimming is perceived to have positive impacts on health and is associated with perceived symptom reductions in mental health, musculoskeletal and injury, and cardiovascular and blood conditions. This study cannot provide causal relationships or provide mechanistic insights. However, it does provide a starting point for more targeted prospective intervention research into individual conditions or categories of conditions to establish the impact in those who choose to start outdoor swimming.

Waterscapes for Promoting Mental Health in the General Population

The WHO estimates that, with the development of urbanization, 25% of the population is suffering from psychological and mental distress. Preliminary evidence has suggested that aquatic environments and riparian areas, i.e., waterscapes, can benefit psychological and mental wellbeing. The aim of this study was to identify the processes of waterscape psychological and mental health promotion through aliterature review. We propose a design framework of waterscapes for achieving psychological and mental health in the general population that often visits waterscapes, which has the function of therapeutic landscapes through values of accessibility, versatility, habitats, and biodiversity. According to theories, waterscapes can improve psychological and mental health to divert negative emotions through mitigation (e.g., reduced urban heat island), instoration (e.g., physical activity and state of nature connectedness), and restoration (e.g., reduced anxiety/attentional fatigue). By accessing water (e.g., streams, rivers, lakes, wetlands, and the coast) and riparian areas, people can get in close contact with nature and spend more time in activities (e.g., walking, exploring, talking, and relaxing). Waterscapes with healing effects can enhance psychological resilience to promote people's psychological and mental health. Future research should focus on ensuring an adequate supply of waterscapes and promoting the efficiency of waterscape ecosystem services on mental health. Moreover, fora deep understanding of the complexity of nature-human health associations, it is necessary to explore more consistent evidence for therapeutic waterscapes considering the characteristics and functional mechanisms of waterscape quality, in terms of freshness, luminescence, rippling or fluidity, and cultural value, to benefit public health and biodiversity conservation.

Factors Affecting Perceived Health Benefits and Use Behaviors in Urban Green Spaces During the COVID-19 Pandemic in Southern China Megacities

Background: The COVID-19 pandemic has alienated people from urban green spaces (UGSs) that have various health outcomes for humans. However, little is known about the influential factors of perceived health benefits and use behaviors in UGSs during the COVID-19 pandemic. This study aims to explore the key factors that influence perceived health benefits and use behaviors in UGSs and to assess the mediating role of place attachment in relationships during the COVID-19 pandemic in Chinese megacities. Methods: We conducted an online questionnaire survey from December 2020 to March 2021 in Guangzhou and Shenzhen, China. Six multiple regression models were constructed to investigate the main factors by which UGSs influence citizens' perceived health benefits and use behaviors. Four mediation models were established using the structural equation modeling (SEM) method to explore the mediating effect of place attachment. Results: A total of 628 questionnaires were included in the analysis. The results revealed that some UGS components (green space access, maintenance, and soundscape) significantly affected perceived health benefits for citizens (physical, mental, and social health) during the COVID-19 pandemic. Conversely, use behaviors (frequency of visits, duration of visits, and activity intensity) were mainly affected by the sociodemographic context but less affected by UGS components. In addition, UGS components were found to significantly predict place attachment, which in turn influenced the perceived health benefits, frequency, and duration of visits. Conclusions: This study distinguished the key factors that affect perceived health benefits and use behaviors during the COVID-19 pandemic: green space access, maintenance, soundscape, and sociodemographic characteristics. Place attachment still needs to be considered when discussing how to encourage citizens to visit UGSs during the pandemic. These findings provide implications for policymakers and landscape planners regarding design and management measures for UGSs that are conducive to coping with pandemics.

Finding the "Heart" in the Green: Conducting a Bibliometric Analysis to Emphasize the Need for Connecting Emotions with Biophilic Urban Planning

