Exploring pathways linking greenspace to health: Theoretical and methodological guidance

The association between greenspace exposure and sperm quality: A retrospective cohort study focusing on sperm kinematics and the influence of buffer settings

BACKGROUND

While previous studies have suggested a potential link between greenspace and semen quality, the effect of greenspace exposure on sperm kinematics, as well as the impact of greenspace estimation scales, remains underexplored.

OBJECTIVES

This study aimed to examine the association between greenspace exposure and sperm kinematics, and to determine whether this relationship varies across different greenspace estimation scales.

METHODS

We conducted a retrospective longitudinal study of 5025 semen measurements from 1674 sperm donors recruited by the Sichuan Provincial Human Sperm Bank (SHSB) between June 2019 and December 2021. Greenspace exposure was estimated using the Normalized Difference Vegetation Index (NDVI) for four buffer zones (250 m, 500 m, 1,000 m, and 2000 m) centred on the geocoded residential addresses. Linear mixed-effects models and restricted cubic spline models (knots = 4) were used to assess the associations between greenspace exposure and both conventional semen parameters and sperm kinematic parameters across all buffer zones.

RESULTS

A non-linear association between NDVI-500m and progressive motility was observed for conventional semen parameters (P non-linear = 0.018). For sperm kinematics, NDVI-500m could be associated with multiple kinematic measures (VCL: % change = 1.81, 95% CI: 0.72, 2.91; VAP: % change = 2.57, 95% CI: 1.46, 3.70; VSL: % change = 3.37, 95% CI: 2.11, 4.66; LIN: % change = 1.51, 95% CI: 0.82, 2.21; STR: % change = 0.83, 95% CI: 0.44, 1.23; WOB: % change = 0.69, 95% CI: 0.35, 1.04; BCF: % change = 1.82, 95% CI: 0.97, 2.68), and significant non-linear associations were found between NDVI-500m and LIN (P non-linear = 0.011), STR (P non-linear = 0.015), WOB (P non-linear = 0.012), and ALH (P non-linear <0.001). Regarding the impact of greenspace estimation scales, smaller buffer zones exhibited stronger non-linear relationships for conventional semen parameters, whereas larger buffer zones revealed more pronounced non-linear relationships for sperm kinematics. There was a stable and significant linear association between greenspace exposure and sperm kinematics during the 70-90 days before ejaculation (spermatocytogenesis). PM2.5 and PM10 attenuated the negative effect of greenspace exposure on IM at a buffer scale of 250 m, while enhanced the positive effect of greenspace on kinematics at all scales.

CONCLUSIONS

Greenspace exposure were significantly associated with sperm kinematics, with the strength and nature of these associations varying by buffer scale. 70-90 days before ejaculation (spermatocytogenesis) was the window of susceptibility for greenspace exposures at all buffer scales. As PM2.5 and PM10 increased, increasing levels of greenspace can improve sperm kinematics more significantly. These findings support the beneficial effect of greenspace on male fertility, and underscore the importance of considering greenspace buffer zones in urban planning to optimize health benefits effectively.

Unique associations among multiple facets of greenspace exposure and emotional and behavioral adjustment in preadolescence: A daily diary study

Research has shown that the frequency, duration, and intensity of greenspace exposure are significantly associated with children's adjustment. However, most studies have examined these facets separately. There is a lack of research that integrates them to offer a more comprehensive understanding of their unique associations with adjustment. This study investigates the unique associations between various facets of greenspace exposure and children's emotional (happiness and emotional problems) and behavioral (helping behavior and direct aggression) adjustment at both the daily and individual levels. The sample included 509 children (235 boys; Mage = 10.58 years, SD = 0.85 years) who completed a 14 days diary on greenspace exposure and adjustment. Multilevel analyses revealed that greenspace exposure (versus nonexposure) was associated with adjustment, and the various facets showed unique associations with adjustment. Specifically, on days when children were exposed to greenspace with more attributes than usual, they reported greater same-day happiness and fewer emotional problems. Compared with children who were exposed to greenspace with fewer attributes, children who were exposed to greenspace with more attributes on average presented greater happiness and more helping behaviors. With respect to duration, on days when children spent more time in greenspace than usual, they reported greater same-day happiness and more helping behaviors. However, frequency was not significantly associated with adjustment at either level. Our findings underscore the importance of enhancing the attributes of greenspace in the construction of child-friendly cities. Practitioners may consider increasing the number of opportunities for children to be exposed to greenspace with rich attributes in greenspace-based intervention programs.

Epigenome-wide association study of pregnancy exposure to green space and placental DNA methylation

Green space exposure during pregnancy has been associated with lower risk of adverse birth outcomes, but the biological mechanisms remain unclear. Epigenetic changes, such as DNA methylation (DNAm), may contribute to this association. The placenta, crucial for foetal development, has been understudied in relation to prenatal green space exposure and DNAm on a genome-wide scale. Here, we aimed to investigate the association between green space exposure during pregnancy and epigenome-wide placental DNAm in 550 mother-child pairs from the Barcelona Life Study Cohort (BiSC) in Spain. Green space exposure was assessed as (i) residential surrounding greenness (satellite-based Normalized Difference Vegetation Index (NDVI) in buffers of 100 m, 300 m and 500 m), (ii) residential distance to the nearest major green space (meters), (iii) use of green space (hours/week), and (iv) visual access to greenery through the home window (≥half of the view). Placental DNAm was measured with the EPIC array. Differentially methylated positions (DMPs) were identified using robust linear regression models adjusted for covariates, while differentially methylated regions (DMRs) were identified using the dmrff method. After Bonferroni correction, cg14852540, annotated to SLC25A10 gene, showed an inverse association with residential greenness within 500 m buffer. Additionally, 101 DMPs were suggestively significant (p-values <1 × 10-5) and annotated to genes involved in glucocorticoid-related pathways, inflammatory response, oxidative stress response, and oocyte maturation. No DMRs were identified. Overall, we identified an association between residential greenness and DNAm levels at one CpG in the SLC25A10 gene. Larger studies are needed to validate these findings and understand the biological pathways.

Adverse associations of pre-pregnancy exposure to PM2.5 and its components with fetal growth alleviated by residential greenness: a prospective cohort study

Maternal exposure to fine particulate matter (PM2.5) and residential greenness both influence fetal growth. No previous studies have examined their sex-specific and interaction effects. We aim to evaluate the sex-specific effects in these associations and exposure interactions. This study involved 1,275 mother-child pairs enrolled in the Ma'anshan birth cohort in China. Pre-pregnancy exposure to PM2.5 and its components was assessed using a spatiotemporal model based on maternal addresses, while residential greenness was estimated through the normalized difference vegetation index (NDVI) based on satellite data. Fetal parameters-including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW)-were measured during pregnancy via ultrasound. To examine associations between these exposures and both continuous and categorical outcomes, generalized estimating equations (GEE) and generalized linear regression were applied. Subgroup analyses were conducted to evaluate sex-specific effects. Pre-pregnancy exposure to PM2.5, OM, BC, SO42-, NH4+, and NO3- was correlated with decreased Z-scores of fetal parameters (BPD, FL, EFW, AC) during the second trimester, particularly in male fetuses. In the third trimester, we found that the Z-scores of AC (0.081, 95% CI: 0.001, 0.160) and EFW (0.097, 95% CI: 0.008, 0.185) increased with each interquartile range (IQR) increase in residential greenness. We observed the effect modification of PM2.5 and its components on the relationship between residential greenness and fetal growth in utero. Residential greenness can mitigate the adverse effects of PM2.5 and its components prior to pregnancy on fetal growth. Our findings suggest that increased residential greenness during pregnancy preparation may help alleviate air pollution's detrimental effects on fetal growth.

Urban greenness for the protection of adverse effects of noise on human health: A PRISMA systematic review

BACKGROUND

The interaction between urban noise and human health is a critical area of research, with evidence suggesting a negative impact on chronic conditions such as obesity, diabetes, and cardiovascular diseases. However, the potential mitigating role of urban green spaces on noise perception and its effects remains underexplored.

OBJECTIVE

This systematic review aims to evaluate the role of urban green spaces in reducing noise exposure and its health effects, providing an updated overview of the existing literature.

METHODS

A systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42023467385). Three scientific databases (PubMed, Scopus, Web of Science) were searched for studies published between January 2000 and January 2025. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Risk of Bias 2 (RoB 2) tool for experimental studies.

RESULTS

Out of 11,435 initially identified articles, 15 studies met the inclusion criteria. The evidence suggests that green spaces can help reduce noise-related distress, improve quality of life, and lower the risk of diseases associated with chronic stress.

CONCLUSIONS

While there are indications of the positive role of urban greenery in mitigating noise and its health effects, the quality of evidence remains variable. Future research should adopt more standardized methodologies for measuring noise exposure and health outcomes, as well as better control for confounding factors. These insights are essential for guiding urban planning policies and improving quality of life in cities.

Long-term exposure to residential greenness and cardiovascular disease and all-cause mortality in China

BACKGROUND

Influence of residential greenness on CVD risk has garnered increasing attention, however, evidence from large-scale cohort studies in developing nations, such as China, remains sparse. This study aimed to evaluate the association of residential greenness with CVD and mortality, and explore the potential mediating role of modifiable risk factors in the associations.

