The effect of greenness on allergic rhinitis outcomes in children and adolescents: A systematic review and meta-analysis

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

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

U-shaped association between residential greenness and keratoconus

Keratoconus is a blinding corneal disorder influenced by genetic factors. Whether environmental factors influence it remains unclear. Here, we observed a U-shaped association between residential greenness and keratoconus, with increased odds ratios (ORs) at low and high greenness levels. In the Chinese Environment-Ocular Surface (EOS) study, a case-control study of 4341 keratoconus and 3723 controls, the multivariate-adjusted ORs [95% confidence intervals (CIs)] of keratoconus associated with the lowest quartile and the highest quartile of residential greenness were 1.33 (1.23, 1.55) and 1.54 (1.37, 1.72) compared with the intermediate quartile, respectively. In spline analysis, the U-shaped association was consistently indicated, with the lowest odds of keratoconus at the 300 m buffer normalized difference vegetation index (NDVI) of 0.42. Specifically, the association was more pronounced for male, younger (<24 years), and urban-dwelling participants. Urban residents tend to benefit from increased greenness, whereas others may experience adverse effects due to hazards associated with high levels of residential greenness. The association was further validated in a prospective cohort of 502,367 participants from the United Kingdom Biobank (UKB). The results showed that participants with the first quartile residential greenness were 1.8 times (1.12, 2.91) more likely to develop keratoconus than those with intermediate greenness. The results suggested a U-shaped association between residential greenness and keratoconus; both low and high levels of residential greenness were associated with higher odds of keratoconus.

Environmental impacts on childhood rhinitis: The role of green spaces, air pollutants, and indoor microbial communities in Taiyuan, a city in Northern China

Rhinitis is one of the most common respiratory diseases, influenced by various environmental factors such as green space, air pollution and indoor microbiomes. However, their interactions and combined effects have not been reported. We recruited 1121 preschool children from day care centers in a northern city of China. Health and demographic data were collected through questionnaires answered by the children's parents. Surrounding green space was assessed by Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI) and land cover data of grassland proportion within 1500/3000 m. Ambient air pollution was estimated using the inverse distance weighted (IDW), and the indoor microbiome in classroom vacuum dust was profiled by bacterial 16S rRNA and fungal ITS amplicon sequencing. Mixed-effect logistic regression revealed the proportion of natural grassland, grassland leaf-off and total grassland was negatively associated with current rhinitis. Stratified analysis indicated that greater green space exposure was associated with a reduced current rhinitis in children at high levels of air pollution. Additionally, grassland also protects children against environmental tobacco smoke at home. Indoor microbiome analysis showed Haemophilus and Dolosigranulum were enriched in low-rhinitis day care centers, while Amaricoccus, Blautia and Mycosphaerella were enriched in high-rhinitis day care centers. Mediation analysis indicated that the indoor microbiome did not have significant mediating effects on the relationship between green space and children's current rhinitis. This is the first study to reveal interactions of green space, air pollution and indoor microbiome on rhinitis, providing new insights into how environmental factors collectively influence respiratory health in children.

From space to street: A systematic review of the associations between visible greenery and bluespace in street view imagery and mental health

A large body of literature shows that living near greenery supports healthy lifestyles and improves mental health. Much of this research has used greenery measured from a bird's eye perspective. Street view images (SVI) are an important alternative data source that could assess visible greenery experienced by residents in daily life. The current review is the first to systematically critique and synthesize the evidence relating to greenery and bluespace in SVI and its associations with mental health outcomes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct this review. First, we identified relevant articles published as of April 2023 in PubMed, Web of Science, Scopus, and CINAHL. Articles meeting inclusion criteria were narratively synthesized. Quality assessments were conducted with the Newcastle-Ottawa Scale (NOS). Based on our search, we identified 35 articles on greenery and bluespace measured with SVI and mental health outcomes. Two-thirds of the included papers found positive associations between greenery in SVI and mental health. The average score for risk of bias was good. Association between visible greenery in SVI and all 10 of the mental health outcomes studied were low or very low quality of evidence and showed limited or inadequate strength of evidence. SVI is likely to be an increasingly used and a validated instrument for estimating health-promoting exposure to greenery. Future research would benefit from the standardization of SVI datasets and computational processes, and studies conducted outside of China and high-income countries. Such advancements would improve the generalizability and robustness of associations between visible greenery and mental health outcomes.

