Blood pressure in young adulthood and residential greenness in the early-life environment of twins

Childhood exposure to air pollution, noise, and surrounding greenness and incident hypertension in early adulthood in a US nationwide cohort-the Growing Up Today Study (GUTS)

Exposure to increased air pollution, noise, and reduced surrounding greenness have been suggested as potential environmental risk factors for hypertension in adults, but limited evidence exists regarding early-life exposure, particularly from prospective studies. We investigated independent and joint associations of childhood exposure to these factors with incident hypertension in early adulthood in a US nationwide cohort. Study participants were from the Growing Up Today Study (GUTS) established in 1996 (GUTSI) and 2004 (GUTSII), who were ages 9-14 (GUTSI) or 10-17 (GUTSII) at enrollment. Incident hypertension was identified by self-report on questionnaires from 2010 to 2021. We estimated residential exposures to air pollution (from spatiotemporal models), noise, and surrounding greenness throughout childhood (10-18y). We applied Cox proportional hazards models adjusted for potential confounders to assess hazard ratios (HRs) and 95% confidence intervals (CIs) associated with each interquartile range (IQR) change in exposure. We performed a quantile g-computation to assess the joint association of simultaneous exposure to the mixture. We considered potential effect modification by sex, maternal history of hypertension, overweight/obese status at age 18, urbanicity, and neighborhood socioeconomic status. Among 17,762 participants, 1530 hypertensive cases occurred during an average follow-up of 12.8 years. HRs for all exposures were small with CIs including unity. A joint HR of 1.03 (95% CI: 0.95, 1.11) was associated with a one-quartile increase across simultaneous exposure to the environmental mixture. The joint associations were stronger among non-obese participants or participants living in less advantaged neighborhoods: HRs of 1.07 (95% CI: 0.97, 1.18) and 1.08 (95% CI: 0.98, 1.18), respectively. In conclusion, we did not identify an independent or joint association between childhood exposure to air pollution, noise, and surrounding greenness and early adulthood hypertension. However, a positive joint association was suggested among non-obese participants or those living in less advantaged neighborhoods.

Association of greenspace with hypertension in adult: a systematic review and meta-analysis of epidemiological studies

BACKGROUND

Several studies have investigated the relationship of greenspace with blood pressure (BP) and hypertension, but the results were inconsistent. We aimed to assess the relationship of greenspace with BP/hypertension.

METHODS

We searched PubMed, Embase and Web of Science on greenspace and BP/hypertension published before 5 April 2023. The methodological quality and risk of bias were evaluated.

RESULTS

Twenty-seven articles were included. Our results suggested that higher normalized difference vegetation index (NDVI) was associated with lower odds of hypertension and levels of SBP [for every 10% increase of NDVI 500-m and NDVI 1000-m, the ORs were 0.95 (95% CI: 0.90-0.99) and 0.95 (95% CI: 0.90-0.99), the ꞵwas -1.32 (95% CI: -2.18, -0.45) and -1.41 (95% CI: -2.57, -0.25), respectively].

CONCLUSION

This study indicated that higher exposure to greenspace might be associated with lower levels of BP and risk of hypertension. Increase green spaces should be regarded as an important public health intervention..

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Exposure to Neighborhood Greenness and Hypertension Incidence in Adults: A Longitudinal Cohort Study in Taiwan

BACKGROUND

There are few studies on the health effects of long-term exposure to neighborhood greenness in a longitudinal setting, especially in Asian countries with high population densities.

OBJECTIVES

This study investigates the association between long-term exposure to neighborhood greenness and hypertension among adults in Taiwan.

METHODS

We selected 125,537 participants (≥ 18  years of age) without hypertension from Taiwan who had joined the standard medical examination program between 2001 and 2016. Neighborhood greenness was estimated using the normalized difference vegetation index (NDVI), derived from satellite images at a resolution of 250   m 2 . The 2-y average NDVI value within a 500 -m circular buffer around participants' residences was calculated. A time-varying Cox regression model was used to investigate the association between neighborhood greenness and incident hypertension. Mediation analyses were performed to examine whether the association was explained by air pollution, leisure-time physical exercise, or body mass index (BMI).

RESULTS

Compared with living in areas within the first quartile of neighborhood greenness, living in areas within the second, third, and fourth quartiles of neighborhood greenness was found to be associated with a lower risk of hypertension, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.95 (95% CI: 0.91, 1.00), 0.95 (95% CI: 0.90, 0.99), and 0.93 (95% CI: 0.88, 0.97), respectively. Each 0.1-unit increase in the NDVI was associated with a 24% lower risk of developing hypertension (HR = 0.76; 95% CI: 0.66, 0.87), with this associations being stronger among males and those with higher education levels. This association was slightly mediated by BMI but not by air pollution or leisure-time physical exercise.

