Coastal proximity and mental health among urban adults in England: The moderating effect of household income

Exploring the Use of Sea Swimming as an Intervention With Young People With Mental Health Challenges: A Qualitative Descriptive Study

There is emerging evidence that sea swimming can have a positive impact on the mental health of adults. Less is known about how this intervention can impact young people's mental health. The aim of this study was to explore young service users and staff's perspectives on sea swimming in the child and adolescent mental health services. Fourteen participants were interviewed (eight young people and six staff members). Data were analysed using reflexive thematic analysis and five themes were identified. A preference for sea swimming was demonstrated by young people in comparison to other therapies. Young people reported an enhanced (and sustained) sense of well-being after sea swimming. They were able to relate the act of entering cold water to their recovery journey, acknowledging the importance of leaving their comfort zone. A sense of social cohesion was also described. Staff members acknowledged the risks of open sea swimming but highlighted the importance of positive risk taking, given the benefits of this novel intervention. Owing to the positive impact sea swimming can have on the physical and psychological health of young people, there is potential for this novel intervention to be used more frequently within the services.

Associations between blue space exposure and rheumatoid arthritis: The modifying effect of genetic susceptibility and air pollutants

Studies on the interaction among genetic susceptibility, blue space exposure, and rheumatoid arthritis (RA) risk have been lacking. Therefore, we examined the association between blue space exposure and RA incidence and assess the modifying effect of genetic susceptibility and air pollutants. Form the UK Biobank, 322,783 participants without RA were enrolled in this study. The association between blue space exposure and RA incidence was estimated using a cox proportional hazards model. The combined effect of blue space and genetic factors on the risk of RA was further evaluated. The polygenic risk score (PRS) for RA was calculated to represent individual genetic risk, and the potential modification effect of air pollution on the relationship between blue space, PRS, and RA were explored. During a median follow-up of 12.4 years, 3659 RA cases were identified. A 10 % increase in blue space300 m was associated with a 22.6 % reduction in RA incidence (HR=0.774, 95 % CI: 0.670, 0.895), exhibiting a consistent downward trend in the exposure-response curve. A high PRS was an independent risk factor for RA (HR=1.393, 95 % CI: 1.347, 1.439). The associations between blue space exposure, PRS, and the risk of RA were dose-dependent, with the lowest risk observed among those with high levels of blue space and lower PRS (HRbluespace300m=0.501, 95 % CI: 0.431, 0.583; HRbluespace1000m=0.476, 95 % CI: 0.408, 0.555). Interaction analysis indicated that increased concentrations of air pollutants strengthened the relationship between PRS and RA. Blue space exposure mitigated the risk of RA development, particularly in individuals with low genetic risk.

Enhancing Human Health and Wellbeing through Sustainably and Equitably Unlocking a Healthy Ocean's Potential

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean's health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean's natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort.

Mechanisms underlying the associations between different types of nature exposure and sleep duration: An 18-country analysis

Whilst green space has been linked to healthier sleep outcomes, the roles of specific types of nature exposure, potential underlying mechanisms, and between-country variations in nature-sleep associations have received little attention. Drawing on cross-sectional survey data from an 18-country sample of adults (N = 16,077) the current study examined: 1) the relative associations between six different types of nature exposure (streetscape greenery, blue view from home, green space within 1 km, coast within 1 km, green space visits, blue space visits) and insufficient sleep (<6 h vs. 7-10 h per day); 2) whether these relationships were mediated by better mental wellbeing and/or physical activity; and 3) the consistency of these pathways among the different countries. After controlling for covariates, neighbourhood nature measures (green space, coast within 1 km) were not significantly associated with insufficient sleep; but nature visible from home (streetscape greenery, blue views) and recreational visits to green and blue spaces were each associated with less insufficient sleep. Significant nature-sleep associations were mediated, to varying degrees, by better mental wellbeing, but not self-reported physical activity. Country-level heterogeneity in the strength of nature-sleep associations was observed. Increasing nature visible from the home may represent a promising strategy for promoting healthier sleep duration at the population level, whilst nature-based interventions encouraging individuals to spend time in local green/blue spaces may be an appropriate target to assist individuals affected by insufficient sleep.

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

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

Survey data linking coastal visit behaviours to socio-demographic and health profiles

Coastal destinations are highly popular for leisure, yet the effects of spending time at the coast on mental and physical health have remained underexplored. To accelerate the research about the effects of the coast on health, we compiled a dataset from a survey on a sample (N = 1939) of the adult Flemish population about their visits to the Belgian coast. The survey queried the number of days spent at the coast in the previous year or before and the following characteristics of their visits: how often they performed specific activities, which of the 14 municipal seaside resorts they visited, who they were with, what they mentally and physically experienced, and what reasons they had for not visiting the coast more often. The respondents' geo-demographic (including residential proximity to the coast), socio-economic, and health profile was also collected. We anticipate that investigations on the data will increase our understanding about the social structuring of coastal visits and give context to the effects of the coast on human health.