Association of residential greenness with incident allergic rhinitis among adults: A prospective analysis of UK Biobank

BACKGROUND

Limited studies have assessed the impact of residential greenness exposure on allergic rhinitis in adults, and its relationship with ambient air pollutants remains unknown.

OBJECTIVE

To investigate the association of residential greenness with allergic rhinitis incidence and explore the mediation effects of ambient air pollutants in adults using data from a prospective cohort study in UK Biobank.

METHODS

Greenness was defined as the area-weighted mean of greenness coverage based on the land used data from the Generalized Land Use Database for England (GLUD) 2005 in the UK Biobank. Multiple Cox proportional hazard models and a generalized additive model incorporating restricted cubic splines were used to model the potential nonlinear effect of residential greenness on allergic rhinitis incidence and the potential mediation effect of ambient air pollutants.

RESULTS

Among the 281,699 subjects included in the analysis, 3260 allergic rhinitis incident cases occurred after a median follow-up of 14 years. With per 10% increase in residential greenness at a 300-m buffer, a 2.5% (95% CI: 1.0%, 4.0%) decreased risk of allergic rhinitis was observed. An L-shaped, non-linear dose-response relationship was indicated with a threshold of 54.9% greenness above which no excess allergic rhinitis risk was seen. PM10 partially mediated the relationship between greenness and allergic rhinitis incidence with a mediation effect of 26.9% (95% CI: 12.6%, 41.2%). A similar pattern of association was found at 1000-m buffer size.

CONCLUSION

This study demonstrates a significant beneficial effect of residential greenness on reducing allergic rhinitis incidence. Greenness may erase air pollutants and mitigate the rhinitis risk from air pollution.

The Health-Related and Learning Performance Effects of Air Pollution and Other Urban-Related Environmental Factors on School-Age Children and Adolescents-A Scoping Review of Systematic Reviews

PURPOSE OF REVIEW

This scoping review aims to assess the impact of air pollution, traffic noise, heat, and green and blue space exposures on the physical and cognitive development of school-age children and adolescents. While existing evidence indicates adverse effects of transport-related exposures on their health, a comprehensive scoping review is necessary to consolidate findings on various urban environmental exposures' effects on children's development.

RECENT FINDINGS

There is consistent evidence on how air pollution negatively affects children's cognitive and respiratory health and learning performance, increasing their susceptibility to diseases in their adult life. Scientific evidence on heat and traffic noise, while less researched, indicates that they negatively affect children's health. On the contrary, green space exposure seems to benefit or mitigate these adverse effects, suggesting a potential strategy to promote children's cognitive and physical development in urban settings. This review underscores the substantial impact of urban exposures on the physical and mental development of children and adolescents. It highlights adverse health effects that can extend into adulthood, affecting academic opportunities and well-being beyond health. While acknowledging the necessity for more research on the mechanisms of air pollution effects and associations with heat and noise exposure, the review advocates prioritizing policy changes and urban planning interventions. This includes minimizing air pollution and traffic noise while enhancing urban vegetation, particularly in school environments, to ensure the healthy development of children and promote lifelong health.

Greenspaces and Health: Scoping Review of studies in Europe

Objectives

Access to greenspaces and contact with nature can promote physical activity and have positive effects on physical and mental health. This scoping literature review aims to examine current evidence linking greenspaces and (a) behaviour change, (b) health outcomes and (c) co-benefits.

Methods

This review was conducted in accordance with the PRISMA scoping review guidelines. Searches were conducted through PubMed and EMBASE databases for studies published between 2000 and March 2023 with a focus on Europe.