METHODS

A total of 22,702 participants aged 35 years and above were enrolled between October 2012 and December 2015. Residential greenness was assessed using Normalized Difference Vegetation Index (NDVI) within radii of 300 m, 500 m, and 1000 m from participants' residential address (NDVI300 m, NDVI500 m, and NDVI1000 m). Primary outcomes comprised CVD events and all-cause mortality, with follow-up from 2018 to 2019. Multivariable Cox regression models were employed to estimate hazard ratios (HRs), and causal mediation analysis was conducted to assess the role of modifiable risk factors in the observed associations.

RESULTS

Residential greenness demonstrated a significant association with the risk of CVD, with HRs per tertile increment of 0.84 (95% confidential interval [CI]: 0.77-0.92) for NDVI300 m, 0.86 (95% CI: 0.79-0.94) for NDVI500 m, and 0.90 (95% CI: 0.82-0.98) for NDVI1000 m, separately. Compared to areas with the lowest NDVI500 m, the HR for CVD incidence in areas with medium and high NDVI500 m were 0.89 (95% CI: 0.76-1.06), and 0.74 (95% CI: 0.62-0.89), respectively. Utilizing a newly proposed two-stage regression method in mediation analysis, approximately 16.18%, 5.34%, 4.04%, and 2.45% of the total effect of NDVI500 m on CVD risk were mediated by high-density lipoprotein cholesterol, physical activity, body mass index, and diabetes mellitus, respectively.

CONCLUSION

This study provides compelling evidence that higher residential greenness is associated with a reduced risk of CVD among the adult Chinese population, with specific modifiable risk factors playing a mediating role. These findings underscore the significance of incorporating green space interventions into CVD prevention strategies.

Is local air pollution concentration a moderator or mediator of the association between residential greenspace and pediatric asthma exacerbations? A longitudinal study of pediatric patients in Philadelphia, Pennsylvania

BACKGROUND

Despite mixed evidence supporting the link between greenspace and asthma exacerbations, several studies suggest a negative association. The mechanisms underlying this relationship are unclear, with air pollution concentrations potentially playing a key role. This study investigated whether air pollution concentrations modify or mediate the relationship between residential greenspace and pediatric asthma exacerbations.

METHODS

Data were drawn from a pediatric asthma cohort at Children's Hospital of Philadelphia (2011-2016), including children aged <18 years. Participants were followed from their initial visit until their first asthma exacerbation. Greenspace (tree canopy, grass/shrub cover) near homes was assessed. Daily air pollution data, including PM2.5, ozone, NO2, and SO2, were obtained from the US Environmental Protection Agency. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated, adjusting for individual and neighborhood characteristics. Effect modification by air pollution concentrations was tested, and causal mediation analyses were conducted.

RESULTS

On days with high SO2 concentrations, children living near the highest quartile of tree canopy coverage had a 14% lower incidence of asthma exacerbations compared to those in the lowest quartile (HR = 0.86, 95% CI = 0.74, 0.98). Conversely, on days with low SO2 concentrations, tree canopy coverage was associated with a nonsignificant 12% higher incidence (HR = 1.12, 95% CI = 0.97, 1.28). Similar patterns were observed for NO2, but no interactions were found for PM2.5 or ozone. Mediation analyses indicated no significant mediation by air pollution.

CONCLUSION

In urban areas with high SO2 or NO2 levels, greenspace near homes may support children with asthma by mitigating air pollution's impact, suggesting greenspace-based urban strategies.

Residential greenness exposure and repeatedly measured hyperglycemic markers in women with gestational diabetes mellitus: A birth cohort study in Foshan, China

OBJECTIVES

To investigate the association between residential greenness exposure and repeatedly measured hemoglobin A1c (HbA1c) levels during pregnancy in women with gestational diabetes mellitus (GDM).

STUDY DESIGN

This was a cohort study.

METHODS

This study was conducted in Foshan City, Southern China from January 1, 2016 to August 31, 2022. Women with GDM who had two HbA1c measurements during their pregnancy were included in the analysis. Residential greenness was assessed using the satellite-derived Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) in different buffer areas. Multivariable linear regression models were used to investigate the associations between residential greenness exposure and glycemic levels during middle and late pregnancy. Linear mixed-effect models were used to analyze the association between greenness exposure and repeatedly measured glycemic levels.

RESULTS

Among 5,814 pregnant women with GDM, the mean HbA1c levels were 5.04 (±0.54) % and 5.39 (±0.57) % in middle and late pregnancy, respectively. Greenness exposure before and throughout pregnancy was associated with decreased HbA1c levels from middle to late pregnancy. In the adjusted models, each 0.1 increase in NDVI and EVI value was associated with a 0.01 % (95 % confidence interval [CI]: -0.02 %, -0.01 %) to 0.03 % (95 % CI: -0.04 %, -0.01 %) decrease in HbA1c levels during middle and late pregnancy. Similar findings were observed in a longitudinal analysis of the associations between greenness exposure and HbA1c levels.

CONCLUSIONS

Greater residential greenness exposure was associated with lower HbA1c levels from middle to late pregnancy in women with GDM.

Association of greenness exposure with serum vitamin D status and effects of ambient particulate matter among pregnant women in early pregnancy

Adequate vitamin D is essential for the health of both the mother and fetus, and it can be influenced by environmental factors. However, research on the associations between greenness exposure and vitamin D concentrations during pregnancy is limited. This retrospective birth cohort study, conducted from 2014 to 2018, assessed the greenness of residences using the satellite-derived normalised difference vegetation index (NDVI). Serum 25-hydroxyvitamin D [25(OH)D] concentrations were categorised as non-deficient (≥50 nmol/L) or deficient (<50 nmol/L). Multiple log-binomial regression models were used to estimate the association of NDVI with serum 25(OH)D concentrations and vitamin D deficiency (VDD). Subgroup and mediation analyses were conducted to estimate the association of ambient particulate matter (PM) on the association between NDVI and VDD. A total of 64,663 pregnant women with a mean maternal age of 30.6 (standard deviation: 3.86) years were included. 250-m NDVI was negatively associated with the risk of VDD (per 0.1-unit increase, relative risk [RR]: 0.98, 95 % CI: 0.97-0.99). With the highest quartile of NDVI exposure as the reference group, the upper-middle quartile (RR: 1.02, 95 % CI: 1.00-1.03), and lowest quartile (RR: 1.03, 95 % CI: 1.01-1.06) had an increased risk of VDD. At higher PM2.5 exposure concentrations, 250-m NDVI exposure was negatively associated with the risk of VDD (RR: 0.98, 95 %CI: 0.97-0.99, per 0.1-unit increase), but not at lower PM2.5 exposure concentrations. Among pregnant women with higher PM2.5, the mediation of PM2.5 exposure on the association between 250-m NDVI and VDD was 44.70 % (P = 0.0116). Among pregnant women with higher PM10 exposure, the mediation of PM10 exposure on the association between 250-m NDVI and VDD was 17.98 % (P = 0.002). These findings suggest that higher residential greenery significantly reduces the risk of VDD in pregnant women, particularly in those exposed to increased PM concentrations.

Effects of residential greenness during pregnancy on childhood asthma, rhinitis, eczema, and their comorbidity: findings from the French mother-child cohort Pélagie

Maternal exposure to residential greenness during pregnancy may influence childhood respiratory and allergic diseases development. Yet, evidence is limited and results are not consistent, furthermore most studies focus on urban areas. In a predominantly rural population, we aimed to assess the effect of maternal residential greenness during pregnancy on childhood asthma, rhinitis, eczema, and their comorbidity. We analyzed data from 1325 to 1119 participants in the 6- and 12-year follow-ups of the Pélagie mother-child cohort in Brittany, France. Ever asthma, rhinitis, and eczema were defined using validated questionnaires, and a multimorbidity phenotype was constructed. Greenness was assessed using the Normalized Difference Vegetation Index (NDVI) within a 300m buffer around the residential address. Adjusted logistic regressions per 0.1-unit increase in NDVI were performed, further stratifying by urban and rural areas. At inclusion, 78 % of mothers were non-smokers, 64 % lived in rural areas, and their average age was 30 ± 4 years; 50 % of children were boys. Median NDVI differed significantly between urban (0.45) and rural (0.57) areas (p=<0.0001). Asthma, rhinitis, and eczema prevalence were respectively around 10 %, 20 %, and 20 % at both follow-ups. Overall, the NDVI within 300m did not show significant associations at either follow-up, across the whole study population, except for eczema (0.87 (0.76-1.00), p=0.05), and the single-disease category of the multimorbidity phenotype (0.87, (0.76-0.99), p=0.03) at 6 years, where it showed protective associations. Our findings highlight the need for further research, particularly in rural populations, to clarify the relationship between prenatal residential greenness and childhood health outcomes.

Mental wellbeing and aging in place: The role of the built environment in promoting healthy aging

We analyze the built environment and its impacts on senior citizens' mental wellbeing. Through "Go-Along" method, 50 walking interviews were made to analyze the emotional experiences of elderly individuals in relation to the built environment. Results indicate that a highly walkable environment with local shops can generate a greater connection with the community, increasing individual tranquility and trust in public space. Natural elements like well-maintained gardens, consistent trees on sidewalks, varied tree leaf colors, and lush grass on streets positively influence seniors' mental wellbeing. These findings are crucial for urban design, offering valuable guidance to create inclusive environments that support healthy aging.

