Multidisciplinary research in public health: a case study of research on access to green space

From service capacity to spatial equity: Accurately and comprehensively evaluating urban park green space distribution under multi-trips mode

The health of city inhabitants is considerably impacted by the urban park green spaces (UPGS). Existing studies lack an assessment of the UPGS equity from different perspectives and are limited to poor accuracy. This study reviews the definition and determination methods of UPGS, as well as UPGS accessibility and spatial equity related studies. Then, a spatial equity evaluation system is established from the dimensions of equity in providing UPGS services and equity in supply and demand matching. This study extrapolates from micro to macro analysis using network big data and census data to pinpoint the population down to the building level in the main urban area of Fuzhou City, China. The network analysis method, improved Gaussian floating catchment area method, Gini coefficient, and Lorenz curve measurement help to evaluate UPGS service euquity, explore the similarities and differences of UPGS fairness under different travel modes. It also helps to understand the service relationship between UPGS service and population demand under objective space, and to pinpoint the weak supply area using the locational entropy method. The results show that: (1) The overall accessibility and per capita accessibility show similar spatial distribution patterns under different travel modes, which are "high around and low in the middle" and "centered on the Minjiang River and dispersed to the north and south, respectively" in study area. (2) The supply of UPGS services in Fuzhou is relatively adequate and at a relatively equity level, while varies in the allocation of UPGS services among sub-districts. The spatial equity of different traveling modes varies widely. (3) The sub-districts on the periphery of the study area should be subject to increased UPGS and improvements to the road network and public infrastructure. Sub-district with high population density and old neighborhoods should implement micro-renewal and build community parks. Our study presents a new idea for spatial equity research.

Citizens' use of public urban green spaces at the time of the COVID-19 pandemic in Italy

Since early 2020, Coronavirus Disease 2019 (COVID-19) has spread rapidly, quickly becoming a global pandemic. To counter the COVID-19 outbreak, national governments have issued different measures and restrictions, forcing citizens to adapt to a whole new lifestyle. These restrictions have impacted on the use of green spaces by citizens owing to many factors: more available free time, increased flexibility in the work environment, and a need to relax in Nature to relieve anxiety and stress. Urban green spaces provide many benefits for the physical and psychological well-being of citizens (e.g., habitat conservation, pollution control, recreational and leisure opportunities). To understand if citizens' habits have changed due to the COVID-19 restrictions, this study provides insights from a web-based survey monitoring the use of such spaces before and during the COVID-19 lockdowns in Italy. A web-based questionnaire was conducted via "Facebook Messenger" and "WhatsApp" at the end of the second wave of COVID-19 (May-June 2021). Data collection having been concluded, 1075 completed questionnaires were collected and processed. The results show that while many reduced their weekly frequentation of green areas (-16.5%), the number of people frequenting green areas near their home every day increased (+7.7%). Two main groups of people were identified: the first, those who intensified their visits to green areas being those who desired to spend time in contact with Nature; the second, those who were reluctant to visit green areas for fear of being infected. The results also show most of the respondents felt urban green areas were either very important (82.1%) or important (14.4%). Overall, the results reveal that COVID-19 induced a positive perception of the benefits provided by urban green areas, with a consequent greater use of them, which seems destined to last even once the public health emergency has passed.

Identification of Priority Implementation Areas and Configuration Types for Green Infrastructure Based on Ecosystem Service Demands in Metropolitan City

During urbanization in developing countries, fragmentation of green infrastructure due to increasing populations and the expansion of construction land leads to an extremely serious imbalance between the supply and demand for urban ecosystem services. In this study, the central city of Zhengzhou, a central city in central China, was selected as the study area and the excessive demand for six ecosystem services, namely, air purification, flood regulation, heat regulation, hydrological regulation, CO₂ sequestration and recreational services, was quantitatively evaluated. The entropy method was used to calculate the weights of various ecosystem services, and spatial overlay analysis was performed to obtain the comprehensive ecosystem service excessive demand. Finally, bivariate spatial autocorrelation analysis was used to explore the response of population density to comprehensive excessive demand for ESs. The results of this study indicate that: (1) The most prevalent need is for more CO₂ regulation service throughout the study area. (2) Except for hydrological regulation service, the spatial distribution of the remaining highly excessive ecosystem service demands are mostly concentrated in old neighborhoods. (3) Of the six excessively demanded economic services, rainwater regulation obtained the greatest weight, reflecting the poor urban infrastructure configuration for countering the rapidly increasing threat of flooding caused by climate change in the city. (4) The comprehensive ecosystem service excessive demand results show that there are eight priority green infrastructure implementation blocks in the central city of Zhengzhou. (5) There were three agglomeration types between population density and comprehensive excessive demand for ESs: high-high type, low-high type and low-low type. The spatial distribution characteristics of population density and comprehensive ES demand are positively correlated. The results of this study could help to provide information for decision making when delineating the priority areas and types of green infrastructure implementation in developing cities.