Nature visits, but not residential greenness, are associated with reduced income-related inequalities in subjective well-being

Nature exposure can promote human health and well-being. Additionally, there is some, albeit mixed, evidence that this relationship is stronger for socio-economically disadvantaged groups (equigenesis). Using a cross-sectional survey of the Austrian population (N = 2300), we explored the relationships between both residential greenness and recreational nature visits, and affective (WHO-5 Well-Being Index) and evaluative (Personal Well-Being Index-7) subjective well-being. Partially supporting the equigenesis hypothesis, regression analyses controlling for potential confounders found that recreational visit frequency, but not residential greenness, moderated the effect of income-related disparities in both subjective well-being metrics. Results suggest that merely making neighborhoods greener may not itself help reduce inequalities in subjective well-being. Additionally, greater efforts are also needed to support individuals from all sectors of society to access natural settings for recreation as this could significantly improve the well-being of some of the poorest in society.

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

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

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

Background

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

Objectives

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

Design

A retrospective, dynamic longitudinal panel study.

Setting

Wales, UK.

Participants

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

Main outcome measures

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

Data sources

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

Methods

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

Results and conclusions

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

Limitations

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

Future work

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

Funding

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

Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales

BACKGROUND

Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities.

METHODS

A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation.

FINDINGS

After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0-1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80-0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93-0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04-1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles.

INTERPRETATION

Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs.

FUNDING

National Institute for Health and Care Research Public Health Research programme.

Education is power: preserving cognition in the UK biobank

Introduction

Dementia is a debilitating syndrome characterized by the gradual loss of memory and cognitive function. Although there are currently limited, largely symptomatic treatments for the diseases that can lead to dementia, its onset may be prevented by identifying and modifying relevant life style risk factors. Commonly described modifiable risk factors include diet, physical inactivity, and educational attainment. Importantly, however, to maximize the utility of our understanding of these risk factors, tangible and meaningful changes to policy must also be addressed.

Objectives

Here, we aim to identify the mechanism(s) by which educational attainment influences cognition.

Methods

We investigated data from 502,357 individuals (Mage = 56.53, SDage = 8.09, 54.40% female) from the UK Biobank cohort via Structural Equation Modelling to illustrate links between predictor variables (i.e., Townsend Deprivation Index, coastal distance, greenspace, years of education), covariates (i.e., participant age) and cognitive function as outcome variables (i.e., pairs-matching, trail-making task B, fluid intelligence).

Results

Our model demonstrated that higher education was associated with better cognitive performance (ps < 0.001), and this relationship was mediated by indices of deprivation, and coastal distance.

Conclusion

Accordingly, our model evinces the mediating effect of socioeconomic and environmental factors on the relationship between years of education and cognitive function. These results further demonstrate the utility and necessity of adapting public policy to encourage equitable access to education and other supports in deprived areas.

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

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

Associations between exposure to blue spaces and natural and cause-specific mortality in Greece: An ecological study

BACKGROUND

A growing body of evidence suggests that exposure to natural environments, such as green space, may have a beneficial role in health. However, there is limited evidence regarding the effects of exposure to blue spaces and mortality. We investigated the association of exposure to blue spaces with natural and cause-specific mortality in Greece using an ecological study design METHODS: Mortality and socioeconomic data were obtained from 1,035 municipal units (MUs) from the 2011 census data. To define exposure to "blue" we used a rate of the land cover categories related to blue space from the COoRdination and INformation on the Environmental (CORINE) 2012 map per 10,000 persons in the municipal unit. We further assessed the exposure to blue space in the MUs that are located in the coastline of Greece using the distance to the coast as a proxy for proximity to blue space. the Annual PM_2.5, NO₂, BC and O₃ concentrations for 2010 were predicted by land use regression models while the normalized difference vegetation index was used to assess greenness. We applied single and two exposure Poisson regression models accounting for spatial autocorrelation and adjusting for unemployment and lung cancer mortality rates, percentages of the population aged 25-64 with upper secondary or tertiary education attainment and of those born in Greece, and urbanicity. The analysis was conducted for the whole country and separately by varying geographical definitions.

RESULTS

An interquartile range (IQR) increase of blue space per 10,000 persons was associated with decreased risk in natural mortality (Relative Risk (RR): 0.98 (95% confidence interval (CI): 0.98, 0.99), as well as in mortality due to cardiovascular causes, respiratory causes and diseases of the nervous system 0.98 (95% CI: 0.97, 0.99); 0.97 (95% CI: 0.95, 0.99); 0.94 (95% CI: 0.88, 1.00) respectively). We estimated protective associations for ischemic heart disease (IHD) mortality (RR = 0.98, 95% CI: 0.97, 1.00 per IQR); COPD mortality (RR = 0.97, 95% CI: 0.93, 1.00 per IQR) and mortality from cerebrovascular disease (RR = 0.97 (95% CI: 0.96, 0.99 per IQR). We estimated protective associations for the distance from the coast and mortality from the diseases of the nervous system (RR = 0.75, 95% CI: 0.61, 0.92, ≤1 km from the coast versus >1 km). Our results were stronger for inhabitants of the islands, the coastline and in the rural areas of Greece while the estimates were robust to co-exposure adjustment.