Residential greenspace and lung function throughout childhood and adolescence in five European birth cohorts. A CADSET initiative

Whether greenspace affects lung function is unclear. We explored associations between the level of greenness or presence of urban green space near the home with lung function measures taken repeatedly during childhood and adolescence in five European birth cohorts. Lung function was measured by spirometry between six and 22 years (2-3 times), and 9,206 participants from BAMSE (Sweden), GINI/LISA South and GINI/LISA North (Germany), PIAMA (The Netherlands) and INMA (Spain) contributed at least one lung function measurement. The mean Normalized Difference Vegetation Index (NDVI) in a 300 m buffer and presence of urban green space within a 300 m buffer (yes/no) were estimated at the home address at the time of each spirometry measurement. Cohort-specific associations were assessed using adjusted linear mixed models and combined in a random-effects meta-analysis. Residential greenness was not associated with forced expiratory volume in one second (FEV1), forced vital capacity (FVC) or FEV1/FVC in the meta-analysis (2.3 ml [-3.2, 7.9], 6.2 ml [-3.4, 15.7] and -0.1 [-0.3, 0.1] per 0.1 increase in NDVI, respectively), nor was having a nearby urban green space (-8.6 ml [-22.3, 5.0], -7.6 ml [-24.7, 9.4] and 0.0 [-0.4, 0.3], respectively). Heterogeneity was low to moderate (I2 = 0 -39 %). Asthma, atopy, air pollution, sex, socioeconomic status and urbanization did not modify the null associations. Using repeated data from five large independent European birth cohorts, we did not find associations between vegetation levels around the home or the presence of an urban green space and lung function levels during childhood and adolescence.

Inequalities in residential green space and trajectory of cardiometabolic multimorbidity: Different associations by sex and socioeconomic status

Residential green space has the potential to benefit cardiometabolic health. However, little is known about its impacts on cardiometabolic multimorbidity (CMM). Furthermore, the capacity of access to green space to reduce health inequalities during the development of CMM is unclear, and longitudinal evidence is urgently needed. Hence, a large prospective study based on the UK Biobank was conducted. CMM was defined as the coexistence of at least two conditions including type 2 diabetes, ischemic heart disease, and stroke. Multi-state models were used to assess the impacts of green space on the transitions of CMM, from free of cardiometabolic disease to first cardiometabolic disease (FCMD), subsequently to CMM, and finally death. This study included 328,260 participants with a median follow-up of 12.5 years. The benefits of access to green space were observed for transitions from baseline to FCMD, from baseline to death, and from FCMD to death, with HRs of 0.975 (95 % CI: 0.959, 0.991), 0.956 (95 % CI: 0.931, 0.982) and 0.943 (95 % CI: 0.897, 0.990) per IQR increase in the percentage of green space, respectively. Although access to green space benefited early transitions related to FCMD, its protective role was not found in the progression from FCMD to CMM and finally death. Furthermore, access to green space was associated with a reduction in health inequalities influenced by sex and socioeconomic status in the earliest transition from healthy to FCMD. Future policies should prioritize green space investments to sustainably enhance cardiometabolic health and improve health inequalities.

Analysis of the characteristics of university common spaces that affect university students' psychological restoration

Common spaces in universities are crucial for the psychological well-being of university students, as they serve as spaces for their daily activities. This study aimed to discuss the factors and pathways that influence the characteristics of common spaces in universities with respect to the psychological restoration of university students. We selected 11 universities in Guangzhou, China for the survey: SCUT Wushan Campus, SCNU Shipai Campus, JNU Shipai Campus, SYSU South Campus, SCNU University Town Campus, GDUFS South Campus, SCUT University Town Campus, GDUT University Town Campus, GZHU University Town Campus, GZIC(SCUT) and HKUST(GZ), all of which are located in the Tianhe, Haizhu, Panyu and Nansha districts of Guangzhou. A questionnaire survey was conducted among 662 university students from the above 11 universities and 630 valid questionnaires were ultimately collected. Structural equation modelling (SEM) was employed to verify the hypotheses and assess the net effects of the variables, and fuzzy set qualitative comparative analysis (fsQCA) was used to explore the configurational patterns of high-level psychologically restorative effects. The results of the empirical research indicated the following: (1) the characteristics of the architectural scale and aesthetics, landscape richness, availability of rest facilities and compatibility of activity facilities within the university common spaces had a significant and direct effect on the psychological restoration of university students; (2) the three behavioural patterns of contact with nature, physical activity, and social interaction had a significant mediating role between the characteristics of university common spaces and psychological restoration of university students; (3) the fsQCA results revealed that four distinct patterns-integrated patterns of environment and facilities, static rest patterns, dynamic exercise patterns and interaction-driven patterns-each facilitated high levels of psychological restoration. These findings elucidate the mechanisms by which common space characteristics affect university students' psychological restoration and offer valuable insights into campus design.

Residential Greenness Is Associated with Lower Thyroid Nodule Prevalence: A Nationwide Study in China

Background: The prevalence of thyroid nodules is increasing globally. This study explored the association between residential greenness and thyroid nodule prevalence. Methods: Data were collected from a national cross-sectional survey of 73,728 participants across 31 provinces in mainland China. Residential greenness was assessed with the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Thyroid nodules >10 mm in diameter were diagnosed via ultrasound. We used quartile comparisons of the NDVI and EVI to compare nodule prevalence and employed logistic regression and restricted cubic spline analyses to examine nodules' associations with greenness. Interaction and sensitivity analyses were performed to test robustness. Results: A total of 73,728 participants were included in this study. The prevalence of 10 mm thyroid nodules decreased across NDVI500 quartiles: Q1: 7.99% (7.59-8.39%), Q2: 10.04% (9.60-10.48%), Q3: 6.59% (6.23-6.95%), and Q4: 5.20% (4.88-5.52%) (p for trend <0.001). The prevalence was 5.25% (95% confidence interval [CI]: 5.02-5.49%) in males and 9.09% (CI: 8.80-9.39%) in females. Logistic regression analysis showed that greater residential greenness was associated with a lower prevalence of thyroid nodules after adjusting for all covariates. This association was observed for both continuous greenness measures (NDVI500: odds ratio [OR] = 0.20, CI: 0.16-0.25; EVI500: OR = 0.08, CI: 0.06-0.12) and across quartiles (NDVI500 Q4: OR = 0.53, CI: 0.48-0.58; EVI500 Q4: OR = 0.55, CI: 0.51-0.60; both compared to Q1). Multiple sensitivity analyses confirmed this negative association, including the use of an alternative thyroid nodule definition (5 mm threshold), exclusion of individuals with cysts on ultrasound, and subgroup analyses excluding individuals with autoimmune thyroid antibody positivity, goiter, or both. In all these sensitivity analyses, NDVI and EVI data were assessed using both 500 m and 1000 m buffers. Conclusion: Our study is the first to identify an association between higher levels of residential greenness and a lower prevalence of thyroid nodules.

Residents' perceptions of urban densification and health - a systems dynamics approach

BACKGROUND

Little is known about residents' perceptions of urban densification and its impact on health. A participatory systems dynamics approach can help to understand residents' perspective on the complex system of interacting factors underlying urban densification and health.

METHODS

We organised group model building sessions with three groups of residents that are living in Katendrecht, a highly densifying neighbourhood in the city of Rotterdam. The groups differed by length of residence (0-5, 10-15, and > 15 years). During the sessions, in which in total 25 residents participated, factors that influence health in the context of urban densification were identified and connected in causal loop diagrams. Also, possible actions to favourably adapt the system were discussed.

RESULTS

According to the participants, densification of Katendrecht increased its attractiveness but negatively affected local social cohesion, the availability and diversity of facilities, and the accessibility of the area. The participants also did not feel sufficiently involved by local authorities in the development of the neighbourhood and argued that densification affects their mental health by increasing levels of stress and loneliness and decreasing enjoyment in living. The residents mainly mentioned actions that increase social cohesion and residential involvement in the neighbourhood's development to maintain or improve their health in the context of densification.

CONCLUSION

This study illustrated the system underlying densification and residential health as a complex interaction between social and physical factors at the individual and neighbourhood level. Taking the perspective of residents into account can help to optimize future policies and urban densification plans in such a way that they do not harm and possibly even benefit residents' health.

Outdoor recreation's association with mental health and well-being during the COVID-19 pandemic

Outdoor recreation provided a crucial way to maintain physical activity, reduce stress, and preserve a sense of normalcy during the COVID-19 pandemic. This study assessed the relationship between outdoor recreation and mental health in the context of COVID-19. Cross-sectional online survey data were collected in early 2021 from a sample (n = 503) representative of the U.S. adult population in age, gender, and race. We observed prevalent engagement in near-home outdoor activities, widespread reductions in outdoor engagement relative to the pre-COVID period, and significant age, financial, and racial differences in engagement patterns. Regression models suggested that reduced outdoor recreation was associated with higher levels of perceived stress and depressive symptoms, whereas more frequent outdoor activities predicted better well-being. The health implications of adaptive engagement versus cumulative exposure during times of significant disruptions are discussed, along with the need to address structural inequities in accessing outdoor recreation as a health behavior.

Association Between Residential Greenness and Risk of Stroke by Ecoregions: The REGARDS Study

BACKGROUND

Living in areas with more greenness has been associated with beneficial health outcomes. However, few studies have examined associations of greenness with incidence of stroke, and it is unclear how these associations may vary with the type of vegetation and surrounding ecology. This study evaluated associations between greenness and incidence of stroke by the major ecological regions in the United States.