Community gardening and wellbeing: The understandings of organisers and their implications for gardening for health

Community gardening is increasingly framed and promoted as a way to foster healthful behaviours, as a wellbeing practice, and as a public health tool. This paper draws on semi-structured interviews with community gardening organisers (n = 9) in the North East of England, who were engaged in translating and transforming discourses and ideas about community gardening into places and practices that people can draw benefit from. Here, community gardening can be understood as a bricolage of ideas, resources, and skills at the nexus of several influences and movements, assembled to produce a localised, everyday sort of social change. We conclude that framing community gardening as a simple solution to be harnessed in the promotion of health and wellbeing undermines the richness that sustains it and may lead to disenchantment within health services and community gardening organisations that could threaten the future of 'green social prescribing'.

Optimization Strategy for Parks and Green Spaces in Shenyang City: Improving the Supply Quality and Accessibility

In this study, we evaluated the supply quality of parks and green spaces within the Third Ring Road area in Shenyang city by combining a landscape pattern index analysis with a principal component analysis. Moreover, a network analysis based on the ArcGIS platform was used to measure the accessibility of parks and green spaces. The research results showed that the overall supply quality of parks and green spaces (−9.55) must be improved. The supply quality levels of the four analyzed park types could be ranked as follows: garden parks (118.00) > community parks (73.67) > comprehensive parks (−16.64) > specific parks (−32.17). Among the analyzed recreation parks, the accessibility of daily recreation parks was poor, while the overall service efficiency of weekly recreation parks was better, except in a few regions. These research results can provide suggestions for future green space planning in Shenyang city. In addition, from the perspective of landscape patterns, studying the service quality of parks and green spaces can provide new ideas for further research on accessibility.

Urban Connectivity: Elements for an Identification of Bir El Bey’s Preferential Landscapes

An urban landscape can be considered as a background environment that influences humans’ movements at various scales in the city. This research is oriented to the study of the interactions between urban forest patches and their degree of influence and attractions on humans’ behaviors and interactions. The objective is to evaluate the relations between individuals’ movements and the city space nearby natural landscapes, and also to question spatial practices in the city. Forest patches are modelled according to a structural approach at the city level, while Space syntax principles have been applied and compared to in situ movements as experimentally observed. A statistical analysis complements the configurational analysis by highlighting correlations between structural properties and human movements. The whole approach is applied to the Bir El Bey Forest of the Tunisian city of Hammam Chatt in order to explore the interaction between the built and natural landscapes at different levels of scale. The findings exhibit the respective effects of the urban network and natural landscape on the urban space, and how such spaces are appropriated by Hammam Chatt inhabitants and users. Finally, the results propose a generic framework analysis for the study of the relations between humans and urban structure and landscape preferences and that offers novel perspectives for urban planning.

Is the physical activity environment surrounding primary schools associated with students' weight status, physical activity or active transport, in regional areas of Victoria, Australia? A cross-sectional study

OBJECTIVES

To explore whether the physical activity (PA) environment (walkability, greenspace and recreational facilities) surrounding regional primary schools is associated with children's PA levels, active transport and weight status. Limited research on this topic has been conducted outside of major cities.

DESIGN

Cross-sectional ecological study using baseline data from two large-scale obesity prevention interventions.

SETTING

Eighty (n=80) primary schools across two regional areas in Victoria, Australia.

PARTICIPANTS

Students aged 8-13 years (n=2144) attending participating primary schools.

OUTCOME MEASURES

Measured weight status (body mass index z-score, proportion overweight/obese) and self-reported PA behaviours (meeting PA recommendations and active travel behaviour).

RESULTS

When adjusted for student and school demographics, students had significantly increased odds of using active transport to or from school when the school neighbourhood was more walkable (OR 1.21 (95% CI 1.09 to 1.35), had a greater number of greenspaces (OR 1.35 (95% CI 1.20 to 1.53)) and a greater number of recreational facilities (OR 1.18 (95% CI 1.07 to 1.31)). A higher cumulative PA environment score was also associated with a higher proportion of children using active transport (OR 1.33 (95% CI 1.28 to 1.51)). There were no significant associations between the PA environment measures and either weight status or meeting the PA recommendations in adjusted models.