CONCLUSIONS

We estimated statistically significant protective effects of exposure to blue space on mortality from natural, cardiovascular and respiratory causes, diseases of the nervous system, cerebrovascular and ischemic heart disease for in Greece with higher estimates in the coastline and the islands. Further research is needed to elaborate our findings.

The Contribution of Environmental Science to Mental Health Research: A Scoping Review

Mental health is influenced by multiple complex and interacting genetic, psychological, social, and environmental factors. As such, developing state-of-the-art mental health knowledge requires collaboration across academic disciplines, including environmental science. To assess the current contribution of environmental science to this field, a scoping review of the literature on environmental influences on mental health (including conditions of cognitive development and decline) was conducted. The review protocol was developed in consultation with experts working across mental health and environmental science. The scoping review included 202 English-language papers, published between 2010 and 2020 (prior to the COVID-19 pandemic), on environmental themes that had not already been the subject of recent systematic reviews; 26 reviews on climate change, flooding, air pollution, and urban green space were additionally considered. Studies largely focused on populations in the USA, China, or Europe and involved limited environmental science input. Environmental science research methods are primarily focused on quantitative approaches utilising secondary datasets or field data. Mental health measurement was dominated by the use of self-report psychometric scales. Measures of environmental states or exposures were often lacking in specificity (e.g., limited to the presence or absence of an environmental state). Based on the scoping review findings and our synthesis of the recent reviews, a research agenda for environmental science's future contribution to mental health scholarship is set out. This includes recommendations to expand the geographical scope and broaden the representation of different environmental science areas, improve measurement of environmental exposure, prioritise experimental and longitudinal research designs, and giving greater consideration to variation between and within communities and the mediating pathways by which environment influences mental health. There is also considerable opportunity to increase interdisciplinarity within the field via the integration of conceptual models, the inclusion of mixed methods and qualitative approaches, as well as further consideration of the socio-political context and the environmental states that can help support good mental health. The findings were used to propose a conceptual model to parse contributions and connections between environmental science and mental health to inform future studies.

Sea swimming and snorkeling in tropical coastal blue spaces and mental well-being: Findings from Indonesian island communities during the COVID-19 pandemic

The COVID-19 pandemic has considerable mental health impacts. Immersive nature-based interventions, such as swimming or snorkeling, may help mitigate the global mental health crisis caused by the pandemic. To investigate this, we collected cross-sectional data from residents of coastal villages (n = 308) in Kepulauan Selayar, Indonesia. Analysis of Covariance (ANCOVA) was used with mental well-being as the outcome variable, operationalized as the Mental Component Summary (MCS) scores from the SF-12 (12-item Short Form Health Survey). After adjusting for covariates, the activity of sea swimming or snorkeling was found to be significantly associated with better mental well-being (η² = 0.036; p < 0.01). Predictive margins analysis revealed that those who engaged in sea swimming or snorkeling for one to three days a week gained a 2.7 increase in their MCS scores, compared to those who did not. A non-linear dose-response relationship was detected: for those swimming or snorkeling more than three days per week, there was only an increase of 1.7 MCS score compared to the 0-day. Overall this study contributes to the expanding of evidence base, showing that interactions with blue spaces can be beneficial for mental health, especially in a potentially stressful time such as the current pandemic.

Management implications

The positive association between the activity of swimming or snorkeling in open seas and the mental well-being of rural coastal communities in Indonesia during the COVID-19 pandemic indicates that access to coastal blue spaces is important in a time of uncertainties and high stress. Ensuring that local communities have continuous access to these spaces is the key challenge for all relevant stakeholders, particularly in light of the growing privatization of the local coastal environment for the sake of tourism. However, considering the importance that these blue spaces hold for the mental well-being of local communities, intensive dialogue amongst these stakeholders must be pursued to ensure that the development of the area does not jeopardize the collective well-being of the people already living there.