METHODS AND RESULTS

We assessed the incidence of stroke in 27 369 participants from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, a prospective cohort recruited across the contiguous United States. Greenness was estimated by the normalized difference vegetation index and enhanced vegetation index (EVI) at multiple buffers around home addresses. Participants were assigned to ecoregions using their baseline residence. We estimated the association between residential greenness and incidence of stroke using covariate-adjusted Cox proportional hazards models. Models were stratified by ecoregions to assess how associations varied by areas with unique vegetation and ecology. We observed 1581 incident cases of stroke during the study period. In the full study population, there was suggestive evidence of a protective association between greenness and stroke incidence (hazard ratio [HR], 0.989 [95% CI, 0.946-1.033]) for a 0.1 increase in normalized difference vegetation index within 250 m. Similar results were obtained using enhanced vegetation index and larger radii. In our analysis by ecoregions, we found greenness was associated with lower stroke risk in the Eastern Temperate Forests region (HR, 0.946 [95% CI, 0.898-0.997]), but higher risk in the Great Plains (HR, 1.442 [95% CI, 1.124-1.849]) and Mediterranean California regions (HR, 1.327 [95% CI, 1.058-1.664]).

CONCLUSIONS

Vegetation may lower the risk of stroke; however, benefits may be limited to certain contexts of the natural environment.

Residential environment and risk of chronic diseases: A prospective study

The impact of green-blue spaces on human health remains inconclusive, and the current understanding of disease spectrum associated with these spaces is still incomplete. We aimed to comprehensively investigate the relationship between residential environment and chronic diseases, while also examining the potential mediating role of air pollutants in these relationships. Using data from the UK Biobank, we created a residential environment score (RES) based on four types of green-blue spaces: natural environment, green space, domestic garden, and water area, with scores assigned according to the percentage of each space within a 300 m buffer. We also calculated an air pollution score derived from concentrations of NO2, NOx, PM2.5, PM2.5-10, and PM10. Employing logistic regression and Cox regression models, we analyzed the associations between RES and multisystem health outcomes among 502,490 participants at baseline. Our assessment identified 41 chronic diseases across 12 categories significantly related to RES increases (false-discovery-rate adjusted P-values < 0.01). Cox regression indicated that higher RES was associated with reduced risks for 18 diseases, excluding melanoma and bladder cancer. For the 21 unreported outcomes such as iron deficiency anemia and purpura, we observed hazard ratios (95 %CI) indicating lower risks for various conditions in the highest quartile of RES compared to the lowest. Furthermore, air pollution significantly mediated the relationship between RES and over 90 % of these chronic diseases. Residential environment with abundant green-blue spaces is linked to lower risks of most chronic diseases, which is partially mediated by diminished air pollutants and largely underestimated.

The modifying role of residential greenness on the association between heat waves and adverse birth outcomes: Results from the ELEFANT project

BACKGROUND

The impact of heat waves on perinatal outcomes has become a focus of attention. However, the association between heat waves and preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA) remains controversial. Furthermore, whether residential greenness can mitigate the adverse effects of heat waves on birth outcomes still unclear.

METHODS

This study employed a retrospective cohort design based on data from the ELEFANT project, conducted in Tianjin, China, spanning from 2011 to 2019. We assessed heat waves exposure by creating 12 definitions of extreme heat with varying relative temperatures (90th, 95th, 97.5th and 99th percentiles) and durations (at least 2, 3, or 4 consecutive days). Residential greenness levels were evaluated using the MODIS Normalized Difference Vegetation Index (NDVI). Cox proportional hazards regression models were fitted to estimate the risks of PTB, LBW, SGA and LGA in relation to heatwaves exposure and the multiplicative and additive interactions of heat waves and greenness on adverse birth outcomes across different pregnancy periods, including pre-pregnancy.

RESULTS

Our findings indicate that heatwaves significantly increase the risks of PTB by 2.4%-15.6%, LBW by 7.6%-18 %, SGA by 3.6%-88.4%, and LGA by 2%-3.4%. The lack of residential greenness exhibited a synergistic interaction with heatwaves on PTB, SGA and LGA (RERI >0), especially during milder heat events during entire pregnancy. For LBW, interactions between greenness and heatwaves were limited. Furthermore, we identified that heatwave was significantly associated with high risk of adverse birth outcomes among mothers living in rural areas.

CONCLUSIONS

Prioritizing greenspace can help mitigate the effects of heatwaves, offering a viable and cost-effective approach to protecting maternal and fetal health.

The importance of nature and wishes for nature-based experiences among older adults in assisted living facilities

Nature-based interventions potentially support physical, mental, and social health. Understanding the needs of the target group is essential when developing such methods as part-of-care. This cross-sectional mixed method survey explores the wishes for nature-based experiences among older adults in assisted living facilities, 854 respondents were included. Diagnoses were confirmed from medical records, while functioning, wellbeing and the meaning of nature were inquired. Respondents' average age was 83 years; 73% were women, and 54% had dementia. Only 24% could move about outdoors independently, 55% suffered from loneliness, and 45% felt depressed at least sometimes. In thematic analyses, open-ended answers highlighted the multifaceted meaning of nature. Nature is a valued source of resilience and a place for physical activity. Although 96% considered nature important, only 51% could have nature contact as often as desired. Respondents provided clear, feasible wishes for activities and 83% were interested in participating in nature-based interventions.

Restoring nature, enhancing active mobility: The role of street greenery in the EU's 2024 restoration law

This article argues for the importance of integrating a mobility perspective into urban greenspace planning and practice related to the 2024 EU Nature Restoration Law. Street greenery can play an important multifunctional role in promoting ecosystem services and functions, sustainable mobility, and human health and well-being. However, planners need more evidence on how street vegetation affects health and well-being during everyday active mobility, as well as what type, where and for whom to enhance vegetation. We discuss current advancements and gaps in literature related to these topics, and identify key research priorities to support restoration policy and practice. These include: moving beyond dominant scientific thinking of being in place to moving through space in understanding greenery exposure and experience; use of multiple exposure metrics with attention to temporal dynamics; integration of objective and subjective assessments; and investigating further the role of street greenery in reducing environmental injustices.

Beyond visits: Investigating the restorative pathways and cumulative effects of park engagement and sustained exposure on psychological well-being with park type as a moderator

Urban green spaces have increasingly been recognized for their role in promoting residents' health and well-being. This study explores how visitors' park usage and perceptions of park restorativeness influence restorative experiences and the potential cumulative health benefits of sustained exposure. It integrates both single and sustained exposure through structural equation modeling (SEM) to examine the complex relationships between park engagement, perceived restorativeness, restoration outcomes, and psychological health and well-being (PWB). The study was conducted across four park types-comprehensive, community, specialized, and pocket parks-within the main urban area of Nanjing, with a sample size of 1562. The results indicate that park engagement has a significant total effect (β = 0.332) on PWB, while perceived restorativeness contributes a smaller but meaningful total effect (β = 0.134). The mediating effects of restoration experience and sustained exposure were also significant. Furthermore, multi-group analysis (MGA) revealed the significant moderating effect of park type. In comparison to other park types, comprehensive parks had the strongest influence of perceived restorativeness on PWB, while specialized parks showed a stronger effect of park engagement on health outcomes. This study uncovers the potential mechanisms through which urban green spaces influence PWB, highlights the varying roles that different park types play in promoting mental health outcomes, and offers insights for green space planning and design aimed at enhancing public well-being, while providing empirical evidence to guide visitors' park engagement.

Associations of prenatal exposure to residential greenspace and active living environments with cerebral palsy: A population-based cohort study in Ontario, Canada

Background

Prenatal exposure to environmental factors, such as greenspace and active living environments, has been associated with numerous health benefits, including improved neurodevelopmental outcomes. Although cerebral palsy (CP) is not typically linked to these exposures, emerging evidence suggests that exposure to environmental factors during pregnancy may influence brain development, making it important to explore their potential role in CP risk.

Methods

We conducted a retrospective cohort study using health administrative data from Ontario, Canada, between 1 April 2002 and 31 December 2020. We identified 1,436,411 mother-infant pairs, of which 2,883 were diagnosed with CP during the follow-up period. Exposures of interest included the Normalized Difference Vegetation Index (NDVI), Green View Index (GVI), and park proximity. The Canadian Active Living Environments index was also utilized. Cox proportional hazards models estimated hazard ratios (HRs) for CP risk associated with these environmental exposures, adjusting for potential confounders.

Results

Interquartile range (IQR) increases in NDVI (HR = 1.040; 95% confidence interval [CI]: 0.987, 1.096; per IQR = 0.1) and GVI (HR =0.989; 95% CI: 0.943, 1.038; per IQR = 10.05%) were not significantly associated with CP risk. Similar results were found for quartile increases of NDVI and GVI. Residential proximity to parks at birth was associated with a reduction in CP risk (HR = 0.946; 95% CI: 0.904, 0.990; per 0.06 increase in park proximity index), after adjusting for active living environment and air pollution.

Conclusions

Our study suggests that living closer to parks reduces the risk of CP. Further research should investigate these protective effects and consider other dimensions of greenspace quality and usability.

Factors associated with clinical antimicrobial resistance in China: a nationwide analysis

BACKGROUND

Antimicrobial resistance (AMR) represents a critical global health threat, necessitating the identification of factors that contribute to its emergence and proliferation. We used a "One Health" perspective to evaluate the association of human and veterinary antibiotic usage, environmental factors, socio-economic factors, and health care factors with clinical AMR in China.

METHODS

We analyzed data from 31 provincial-level administrative divisions in China, encompassing 20,762,383 bacterial isolates sourced from the China Antimicrobial Resistance Surveillance System dataset between 2014 and 2022. A β regression model was used to explore the relationship of AMR with multiple variables. We also estimated the contribution of factors associated with AMR, and evaluated the avoidable risk of AMR under six different measures during 2019 according to available guidelines.