DISCUSSION

Our findings suggest the protective effects of neighborhood greenness on hypertension development, especially in males and well-educated individuals. Our results reinforced the importance of neighborhood greenness for supporting health. https://doi.org/10.1289/EHP13071.

Prenatal Urban Environment and Blood Pressure Trajectories From Childhood to Early Adulthood

Background

Prenatal urban environmental exposures have been associated with blood pressure in children. The dynamic of these associations across childhood and later ages is unknown.

Objectives

The purpose of this study was to assess associations of prenatal urban environmental exposures with blood pressure trajectories from childhood to early adulthood.

Methods

Repeated measures of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were collected in up to 7,454 participants from a UK birth cohort. Prenatal urban exposures (n = 43) covered measures of noise, air pollution, built environment, natural spaces, traffic, meteorology, and food environment. An exposome-wide association study approach was used. Linear spline mixed-effects models were used to model associations of each exposure with trajectories of blood pressure. Replication was sought in 4 independent European cohorts (up to 9,261).

Results

In discovery analyses, higher humidity was associated with a faster increase (mean yearly change in SBP for an interquartile range increase in humidity: 0.29 mm Hg/y, 95% CI: 0.20-0.39) and higher temperature with a slower increase (mean yearly change in SBP per interquartile range increase in temperature: -0.17 mm Hg/y, 95% CI: -0.28 to -0.07) in SBP in childhood. Higher levels of humidity and air pollution were associated with faster increase in DBP in childhood and slower increase in adolescence. There was little evidence of an association of other exposures with change in SBP or DBP. Results for humidity and temperature, but not for air pollution, were replicated in other cohorts.

Conclusions

Replicated findings suggest that higher prenatal humidity and temperature could modulate blood pressure changes across childhood.

A decision tree model of hypertension among college students in Yunnan Province, China

PURPOSE

Previous studies have indicated that the prevalence rate of hypertension in adolescents is high, but it has not received much attention and the influencing factors are unclear, especially in Yunnan Province, China.

MATERIALS AND METHODS

A cluster sampling method was used to investigate 4781 freshmen in a college in Kunming, Yunnan Province from November to December. Demographic and lifestyle data were collected using questionnaires, and height, weight and blood pressure were measured. Decision tree model of hypertension in college students was established by Chi-square automatic interactive detection method.

RESULTS

Prevalence of prehypertension of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 33.9% and 32.1%, respectively. Prevalence of hypertension of SBP and DBP was detected in 1.2% and 7.2%, respectively. The hypertension and prehypertension decision tree of SBP has gender (χ2 = 728.64, p < .001) at the first level and body mass index (BMI) (boys: χ2 = 55.98, p < .001; girls: χ2 = 79.58, p < .001) at the second level. The hypertension and prehypertension decision tree of DBP has gender (χ2 = 381.83, p < .001) at the first level, BMI (boys: χ2 = 40.54, p < .001; girls: χ2 = 48.79, p < .001) at the second level, only children (χ2 = 6.43, p = .04) and red wine consumption (χ2 = 8.17, p = .017) at the third level.

CONCLUSIONS

The present study suggests that gender, BMI, only children and red wine consumption were the main factors affecting hypertension in college students in southwest border areas of China.

Associations of Urban Built Environment with Cardiovascular Risks and Mortality: a Systematic Review

With rapid urbanization, built environment has emerged as a set of modifiable factors of cardiovascular disease (CVD) risks. We conducted a systematic review to synthesize evidence on the associations of attributes of urban built environment (e.g. residential density, land use mix, greenness and walkability) with cardiovascular risk factors (e.g. hypertension and arterial stiffness) and major CVD events including mortality. A total of 63 studies, including 31 of cross-sectional design and 32 of longitudinal design conducted across 21 geographical locations and published between 2012 and 2023 were extracted for review. Overall, we report moderately consistent evidence of protective associations of greenness with cardiovascular risks and major CVD events (cross-sectional studies: 12 of 15 on hypertension/blood pressure (BP) and 2 of 3 on arterial stiffness; and longitudinal studies: 6 of 8 on hypertension/BP, 7 of 8 on CVD mortality, 3 of 3 on ischemic heart disease mortality and 5 of 8 studies on stroke hospitalization or mortality reporting significant inverse associations). Consistently, walkability was associated with lower risks of hypertension, arterial stiffness and major CVD events (cross-sectional studies: 11 of 12 on hypertension/BP and 1 of 1 on arterial stiffness; and longitudinal studies: 3 of 6 on hypertension/BP and 1 of 2 studies on CVD events being protective). Sixty-seven percent of the studies were rated as "probably high" risk of confounding bias because of inability to adjust for underlying comorbidities/family history of diseases in their statistical models. Forty-six percent and 14% of the studies were rated as "probably high" risk of bias for exposure and outcome measurements, respectively. Future studies with robust design will further help elucidate the linkages between urban built environment and cardiovascular health, thereby informing planning policies for creating healthy cities.