Results

122 scientific articles and grey literature reports were identified. Access to greenspaces is positively associated with physical and mental health, and reduced risk of all-cause mortality and some non-communicable diseases. Greenspace quality is associated with increased physical activity and reduced risk of obesity. Nature-based therapies or green prescription are effective in improving mental health outcomes and overall health. Importantly, numerous co-benefits of greenspaces are identified.

Conclusion

Increasing access to greenspaces for populations with particular attention to greenspace quality is important for co-benefits. Responsible governance and use of greenspaces are crucial to minimize public health risks and human disturbance of nature.

Impact of green space and built environment on metabolic syndrome: A systematic review with meta-analysis

Metabolic Syndrome presents a significant public health challenge associated with an increased risk of noncommunicable diseases such as cardiovascular conditions. Evidence shows that green spaces and the built environment may influence metabolic syndrome. We conducted a systematic review and meta-analysis of observational studies published through August 30, 2023, examining the association of green space and built environment with metabolic syndrome. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 18 studies that met the inclusion criteria and were included in our review. Most were from China (n = 5) and the USA (n = 5), and most used a cross-sectional study design (n = 8). Nine studies (50 %) reported only green space exposures, seven (39 %) reported only built environment exposures, and two (11 %) reported both built environment and green space exposures. Studies reported diverse definitions of green space and the built environment, such as availability, accessibility, and quality, particularly around participants' homes. The outcomes focused on metabolic syndrome; however, studies applied different definitions of metabolic syndrome. Meta-analysis results showed that an increase in normalized difference vegetation index (NDVI) within a 500-m buffer was associated with a lower risk of metabolic syndrome (odds ratio [OR] = 0.90, 95%CI = 0.87-0.93, I2 = 22.3 %, n = 4). A substantial number of studies detected bias for exposure classification and residual confounding. Overall, the extant literature shows a 'limited' strength of evidence for green space protecting against metabolic syndrome and an 'inadequate' strength of evidence for the built environment associated with metabolic syndrome. Studies with more robust study designs, better controlled confounding factors, and stronger exposure measures are needed to understand better what types of green spaces and built environment features influence metabolic syndrome.

The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.

Association of air pollution exposure with overweight or obesity in children and adolescents: A systematic review and meta-analysis

Childhood overweight and obesity is a global problem. 38 million children under five years old were reported as being overweight/obese in 2019. However, current evidence regarding the effects of air pollution on children weight status remains scarce and inconsistent. This study aimed to determine the association between air pollutants and the weight status of children and adolescents. Four databases were searched up to August 9, 2023. Adjusted merged odds ratios (ORs), regression coefficients (β), and their 95 % confidence intervals (95 % CIs) were calculated and pooled. A total of 27 studies were included. The results showed that air pollutants had adverse effects on the body weight of children and adolescents. Exposure to PM1, PM2.5, PMcoarse, and PM10 were associated with increased risk of overweight/obesity, with pooled ORs (95 % CI) of 1.23 (1.09, 1.40), 1.18 (1.10, 1.28), 1.04 (1.03, 1.05) and 1.11 (1.06, 1.17) per 10 μg/m3 increment, respectively. Individuals with higher exposure levels to NOX, O3, SO2 and CO (per 10 μg/m3 increment) were associated with 12 %, 6 %, 28 % and 1 % increased odds of being overweight/obese, respectively. With respect to the level of body mass index, the pooled β (95 % CIs) for each 10 μg/m3 increase in PM1, PM2.5, PM10, and NOX exposure were 0.15 (0.12, 0.18), 0.11 (0.06, 0.16), 0.07 (0.03, 0.10), and 0.03 (0.01, 0.04), respectively. PM1 has relatively strong adverse effects on body weight status. The subgroup analysis revealed a significantly increase in the risk of overweight/obesity when the concentrations of PM2.5, PM10, and NO2 exceeded 35 μg/m3, 50 μg/m3, and 40 μg/m3, respectively. Exposure to PM2.5, PM10 and NOX increased the risk of overweight/obesity, especially in Asia. This study provides evidence of the association between air pollution and being overweight/obese in children and adolescents.