RESULTS

AMR had positive associations with human antibiotic usage, veterinary antibiotic usage, particulate matter smaller than 2.5 µm (PM2.5) level, population density, gross domestic product per capita, and length of hospital stay, and a 1 unit increase in the level of above independent variables were associated with a percentage change in the aggregate AMR of 1.8% (95% CI: 1.1, 2.5), 2.0% (95% CI: 0.6, 3.4), 0.9% (95% CI: 0.4, 1.4), 0.02% (95% CI: 0.01, 0.03), 0.5% (95% CI: 0.1, 0.8), and 8.0% (95% CI: 1.2, 15.3), respectively. AMR had negative associations with city water popularity, city greenery area per capita, and health expenditure per capita, and a 1 unit increase in the level of above independent variables were associated with a percentage change in the aggregate AMR of -4.2% (95% CI: -6.4, -1.9), -0.4% (95% CI: -0.8, -0.07), and -0.02% (95% CI: -0.04, -0.01), respectively. PM2.5 might be a major influencing factor of AMR, accounting for 13.7% of variation in aggregate AMR. During 2019, there was estimated 5.1% aggregate AMR could be attributed to PM2.5, corresponding to 25.7 thousand premature deaths, 691.8 thousand years of life lost, and 63.9 billion Chinese yuan in the whole country. Human antibiotic usage halved, veterinary antibiotic usage halved, city water popularity improved, city greenery area improved, and comprehensive measures could decrease nationwide aggregate AMR by 8.5, 0.5, 1.3, 4.4, and 17.2%, respectively.

CONCLUSIONS

The study highlights the complex and multi-dimensional nature of AMR in China and finds PM2.5 as a possible major influencing factor. Despite improvements in decreasing AMR, future initiatives should consider integrated strategies to control PM2.5 and other factors simultaneously to decrease AMR.

Neighborhood Characteristics and Mental Health From Childhood to Adolescence

Importance

The relationship of neighborhood environmental and socioeconomic factors with mental health across childhood and adolescence remains unclear.

Objective

To investigate the associations of neighborhood characteristics with mental health at various developmental stages, from early childhood to late adolescence.

Design, Setting, and Participants

This population-based cohort study used data from the Millennium Cohort Study, including approximately 19 000 children born in the UK from 2000 to 2002. This analysis included individuals in England with complete data on neighborhood exposures at ages 3, 5, 7, 11, 14, and 17 years. Data were analyzed from January to December 2023.

Exposures

Neighborhood-level air pollution, green space, and socioeconomic status.

Main Outcomes and Measures

Strengths and Difficulties Questionnaire (SDQ) scores linked with exposure to air pollution, green space, and socioeconomic status, measured at participants' residential addresses, were analyzed using a hierarchical bayesian regression model. Hypotheses were formulated after data collection.

Results

The sample included 3595 children and adolescents, with 1826 (50.5%) female; 3012 participants (83.8%) were White and 583 participants (16.2%) were another ethnicity. The mean (SD) SDQ score was 7.1 (5.1). After adjusting for individual and household factors, neighborhood socioeconomic status emerged as the strongest factor associated with mental health. Residing in affluent neighborhoods was associated with improved mental health, with this association magnifying through adolescence. For children of the same age, those in the most affluent neighborhoods had log-transformed SDQ scores 0.73 (95% credible interval [CrI], 0.58 to 0.88) lower at age 17 years compared with their peers in the most deprived areas; at age 5 years, scores were 0.31 (95% CrI, 0.17 to 0.45) lower. Exposure to particulate matter with diameter less than 2.5 μm was associated with poorer mental health during early childhood (age 3 years), with an effect size of 0.15 (95% CrI, 0.08 to 0.22). While green space was not directly associated with improved mental health, a sex-based difference was observed, with males showing more favorable associations (interaction, -0.10 [95% CrI, -0.17 to -0.03]).

Conclusions and Relevance

In this cohort study of children and adolescents, associations between neighborhood characteristics and mental health evolved from childhood through adolescence. These findings suggest that targeted interventions in disadvantaged neighborhoods and strategies to protect young children from air pollution are essential. A comprehensive approach is recommended to incorporate air pollution, green space, and socioeconomic status not only in residential neighborhoods but also in other settings, such as schools.

A health impact assessment of progress towards urban nature targets in the 96 C40 cities

BACKGROUND

Urban greenspaces (eg, parks and trees) and blue spaces (eg, rivers and coasts) improve climate regulation and human health. In 2021, the mayors of 31 cities in the C40 Climate Leadership Group set 2030 targets for the percentage of urban greenspace and population with nearby natural (green or blue) space. We quantified annual all-cause mortality reductions from progress towards these targets for C40's 96 member cities.

METHODS

We conducted a quantitative health impact assessment, testing three illustrative scenarios to increase urban greenspace: uniformly across space, in areas with the least nature, and in the most populated areas. We converted one percentage point progress towards each target in terms of the Normalized Difference Vegetation Index (NDVI) using previously published associations. We used mortality rate estimates from The Global Burden of Diseases, Injuries, and Risk Factors Study, population data from WorldPop, and a pooled hazard ratio of NDVI and all-cause mortality from an epidemiological meta-analysis.

FINDINGS

Uniformly increasing greenspace by 1% yielded an estimated 96-city median of 1·77 (range 0·65-3·52, IQR 1·46-2·19) fewer annual premature deaths per 100 000 population; increasing the population percentage with nearby natural space yielded an estimated median of 0·56 (range 0·11-1·70, IQR 0·44-0·69) fewer annual premature deaths per 100 000 population. On average, compared with uniform increases, adding greenspace in the least natural areas provided 1·4-1·7 times (depending on the target) the health benefits, and adding greenspace in the most populated areas provided 2·7 times the health benefits.

INTERPRETATION

The geographical distribution of greenspace expansion influences the magnitude of associated health benefits across varied urban contexts. Health benefits are largest when greenspace is added near population centres.

FUNDING

Wellcome Trust, NASA, and The George Washington University.

Residential greenness, air pollution, genetic predisposition and the risk of lung cancer

BACKGROUND

Growing evidence suggests that greenness is associated with multiple health outcomes, but its association with lung cancer risk remains limited and far from consistent. In particular, it is unclear whether this association varies across different types of lung cancer and whether it is influenced by factors such as genetics, air pollution, and physical activity.

METHOD

This prospective cohort study included 425108 participants aged 37-73 years from the UK Biobank. Residential greenness was estimated with the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI) within the 500 m buffer. Cox proportional hazards regression was performed to evaluate the hazard ratios (HR) and 95 % confidence intervals (CI) of the relationship between greenness and risk of lung cancer. A genetic risk was calculated using 18 independent susceptibility loci for lung cancer. Mediation analysis was conducted to assess the indirect effects through air pollutants (including PM2.5, PM10, NO2, NOx) and physical activity.

RESULTS

During a median follow-up of 14.0 years, 3814 lung cancer cases identified. An inversely linear correlation between residential greenness and incident lung cancer was found. Specifically, each interquartile range increase in NDVI and EVI within the 500 m buffer was linked to 8 % (HR 0.92, 95 % CI: 0.88, 0.96) and 9 % (HR 0.91, 95 % CI: 0.87, 0.94) decreased in lung cancer risk, respectively. Moreover, the association was particularly pronounced for adenocarcinoma (HR 0.88, 95 % CI: 0.83, 0.94 for NDVI; HR 0.87, 95 % CI: 0.82, 0.92 for EVI). Mediation analysis suggested that reductions in PM2.5 exposure and increased physical activity accounted for approximately 45 % and 1.5 % of the observed association.

CONCLUSION

Increased residential greenness was linearly associated with reduced risk of lung cancer, particularly adenocarcinoma, and such an association may be substantially mediated by mitigating air pollutants, especially PM2.5 and increased physical activity. The study provides promising evidence and strategy of improving greenness during urbanization to reduce the risk of lung adenocarcinoma in the context of the grimmer trend of rapidly increasing risk of adenocarcinoma.

Urban greenspace under a changing climate: Benefit or harm for allergies and respiratory health?

An increasing proportion of the world's population lives in urban settings that have limited greenspace. Urbanization puts pressure on existing greenspace and reduces its access. Climate impacts, including increased temperature and extreme weather events, challenge the maintenance of urban vegetation, reducing its ecosystem services and benefits for human health. Although urban greenspace has been positively associated with numerous health indicators, the evidence for allergies and respiratory health is much less clear and mixed. To address these uncertainties, a workshop with 20 global participants was held in Munich, Germany, in May 2024, focusing on the impact of greenspace-related co-exposures on allergies and respiratory health. This narrative review captures key insights from the workshop, including the roles of urban greenspace in (1) climate change mitigation, (2) interactions with pollen, and (3) emissions of biogenic volatile organic compounds and their byproducts, such as ozone. Additionally, it presents research and stakeholder recommendations from the workshop. Future studies that integrate advanced greenspace exposure assessments and consider the interplay of greenspace with pollen and biogenic volatile organic compounds, along with their relevant byproducts are needed. Increased public awareness and policy actions will also be essential for developing urban greenspace that maximizes health benefits, minimizes risks, and ensures resilience amid a changing climate and rapid urbanization.

Greenspace and depression incidence in the US-based nationwide Nurses' Health Study II: A deep learning analysis of street-view imagery

BACKGROUND

Greenspace exposure is associated with lower depression risk. However, most studies have measured greenspace exposure using satellite-based vegetation indices, leading to potential exposure misclassification and limited policy relevance. We examined the association of street-view greenspace measures with incident depression in a prospective cohort of US women.