Who benefits from green spaces? Surrounding greenness and incidence of cardiovascular disease in a population-based electronic medical records cohort in Madrid

The objective was to study the association between surrounding greenness and the incidence of cardiovascular diseases (CVD) with a four years follow-up in almost half a million high CVD-risk women and men, as well as its differential effect by area-level deprivation in Madrid. We analyzed 2015-2018 primary healthcare electronic medical records for 437,513 high CVD risk individuals representing more than 95% of the population of that age range residing in Madrid. The outcome variable was any cardiovascular event. We measured surrounding residence greenness at 200 m, 300 m, 500 m, and 1000 m through the Normalized Difference Vegetation Index (NDVI). We assessed socioeconomic deprivation through a census-based deprivation index. We estimated the 4-year relative risk of CVD by an increase in 0.1 units of NDVI and then stratified the models by quintiles of deprivation (Q5 the most deprived). We found that for every increase in 0.1 units of NDVI at 1000 m there was a 16% decrease in CVD risk (RR = 0.84 95% CI 0.75-0.94). CVD risk for the remaining distance exposures (at 200 m, 300 m, and 500 m) were none statistically significant. In general, the protective effect of green spaces was present in medium-deprivation areas and males, but the associations were inconsistent across deprivation levels. This study highlights the relevance of evaluating the interaction between physical and social urban components to further understand possible population prevention approaches for cardiovascular diseases. Future studies should focus on the mechanisms of context-specific interactions between social inequalities and green spaces' effects on health.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Association of SO2/CO exposure and greenness with high blood pressure in children and adolescents: A longitudinal study in China

Introduction

We aimed to investigate the association between greenness around schools, long-term gaseous air pollution exposure (SO₂ and CO), and blood pressure in children and adolescents.

Methods

From 2006 to 2018, a total of 219,956 Chinese children and adolescents aged 7-17 years in Beijing and Zhongshan were included in this longitudinal study. Annual average concentrations of SO₂ and CO and the mean values of normalized difference vegetation index around schools were calculated. We used the generalized estimation equation model, restricted cubic spline model, and Cox model to analyze the health effects.

Results

Among all the subjects, 52,515 had the first onset of HBP. During the follow-up, HBP's cumulative incidence and incidence density were 23.88% and 7.72 per 100 person-year respectively. Exposures to SO₂ and CO were significantly associated with SBP [β = 1.30, 95% CI: (1.26, 1.34) and 0.78 (0.75, 0.81)], DBP [β = 0.81 (0.79, 0.84) and 0.46 (0.44, 0.48)] and HBP [HR = 1.58 (1.57, 1.60) and 1.42 (1.41, 1.43)]. The risks of HBP attributed to SO₂ and CO pollution would be higher in school-aged children in the low greenness group: the attributable fractions (AFs) were 26.31% and 20.04%, but only 13.90% and 17.81% in the higher greenness group. The AFs were also higher for normal-BMI children and adolescents in the low greenness group (AFs = 30.90% and 22.64%, but 14.41% and 18.65% in the high greenness group), while the AFs were not as high as expected for obese children in the low greenness group (AFs = 10.64% and 8.61%), nor was it significantly lower in the high greenness group (AFs = 9.60% and 10.72%).

Discussion

Greenness could alleviate the damage effects of SO₂/CO exposure on the risks of HBP among children and adolescents, and the benefit is BMI sensitivity. It might offer insights for policymakers in making effective official interventions to prevent and control the prevalence of childhood HBP and the future disease burden caused by air pollution.

Early-life residential green spaces and traffic exposure in association with young adult body composition: a longitudinal birth cohort study of twins

BACKGROUND

Globally, the rapid increase of obesity is reaching alarming proportions. A new approach to reduce obesity and its comorbidities involves tackling the built environment. Environmental influences seem to play an important role, but the environmental influences in early life on adult body composition have not been thoroughly investigated. This study seeks to fill the research gap by examining early-life exposure to residential green spaces and traffic exposure in association with body composition among a population of young adult twins.

METHODS

As part of the East Flanders Prospective Twin Survey (EFPTS) cohort, this study included 332 twins. Residential addresses of the mothers at time of birth of the twins were geocoded to determine residential green spaces and traffic exposure. To capture body composition, body mass index, waist-to-hip ratio (WHR), waist circumference, skinfold thickness, leptin levels, and fat percentage were measured at adult age. Linear mixed modelling analyses were conducted to investigate early-life environmental exposures in association with body composition, while accounting for potential confounders. In addition, moderator effects of zygosity/chorionicity, sex and socio-economic status were tested.