CONCLUSIONS

This study is the first of its kind exploring school neighbourhood environments and child weight status and PA in regional areas of Australia. It highlights the potential of the environment surrounding primary schools in contributing to students' active travel to and from school. Further research with the use of objective PA measurement is warranted in regional areas that have been under-researched.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR.org.au) identifier 12616000980437; Results.

Virtual Reality Representations of Nature to Improve Well-Being amongst Older Adults: a Rapid Review

Poor well-being amongst older adults poses a serious health concern. Simultaneously, research shows that contact with nature can improve various facets of well-being, including physical, social, and mental well-being. However, nature is not always accessible for older adults due to mobility restrictions and related care needs that come with age. A promising strategy aims at bringing nature inside through pervasive technologies. However, so far, there is little academic understanding of essential nature characteristics, psychological processes involved, and means for implementation in practice. The current study used a three-folded rapid review to assess current understanding and strategies used for improving well-being for older adults through virtual reality representations of nature. Searches were performed across three databases, followed-up by content-based evaluation of abstracts. In total, a set of 25 relevant articles was identified. Only three studies specifically focus on digital nature as an intervention strategy for improving well-being amongst older adults. Although these studies provide useful starting points for the design and (technological) development of such environments, they do not generate understanding of how specific characteristics of virtual nature representations impact social well-being measures in particular, and of the underlying psychological processes involved. We conclude that follow-up research is warranted to close the gap between insights and findings from nature research, gerontology, health research, and human-technology interaction.

A critical realist synthesis of cross-disciplinary health policy and systems research: defining characteristic features, developing an evaluation framework and identifying challenges

BACKGROUND

Health policy and systems research (HPSR) is an inherently cross-disciplinary field of investigation. However, conflicting conceptualisations about inter-, multi- and transdisciplinary research have contributed to confusion about the characteristics of cross-disciplinary approaches in HPSR. This review was conducted to (1) define the characteristic features of context-mechanism-outcome (CMO) configurations in cross-disciplinary HPSR, (2) develop criteria for evaluating cross-disciplinarity and (3) synthesise emerging challenges of the approach.

METHOD

The paper is a critical realist synthesis conducted in three phases, as follows: (1) scoping the literature, (2) searching for and screening the evidence, and (3) extracting and synthesising the evidence. Five databases, namely the International Bibliography of the Social Sciences and Web of Science, PubMed central, Embase and CINHAL, and reference lists of studies that qualified for inclusion in the review were searched. The search covered peer-reviewed original research, reviews, commentary papers, and institutional or government reports published in English between January 1998 and January 2020.

RESULTS

A total of 7792 titles were identified in the online search and 137 publications, comprising pilot studies as well as anecdotal and empirical literature were selected for the final review. The review draws attention to the fact that cross-disciplinary HPSR is not defined by individual characteristics but by the combination of a particular type of research question and setting (context), a specific way of researchers working together (mechanism), and research output (outcome) that is superior to what could be achieved under a monodisciplinary approach. This CMO framework also informs the criteria for assessing whether a given HPSR is truly cross-disciplinary. The challenges of cross-disciplinary HPSR and their accompanying coping mechanisms were also found to be context driven, originating mainly from conceptual disagreements, institutional restrictions, communication and information management challenges, coordination problems, and resource limitations.

CONCLUSION

These findings have important implications. First, the CMO framework of cross-disciplinary HPSR can provide guidance for researchers engaging in new projects and for policy-makers using their findings. Second, the proposed criteria for evaluating theory and practice of cross-disciplinary HPSR may inform the systematic development of new research projects and the structured assessment of existing ones. Third, a better understanding of the challenges of cross-disciplinary HPSR and potential response mechanisms may help researchers to avoid these problems in the future.

The Impact of Street Space Perception Factors on Elderly Health in High-Density Cities in Macau—Analysis Based on Street View Images and Deep Learning Technology

The urban space environment has been proven to be related to the health of the elderly. However, as a high-density city, Macau’s limited urban space must cope with the growing population and the arrival of an aging society. In the existing studies, less attention has been paid to Macau, especially the relationship between Macanese elderly and urban space. This study uses Baidu Street View (BSV) on the Macau Peninsula and conducts field surveys to obtain street view data to evaluate the openness, greenness, interface coverage, and road area ratio of street space and its association with the physical and mental health of the elderly and social health. The results show that the data truly reflect the overall street space conditions on the Macau Peninsula. The street openness, greenery rate, and interface enclosure are all related to the elderly in various evaluations in areas with a higher population dependency index and aging index. Human space perception is related to health gain, and road area ratio is weaker than other indicators. The research results have certain policy implications and have practical significance for city managers and designers.