Although there is a robust body of literature exploring the relationship between biophilic urban planning (BUP) and public health and well-being, there is a dearth of scholarship on the emotional components of BUP. It is crucial to understand these sentiment-related elements, so planners can assign "human value" to green spaces as a strategy for emphasizing the need to thoughtfully implement and properly maintain them in urban environments. Furthermore, humans' emotional experiences with green spaces may also reveal hidden or unexpected functions of those spaces. To confirm this lack of emphasis on emotions in BUP, we used Scopus to conduct a bibliometric analysis on relevant literature published within the last twenty years (2001-2021), ultimately collecting 589 relevant peer-reviewed articles. We then utilized VOSviewer (Centre for Science and Technology Studies, Leiden University, The Netherlands) to visualize our results and identify thematic, geographic, authorship/co-authorship, publication, and temporal trends. "Green space" appeared as our most frequently occurring keyword and scholars affiliated with institutions located within the United States, the United Kingdom and China were the top producers of relevant results. Our authorship analysis resulted in 67 different clusters and three major but isolated networks. Urban Forestry and Urban Greening was the most prevalent source of publication and 2019-2021 was the most prolific period of activity to date. While the goal of our review is to underscore the dearth of controlled, interdisciplinary research on the emotional components of BUP, we also uncovered additional key gaps in scholarship that could promote future avenues of inquiry. First, by focusing on the emotional value of green spaces, practitioners can ascribe them an intangible "human value" that could, in turn, generate more community-focused designs that provide access across socioeconomic, racial and age brackets. Second, an increase in scholarly representation from developing countries could help address the "human value" of green spaces not simply as a "first-world" phenomenon. Finally, a global focus on the emotional, human connections to green spaces may help scholars and practitioners alike mitigate the growing trend of green gentrification.

Coastal exposure and residents' mental health in the affected areas by the 2011 Great East Japan Earthquake and Tsunami

No previous study has ever explored the association between coastal exposure and the mental health of residents in a post-disaster context. Therefore, we aimed to confirm whether there was an association between sea visibility and coastal proximity and the mental health of coastal residents a devastating tsunami. We targeted 15 coastal municipalities located in the Miyagi Prefecture, and obtained data from a community-based cohort study. The baseline survey was initiated 2 years after the 2011 Great East Japan Earthquake and Tsunami and the secondary survey was initiated 6 years after the disaster. We applied multilevel mixed-effects models to the longitudinal data. Our outcome measure was the Kessler Psychological Distress Scale (K6) score. We assessed the data collected from 2,327 respondents on both surveys as of April 2018 for this ongoing cohort study. We found that neither sea visibility nor coastal proximity was significantly associated with the recovery of mental health after the disaster. However, we found a distinctive trend of mental health recovery in people who lived alone with a sea view, indicating that visibility of the sea had a negative effect on their mental health immediately after the GEJET, but that the negative effect was subsequently eliminated.

A Qualitative Analysis of UK Wetland Visitor Centres as a Health Resource

The health benefits associated with spending time in natural environments have been highlighted during the COVID-19 pandemic. Lockdowns and restrictions to safeguard public health have exacerbated the pre-existing mental health crisis and rise of non-communicable diseases. Thus, the importance of nature as a health resource has been elevated, hastening calls for a better understanding of how health benefits might differ across user groups and nature provisions. In this regard, urban green spaces have become the greatest research focus; however, blue spaces, especially inland freshwater (e.g., wetlands), remain less studied. First-hand user experiences are also under-represented. This exploratory study examines the motivations and benefits of active wetland centre users in the UK, both during and after visits. Responses to three open-ended questions were collated online from 385 participants, and a qualitative content analysis was conducted based on an existing taxonomy from users of urban green spaces. The results showed strong motivations to visit due to the biodiversity at the site (mainly the birdlife), while less tangible nature (e.g., fresh air) and amenities were also important. In contrast to other studies on natural environments, physical activity was a less influential motivation. Salient derived effects included positive and intensely positive emotions, relaxation and mental restoration. After visits to wetland centres, feelings of vitality and satisfaction were the most prominent effects that emerged. For decision-makers looking to leverage inland blue spaces for public health benefit, our results highlight the broad range and relative prominence of the reasons for use and the associated perceived health benefits derived by users of UK wetland centres. They highlight how biodiversity, abiotic nature and good amenities are important qualities to consider when planning, managing and encouraging people to use natural environments for health benefit, qualities that may also provide important environmental co-benefits.

Is Living in a U.S. Coastal City Good for One's Health?

Background: Evidence suggests that living close to “blue spaces” (water features), particularly coastlines, has salutary effects on human health. Methods: We analyzed five years of annual, self-reported general health and unhealthy days data from the Behavioral Risk Factor Surveillance System of the U.S. Centers for Disease Control and Prevention for 165 urban areas across the contiguous U.S. We compared health self-reports for people living in coastal vs. non-coastal urban areas and for residents of the disaster-prone Gulf of Mexico region vs. other locations. Coastal urban areas were defined as those having ≥50% of their population living within 20 km of a coast. Results: We found no overall health advantage of residing in a coastal urban location when all urban areas were considered. However, residents from non-Gulf of Mexico coastal urban areas reported modestly better health than residents from non-coastal areas. In contrast, self-reported health of Gulf coastal urban residents was significantly poorer than that of residents from other urban areas. Conclusions: The frequency of disasters and history of health and socioeconomic disparities in the Gulf region may be responsible, at least in part, for the apparent lack of health promoting effects of coastal location there.