RESULTS

Each interquartile range (IQR) increase in distance to highway was found associated with an increase of 1.2% in WHR (95%CI 0.2-2.2%). For landcover of green spaces, each IQR increase was associated with 0.8% increase in WHR (95%CI 0.4-1.3%), 1.4% increase in waist circumference (95%CI 0.5-2.2%), and 2.3% increase in body fat (95%CI 0.2-4.4%). Stratified analyses by zygosity/chorionicity type indicated that in monozygotic monochorionic twins, each IQR increase in land cover of green spaces was associated with 1.3% increase in WHR (95%CI 0.5-2.1%). In monozygotic dichorionic twins, each IQR increase in land cover of green spaces was associated with 1.4% increase in waist-circumference (95%CI 0.6-2.2%).

CONCLUSIONS

The built environment in which mothers reside during pregnancy might play a role on body composition among young adult twins. Our study revealed that based on zygosity/chorionicity type differential effects of prenatal exposure to green spaces on body composition at adult age might exist.

Relationship between Built-Up Environment, Air Pollution, Activity Frequency and Prevalence of Hypertension-An Empirical Analysis from the Main City of Lanzhou

In the process of promoting the strategy of a healthy China, the built environment, as a carrier of human activities, can effectively influence the health level of residents in the light of its functional types. Based on the POI data of four main urban areas in Lanzhou, this paper classifies the built environment in terms of function into four types. The association between different types of built environments and the prevalence of hypertension was investigated by using the community as the study scale, and activity frequency, air pollution and green space were used as mediating variables to investigate whether they could mediate the relationship between built environments and hypertension. The results indicate that communities with a high concentration of commercial service facilities, road and traffic facilities and industrial facilities have a relatively high prevalence of hypertension. By determining the direct, indirect and overall effects of different functional types of built environment on the prevalence of hypertension, it was learned that the construction of public management and service facilities can effectively mitigate the negative effects of hypertension in the surrounding residents. The results of the study contribute to the rational planning of the structure of the built environment, which is beneficial for optimizing the urban structure and preventing and controlling chronic diseases such as hypertension.

Higher buccal mtDNA content is associated with residential surrounding green in a panel study of primary school children

BACKGROUND

Mitochondria are known to respond to environmental stressors but whether green space is associated with mitochondrial abundance is unexplored. Furthermore, as exposures may affect health from early life onwards, we here evaluate if residential green space is associated with mitochondria DNA content (mtDNAc) in children.

METHODS

In primary schoolchildren (COGNAC study), between 2012 and 2014, buccal mtDNAc was repeatedly (three times) assessed using qPCR. Surrounding low (<3m), high (≥3m) and total (sum of low and high) green space within different radii (100m-1000m) from the residence and distance to the nearest large green space (>0.5ha) were estimated using a remote sensing derived map. Given the repeated measures design, we applied a mixed-effects model with school and subject as random effect while adjusting for a priori chosen fixed covariates.

RESULTS

mtDNAc was assessed in 246 children with a total of 436 measurements (mean age 10.3 years). Within a 1000m radius around the residential address, an IQR increment in low (11.0%), high (9.5%), and total (13.9%) green space was associated with a respectively 15.2% (95% CI: 7.2%-23.7%), 10.8% (95% CI: 4.5%-17.5%), and 13.4% (95% CI: 7.4%-19.7%) higher mtDNAc. Conversely, an IQR increment (11.6%) in agricultural area in the same radius was associated with a -3.4% (95% CI: 6.7% to -0.1%) lower mtDNAc. Finally, a doubling in distance to large green space was associated with a -5.2% (95% CI: 7.9 to -2.4%) lower mtDNAc.

CONCLUSION

To our knowledge, this is the first study evaluating associations between residential surrounding green space and mtDNAc in children. Our results showed that green space was associated with a higher mtDNAc in children, which indicates the importance of the early life environment. To what extent these findings contribute to later life health effects should be further examined.