Perceptions of Freshwater Algal Blooms, Causes and Health among New Brunswick Lakefront Property Owners

Changes to water conditions due to eutrophication and climate change have resulted in the proliferation of algae blooms in freshwater and marine environments globally, including in Canadian lakes. We developed and administered an online survey to evaluate the awareness of these blooms and the perceptions of health risks in a sample of New Brunswick waterfront cottage and homeowners. The survey was distributed to lake and cottage associations in New Brunswick and was completed by 186 eligible respondents (18 years of age or older). Participants were asked about the water quality of their lake, awareness about algae blooms, sociodemographic and cottage characteristics, and to complete a self-rated measure of physical and mental health. While approximately 73% of participants reported that the quality of their lake water was good or very good, 41% indicated a concern about algae blooms. We found no differences in self-reported physical or mental health between those who were aware of algae blooms at their cottage and those who were not (p > 0.05). Participants expressed concerns about the impacts of algae blooms on the health of their pets, and wildlife. While climate change was the most frequently identified cause of algae blooms, there was substantial heterogeneity in the responses. In addition, the reporting of the presence and frequency of algae bloom varied between respondents who lived on the same lake. Taken together, the findings from our survey suggest that cottage owners in New Brunswick are aware and concerned about the impacts of algae blooms, however, there is a need to provide additional information to them about the occurrence and causes of these blooms.

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

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

Living near coasts is associated with higher suicide rates among females but not males: A register-based linkage study in the Netherlands

Exposure to blue spaces may promote psychological wellbeing and reduce mental distress. Whether these effects extend to suicide is unknown. We used register data from 14 million Dutch adults aged 18-64-years between 2007 and 2016 in a nested case-control study to estimate associations between blue space exposures and suicide risk. Each suicide case was matched to ten randomly selected controls. Two blue space exposures were assigned over a ten-year residential address history: distance to the closest inland blue space and distance to the coast. We fitted (gender-stratified) conditional logistic regressions to the data. Possible effect modifications by income were also examined. In total, our analyses included 9757 cases and 95,641 controls. Effect estimates for distance to the closest inland blue space in the total population showed that people living farthest away from inland blue space were at-risk. Suicide risk was lower among women who lived farther away from the coast; no significant effect was observed for men. No evidence was observed that income modified these associations. Our findings provide suggestive evidence that living close to the coast is associated with greater suicide risk for women, while living closer to inland blue spaces may add to the resilience against suicide in the total population. Past research shows that coastal proximity protects against milder forms of mental illness, but these protective effects do not appear to hold for suicide. Blue space interventions for women with severe mental illness or propensities to engage in self-harm should be approached with caution.

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

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

A population-based retrospective study of the modifying effect of urban blue space on the impact of socioeconomic deprivation on mental health, 2009-2018

The incidence of mental health disorders in urban areas is increasing and there is a growing interest in using urban blue spaces (urban waterways, canals, lakes, ponds, coasts, etc.) as a tool to manage and mitigate mental health inequalities in the population. However, there is a dearth of longitudinal evidence of the mechanisms and impact of blue spaces on clinical markers of mental health to support and inform such interventions. We conducted a 10-year retrospective study, following STROBE guidelines, using routinely collected population primary care health data within the National Health Service (NHS) administrative area of Greater Glasgow and Clyde for the North of Glasgow city area. We explored whether living near blue space modifies the negative effect of socio-economic deprivation on mental health during the regeneration of an urban blue space (canal) from complete dereliction and closure. A total of 132,788 people (65,351 female) fulfilling the inclusion criteria were entered in the analysis. We established a base model estimating the effect of deprivation on the risk of mental health disorders using a Cox proportional hazards model, adjusted for age, sex and pre-existing comorbidities. We then investigated the modifying effect of living near blue space by computing a second model which included distance to blue space as an additional predicting variable and compared the results to the base model. Living near blue space modified the risk of mental health disorders deriving from socio-economic deprivation by 6% (hazard ratio 2.48, 95% confidence interval 2.39–2.57) for those living in the most deprived tertile (T1) and by 4% (hazard ratio 1.66, 95% confidence interval 1.60–1.72) for those in the medium deprivation tertile (T2). Our findings support the notion that living near blue space could play an important role in reducing the burden of mental health inequalities in urban populations.

A Qualitative Study on Emotions Experienced at the Coast and Their Influence on Well-Being

Coastal environments are increasingly shown to have a positive effect on our health and well-being. Various mechanisms have been suggested to explain this effect. However, so far little focus has been devoted to emotions that might be relevant in this context, especially for people who are directly or indirectly exposed to the coast on a daily basis. Our preregistered qualitative study explored how coastal residents experience the emotions they feel at the coast and how they interpret the effect these emotions have on them. We conducted semi-structured interviews with a purposive sample of eight Belgian coastal residents aged 21-25 years old. The interviews were analyzed with the approach of interpretative phenomenological analysis. Five superordinate themes were identified and indicate that, for our participants, the coast represents a safe haven (1) in which they can experience emotional restoration (2), awe (3), and nostalgia (4). These emotional states are accompanied with adaptive emotion regulating strategies (5), such as reflection and positive reappraisal, that may facilitate coping with difficult thoughts and feelings. Our study demonstrates the importance of investigating specific emotions and related processes triggered at the coast and how these could contribute to the therapeutic value of the coast.