METHODS

We applied deep learning segmentation models to 350 million US street-view images nationwide (2007-2020) to derive ground-level greenspace metrics, including percentage of trees, grass, and other greenspace (plants/flowers/fields), and linked metrics to Nurses' Health Study II participants' residences (N = 33,490) within 500 m each year. Cox proportional hazards models estimated the relationship between street-view greenspace metrics and incident depression, assessed through self-report of clinician-diagnosed depression or regular antidepressant use and adjusted for individual- and area-level factors.

FINDINGS

In adjusted models, higher percentages of street-view trees were inversely associated with incident depression (HR per IQR, 0.98; 95%CI: 0.94-1.01) and specifically clinician-diagnosed depression (HR per IQR, 0.94; 95%CI: 0.90-0.99). Higher percentages of street-view grass were also inversely associated with incident depression, but only in areas with low particulate matter (PM2.5) levels (HR per IQR, 0.79; 95%CI: 0.71-0.86). Results were consistent after adjusting for additional spatial and behavioral factors, and persisted after adjusting for traditional satellite-based vegetation indices.

CONCLUSION AND RELEVANCE

We observed participants who lived in areas with more trees visible in street-view images had a lower risk of depression. Our findings suggest tree-planting interventions may reduce depression risk.

Residential exposure to green and blue spaces over childhood and cardiometabolic health outcomes: The generation XXI birth cohort

Evidence on the effects of green and blue spaces on childhood cardiometabolic health is inconsistent and mostly cross-sectional. We assessed the associations of green and blue spaces exposure at birth 4, 7, and 10 years (to identify vulnerable periods of exposure) and as longitudinal trajectories (to identify the longitudinal effect over time) with cardiometabolic outcomes at 10 years. Among 4669 participants from a population-based birth cohort, we assessed the residential normalized difference vegetation index (NDVI) and distance to urban green and blue spaces at each time point using geographic information systems and standardized by dividing the observed value by the standard deviation. Longitudinal exposure trajectories were derived using latent class mixed models. At 10 years, we measured body mass index, fat mass index, android-to-gynoid fat ratio, blood pressure, and metabolic outcomes. We defined overweight/obesity (World Health Organization), high blood pressure (American Academy of Pediatrics), and metabolic syndrome (IDEFICS). No significant associations were observed between natural spaces exposure and adiposity outcomes. We found an inverse association between distance to nearest blue space at birth and systolic blood pressure z-scores, and a positive association between distance to nearest green space at 7 and 10 years and metabolic syndrome score (p < 0.05). Children in the descending NDVI500m trajectory, compared to those in the high stable trajectory, showed lower diastolic blood pressure z-scores and metabolic syndrome scores (p < 0.05). However, after multiple testing corrections, all associations lost statistical significance. This study did not find robust associations between natural spaces during key developmental periods and cardiometabolic health.

Association of residential green space with risk of sarcopenia and the role of air pollution: Evidence from UK Biobank

This study aims to explore the association between residential green space exposure and sarcopenia, and the role of air pollutants in the association. This study utilized data from the UK Biobank. Residential green space and natural environment were assessed by the percentage of land covered by greenness within 300 m and 1000 m buffers. Logistic regression models were used to explore the associations of green space and natural environment with possible sarcopenia and sarcopenia. We explored the mediating role of air pollution mixtures in the above associations. Interactions between green space and air pollution were assessed on the multiplicative and the additive scales. A total of 430790 participants were included in this study, and 23637 (5.5%) possible sarcopenia and 769 (0.2%) sarcopenia cases were identified. Each 10% increment of green space and natural environment coverage was associated with lower risks of possible sarcopenia (odds ratio (OR): 0.968, 95% confidence interval (CI): 0.961, 0.976 in green space; OR: 0.968, 95%CI: 0.962, 0.975 in natural environment) and sarcopenia (OR: 0.958, 95%CI: 0.920, 0.999 in green space; OR: 0.961, 95%CI: 0.926, 0.998 in natural environment). Population-attributable fraction analyses revealed that lower green space and natural environment levels could attribute to 8.8% and 8.5% of possible sarcopenia, 17.0% and 15.4% of sarcopenia. The associations of green space and natural environment with possible sarcopenia status could be partially explained by reducing air pollution. We also identified a significant multiplicative interaction between air pollution mixtures and green space on possible sarcopenia. In summary, higher green space and natural environment levels were associated with lower risks of possible sarcopenia and sarcopenia. Both modification and mediation roles of air pollution were found in the association between green space and possible sarcopenia. Therefore, expanding green space and reducing air pollution are crucial strategies for mitigating the risk of sarcopenia and promoting healthy aging.

Lower risk of atrial fibrillation associated with visible greenness within community life circle: Findings from a population-based study

Existing studies have found the health implications of greenness on cardiovascular health, but largely focus on greenspace rather than visible greenness. We aimed to investigate the relationship between visible greenness within the community life circle and atrial fibrillation (AF). Our study included 11,539 permanent residents from a large prospective cohort in a megacity of southern China from 2015 to 2017. We generated 15-minute walking isochrone for each study participant as the community life circle and combined it with green view index (GVI) to estimate corresponding exposure to residential greenness. GVI was calculated utilizing street view images and a fully convolutional neural network tailored for evaluating urban environments. We combined logistic regression model and a doubly-robust approach to explore the relationship between GVI and AF. Mediation analyses were used to assess the mediating role of air pollution, body mass index (BMI) and exercise time on the relationship between GVI and AF. We found that each IQR increase in GVI exposure was associated with a 22.6 % (95 % CI: 8.7 %, 34.1 %) reduction in the risk of AF. The mediation effect of PM1 on the relationship between GVI and AF was also identified. Higher visible greenness exposure within community life circle was associated with reduced risk of AF among urban residents. Visible greenness within urban community areas should be emphasized as a solution to promote cardiovascular health.

Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: The Life-GAP project

BACKGROUND

Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive.

OBJECTIVE

We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study.

METHODS

We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990-2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes.

RESULTS

The analysis included 1675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00-1.35; 2000: RR 1.24, 95% CI: 0.98-1.57; 1990-2000: RR 1.17, 95% CI: 0.97-1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00-2.01; 2000: RR 2.20, 95% CI: 1.43-3.38; 1990-2000: RR 1.44, 95% CI: 1.04-2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows.

CONCLUSION

Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.

A study on the relationship between internet popularity and emotional perception of urban parks using Weibo data in Luoyang, China

The role of Internet Popularity (INPY) in shaping public perception of urban parks is increasingly significant. Although existing studies have explored the impact of parks on public perception, they primarily focus on traditional environmental indicators (such as NDVI and GVI), overlooking the potential influence of INPY generated on social media on public emotions. This study aims to fill this gap by analyzing 41,675 social media data from Luoyang, China, quantifying emotional perception(ETPN), and using Multi-task and Hierarchical Linear regression models to explore the relationship between INPY, public perception, and urban parks. The results show: (1) INPY has varying degrees of positive influence on the Emotional Gradients (ETGD) from negative to positive, with the impact intensity increasing from low to high; (2) A 200-meter GVI is negatively correlated with negative emotions, whereas 500-meter and 1000-meter NDVI scales positively affect positive emotions; (3) Seasons affect emotional expression, particularly positive emotions. The study highlights that INPY mainly impacts positive emotions, while GVI and NDVI help mitigate negative emotions and enhance overall ETPN. These results provide urban planners with a new perspective on understanding the value of urban parks and offer scientific support for urban space optimization and policy-making.

Night running and night cycling: a review of sociological drivers, health benefits, and their interaction with urban green spaces

This study investigates the rising trends, sociological drivers, health benefits, and the interaction of night running and night cycling with urban green spaces. Findings indicate that night running and night cycling are mainly driven by increased health awareness, changes in work patterns, social media promotion, and urban economic development. Physiologically, night running and cycling enhance cardiovascular function, alleviate stress, and improve sleep. However, air pollution, inadequate infrastructure, and safety concerns limit the sustainability of these activities. Urban green spaces play a crucial role in promoting nocturnal exercise, with improvements in lighting, safety, and recreational areas due to the growing demand for night fitness. Governments are encouraged to enhance infrastructure and optimize green space planning to foster healthier urban environments.

The restorative effects of working individually in a vegetated office space: A crossover controlled experimental study in real-life workplace setting

BackgroundExamining the restorative effects of indoor nature exposure that can be controlled through management and design in work settings is crucial for public health. However, concerns about the external validity of existing findings persist due to insufficiency of studies with ecologically sound experimental designs.ObjectiveThrough an experiment that prioritized higher ecological validity, this study aimed to explore the effects of working in an office room vegetated with green plants on employees' physiological and psychological well-being, and their attentional performance.MethodsThis controlled experimental study employed a crossover design in real-life work environments, involving 40 working individuals. It assessed changes in perceived fatigue, psychological and physiological stress, and attentional performance after individual work in either a vegetated or plant-free office room, with other environmental factors kept constant.ResultsAfter an hour of individual work in a vegetated room, participants reported decreased perceived stress and fatigue, supported by changes in measures of systolic blood pressure and heart rates when compared to a plant-free room. Gender differences emerged, with females experiencing greater relief in perceived stress and males showing more noticeable reductions in stress-related physiological indicators. Enhanced attentional reactions were noted solely among males.ConclusionsThis study accentuated the immediate emotional well-being benefits of indoor plants at work, highlighting the importance of considering diverse user groups in indoor workspace design. It also proposes potential explanations for how indoor plants induce restorative effects on working individuals, suggesting further research.