Climate Change and Cascading Risks from Infectious Disease

Climate change is adversely affecting the burden of infectious disease throughout the world, which is a health security threat. Climate-sensitive infectious disease includes vector-borne diseases such as malaria, whose transmission potential is expected to increase because of enhanced climatic suitability for the mosquito vector in Asia, sub-Saharan Africa, and South America. Climatic suitability for the mosquitoes that can carry dengue, Zika, and chikungunya is also likely to increase, facilitating further increases in the geographic range and longer transmission seasons, and raising concern for expansion of these diseases into temperate zones, particularly under higher greenhouse gas emission scenarios. Early spring temperatures in 2018 seem to have contributed to the early onset and extensive West Nile virus outbreak in Europe, a pathogen expected to expand further beyond its current distribution, due to a warming climate. As for tick-borne diseases, climate change is projected to continue to contribute to the spread of Lyme disease and tick-borne encephalitis, particularly in North America and Europe. Schistosomiasis is a water-borne disease and public health concern in Africa, Latin America, the Middle East, and Southeast Asia; climate change is anticipated to change its distribution, with both expansions and contractions expected. Other water-borne diseases that cause diarrheal diseases have declined significantly over the last decades owing to socioeconomic development and public health measures but changes in climate can reverse some of these positive developments. Weather and climate events, population movement, land use changes, urbanization, global trade, and other drivers can catalyze a succession of secondary events that can lead to a range of health impacts, including infectious disease outbreaks. These cascading risk pathways of causally connected events can result in large-scale outbreaks and affect society at large. We review climatic and other cascading drivers of infectious disease with projections under different climate change scenarios. Supplementary file1 (MP4 328467 KB).

The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study

BACKGROUND

Although the oldest-old (those aged over 80 years) are vulnerable to environmental factors and have the highest prevalence of hypertension, studies focusing on greenness exposure and the development of hypertension among them are insufficient. The aim of this study was to explore the association between residential greenness and hypertension in the oldest-old population.

METHODS

This cohort study included data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The oldest-old were free of hypertension at baseline (2008), and hypertension events were assessed by follow-up surveys in 2011, 2014, and 2018. The one-year averages of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) at 500-m buffer before the interview year of incident hypertension or last censoring interview were collected at the level of 652 residential units (district or county). The linear or nonlinear association between greenness and hypertension incidence was analyzed using the Cox proportional hazards model with penalized splines. The linear links between greenness and hypertension incidence were determined using the Cox proportional hazards model included a random effect term.

RESULTS

Among 5253 participants, the incidence rate of hypertension was 7.25 (95% confidence interval [CI]: 6.83-7.67) per 100 person-years. We found a nonlinear association between greenness exposure and hypertension risk, and the exposure-response curve showed that 1 change point existed. We examined the linear effect of greenness on hypertension by categorizing the NDVI/EVI into low and high-level exposure areas according to the change point. We found more notable protective effects of each 0.1-unit increase in greenness on hypertension incidence for participants living in the high-level greenness areas (hazard ratio (HR) = 0.60; 95% CI: 0.53-0.70 for NDVI; HR = 0.46; 95% CI: 0.37-0.57 for EVI). In contrast, no significant influence of greenness exposure on hypertension risk was found for participants living in the low-level greenness areas (HR = 0.77; 95% CI: 0.38-1.55 for NDVI; HR = 0.73; 95% CI: 0.33-1.63 for EVI).

CONCLUSIONS

Greenness exposure is nonlinearly associated with hypertension risk among the oldest-old, presenting its relationship in an inverse "U-shaped" curve. Greenness is a protective factor that decreases the risk of hypertension.

Association between greenspace and blood pressure: A systematic review and meta-analysis

Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and meta-analysis to comprehensively evaluate the evidence concerning greenspaces with BP levels and prevalent hypertension. Systematic literature searches were performed in Web of Science, PubMed, and Embase up to 25 April 2021. Combined effect estimates were calculated using random-effect models for each greenspace exposure assessment method that had been examined in ≥3 studies. Sensitivity analysis, subgroup analysis, and publication bias were also conducted. Of 38 articles (including 52 analyses, 5.2 million participants in total) examining the effects of normalized difference vegetation index (NDVI) (n = 23), proportion of greenspace (n = 11), distance to greenspace (n = 9), and others (n = 9) were identified. Most studies (65%) reported beneficial associations between greenspaces and BP levels/hypertension. Our results of meta-analyses showed that higher NDVI_500m was significantly associated with lower levels of systolic blood pressure (SBP = -0.77 mmHg, 95%CI: -1.23 to -0.32) and diastolic blood pressure (DBP = -0.32 mmHg, 95%CI: -0.57 to -0.07). We also found that NDVI in different buffers and the proportion of greenspaces were significantly associated with lower odds (1-9%) of hypertension. However, no significant effect was found for distance to greenspaces. In summary, our results indicate the beneficial effects of greenspace exposure on BP and hypertension. However, future better-designed studies, preferably longitudinal, are needed to confirm and better quantify the observed benefits in BP and/or hypertension.