When One Health Meets the United Nations Ocean Decade: Global Agendas as a Pathway to Promote Collaborative Interdisciplinary Research on Human-Nature Relationships

Strong evidence shows that exposure and engagement with the natural world not only improve human wellbeing but can also help promote environmentally friendly behaviors. Human-nature relationships are at the heart of global agendas promoted by international organizations including the World Health Organization’s (WHO) “One Health” and the United Nations (UN) “Ocean Decade.” These agendas demand collaborative multisector interdisciplinary efforts at local, national, and global levels. However, while global agendas highlight global goals for a sustainable world, developing science that directly addresses these agendas from design through to delivery and outputs does not come without its challenges. In this article, we present the outcomes of international meetings between researchers, stakeholders, and policymakers from the United Kingdom and Brazil. We propose a model for interdisciplinary work under such global agendas, particularly the interface between One Health and the UN Ocean Decade and identify three priority research areas closely linked to each other: human-nature connection, conservation-human behavior, and implementation strategies (bringing stakeholders together). We also discuss a number of recommendations for moving forward.

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

Background

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

Methods

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

Results

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

Conclusion

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

Investigating the association between regeneration of urban blue spaces and risk of incident chronic health conditions stratified by neighbourhood deprivation: A population-based retrospective study, 2000-2018

Chronic non-communicable diseases are leading causes of poor health and mortality worldwide, disproportionately affecting people in highly deprived areas. We undertook a population-based, retrospective study of 137,032 residents in Glasgow, Scotland, to investigate the association between proximity to urban blue spaces and incident chronic health conditions during a canal regeneration programme. Hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for age and sex, with the incidence of a given health condition as the dependent variable. The analyses were stratified by socioeconomic deprivation tertiles. We found that, in areas in the highest deprivation tertile, proximity to blue space was associated with a lower risk of incident cardiovascular disease (HR 0.85, 95% Confidence Interval (CI) 0.76-0.95), hypertension (HR 0.85, 95% CI 0.79-0.92), diabetes (HR 0.88, 95% CI 0.83-0.94), stroke (HR 0.85, 95% CI 0.77-0.94) and obesity (HR 0.90, 95% CI 0.86-0.94), but not chronic pulmonary disease, after adjusting for age and sex covariates. In middle and low deprivation tertiles, living closer to the canal was associated with a higher risk of incident chronic pulmonary disease (middle: HR 1.56, 95% CI 1.24-1.97, low: HR 1.34, 95% CI 1.05-1.73). Moreover, in the middle deprivation tertile, a higher risk of stroke (HR 1.36, 95% CI 1.02-1.81) and obesity (HR 1.14, 95% CI 1.01-1.29) was observed. We conclude that exposure to blue infrastructure could be leveraged to mitigate some of the health inequalities in cities.

Oceans and society: feedbacks between ocean and human health

The concentration of human population along coastlines has far-reaching effects on ocean and societal health. The oceans provide benefits to humans such as food, coastal protection and improved mental well-being, but can also impact negatively via natural disasters. At the same time, humans influence ocean health, for example, via coastal development or through environmental stewardship. Given the strong feedbacks between ocean and human health there is a need to promote desirable interactions, while minimising undesirable interactions. To this end, we articulate two scenarios for 2030. First, Business-as-Usual, named 'Command and (out of) Control', focuses on the anticipated future based on our current trajectory. Second, a more sustainable scenario called 'Living and Connecting', emphasises the development of interactions between oceans and society consistent with achieving the Sustainable Development Goals. We describe a potential pathway to achieving the 'Living and Connecting' scenario, centred on improving marine citizenship, achieving a more equitable distribution of power among stakeholders, and more equitable access to resources and opportunities. The constituent actions of this pathway can be categorised into four groups: (i) improved approaches to science and health communication that account for society's diverse values, beliefs and worldviews, (ii) a shift towards more trusted relationships among stakeholders to enable two-way knowledge exchange, (iii) economic incentives that encourage behavioural changes necessary for achieving desired sustainability outcomes, and (iv) stronger regulations that simultaneously focus on ocean and human health. We contend that these changes will provide improved outcomes for both oceans and society over the United Nations Decade of Ocean Science.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11160-021-09669-5.