The urban public realm and adolescent mental health and wellbeing: A systematic review

Adolescent mental health is becoming a critical concern. Mental illness rates are rising and many psychological disorders first present symptoms during teenage years. Studies consistently show associations between the built environment and mental health, including internalising mental health disorders in adults, but the evidence for adolescents is less robust and few studies attempt to isolate causality. This review examines the relationship between the urban public realm and adolescent mental health and wellbeing. Our search yielded 24 studies for inclusion. We undertook qualitative synthesis of 20 cross-sectional studies and conducted a separate quality analysis of four longitudinal studies. Greenspace and neighbourhood quality are associated with adolescent mental health and wellbeing although this may be due more to residual confounding, selection effects and same-source bias than evidence for a causal effect. Furthermore, the few longitudinal studies that seek to test causality remain prone to these biases. Overall, we find little evidence of an effect of the urban public realm on adolescent mental health and wellbeing, which, we argue, reflects the difficulty of researching complex pathways between environments and health and highlights a challenge to the field. To address this challenge, we propose a research agenda that prioritises more and better data drawn from diverse study designs, and more and better theories developed from diverse epistemologies.

Does the perceived neighborhood environment promote mental health during pregnancy? Confirmation of a pathway through social cohesion in two Spanish samples

Physical neighborhood attributes such as greenness, walkability and environmental pollution may have an influence on people's behavior and health. It has been claimed that part of such effects may come from the promotion of physical activity and the strengthening of social cohesion. In this study, we recruited samples of pregnant women in two Spanish cities (Donostia-San Sebastián, 440 participants and Barcelona, 360 participants) who filled in a questionnaire and wore an accelerometer for 1 week during the first trimester of pregnancy. The influence of perceived residential greenness, walkability and environmental pollution on mental health (GHQ-12) was tested in two structural equation models that included light physical activity, moderate-to-vigorous physical activity and social cohesion as mediators. Two solutions showing excellent and good fits (Donostia-San Sebastián: X²(3) = 2.56, p = .465, CFI = 1, RMSEA < 0.001; Barcelona: X²(6) = 4.86, p = .566, CFI = 1, RMSEA = 0.048) consistently showed that neighborhood attributes promote mental health through social cohesion in the two cities. Stratified analyses revealed that the social cohesion-mental health effect was only statistically significant for low and medium socioeconomic status groups in the Donostia-San Sebastián sample. Pathways through physical activity were not confirmed.

The value of blue-space recreation and perceived water quality across Europe: A contingent behaviour study

This study estimates the value of recreational visits to blue-space sites across 14 EU Member States, representing 78% of the Union's population. Across all countries surveyed, respondents made an average of 47 blue-space visits per person per year. Employing travel cost and contingent behaviour methods, the value of a visit is estimated at €41.32 which adds up to a recreational value of €631bn per year for the total adult population surveyed. Using the Bathing Water Directive's water quality designation, the analysis shows that a one-level improvement in water quality leads to 3.13 more visits (+6.67%), whereas a one-level deterioration leads to 9.77 fewer annual visits (-20.83%). This study provides valuations of benefits of recreation and changes of recreational values due to changes in surface water quality, which can be compared to the implementation and monitoring costs of efforts under the EU's Bathing Water, Water Framework and Marine Strategy Framework Directives.

Does greenery experienced indoors and outdoors provide an escape and support mental health during the COVID-19 quarantine?

BACKGROUND

The COVID-19 pandemic has profoundly changed people's ability to recreate in public green spaces, which is likely to exacerbate the psychological impacts of the pandemic. In the current study, we seek to understand whether greenery can support mental health even with insufficient outdoor exposure in times of physical isolation from the outdoor environment.

METHODS

Between 17 May and 10 June, 2020, we conducted an online survey among 323 students (21.99 ± 3.10 years; 31% male) in health-related programs from two universities in the city of Plovdiv, Bulgaria. Severities of depressive and anxiety symptoms over the past two weeks were measured with the Patient Health Questionnaire 9-item and the Generalized Anxiety Disorder 7-item scale. We employed two self-reported measures of greenery experienced indoors (number of houseplants in the home and proportion of exterior greenery visible from inside the home) and two measures of greenery experienced outdoors (presence/absence of a domestic garden and availability of neighborhood greenery). Restorative quality of the home (the "being away" dimension of the Perceived Restorativeness Scale; PRS) and the neighborhood (the "being away" and "fascination" dimensions of the PRS), engagement with outdoor greenery (frequency of different types of interaction) and perceived social support were treated as mediators. Associations between greenery and mental health were tested using generalized linear regression and logistic regression. Structural equation modelling (SEM) techniques were used to test the theoretically-indicated relations among the variables.