Greenness alleviates the effects of ambient particulate matter on the risks of high blood pressure in children and adolescents

Both ambient particulate matter (PM) and decrease of greenness have been suggested as risk factors for high blood pressure (HBP) in children and adolescents. But most evidence were from cross-sectional studies with limited data from prospective cohorts. In this cohort study, we included 588,004 children and adolescents aged 7 to 18 years without HBP from 2005 to 2018 in Beijing (240,081) and Zhongshan (347,923) city of China. The cumulative incidence of HBP was 32.04%, and incidence rate was 14.86 per 100 person-year. After adjustment for confounders, the ten-unit increase in PM₁, PM_2.5, and PM₁₀ exposure was significantly associated with 43%, 70%, and 43%- higher risks of HBP, respectively, but the 0.1-unit increase in NDVI exposure was significantly associated with a 25% lower risk of HBP. The HRs of PM₁ on the HBP risk were 1.486 and 1.150 in the low and the high-level of greenness, and they were 2.635 and 2.507 for PM_2.5, and for PM₁₀ 1.367 and 1.702 in the two groups. The attributable fraction (AFs) of PM₁, PM_2.5, and PM₁₀ on HBP incidents were 13.74%, 40.08%, and 15.47% in the low-level of greenness, which simultaneously was higher than those in the high-level of greenness (AF = 4.62%, 17.28%, and 9.96%). The exposure to higher ambient PM air pollution and lower greenness around schools were associated with a higher risk of HBP in children and adolescents, but higher greenness alleviated the adverse effects of ambient PM₁ and PM_2.5 on the HBP risks. Our findings highlighted a synergic strategy in preventing childhood HBP by decreasing air pollution reduction and improving greenness concurrently.

Associations of greenness surrounding schools with blood pressure and hypertension: A nationwide cross-sectional study of 61,229 children and adolescents in China

BACKGROUND

Greenness exposure may lower blood pressure. However, few studies of this relationship have been conducted with children and adolescents, especially in low and middle-income countries.

OBJECTIVES

To evaluate associations between greenness around schools and blood pressure among children and adolescents across China.

METHODS

We recruited 61,229 Chinese citizens aged 6-18 years from 94 schools in a nationwide cross-sectional study in seven Chinese provinces/province-level municipalities. Participants' blood pressures and hypertension were assessed with standardized protocols. Greenness levels within 500 m and 1,000 m of each school were estimated with three satellite-based indices: vegetation continuous fields (VCF), normalized difference vegetation index (NDVI), and soil adjusted vegetation index (SAVI). Generalized linear mixed models were used to evaluate associations between greenness and blood pressure, greenness and prevalent hypertension, using coefficient and odds ratio respectively. Stratified analyses and mediation analyses were also performed.

RESULTS

One interquartile range increase in greenness was associated with a 17%-20% reduced prevalence of hypertension for all measures of greenness (odds ratios for VCF_500m = 20% (95% CI:18%, 23%); for NDVI_500m = 17% (95% CI:13%, 21%); and for SAVI_500m = 17% (95% CI: 13%, 20%). Increases in greenness were also associated with reductions in systolic blood pressure (0.48-0.58 mmHg) and diastolic blood pressure (0.26-0.52 mmHg). Older participants, boys, and urban dwellers showed stronger associations than their counterparts. No evidence of mediation was observed for air pollution (i.e., NO₂ and PM_2.5) and body mass index.

CONCLUSION

Higher greenness around schools may lower blood pressure levels and prevalent hypertension among Chinese children and adolescents, particularly in older subjects, boys, and those living in urban districts. Further studies, preferably longitudinal, are needed to examine causality.

Associations of residential greenness with hypertension and blood pressure in a Chinese rural population: a cross-sectional study

Limited epidemiological literature identified the associations between residential greenness and hypertension in low-/middle-income countries. A random sampling strategy was adopted to recruit 39,259 residents, ≥ 18 years, and from 5 counties in central China. Blood pressure was measured based on the protocol of the American Heart Association. Hypertension was defined according to the 2010 Chinese guidelines for the management of hypertension. The satellite-derived normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) were applied to estimate the residential greenness. Mixed logit model and mixed linear model were utilized to explore the relationships of residential greenness with hypertension and blood pressure. Higher residential greenness was associated with lower odds of hypertension and blood pressure levels. For instance, an interquartile range (IQR) increase in NDVI_500m was linked with lower odds of hypertension (OR = 0.92, 95%CI 0.88 to 0.95), a decrease of -0.88 mm Hg (95% CI -1.17 to -0.58) and -0.64 mm Hg (95% CI -0.82 to -0.46) in SBP and DBP, respectively. The effect of residential greenness was more pronounced in males, smokers, and drinkers. Long-term exposure to residential greenness was linked with lower odds of hypertension. More prospective studies are needed to verify the hypothesis.