Oceans and society: feedbacks between ocean and human health

The concentration of human population along coastlines has far-reaching effects on ocean and societal health. The oceans provide benefits to humans such as food, coastal protection and improved mental well-being, but can also impact negatively via natural disasters. At the same time, humans influence ocean health, for example, via coastal development or through environmental stewardship. Given the strong feedbacks between ocean and human health there is a need to promote desirable interactions, while minimising undesirable interactions. To this end, we articulate two scenarios for 2030. First, Business-as-Usual, named 'Command and (out of) Control', focuses on the anticipated future based on our current trajectory. Second, a more sustainable scenario called 'Living and Connecting', emphasises the development of interactions between oceans and society consistent with achieving the Sustainable Development Goals. We describe a potential pathway to achieving the 'Living and Connecting' scenario, centred on improving marine citizenship, achieving a more equitable distribution of power among stakeholders, and more equitable access to resources and opportunities. The constituent actions of this pathway can be categorised into four groups: (i) improved approaches to science and health communication that account for society's diverse values, beliefs and worldviews, (ii) a shift towards more trusted relationships among stakeholders to enable two-way knowledge exchange, (iii) economic incentives that encourage behavioural changes necessary for achieving desired sustainability outcomes, and (iv) stronger regulations that simultaneously focus on ocean and human health. We contend that these changes will provide improved outcomes for both oceans and society over the United Nations Decade of Ocean Science.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11160-021-09669-5.

Influence of the Belgian Coast on Well-Being During the COVID-19 Pandemic

There is increasing evidence that blue spaces, particularly coastal environments, are beneficial for well-being. During the first-wave lockdown of the COVID-19 pandemic in Belgium, access to the coast was restricted due to restraint in circulation. Making use of this unique opportunity, this study investigated whether access and visits to the coast were positively associated with well-being by using a quasi-experimental design. The emotions of awe and nostalgia were studied as potential mediators between coastal visits and well-being. A total of 687 Flemish adults took part in an online survey that was launched end of April until beginning of June 2020. After controlling for covariates, results showed that access to the coast, but not visit frequency, was positively associated with well-being. More specifically, coastal residents reported less boredom and worry, and more happiness than inland residents. Awe and nostalgia were not significantly associated with coastal visits, but awe was negatively correlated with boredom. The study suggests a potential buffer effect of residential proximity to the coast against negative psychological consequences of the COVID-19 pandemic, supporting the notion that the coast has a positive impact on well-being.

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

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

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

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

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

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

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

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

Averting a public health crisis in England's coastal communities: a call for public health research and policy

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level.

Mental Health Outcome Measures in Environmental Design Research: A Critical Review

AIM

During the last several decades, researchers have produced abundant evidence of the environmental impacts on stress, attention, and physical activity. More recently, scholars have turned their focus to the influence environments have on mental wellness. Therefore, a critical review of this more recent research is both timely and crucial for setting the future research agenda.

METHODS

In this article, we examined 65 papers published between 2008 and 2019 that examined the environmental correlates of a wide variety of mental health outcomes. We coded each study by type of environment, research design, mental health measurement scale used, and p-value.

RESULTS

We categorized the research studies into six groups based on mental health outcomes: emotions, moods, vitality, executive function, stress, and general well-being. Our review revealed several trends among the studies, including a heavy focus on nature and outdoor environments with little attention to workplace or residential environments; a lack of consensus on how to operationalize the environment; a heavy reliance on self-reported ratings using a wide variety of scales, many focused on the same outcome; and a disproportionate focus on short-term health effects.

CONCLUSIONS

There is a need for greater consensus on research constructs and health outcome measurements, focused on a wider variety of environmental settings and scales, in order to better inform evidence-based environmental design practice.

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

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

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Nature's Role in Supporting Health during the COVID-19 Pandemic: A Geospatial and Socioecological Study

The COVID-19 pandemic has brought about unprecedented changes to human lifestyles across the world. The virus and associated social restriction measures have been linked to an increase in mental health conditions. A considerable body of evidence shows that spending time in and engaging with nature can improve human health and wellbeing. Our study explores nature's role in supporting health during the COVID-19 pandemic. We created web-based questionnaires with validated health instruments and conducted spatial analyses in a geographic information system (GIS). We collected data (n = 1184) on people's patterns of nature exposure, associated health and wellbeing responses, and potential socioecological drivers such as relative deprivation, access to greenspaces, and land-cover greenness. The majority of responses came from England, UK (n = 993). We applied a range of statistical analyses including bootstrap-resampled correlations and binomial regression models, adjusting for several potential confounding factors. We found that respondents significantly changed their patterns of visiting nature as a result of the COVID-19 pandemic. People spent more time in nature and visited nature more often during the pandemic. People generally visited nature for a health and wellbeing benefit and felt that nature helped them cope during the pandemic. Greater land-cover greenness within a 250 m radius around a respondent's postcode was important in predicting higher levels of mental wellbeing. There were significantly more food-growing allotments within 100 and 250 m around respondents with high mental wellbeing scores. The need for a mutually-advantageous relationship between humans and the wider biotic community has never been more important. We must conserve, restore and design nature-centric environments to maintain resilient societies and promote planetary health.

