Could nature help children rise out of poverty? Green space and future earnings from a cohort in ten U.S. cities

Neighborhood intergenerational mobility and population health inequality: Spatial dependency and heterogeneity

Health inequity represents a significant social injustice with major policy implications. This study examines the role of neighborhood intergenerational mobility (IM)-defined as the extent to which children within a specific neighborhood can achieve better socioeconomic outcomes than their parents-in shaping population health, addressing widening health inequalities. We propose that neighborhood IM is positively associated with population health, moderated by spatial dependency and heterogeneity. Analyzing over 69,000 census tracts in the contiguous United States using spatially-lagged X models, we find that neighborhood IM is positively associated with health status. The positive relationship weakens in neighborhoods surrounded by neighborhoods with higher levels of IM and strengthens in neighborhoods surrounded by neighborhoods with lower levels of IM. It also weakens in more advantaged environments-characterized by higher socioeconomic indicators, better built environment features, and more favorable natural environment conditions-and strengthens in less advantaged environments with poorer socioeconomic, built, and natural conditions. Our findings underscore the critical role of neighborhood context and heterogeneity in shaping the effects of social determinants on health, suggesting that policymakers should prioritize resources for disadvantaged neighborhoods with lower IM, particularly those surrounded by similarly low-IM areas, to mitigate health disparities more effectively. Our study provides new insights into the role of neighborhood IM in population health and demonstrates the value of geographic approaches for understanding and mitigating health disparities.

Physical and Mental Health of Caregivers and Educators of Preschool-Aged Children: Identifying Benefits and Barriers to Outdoor Time, How Outdoor Time Can Make a Difference for Health Equity, and Why Income Matters

Outdoor time is positively associated with improved physical and mental health in adults. Little is known about the specific effects of outdoor time on health outcomes for parents and educators of preschool-aged children. Early childhood is a critical window for growth and development, as parental and educator stress negatively impacts young children; thus, it is of paramount importance to systematically support parents and educators during these developmental years. The objectives of this research were to use a cross-sectional natural experiment to (1) evaluate the association between outdoor time and physical and mental health in caregivers and educators who engage with preschool-aged children; (2) evaluate the association between income and physical and mental health in caregivers and educators who engage with preschool-aged children; and (3) identify benefits and barriers of outdoor time and the importance, availability, and accessibility of community resources for outdoor time. Participants were recruited from three stakeholder groups: preschool educators, parents of children attending an outdoor preschool, and parents of preschool-aged children in the local community. Participants completed a health needs assessment (n = 46) to assess demographics, mental and physical health outcomes, and benefits, barriers, and resources for outdoor time. Caregivers and educators in the higher income group (≥USD 70,000) were 41% (95% CI: 12%, 70%) more likely to report very good or excellent self-reported health. Mean anxiety, depression, and perceived stress were lower in the higher-income group. Caregivers and educators in the higher outdoor time group had lower body mass index (-5.5 kg/m2; 95% CI: -11.6, 0.7), and outdoor time appeared to be protective for general health independent of income. Thus, outdoor time may be a critical protective factor to enhance biological resilience for caregivers and educators, especially for those facing financial adversity.

The Children, Caregivers, and Community (C3) study of together growing strong: A protocol for an observational, place-based initiative in Sunset Park, Brooklyn

Reaching population-level impact for families in poverty requires moving beyond a sole focus on individuals, to a wider focus on interactions between individuals and their broader environmental contexts. Place-based initiatives have emerged as a policy response to promote community-level change around these broader interactions between individuals and their local communities through addressing long-standing disparities in housing, employment, education, and health. Together Growing Strong (TGS) is one such place-based initiative focused on transforming the health, wellbeing, and development of young children and their families in Sunset Park, Brooklyn. The Children, Caregivers, and Community (C3) Study is an outcomes-based study designed to assess the trajectories of children and families in Sunset Park along indicators such as family health and wellbeing and child development in relation to TGS program participation. The aims, scope, and protocol of the C3 Study are the subjects of this paper.

The neighborhood built environment and COVID-19 hospitalizations

Research on the associations between the built environment and COVID-19 outcomes has mostly focused on incidence and mortality. Also, few studies on the built environment and COVID-19 have controlled for individual-level characteristics across large samples. In this study, we examine whether neighborhood built environment characteristics are associated with hospitalization in a cohort of 18,042 individuals who tested positive for SARS-CoV-2 between May and December 2020 in the Denver metropolitan area, USA. We use Poisson models with robust standard errors that control for spatial dependence and several individual-level demographic characteristics and comorbidity conditions. In multivariate models, we find that among individuals with SARS-CoV-2 infection, those living in multi-family housing units and/or in places with higher particulate matter (PM2.5) have a higher incident rate ratio (IRR) of hospitalization. We also find that higher walkability, higher bikeability, and lower public transit access are linked to a lower IRR of hospitalization. In multivariate models, we did not find associations between green space measures and the IRR of hospitalization. Results for non-Hispanic white and Latinx individuals highlight substantial differences: higher PM2.5 levels have stronger positive associations with the IRR of hospitalization for Latinx individuals, and density and overcrowding show stronger associations for non-Hispanic white individuals. Our results show that the neighborhood built environment might pose an independent risk for COVID-19 hospitalization. Our results may inform public health and urban planning initiatives to lower the risk of hospitalization linked to COVID-19 and other respiratory pathogens.