Greenness-air pollution-physical activity-hypertension association among middle-aged and older adults: Evidence from urban and rural China

BACKGROUND

Although some evidence suggests that residential greenness may prevent hypertension in urban areas, limited attention has been paid to urban-rural disparities in the association of greenness with hypertension in rapidly urbanizing developing countries.

OBJECTIVES

The current study investigated the association between the amount of neighbourhood greenness and hypertension among middle and older aged people in Chinese urban and rural areas. It further examined whether PM_2.5 (particulate matter ≤2.5 μm in aerodynamic diameter) concentrations, physical activity, and body mass index (BMI) mediated the association of greenness with hypertension.

METHODS

We used data from 11 486 adults aged 50 years or above within the first wave of the Study on Global Ageing and Adult Health in China during 2007-2010. Hypertension was assessed by criterion-based measures of blood pressure. Residential greenness was characterized by satellite-derived Normalized Difference Vegetation Index. We employed multilevel generalized structural equation models to estimate the association between neighbourhood greenness and hypertension in urban and rural areas. Serial mediation models have been performed to test potential pathways linking greenness to hypertension.

RESULTS

In rural areas, a greater amount of residential greenness was directly associated with a decrease in the odds of hypertension (odds ratio = 0.51, 95% confidence interval 0.29-0.89). No direct association was observed in urban areas (odds ratio = 1.33, 95% confidence interval 0.94-1.89). Serial mediation models showed that the association of greenness with hypertension was completely mediated by PM_2.5 concentrations in urban areas, while the association of greenness with hypertension was only partially mediated by PM_2.5 concentrations and serial PM_2.5 concentrations-physical activity path in rural areas. There was no evidence that physical activity, air pollution-BMI path, air pollution-physical activity-BMI path, and physical activity-BMI path mediated the association in both urban and rural areas.

CONCLUSIONS

Higher neighbourhood greenness was directly associated with a lower prevalence of hypertension among middle and older aged adults in rural China but not in urban areas. The association of greenness with hypertension was completely mediated by air pollution (without any mediation effect of physical activity and BMI) in urban areas. In contrast, the association was partly mediated by air pollution, physical activity, and other unobservables in rural areas. Further longitudinal studies are warranted to prove a cause-and-effect association, which may help policymakers and practitioners to conduce effective interventions to prevent and control the prevalence of hypertension and the attendant disease burden.

Residential urban greenspace and hypertension: A comparative study in two European cities

BACKGROUND

Living in green areas has been associated with several health benefits; however, the available evidence on such benefits for hypertension is still limited. This study aimed to investigate and compare the association between residential exposure to greenspace and hypertension in Barcelona, Spain and Brussels, Belgium.

METHODS

This cross-sectional study was based on data from the 2016 Barcelona Health Interview Survey (HIS) (n = 3400) and the 2013 Belgian HIS (n = 2335). Both surveys were harmonized in terms of outcomes, confounders and exposure assessment. Residential exposure to greenspace was characterized as 1) surrounding greenspace (normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index 2 (MSAVI2)) across buffers of 100 m, 300 m, and 500 m; 2) surrounding green space across 300 m and 500 m buffers; and 3) Euclidean distance to the nearest green space. Our outcome was self-reported hypertension. We developed logistic regression models to evaluate the city-specific association between each greenspace measure and hypertension, adjusting for relevant covariates.

RESULTS

One interquartile range (IQR) increase in residential distance to the nearest green space was associated with higher risk of hypertension in Barcelona [odds ratio (OR): 1.15; 95%CI 1.03-1.29 (IQR: 262.2)], but not in Brussels [OR: 0.95; 95%CI 0.77-1.17 (IQR: 215.2)]. Stratified analyses suggested stronger associations in older participants (≥65 years) for both cities. Findings for residential surrounding green space and greenspace were not conclusive. However, in Brussels, we found protective associations in older participants for both residential surrounding greenspace metrics [NDVI 300 m buffer OR: 0.51; 95%CI 0.32-0.81 (IQR: 0.21) and MSAVI2 300 m buffer OR: 0.51; 95%CI 0.32-0.83 (IQR: 0.18)]. We did not find any indication for the modification of our evaluated associations by sex and education level.

CONCLUSION

Our study suggests that living closer to greenspace could be associated with lower risk of hypertension, particularly in older age. Future research is needed to replicate our findings in other settings and shed light on potential underlying mechanism(s).

Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China

BACKGROUND

Proximity to greenness has shown protective effects on coronary heart diseases by limiting exposure to environmental hazards, encouraging physical activity, and reducing mental stress. However, no studies have previously evaluated the impacts of greenness on congenital heart defects (CHDs). We examined the association between maternal residential greenness and the risks of CHDs.