Review of the evidence for oceans and human health relationships in Europe: A systematic map

BACKGROUND

Globally, there is increasing scientific evidence of critical links between the oceans and human health, with research into issues such as pollution, harmful algal blooms and nutritional contributions. However, Oceans and Human Health (OHH) remains an emerging discipline. As such these links are poorly recognized in policy efforts such as the Sustainable Development Goals, with OHH not included in either marine (SDG14) or health (SDG3) goals. This is arguably short-sighted given recent development strategies such as the EU Blue Growth Agenda.

OBJECTIVES

In this systematic map we aim to build on recent efforts to enhance OHH in Europe by setting a baseline of existing evidence, asking: What links have been researched between marine environments and the positive and negative impacts to human health and wellbeing?

METHODS

We searched eight bibliographic databases and queried 57 organizations identified through stakeholder consultation. Results include primary research and systematic reviews which were screened double blind against pre-defined inclusion criteria as per a published protocol. Studies were limited to Europe, US, Australia, New Zealand and Canada. Data was extracted according to a stakeholder-defined code book. A narrative synthesis explores the current evidence for relationships between marine exposures and human health outcomes, trends in knowledge gaps and change over time in the OHH research landscape. The resulting database is available on the website of the Seas, Oceans and Public Health in Europe website (https://sophie2020.eu/).

RESULTS

A total of 1,542 unique articles were included in the database, including those examined within 56 systematic reviews. Research was dominated by a US focus representing 50.1% of articles. A high number of articles were found to link: marine biotechnology and cardiovascular or immune conditions, consumption of seafood and cardiovascular health, chemical pollution and neurological conditions, microbial pollution and gastrointestinal or respiratory health, and oil industry occupations with mental health. A lack of evidence relates to direct impacts of plastic pollution and work within a number of industries identified as relevant by stakeholders. Research over time is dominated by marine biotechnology, though this is narrow in focus. Pollution, food and disease/injury research follow similar trajectories. Wellbeing and climate change have emerged more recently as key topics but lag behind other categories in volume of evidence.

CONCLUSIONS

The evidence base for OHH of relevance to European policy is growing but remains patchy and poorly co-ordinated. Considerable scope for future evidence synthesis exists to better inform policy-makers, though reviews need to better incorporate complex exposures. Priorities for future research include: proactive assessments of chemical pollutants, measurable impacts arising from climate change, effects of emerging marine industries, and regional and global assessments for OHH interactions. Understanding of synergistic effects across multiple exposures and outcomes using systems approaches is recommended to guide policies within the Blue Growth Strategy. Co-ordination of research across Europe and dedicated centres of research would be effective first steps.

The Restorative Potential of Icelandic Nature

This study aimed to investigate if proposed restorative attributes according to attention restoration theory and supportive environment theory could be experienced and identified in Icelandic landscape and contribute to a restorative experience in nature sites in rural Iceland. A prospective mixed-method study was conducted over the period of one year. Seven different nature sites that were considered likely to have restorative qualities were selected for the evaluation i.e., three forest sites, three seashores, and one park in and in the vicinity of Ísafjörður, Iceland. Each site was evaluated regarding how the participants experienced its restorative qualities and how a stay therein affected their mental state. Nature visits were offered once a week, where the participants visited one of the seven locations for two hours. The findings show that the participants perceived and experienced nature sites as having the characteristics of a restorative environment and that staying at the nature sites positively affected their mental state. External conditions, like weather, which can affect nature visits, were rarely a hinderance. Thus, it can be concluded that numerous coastal areas, forests, and parks in Iceland, especially in rural areas, might possess restorative qualities as well. This result shows that wild and open nature in North West Iceland has the characteristics of a restorative environment and can be utilized for health promotion.

Blue space, health and well-being: A narrative overview and synthesis of potential benefits

Research into the potential health and well-being benefits from exposure to green spaces such as parks and woodlands has led to the development of several frameworks linking the different strands of evidence. The current paper builds on these to provide a model of how exposure to aquatic environments, or blue spaces such as rivers, lakes and the coast, in particular, may benefit health and well-being. Although green and blue spaces share many commonalities, there are also important differences. Given the breadth of the research, spanning multiple disciplines and research methodologies, a narrative review approach was adopted which aimed to highlight key issues and processes rather than provide a definitive balance of evidence summary. Novel aspects of our framework included the inclusion of outcomes that are only indirectly good for health through being good for the environment, the addition of nature connectedness as both a trait and state, and feedback loops where actions/interventions to increase exposure are implemented. Limitations of the review and areas for future work, including the need to integrate potential benefits with potential risks, are discussed.

Results from an 18 country cross-sectional study examining experiences of nature for people with common mental health disorders

Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but ‘green prescription’ programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.

Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income

BACKGROUND

Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched.

METHODS

We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status.

RESULTS

After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (OR_adj) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% OR_adj = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample.

CONCLUSION

Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.