Associations of green and blue space and the natural environment with suicidal ideation: The role of psychiatric disorders

BACKGROUND

Previous research has demonstrated the importance of environmental factors and exposure to the natural environment for human physical and mental health. However, the associations between green space, blue space, and the natural environment (GBN) and the risk of suicidal ideation have not been prospectively studied, and the potential role of psychiatric disorders in these associations has not been explored.

METHODS

Longitudinal data from the UK Biobank was used. At study baseline (2006-2010), 135,901 participants (female: 56.6%; mean age 56.05 ± 7.73 years) were included. A series of binary logistic regression models were used to examine the independent, joint, and interactive associations of GBN and psychiatric disorders with suicidal ideation.

RESULTS

Compared with the first quartile (lowest) of exposure, the natural environment at 300 m buffer [Q2, OR = 0.899, 95% CI: 0.835-0.968; Q3, OR = 0.897, 95% CI: 0.831-0.968] and blue space at 1000 m buffer [Q3, OR = 0.920, 95% CI: 0.853-0.993] were significantly associated with lower risk of suicidal ideation. Green space (the fourth quartile) and the natural environment (the fourth quartile) at 1000 m buffer had 14.5% and 15.2% decreased risk of suicidal ideation, respectively. The lowest risk of suicidal ideation was observed among participants with high levels of GBN and no psychiatric disorders, which may be attributed to significant multiplicative and synergistic interactions.

CONCLUSIONS

Our findings emphasized the significant benefits of GBN exposure in reducing the risk of suicidal ideation, especially in groups with psychiatric disorders. Future research is necessary to conduct to explore potential mechanisms.

Perceived biodiversity of public greenspace and mental well-being

Biodiversity is known to promote the mental well-being of urban residents. However, few studies have examined the perceived and empirically measured biodiversity and their potential pathways related to mental health. This study constructed a composite biodiversity index (bio index) using multiple NDVI metrics through Principal Component Analysis (PCA) and validated its effectiveness through a validation experiment. Relying on a survey in two major cities in China (N = 5,895), this study explored how perceived and empirically measured biodiversity are associate with mental well-being (CESD-10 score) through people's perceived psychological restoration, physiological restoration, and satisfaction with greenspace. Pathway analyses were conducted using PLS-SEM to examine the complex interplay of these variables. The results showed that perceived biodiversity was significantly and positively associated with mental health, potentially mediated by perceived psychological restoration, physiological restoration, and satisfaction with greenspace. The total effect of perceived biodiversity on mental health was stronger in Shanghai than in Beijing, with specific mechanisms differing regionally. Empirically measured biodiversity showed an insignificant relationship with mental health. Our finding recommends the importance of integrating perceived biodiversity into urban greening practice to promote mental well-being.

The association between living environment and out-of-hospital cardiac arrest risk in adults: the perspective of daily-life contexts

BACKGROUND

Studying the spatial pattern of out-of-hospital cardiac arrest (OHCA) and its environmental impactors is crucial for both providing timely medical assistance and implementing preventative measures. Existing researches have mainly focused on natural and sociodemographic environments, usually at a macro- or meso-scale, while giving less attention to understanding the association between environment and OHCA risk from the perspective of daily-life contexts.

METHODS

In this study, we utilized 1843 eligible OHCA cases from core districts of Beijing in 2020 and employed modified Besag-York-Mollié (BYM2) Bayesian models to investigate the association between living environment (consisting of food environment, physical activity environment, healthcare environment and leisure environment) and adult OHCA risk, as well as its age disparities, at a 1 × 1 km2 cell resolution.

RESULTS

The results show that: (1) Fewer living environment factors are associated with the OHCA risk in the young/middle-aged group compared to the elderly group. (2) Unhealthy food destination like barbecue restaurants in living area is associated with increased OHCA risk in both age groups. (3) Facility inducing sedentary activity like chess rooms and healthcare facilities are associated with increased OHCA risk, but only among the elderly groups. (4) The decreased OHCA risk in the young/middle-aged group is related to public gathering places for socialization and relaxation in living area like coffee shops, while for the elder groups, decreased OHCA risk is associated with more green spaces in the living area.

CONCLUSIONS

The findings suggest that living environment may impact adult OHCA risk through shaping daily habits or providing access to health resources, with the underlying mechanism varying across different age groups. Future planning should fully consider and leverage the impact of living environment in order to effectively reduce OHCA risk.

Nature's impact on human health and wellbeing: the scale matters

Contact with nature can have a significant influence on human physical and mental health and wellbeing. As such, various concepts and theories as well as therapeutic approaches have been developed. The term "nature," however, covers a broad range of size and scales, ranging from individuals or small groups of animals or plants, certain ecosystems toward landscapes. The purpose of this paper is to differentiate concepts, theories, and therapy forms according to the scales of nature. We base our conceptional approach on the biological/ecological scales of species/individuals, ecosystems/land-use types, and landscapes. Based on a review, we differentiate the current state of the utilization of greenspace exposure measurements and measures assessing mental health according to these scales. We argue that a clear differentiation of biological and ecological scales provides a better understanding of the impact of nature with its components, characteristics, and dynamics on human health and wellbeing. Our paper also supports further inter- and transdisciplinary research as well as methodological approaches with regard to environment and health, such as environmental public health.

Assessing the restorative effects of campus greeness on student depression: a comparative study across three distinct university campus type in Macau

This study addresses the growing mental health challenges among university students, with a particular focus on depression, by examining the role of campus greenness in mitigating its effects. In contrast to the majority of studies that concentrate on campus environments in Western countries, this research uniquely investigates how variations in campus density and form within the Chinese context influence the role of campus greenness in mitigating depression among university students. By analyzing three distinct types of university campuses in Macau, the study also reflects on the broader implications for campuses across China. A comprehensive model is then employed to assess the effects of perceived greenness, frequency of use, and ease of access on depression, identifying both mediation and moderation effects through the application of PLS-SEM. The results demonstrate that perceived greenness exerts the most significant influence in high-density campuses, while frequency of use and convenience of access play a greater role in larger, lower-density campuses. Mediation analysis shows that perceived greenness partially mediates the relationship between green space usage and depression, particularly in smaller, high-density campuses. Additionally, moderation analysis indicates that frequency of use amplifies the restorative effects of higher perceived greenness, especially in medium and large campuses. These findings advance current theories in environmental psychology and campus planning by underscoring the contextual intricacies of green space benefits. The outcomes are expected to inform future campus design and urban planning, emphasizing the importance of green spaces in fostering environments that support student well-being.

Association of residential greenness and sleep duration in adults: A prospective cohort study in China

BACKGROUND

Exposure to residential greenness has been linked with improved sleep duration; however, longitudinal evidence is limited, and the potential mediating effect of ambient fine particulate matter (PM2.5) has yet to be assessed.

METHODS

We obtained data for 19,567 participants across seven counties in a prospective cohort in Ningbo, China. Greenness was estimated using Normalized Difference Vegetation Index (NDVI) within 250-m, 500-m and 1000-m buffer zones, while yearly average PM2.5 concentrations were measured using validated land-use regression models, both based on individual residential addresses. Sleep duration was assessed using structured questionnaires at baseline and during follow-up. The longitudinal associations between residential greenness and sleep duration were evaluated using linear mixed-effect models. Adjustments for PM2.5 and county were implemented. To identify the effect of greenness exposure on age-related declines in sleep duration, we included an interaction term between NDVI and visit (baseline and follow-up). Additionally, half-longitudinal mediation analyses were conducted to evaluate the potential mediating role of PM2.5 in this relationship.

RESULTS

Each interquartile range (IQR) increase in NDVI within 250 m, 500 m and 1000 m was associated with increases in sleep duration of 0.044 h (95% CI: 0.028,0.061), 0.045 h (95% CI: 0.028,0.062), and 0.031 h (95% CI: 0.013,0.049), respectively. Associations were attenuated after adjusting for PM2.5. Farmers, homemakers, and short-nap individuals benefited the most from greenness exposure. Higher greenness exposure significantly lowered PM2.5 levels, which was associated with a slower decline in sleep duration over the follow-up period.

CONCLUSION

Exposure to higher levels of residential greenness was associated with increased sleep duration and a slower decline in sleep over time. County-level heterogeneity in the effects of residential greenness on sleep duration was observed. PM2.5 partially mediating this relationship.

Children-specific environmental protection strategies are needed in China

China, home to over 250 million children, has witnessed remarkable economic development in recent decades, successfully addressing many issues related to basic hygiene and sanitation in children, thereby altering the childhood disease spectrum. However, the emergence of environment-related disorders among children has become a significant concern. Despite the rapid accumulation of scientific knowledge on the adverse effects of environmental pollution on child health, the availability of children-specific protective strategies and actions remains alarmingly low. This commentary synthesizes the information and viewpoints presented and discussed by experts at the International Forum on Children's Environmental Health in China. It summarizes the strategies and actions proposed to reduce adverse environmental exposure and protect children's short- and long-term health and a call for more children-centered evidence-action transformation. The following four specific actions were proposed: (1) strengthen health education in parents, caregivers, and children, and personal protection for children; (2) monitor child exposure and environment-related health status; (3) set up child-specific interventions and regulations; and (4) conduct more research on environment exposures and child health.