Greenness and equity: Complex connections between intra-neighborhood contexts and residential tree planting implementation

Associations between neighborhood greenness and socioeconomic status (SES) are established, yet intra-neighborhood context and SES-related barriers to tree planting remain unclear. Large-scale tree planting implementation efforts are increasingly common and can improve human health, strengthen climate adaptation, and ameliorate environmental inequities. Yet, these efforts may be ineffective without in-depth understanding of local SES inequities and barriers to residential planting. We recruited 636 residents within and surrounding the Oakdale Neighborhood of Louisville, Kentucky, USA, and evaluated associations of individual and neighborhood-level sociodemographic indicators with greenness levels at multiple scales. We offered no-cost residential tree planting and maintenance to residents within a subsection of the neighborhood and examined associations of these sociodemographic indicators plus baseline greenness levels with tree planting adoption among 215 eligible participants. We observed positive associations of income with Normalized Difference Vegetation Index (NDVI) and leaf area index (LAI) within all radii around homes, and within yards of residents, that varied in strength. There were stronger associations of income with NDVI in front yards but LAI in back yards. Among Participants of Color, associations between income and NDVI were stronger than with Whites and exhibited no association with LAI. Tree planting uptake was not associated with income, education, race, nor employment status, but was positively associated with lot size, home value, lower population density, and area greenness. Our findings reveal significant complexity of intra-neighborhood associations between SES and greenness that could help shape future research and equitable greening implementation. Results show that previously documented links between SES and greenspace at large scales extend to residents' yards, highlighting opportunities to redress greenness inequities on private property. Our analysis found that uptake of no-cost residential planting and maintenance was nearly equal across SES groups but did not redress greenness inequity. To inform equitable greening, further research is needed to evaluate culture, norms, perceptions, and values affecting tree planting acceptance among low-SES residents.

The PAD-US-AR dataset: Measuring accessible and recreational parks in the contiguous United States

Most spatial epidemiological studies of nature-health relationships use generalized greenspace measures. For instance, coarse-resolution spatial data containing normalized difference vegetative index (NDVI) values are prominent despite criticisms, such as the inability to restrain exposure estimates to public and private land. Non-threatening natural landscapes can improve health by building capacities for health-promoting behaviors. Recreational and accessible parks may best activate such behaviors. We curated the Parks and Protected Areas Database of the U.S. (PAD-US) to identify parks that are accessible for outdoor recreation. Our title adds "AR" to "PAD-US" where A = Accessible and R = Recreational. We validated the PAD-US-AR by comparisons with greenspace datasets and sociodemographics, which demonstrated its uniqueness from other commonly employed metrics of nature exposure. The PAD-US-AR presents reliable estimates of parks in the contiguous U.S. that are accessible for outdoor recreation. It has strong associations with home prices, shares of female residents, and shares of older residents. This dataset can accompany other nature exposure metrics in environmental epidemiology and allied research fields.

Lessons in a Green School Environment and in the Classroom: Effects on Students' Cognitive Functioning and Affect

The positive impact of short-term exposure to nature during a green recess in a school day is documented in the literature. In this study we investigated cognitive, academic, and affective effects of a single contact with nature during a regular school lesson in the greenness, compared to an usual classroom lesson, on young students in second and third grades (N = 65). In a within-subjects design, for the cognitive effects we examined children's (a) selective and sustained attention and (b) math calculation performance in common school tasks. For affective effects we considered (c) their positive and negative mood and (d) the perception of environmental restorativeness. Findings revealed that after a single lesson taught in the green school garden, children had greater selective attention and math calculation performance in two tasks than after a similar lesson in the classroom environment. Moreover, children with higher self-reported emotional difficulties showed greater selective attention and reported a statistically significant increase in positive affect and a tendency to a significant decrease in negative affect after the lesson in the greenness than in the classroom. Students also perceived the green space as more restorative than the classroom environment. Results are discussed against theories on the benefits of exposure to natural environments, highlighting the theoretical and practical significance of the study.

Association between residential green cover and direct healthcare costs in Northern California: An individual level analysis of 5 million persons

BACKGROUND AND OBJECTIVE

Prior studies have shown higher green cover levels are associated with beneficial health outcomes. We sought to determine if residential green cover was also associated with direct healthcare costs.

METHODS

We linked residential Normalized Difference Vegetation Index (NDVI) satellite data for 5,189,303 members of Kaiser Permanente Northern California (KPNC) to direct individual healthcare costs for 2003-2015. Using generalized linear regression to adjust for confounding, we examined the association between direct healthcare costs and green cover within250, 500, and 1000 meters (m) of an individual's residence. Costs were determined from an internal cost accounting system that captures administrative and patient care costs for each clinical encounter. Sensitivity analyses included adjustments for comorbidity and an alternative measure of green cover, tree canopy.