Development and validation of the neighborhood environment walkability scale for youth across six continents

BACKGROUND

The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents' physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability.

METHODS

Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status.

RESULTS

Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity.

CONCLUSIONS

A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Access to and availability of exercise facilities in Madrid: an equity perspective

BACKGROUND

Identifying socioeconomic determinants that are associated with access to and availability of exercise facilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reduce health inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to, and availability of, exercise facilities in Madrid, Spain.

METHODS

Area-level SES was measured using a composite index based on seven sociodemographic indicators. Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional. Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the 125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilities in a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflated Poisson regression analyses to assess the association between area-level SES and exercise facility accessibility and availability.

RESULTS

Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities. Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities.

CONCLUSION

Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number of facilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lower SES areas may be an intervention to improve health equity.

Measuring Urban Greenspace Distribution Equity: The Importance of Appropriate Methodological Approaches

Urban greenspace can provide physical and mental health benefits to residents, potentially reducing health inequalities associated with socioeconomic deprivation. The distribution of urban greenspace is an important social justice issue, and consequently is increasingly studied. However, there is little consistency between studies in terms of methods and definitions. There is no consensus on what comprises the most appropriate geographic units of analysis or how to capture residents’ experience of their neighbourhood, leading to the possibility of bias. Several complementary aspects of distribution equity have been defined, yet few studies investigate more than one of these. There are also alternative methods for measuring each aspect of distribution. All of these can lead to conflicting conclusions, which we demonstrate by calculating three aspects of equity for two units of aggregation and three neighbourhood sizes for a single study area. We make several methodological recommendations, including taking steps to capture the relevant neighbourhood as experienced by residents accurately as possible, and suggest that using small-area aggregations may not result in unacceptable levels of information loss. However, a consideration of the local context is critical both in interpreting individual studies and understanding differing results.

Variation in the physical activity environment according to area-level socio-economic position-A systematic review

Physical inactivity is a major contributing factor to obesity, and both follow a socio-economic gradient. This systematic review aims to identify whether the physical activity environment varies by socio-economic position (SEP), which may contribute to socio-economic patterning of physical activity behaviours, and in turn, obesity levels. Six databases were searched. Studies were included if they compared an objectively measured aspect of the physical activity environment between areas of differing SEP in a high-income country. Two independent reviewers screened all papers. Results were classified according to the physical activity environment analysed: walkability/bikeability, green space, and recreational facilities. Fifty-nine studies met the inclusion criteria. A greater number of positive compared with negative associations were found between SEP and green space, whereas there were marginally more negative than positive associations between SEP and walkability/bikeability and recreational facilities. A high number of mixed and null results were found across all categories. With a high number of mixed and null results, clear socio-economic patterning in the presence of physical activity environments in high-income countries was not evident in this systematic review. Heterogeneity across studies in the measures used for both SEP and physical activity environments may have contributed to this result.

Value of urban green spaces in promoting healthy living and wellbeing: prospects for planning

There has been considerable work done in recent years exploring the value of urban green space for health and wellbeing. Urban green spaces provide environmental benefits through their effects on negating urban heat, offsetting greenhouse gas emissions, and attenuating storm water. They also have direct health benefits by providing urban residents spaces for physical activity and social interaction, and allowing psychological restoration to take place. Consequently, there is a real need to understand the mechanisms by which these benefits accrue. Previously, much of the focus has been on the characteristics of the urban green space that are likely to influence its use, such as its accessibility, quality, facilities, attractiveness, and security. This assumes a causal relationship, when in reality the relationship is more complex and multifactorial. It is more likely that it is the functionality of the green space, be it for exercise or sociocultural activities, rather than its character, which translates to the reported benefits. Challenges exist, such as competing urban planning priorities, economic considerations, and market forces. There is thus a need for urban planning to match the health benefits sought with the needs of the community and the functionality that the urban green space will serve.

Physical activity patterns in urban neighbourhood parks: insights from a multiple case study

Background

Many characteristics of urban parks and neighbourhoods have been linked to patterns of physical activity, yet untangling these relationships to promote increased levels of physical activity presents methodological challenges. Based on qualitative and quantitative data, this article describes patterns of activity within urban parks and the socio-demographic characteristics of park visitors. It also accounts for these patterns in relation to the attributes of parks and their surrounding neighbourhoods.