Neighborhood environment and cognitive functioning in middle-aged and older population: A mediating role of physical activity

BACKGROUND

Evidence on the impact of complex neighborhood environment, including air pollution, greenness, and neighborhood socioeconomic deprivation (nSED) on cognitive health in older adults remains scarce. Both cognition and neighborhood environment are associated with physical activity, but little is known about the potential mediating role of physical activity in this association.

METHODS

Cross-sectional data of the Czech arm of the HAPIEE cohort study examined 4,178 participants (55.6% women) aged 45-69 years. Global cognitive score was constructed from memory, verbal fluency, and concentration domains. The exposures, assigned to participant's addresses, include 4-year (2000-2003) average concentrations of PM2.5, greenness index calculated from tree crown canopy cover estimation (2000), and census-based nSED characteristics. Physical activity and other covariates were assessed by a questionnaire. Structural equation modelling was used to estimate standardized β coefficients for the relationships between neighborhood environment, physical activity and cognitive performance.

RESULTS

After controlling for a range of covariates, global cognitive function was inversely associated with PM2.5 (β = -0.087; 95%CI: 0.122 to -0.052) and nSED (β = -0.147; 95%CI: 0.182 to -0.115), and positively associated with greenness (β = 0.036; 95%CI: 0.001 to 0.069). We identified a weak but statistically significant mediating role of physical activity in the associations of PM2.5 exposures and nSED on global cognitive score. Total mediation proportions ranged from 3.9% to 6.5% for nSED and PM2.5, respectively.

CONCLUSIONS

The neighborhood environment was associated with cognitive health in older individuals; the associations were partially mediated by physical activity.

Residential tree canopy configuration and mortality in 6 million Swiss adults: a longitudinal study

BACKGROUND

Residential exposure to trees has been associated with reduced mortality risks. We hypothesise that in addition to tree canopy cover, tree canopy configuration also plays a role in exposure-mortality relationships. As there is limited evidence on this hypothesis, especially longitudinal evidence, we performed a nationwide study to investigate the residential tree canopy configuration-mortality associations in the Swiss population.

METHODS

In this longitudinal study, the tree canopy cover and configuration metrics within 500 m of individuals' residences were quantified using high-resolution tree canopy data (1 × 1 m) from 2010 to 2019. We developed single-exposure and multi-exposure time-varying Cox regression models to estimate the associations between the different exposure metrics and natural-cause and cause-specific mortality in Swiss adults (aged from 20 years to 90 years). Mortality and census data were taken from the Swiss National Cohort (SNC). We estimated the hazard ratios (HRs) and corresponding 95% CIs per IQR increase in the metrics adjusting for personal sociodemographic and contextual covariates. We also explored the effect modification by tree canopy cover, PM10, air temperature, urbanisation level, age, sex, and area-based local socioeconomic position.

FINDINGS

Our analyses included 6 215 073 individuals from the SNC between 2010 and 2019. In the fully adjusted single-exposure models, we observed protective associations between natural-cause mortality risk and tree canopy cover (IQR 12·4%, HR 0·979 [95% CI 0·975-0·983]) and configuration metrics describing the aggregation (6·3%, 0·831 [0·823-0·840]), and connectedness (2·9%, 0·946 [0·938-0·953]); and detrimental associations with two metrics describing the fragmentation (211 patches per 100 ha, 1·073 [1·066-1·080]) and shape complexity (1·9, 1·094 [1·089-1·100]) of patches. The associations were generally preserved with other common causes of death. According to the multi-exposure models, the HR (95% CI) for the combination of one IQR decrease in aggregation and one IQR increase in fragmentation and shape complexity was 1·366 (1·343-1·390). Analyses on modification effects suggested a stronger association in people living in areas with a higher level of tree canopy cover, PM10 concentration, air temperature, and urbanisation level.

INTERPRETATION

Aggregated, connected, and less fragmented forested greenspaces might offer stronger health benefits than isolated, fragmented ones, but are difficult to implement in cities. Our study provided valuable insights into optimising forested greenspaces and highlighted future directions for the planning and management of urban forests towards healthy and green cities.

FUNDING

National Research Foundation, Prime Minister's Office, Singapore under its Campus for Research Excellence and Technological Enterprise programme and ETH Zurich.

The role of greenspace in vitamin D status: cross-sectional, observational evidence from the UK Biobank

BACKGROUND

Exposure to greenspace is associated with positive health outcomes. This relationship is poorly understood, with limited knowledge on the mechanisms through which greenspace affects health, including biomarkers of greenspace effects.

METHODS

We used data from the UK Biobank to examine the cross-sectional association between greenspace exposure and serum 25-hydroxyvitamin D [25(OH)D]. Greenspace was assessed in a 300- and 1000-m buffer of land cover around each participant's home location, while 25(OH)D was measured by chemiluminescent immunoassay. We used multinomial regression models accounting for individual and area-level covariates. Additionally, we conducted mediation analysis by physical activity and time spent outdoors and performed various stratifications and sensitivity analyses.

RESULTS

A total of 443 810 participants (mean age: 56.51 [SD: 8.1] years, 53.6% females) were included in the study. Compared to the first quartile (within 1000 m buffer of participants' home locations), we found positive associations between the highest quartile of greenspace and insufficient (OR: 1.16, 95% CI: 1.11, 1.21) and sufficient 25(OH)D (OR: 1.36, 95% CI: 1.30, 1.42) categories after adjusting for individual- and areal-level covariates. Other quartiles showed similar but smaller effect estimates. The observed association exhibited similar directionality when a 300 m buffer was used, and was more pronounced among males, and most deprived individuals. Physical activity and time spent outdoors partially explained the relationship between greenspace quartiles and sufficient serum 25(OH)D.

CONCLUSION

We found positive associations between greenspace quartiles and serum 25(OH)D categories. This has implications for greening policies aimed at reducing vitamin D deficiency through controlled sun exposure.

Physical urban environment and cardiometabolic diseases in the five largest Bulgarian cities

This study investigated the associations between residential environmental characteristics and the prevalence of cardiometabolic diseases in the five largest Bulgarian cities. Representative cross-sectional survey data (N = 4640 adults) was collected in Sofia, Plovdiv, Varna, Burgas, and Ruse. Participants self-reported diagnosis or medication intake for hypertension, ischemic heart disease (IHD), stroke, and diabetes mellitus, as well as domestic burning of solid fuel and having a domestic garden. Residential addresses were linked to greenspace (overall vegetation level, tree cover, urban greenspace), bluespace, walkability, air pollution (NO2), and traffic noise (Lden). In the 300 m buffer, bluespace presence was inversely associated with hypertension (odds ratio [OR] = 0.67; 95% CI: 0.45, 1.00), IHD (OR = 0.45; 95% CI: 0.21, 0.99), and diabetes (OR = 0.51; 95% CI: 0.25, 1.04). Higher walkability and tree cover were inversely associated with hypertension (OR per 2 units = 0.85; 95% CI: 0.75, 0.96) and diabetes (OR per 10% = 0.77; 95% CI: 0.62, 0.97), respectively. These associations were stronger in larger buffers. Solid fuel burning was associated with IHD (OR = 1.63; 95% CI: 1.07, 2.50). There was an indication of a positive association between aircraft Lden and both stroke and IHD. The direction of the associations for domestic gardens, NO2, road traffic and railway Lden was counterintuitive. We detected some nonlinear associations. In conclusion, people living in urban neighborhoods that were more walkable, closer to bluespace, and greener had lower prevalence of cardiometabolic diseases, while solid fuel burning was associated with higher odds of cardiovascular diseases. Unexpected associations with some exposures may be due to unaccounted for urban fabric characteristics. This study is among the first assessing an understudied region in Southeastern Europe. Its findings have the potential to inform public discourse and provide evidence to support the implementation of urban design conducive to cardiometabolic health.

Maternal green space exposure and congenital heart defects: A population-based study

BACKGROUND

Beneficial effects of maternal green space exposure on preterm birth and low birth weight have been documented, but few studies have investigated its protective effect on fetal congenital heart defects (CHDs). Our study aimed to investigate the association between maternal green space exposure and CHDs, and quantify the potential benefits of reducing the risk of fetal CHDs by achieving the target of green space coverage.

METHODS

The study included 4160 births with CHDs and 567,483 births without birth defects born from 2014 to 2019 in 14 cities in Liaoning Province, China. Maternal green space exposure, including periconception period (3 months before conception to 3 months into pregnancy), preconception period (3 months before conception), and the first trimester (3 months into pregnancy), was assessed using satellite-based normalized difference vegetation index (NDVI). Logistic regression models were used to estimate the associations between maternal green space exposure and the risk of fetal CHDs.

RESULTS

A 0.1-unit increase in maternal green space exposure during the periconception was significantly associated with 5% declines in the risk of CHDs (OR: 0.95, 95% CI: 0.92, 0.98). Exposure-response association suggested that continuous improvements in maternal green space exposure during the periconception had a greater protective impact on the risk of total CHDs, while attenuated benefits were identified in the area where NDVI is around 0.23. Assuming causality, 5.06% (95% CI: 1.72%, 8.28%) of the annual rate of CHDs could be avoided by increasing NDVI exposure to 0.23 during periconception period in the areas where NDVI is below 0.23. In addition, rural residents, and mothers who have parity twice or more, were more prone to the protective effect of green space exposure.

CONCLUSIONS

Our study provides evidence that maternal green space exposure is a protective factor against the risk of fetal CHDs. The findings suggest that prioritizing green space in public policy can be an effective health-promoting measure.