Greenness and chronic respiratory health issues: a systematic review and meta-analysis

Introduction

The number of chronic respiratory disease (CRD) individuals worldwide has been continuously increasing. Numerous studies have shown that greenness can improve chronic respiratory health issues through different mechanisms, with inconsistent evidence. By quantitatively summarizing existing studies, our purpose is to determine the connection between greenness exposure and various chronic respiratory health.

Methods

We conducted a comprehensive search on PubMed, EMBASE, and Web of Science core databases to identify relevant studies on the correlation between greenness exposure and chronic respiratory health issues. Studies published up to January 2023 were included in the search. The study used the most frequent indicator (normalized difference vegetation index [NDVI]) as the definition of greenness exposure.

Results

We finally identified 35 studies for meta-analysis. We calculated pooled effects across studies using a random-effects model and conducted a subgroup analysis by age and buffer zones to discuss the effects on chronic respiratory health issues. This study showed that 0.1 increments in NDVI were significantly related to lower rates of asthma incidence, lung cancer incidence, and chronic obstructive pulmonary disease (COPD) mortality risk; the pooled RRs were 0.92 (95% CI: 0.85-0.98), 0.62 (95% CI: 0.40-0.95), and 0.95 (95% CI: 0.92- 0.99), respectively. For the age subgroup, the higher greenness exposure level was related to the incidence rate of asthma among teenagers aged 13-18years (RR: 0.91; 95% CI: 0.83-0.99). For the buffer subgroup, a positive relationship with greenness exposure and asthma incidence/prevalence at 200-300m and 800- 1000m buffers, as well as the COPD mortality at 800-1000m buffer, the pooled RRs were 0.92 (95% CI: 0.86-0.98), 0.87 (95% CI: 0.81-0.93), and 0.93 (95% CI: 0.88- 0.98), respectively. Evidence of publication bias was not detected in this study.

Discussion

Our study is the first global meta-analysis between greenness and various CRDs to report an inverse association. Further research is needed in order to determine the effect of greenness exposure on different CRDs. Therefore, when planning for green development, more consideration must be given to public health and green management as intervention measures.

https://www.crd.york.ac.uk/PROSPEROFILES/384029_STRATEGY_20230116.pdf.

Environmental Risk Factors, Protective Factors, and Biomarkers for Allergic Rhinitis: A Systematic Umbrella Review of the Evidence

Many potential environmental risk factors, protective factors, and biomarkers of AR have been published, but so far, the strength and consistency of their evidence are unclear. We conducted a comprehensive review of environmental risk, protective factors, and biomarkers for AR to establish the evidence hierarchy. We systematically searched Embase, PubMed, Cochrane Library, and Web of Science electronic database from inception to December 31, 2022. We calculated summary effect estimate (odds ratio (OR), relative risk (RR), hazard ratio (HR), and standardized mean difference (SMD)), 95% confidence interval, random effects p value, I2 statistic, 95% prediction interval, small study effects, and excess significance biases, and stratification of the level of evidence. Methodological quality was assessed by AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). We retrieved 4478 articles, of which 43 met the inclusion criteria. The 43 eligible articles identified 31 potential environmental risk factors (10,806,206 total population, two study not reported), 11 potential environmental protective factors (823,883 total population), and 34 potential biomarkers (158,716 total population) for meta-analyses. The credibility of evidence was convincing (class I) for tic disorders (OR = 2.89, 95% CI 2.11-3.95); and highly suggestive (class II) for early-life antibiotic use (OR = 3.73, 95% CI 3.06-4.55), exposure to indoor dampness (OR = 1.49, 95% CI 1.27-1.75), acetaminophen exposure (OR = 1.54, 95% CI 1.41-1.69), childhood acid suppressant use (OR = 1.40, 95% CI 1.23-1.59), exposure to indoor mold (OR = 1.66, 95% CI 1.26-2.18), coronavirus disease 2019 (OR = 0.11, 95% CI 0.06-0.22), and prolonged breastfeeding (OR = 0.72, 95% CI 0.65-0.79). This study is registered in PROSPERO (CRD42022384320).