Methods

A multiple case study was undertaken that incorporated quantitative and qualitative data derived from first-hand observation in a purposive sample of four urban parks. Quantitative data, based on direct observation of visitors’ patterns of use and socio-demographic characteristics, were collected using a structured instrument. Differences in frequencies of observed activities and socio-demographic characteristics of visitors were compared between the four parks. Qualitative data, based on direct observation of park characteristics and patterns of use, were generated through digital photography and analyzed through captioning. Quantitative data on patterns in activity and socio-demographic characteristics were synthesized with the qualitative data on park and usage characteristics.

Results

A comprehensive portrait of each park in the study was generated. Activity types (sedentary, walking, dog-related, cycling, and play), patterns of park use (time of day, day of week), and socio-demographic characteristics (age group, social group) differed between the four parks. Patterns in park use and activity appeared to be associated with socio-demographic characteristics of the surrounding neighbourhoods as well as the physical and social environmental characteristics specific to each park.

Conclusions

Both park and neighbourhood characteristics influence patterns of use and physical activity within parks. The study findings suggest that socio-demographic characteristics of neighbourhoods surrounding parks need be considered in planning, development and management. Engaging local communities could help planners to develop and update urban parks in ways that reflect the needs and characteristics of community residents and, in turn, encourage visits and more physical activity amongst visitors.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-962) contains supplementary material, which is available to authorized users.

Beyond proximity: the importance of green space useability to self-reported health

Access to parks and green spaces within residential neighbourhoods has been shown to be an important pathway to generating better physical and mental health for individuals and communities. Early research in this area often failed to identify specific attributes that contributed to reported health outcomes, with more recent research focused on exploring relationships between health outcomes and aspects of access and design. A mixed methods research project conducted in Perth, Western Australia examined the role that neighbourhood green space played in influencing residents' self-reported health status, and this paper identifies significant relationships found between perceptions of green space quality and self-reported health. It focuses on the factors that were found to be most positively associated with better health outcomes: proximity, retention, useability and visitation of neighbourhood green space.

Engaging with peri-urban woodlands in England: the contribution to people's health and well-being and implications for future management

In this paper we engage with debates concerning people and their contact with the natural environment as part of everyday life drawing on Irwin’s ideas of co-construction and Gibson’s theory of affordances. We focus on peri-urban woodlands in England as important places where people can interact with nature for health and well-being. Qualitative data were collected in situ via walks in the woods, focus group discussions and photo elicitation, with a sample of 49 people. These methods provide rich data on the wide range of meanings associated with woodlands that can have a perceived impact on people’s health and well-being. The findings link to contemporary debates about health, well-being and ecosystem services. We explore the inter-play between attributes of the physical environment and the range of facilities provided to enable access, social interactions and the benefits people attribute to their woodland experiences. We conclude that peri-urban woodlands can clearly contribute to self-reported health and well-being in multiple ways, and that organized activities can be important for those who face barriers to accessing woodlands. A strong message emerging from the research is the opportunity afforded by woodlands for social connections with others, as well as the provision of a range of sensory benefits and opportunities to observe and enjoy seasonal change in woodlands. Mental restoration via connection with nature also emerged as important, confirming previous research.

Opportunity or orientation? Who uses urban parks and why

There is growing recognition that interactions with nature provide many desirable human well-being outcomes, yet increasing urbanization is degrading the quality and quantity of nature experiences. Thus, it has become increasingly important to understand how and why urban dwellers interact with nature. Studies of urban green space use have largely focused on the availability and ease of access to green space, suggesting that greater opportunities to experience such space will lead to increased use. However, a growing literature emphasizes the potential for an individual's nature orientation to affect their interaction with green space. Here we measure the importance of both opportunity and orientation factors in explaining urban park use. An urban lifestyle survey was deployed across Brisbane, Australia in November 2012 to assess patterns of green space use. Participants (n = 1479) were asked to provide information on demographics, private yard use, park visitations in the past week, and their orientation toward nature. About 60% of those surveyed had visited a park in the past week, and while this park user population had significantly greater nearby park coverage (within a 250 m radius; p = 0.006), a much stronger determinant of visitation was their higher nature orientation (p<0.00001), suggesting that while both opportunity and orientation are important drivers for park visitation, nature orientation is the primary effect. Park users also spent significantly more time in their yards than non-park users (p<0.00001), suggesting that yard use does not necessarily compensate for lower park use. Park users with stronger nature orientation (i) spent more time in their yard, (ii) traveled further to green spaces, and (iii) made longer visits than park visitors with weaker nature orientation. Overall, our results suggest that measures to increase people's connection to nature could be more important than measures to increase urban green space availability if we want to encourage park visitation.