RESULTS

Clinically-meaningful symptoms of moderate depression and anxiety were reported by approximately 33% and 20% of the students, respectively. The relative abundance of greenery visible from the home or in the neighborhood was associated with reduced depressive/anxiety symptoms and lower depression/anxiety rates. Having more houseplants or a garden was also associated with some of these markers of mental health. As hypothesized, the mental health-supportive effects of indoor greenery were largely explained by increased feelings of being away while at home. Neighborhood greenery contributed to neighborhood restorative quality, which in turn facilitated social support and more frequent engagement with greenery, and that led to better mental health.

CONCLUSIONS

Students who spent most of their time at home during the COVID-19 epidemic experienced better mental health when exposed to more greenery. Our findings support the idea that exposure to greenery may be a valuable resource during social isolation in the home. However, causal interpretation of these associations is not straightforward.

Types of coastlines and the evacuees' mental health: A repeated cross-sectional study in Northeast Japan

Although the health risks and benefits of coastal areas have long been researched, these effects of the different types of coastlines have rarely been explored on the evacuees living near the coast, in a post-disaster context. Thus, this study aimed to explore, with the passing of years after a disaster, what kind of coastline is a useful public health resource as a post-disaster reconstruction approach in coastal environments that have suffered significantly from the tsunami disaster in northeast Japan in 2011. This study compared the evacuees' mental health based on proximity to the coast and the types of coastlines (artificial, semi-natural, and natural). Data were drawn from the Miyagi Prefectural Government surveys, which targeted almost all evacuees of the 2011 Great East Japan Earthquakes and Tsunami (n = 96,203). We applied a pooled Poisson regression model to a repeated cross-sectional dataset of evacuees' mental health between 2012 and 2016. Moderate psychological distress, measured via the Kessler Psychological Distress Scale (K6) score, was the dependent variable, while proximity to the coast and type of coastline were the independent variables. The estimated main effects of type of coastline indicated that overall associations between K6 ≥5 and all types of coastlines within a 1.6 km buffer of participants' residential space were not statistically significant (p > 0.05). However, among types of coastlines, the interaction terms of semi-natural coastline × year (2015 and 2016) were significantly associated with lower incidence rate ratios (IRR), which decreased in 2015 and 2016 (IRR: 0.88, 95%CI: 0.79-0.98; IRR: 0.78, 95%CI: 0.68-0.90, respectively). Further, we computed the marginal effects of coastline types for each year to observe differences in the impact on moderate psychological distress depending on different accessible coastline types within a distance of 1.6 km from the participants' living space. We found that, after the revision of the coastal act in 2014, the moderate mental stress of participants who lived around semi-natural coastlines significantly tended to be low (dy/dx: -0.04, 95%CI: -0.08-0.01 in 2015; dy/dx: -0.07, 95%CI: -0.11-0.04 in 2016). This finding can encourage policymakers to manage coastal areas with green infrastructure in the post-disaster reconstruction sustainably.

A qualitative investigation into the perceived therapeutic benefits and barriers of a surf therapy intervention for youth mental health

OBJECTIVE

This study aims to investigate potential therapeutic pathways and barriers to participation in a surf therapy program for youth at risk of mental health problems from the perspective of participants, surf mentors and program coordinator.

METHOD

Nineteen individuals, consisting of youth (n = 9, 5 male, 4 female, M = 12.8, SD = 2.6), mentors (n = 9, male 5, female 4, M = 37.60, SD = 13.62) and the Ocean Mind program coordinator (n = 1, male, age 26 years), participated in semi-structured focus groups or follow-up interviews. This qualitative study analysed data using inductive thematic analysis.

RESULTS

Six themes were identified in total, with self-efficacy, interpersonal skills and forming a mentorship being potential therapeutic pathways of the surf therapy intervention. Surf instruction techniques and family engagement were both identified as potential barriers that negatively affect participant engagement. Additionally, the natural environment was identified as both a potential therapeutic pathway and a barrier.

CONCLUSION

Surf therapy interventions appears to hold a number of benefits for youth mental health via pathways relating to the promotion of mental health protective factors.