The Beneficial Effects of Short-Term Exposure to Scuba Diving on Human Mental Health

Exposure to outdoor blue spaces can help improve human health by reducing stress, promoting social relationships, and physical activity. While most studies have focused on the adverse health effects of scuba diving, very few have assessed its health benefits. Moreover, when scuba diving is done in large groups with no diving instructor or pre-dive briefing, negative environmental impacts are generated and negative impacts on human health may also occur due to overcrowding, which may create stress. This is the first study to evaluate the effects of scuba diving on divers' mental health using their diving practices to estimate the impacts on the ecosystem. In the marine-protected area of Cap de Creus and adjacent areas, we assessed the mental health of 176 divers and 70 beach users (control group) by employing a 29-item version of Profile of Mood State (POMS) questionnaires. According to the parameters associated with reduced environmental impacts, two scuba diving experiences were established. Poisson regression models were performed to assess both the contribution of the activity and diving experiences to POMS scores. Both groups (scuba divers and beach goers) reduced their POMS scores after carrying out the activities. Although no significant differences were found between beach and scuba diving activities, nor between the two different scuba diving experiences, our results showed that subjects with regular medication intake due to a chronic or psychiatric illness had a POMS reduction score significantly higher than other subjects. We conclude that both beach and scuba diving activities have positive effects for human mental health, particularly among subjects with regular medication intake.

Physical and mental health effects of repeated short walks in a blue space environment: A randomised crossover study

INTRODUCTION

Blue spaces may benefit mental health and promote physical activity, although the evidence is still scarce. And benefits on physical health are less consistent. The objective of this randomized crossover study was to assess psychological and cardiovascular responses to blue spaces' exposure.

METHODS

A sample of 59 healthy adult office workers was randomly assigned to a different environment (i.e. blue space, urban space, and control site) on 4 days each week, for 3 weeks. For 20 min per day, they either walked along a blue or an urban space or rested at a control site. Before, during and/or after the exposure, we measured self-reported well-being and mood, blood pressure, and heart rate variability parameters. For well-being, we also assessed the duration of these potential effects over time (at least 4 h after exposure).

RESULTS

We found significantly improved well-being and mood responses immediately after walking in the blue space compared with walking in the urban space or when resting in the control site. Cardiovascular responses showed increased activity of the sympathetic nervous system, both during and after walking along the blue and urban spaces. However, cardiovascular responses measured after the walks, showed no statistically significant differences between the blue and the urban space environments.

CONCLUSIONS

Short walks in blue spaces can benefit both well-being and mood. However, we did not observe a positive effect of blue spaces for any of the cardiovascular outcomes assessed in this study.

Understanding coastal public health: Employment, behavioural and psychosocial factors associated with geographical inequalities. The HUNT study, Norway

Recent decades have shown an international trend of decline in small-scale fishing; a longstanding and vital industry for numerous coastal populations. The decline has resulted in a loss of livelihoods in many coastal communities, potentially afflicting public health. Still, knowledge about the health situation of these areas is limited. Former studies on coastal health have primarily defined coastal areas based solely on their proximity to the coast, therefore not targeting the traditional coastal communities with longstanding coastal involvement through small-scale fishing. In this paper, we aim to illuminate the health situation in these areas by introducing a more fine-grained classification of the coastal study population; considering both geographical proximity to the coast, population density and employment in fishing. Using data from the Norwegian population-based HUNT Study, we perform individual and simultaneous adjustments for employment, behavioural and psychosocial factors to assess the contributions of these factors to the association between geographical affiliation and self-rated general health. The rural coastal areas with a history of small-scale fishing show a poorer health situation compared to urban coastal, rural inland and rural fjord populations, and behavioural factors contribute the most to the observed health disparities. Our findings encourage greater focus on societal differences between coastal communities when studying coastal health.

General health and residential proximity to the coast in Belgium: Results from a cross-sectional health survey

The health risks of coastal areas have long been researched, but the potential benefits for health are only recently being explored. The present study compared the general health of Belgian citizens a) according to the EU's definition of coastal (<50 km) vs. inland (>50 km), and b) between eight more refined categories of residential proximity to the coast (<5 km to >250 km). Data was drawn from the Belgian Health Interview Survey (n = 60,939) and investigated using linear regression models and mediation analyses on several hypothesized mechanisms. Results indicated that populations living <5 km of the coast reported better general health than populations living at >50-100 km. Four commonly hypothesized mechanisms were considered but no indirect associations were found: scores for mental health, physical activity levels and social contacts were not higher at 0-5 km from the coast, and air pollution (PM₁₀ concentrations) was lower at 0-5 km from the coast but not statistically associated with better health. Results are controlled for typical variables such as age, sex, income, neighbourhood levels of green and freshwater blue space, etc. The spatial urban-rural-nature mosaic at the Belgian coast and alternative explanations are discussed. The positive associations between the ocean and human health observed in this study encourage policy makers to manage coastal areas sustainably to maintain associated public health benefits into the future.