The beach as a setting for families' health promotion: a qualitative study with parents and children living in coastal regions in Southwest England

This study explores the neglected issue of how families engage with beach environments in their local areas and use them in health promoting ways. Fifteen families with children aged 8-11 years living in coastal regions in Southwest England participated in individual semi-structured interviews. The findings indicate that beaches encouraged families to be physically active. Although families valued the opportunities for physical activity and active play afforded by beaches, the key health benefits emphasised were psychological, including experiencing fun, stress relief and engagement with nature. Increased social and family interaction was also highlighted as benefits. Despite perceiving health benefits, not all families regularly visited the beach. Barriers to visits included parents having limited time, cost of parking, lack of car access and cold weather. Parents played a key role in enabling visits by choosing to share these environments with their children. The social dimension of visits also encouraged families to make regular trips. The findings support the use of beach environments to promote families' health and wellbeing and positive relationships with nature.

Methods in public health services and systems research: a systematic review

CONTEXT

Public Health Services and Systems Research (PHSSR) is concerned with evaluating the organization, financing, and delivery of public health services and their impact on public health. The strength of the current PHSSR evidence is somewhat dependent on the methods used to examine the field. Methods used in PHSSR articles, reports, and other documents were reviewed to assess their methodologic strengths and challenges in light of PHSSR goals.

EVIDENCE ACQUISITION

A total of 364 documents from the PHSSR library met the inclusion criteria as empirical and based in the U.S. After additional exclusions, 327 of these were analyzed.

EVIDENCE SYNTHESIS

A detailed codebook was used to classify articles in terms of (1) study design; (2) sampling; (3) instrumentation; (4) data collection; (5) data analysis; and (6) study validity. Inter-coder reliability was assessed for the codebook; once it was found reliable, the available empirical documents were coded.

CONCLUSIONS

Although there has been a dramatic increase in the amount of published PHSSR recently, methods used remain primarily cross-sectional and descriptive. Moreover, although appropriate for exploratory and foundational work in a new field, these approaches are limiting progress toward some PHSSR goals. Recommendations are given to advance and strengthen the methods used in PHSSR to better meet the goals and challenges facing the field.

Investigating the Implications of Using Alternative GIS-Based Techniques to Measure Accessibility to Green Space

A large body of research has examined relationships between accessibility to green space and a variety of health outcomes with many researchers finding benefits in terms of levels of physical activity and relationships with levels of obesity, mental health, and other health conditions. Such studies often use spatial analytical techniques to examine relationships between distance to such spaces and health data collated at an individual survey respondent's home address or, more commonly, derived from area-based census measures summarised at a centroid. Generally, such measures are becoming more sophisticated and have moved on from the use of straightforward Euclidean-based measures to those based on network distance. However, few studies tend to use a combination of approaches or seek to establish the implications of incorporating alternative measures of accessibility on potential relationships. Using a database of green spaces (and associated attributes) and a detailed network dataset for the city of Cardiff, Wales, we examine the sensitivity of findings to the ways in which different metrics are calculated. This is illustrated by examining the variations in association between such metrics and a census-based deprivation index widely used in health studies to measure socioeconomic conditions. Our findings demonstrate that not only will the distances to green spaces vary according to the methodologies adopted but that any study that aims to investigate relationships with attributes of the nearest green space should acknowledge that matches may vary widely according to the techniques used. We conclude by warning against the use of inappropriate methodologies in examining access to green space which may directly influence directions (and levels) of association and hence may limit their relevance in wider geographical contexts.

The health benefits of urban green spaces: a review of the evidence

BACKGROUND

Urban development projects can be costly and have health impacts. An evidence-based approach to urban planning is therefore essential. However, the evidence for physical and non-physical health benefits of urban green space is unclear.

METHODS

A literature search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly. Their findings were then thematically categorized.

RESULTS

There is weak evidence for the links between physical, mental health and well-being, and urban green space. Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important. However, many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations.

CONCLUSION

Most studies reported findings that generally supported the view that green space have a beneficial health effect. Establishing a causal relationship is difficult, as the relationship is complex. Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.