RESULTS

We observed a significant inverse association between higher levels of residential green cover and lower direct healthcare costs. The relative rate of total cost for the highest compared to the lowest decile of NDVI was 0.92 (95% CI 0.90-0.93) for the 500 m buffer. The association was robust to adjustment from a broad array of confounders, found at each buffer size, and largely driven by hospitalization, and emergency department visits. Individuals in the top decile of residential green cover had adjusted healthcare costs of $374.04 (95% CI $307.31-$439.41) per person per year less than individuals living in the bottom or least green decile. Sensitivity analyses including tree canopy cover as the green space measure yielded similar findings. Analyses that included adjustment for comorbidity were consistent with the hypothesis that green cover reduces healthcare costs by improving health status.

CONCLUSION

Green cover was associated with lower direct healthcare costs, raising the possibility that residential greening can have a significant healthcare cost impact across the population.

Short-Term Exposure to Nature and Benefits for Students’ Cognitive Performance: a Review

There is growing interest recently in the outdoor environment surrounding schools where students spent time during breaks, in-school activities, and after-school programs. Several reviews have examined the impact of long-term exposures to nearby nature on students’ academic achievement, but none has focused on the effects of short-term contacts with nature on students’ cognitive performance. The aim of this review is to understand the context in which short-term passive exposures to greenness occur, how cognitive performance is measured, and the conditions under which cognitive benefits emerge at various educational levels. We reviewed 14 studies in the extant literature that report investigations involving students at different educational levels, from elementary school to university, in a short exposure to nature lasting from 10 to 90 min during a study day. The review shows that in 12 out of the 14 studies, across educational levels, cognitive benefits emerge in terms of directed attention restoration from mental fatigue due to contact with nature. A no-cost opportunity to sustain students’ cognition is a break in a green environment after mentally demanding activities.

Impact of Changed Use of Greenspace during COVID-19 Pandemic on Depression and Anxiety

The COVID-19 pandemic has had devastating consequences for health, social, and economic domains, but what has received far less focus is the effect on people's relationship to vital ecological supports, including access to greenspace. We assessed patterns of greenspace use in relation to individual and environmental factors and their relationship with experiencing psychological symptoms under the pandemic. We conducted an online survey recruiting participants from social media for adults in Korea for September-December 2020. The survey collected data on demographics, patterns of using greenspace during the pandemic, and major depression (MD) and generalized anxiety disorder (GAD) symptoms. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 2-item (GAD-2) were applied to identify probable cases of MD and GAD. A logistic regression model assessed the association decreased visits to greenspace after the outbreak compared to 2019 and probable MD and GAD. Among the 322 survey participants, prevalence of probable MD and GAD were 19.3% and 14.9%, respectively. High rates of probable MD (23.3%) and GAD (19.4%) were found among persons currently having job-related and financial issues. Of the total participants, 64.9% reported decreased visits to greenspace after the COVID-19 outbreak. Persons with decreased visits to greenspace had 2.06 higher odds (95% CI: 0.91, 4.67, significant at p < 0.10) of probable MD at the time of the survey than persons whose visits to greenspace increased or did not change. Decreased visits to greenspace were not significantly associated with GAD (OR = 1.45, 95% CI: 0.63, 3.34). Findings suggest that barriers to greenspace use could deprive people of mental health benefits and affect mental health during pandemic; an alternative explanation is that those experiencing poor mental health may be less likely to visit greenspaces during pandemic. This implies the need of adequate interventions on greenspace uses under an outbreak especially focusing on how low-income populations may be more adversely affected by a pandemic and its policy responses.

The Impact of Schoolyard Greening on Children's Physical Activity and Socioemotional Health: A Systematic Review of Experimental Studies

Access to green schoolyards (schoolyards designed with greenery and natural elements to create a park-like environment, as opposed to asphalt-based playgrounds) are associated with many benefits for students, including improvements in physical and mental health. While many studies examining these associations are cross-sectional, some feature experimental designs that offer the possibility of causal inference. In this review, we looked at experimental studies that examine the impact of schoolyard greening on measures of physical activity and socioemotional health in children. Four electronic databases (Ovid Medline, PsycINFO, Scopus and Greenfile) were searched, and from 1843 articles retrieved, 6 articles met the inclusion criteria. Examination of the eligible studies revealed a general consensus on the positive impact of schoolyard greening on both physical activity and socioemotional health outcomes for students, suggesting that schoolyard greening is a viable intervention in reducing the health equity gaps and improving children’s health regardless of their racial or ethnic backgrounds or residential neighborhood socioeconomic status. Further experimental research on this topic should elucidate how educators, administrators, policy makers, and other stakeholders can harness the benefits of schoolyard greening to improve the health and well-being of children in their communities.

Economic value of protected areas via visitor mental health

We evaluate methods to calculate the economic value of protected areas derived from the improved mental health of visitors. A conservative global estimate using quality-adjusted life years, a standard measure in health economics, is US$6 trillion p.a. This is an order of magnitude greater than the global value of protected area tourism, and two to three orders greater than global aggregate protected area management agency budgets. Future research should: refine this estimate using more precise methods; consider interactions between health and conservation policies and budgets at national scales; and examine links between personalities and protected area experiences at individual scale.