METHODS

We conducted a case-control study (8042 children with major CHDs and 6887 controls without malformations) in 21 cities in Southern China, 2004 - 2016. CHDs cases were diagnosed and verified by obstetrician, pediatrician, or pediatric cardiologists, within one year. We estimated maternal residential greenness using satellite-derived normalized difference vegetation index (NDVI) in zones of 500 meters (m) and 1000 m surrounding participants' residences. Logistic regression models were used to assess NDVI-CHD relationships adjusting for confounders.

RESULTS

Interquartile range NDVI increases within 500 m or 1000 m were associated with odds ratios (OR) of 0.95 (95% confidence interval (CI): 0.92, 0.98) and 0.94 (95%CI: 0.91, 0.97) for total CHDs respectively. Air pollutants mediated 52.1% of the association. We also identified a protective threshold at 0.21 NDVI on CHD. Similar protective effects from greenness were found in most CHDs subtypes. The protective associations were stronger for fall, urban or permanent residents, higher household income maternal age ≤35 years of age, and high maternal education (ORs: ranged from 0.85 to 0.96).

CONCLUSION

Our findings suggest a beneficial effect of maternal residential greenness on CHDs. Further studies are needed to confirm our findings, which will help to refine preventive health and urban design strategies.

Associations of types of green space across the life-course with blood pressure and body mass index

Green space has been associated with better health and well-being. However, most studies have been cross-sectional with limited long-term exposure data. Further, research is limited in what type of green space is beneficial for health. We conducted a longitudinal study to assess sensitive periods (birth, childhood or adulthood) of exposure to different types of green space in association with adult blood pressure and body mass index (BMI). Using longitudinal data from the New England Family Study (1960-2000) and multilevel regression analysis, we examined associations between time-varying markers of residential exposure to green space, and adult BMI, systolic (SBP) and diastolic blood pressure (DBP) (N = 517). We created three exposure metrics: distance, average area, and green space count in the neighborhood throughout the life-course. In adjusted models, living one mile farther away from a green space at birth was associated with a 5.6 mmHg higher adult SBP (95%CI: 0.7, 10.5), and 3.5 mmHg higher DBP (95%CI: 0.3, 6.8). One more green space in the neighborhood at birth was also associated with lower DBP (-0.2 mmHg, 95%CI: -0.4, -0.02) in adulthood. Finally, average area of green space was not associated with SBP, DBP nor BMI. Analysis by type of green space suggested that parks may be more relevant than playgrounds, cemeteries or golf courses. Our study suggests that the perinatal period may be a critical time-period where living closer to green spaces may lower hypertension risk in adulthood, but not obesity.

Greenness around schools associated with lower risk of hypertension among children: Findings from the Seven Northeastern Cities Study in China

Evidence suggests that residential greenness may be protective of high blood pressure, but there is scarcity of evidence on the associations between greenness around schools and blood pressure among children. We aimed to investigate this association in China. Our study included 9354 children from 62 schools in the Seven Northeastern Cities Study. Greenness around each child's school was measured by NDVI (Normalized Difference Vegetation Index) and SAVI (Soil-Adjusted Vegetation Index). Particulate matter ≤ 1 μm (PM₁) concentrations were estimated by spatiotemporal models and nitrogen dioxide (NO₂) concentrations were collected from air monitoring stations. Associations between greenness and blood pressure were determined by generalized linear and logistic mixed-effect models. Mediation by air pollution was assessed using mediation analysis. Higher greenness was consistently associated with lower blood pressure. An increase of 0.1 in NDVI corresponded to a reduction in SBP of 1.39 mmHg (95% CI: 1.86, -0.93) and lower odds of hypertension (OR = 0.76, 95% CI: 0.69, 0.82). Stronger associations were observed in children with higher BMI. Ambient PM₁ and NO₂ mediated 33.0% and 10.9% of the association between greenness and SBP, respectively. In summary, greater greenness near schools had a beneficial effect on blood pressure, particularly in overweight or obese children in China. The associations might be partially mediated by air pollution. These results might have implications for policy makers to incorporate more green space for both aesthetic and health benefits.

Density of Green Spaces and Cardiovascular Risk Factors in the City of Madrid: The Heart Healthy Hoods Study

The aim of this study is to evaluate the relationship between the density of green spaces at different buffer sizes (300, 500, 1000 and 1500 m) and cardiovascular risk factors (obesity, hypertension, high cholesterol, and diabetes) as well as to study if the relationship is different for males and females. We conducted cross-sectional analyses using the baseline measures of the Heart Healthy Hoods study (N = 1625). We obtained data on the outcomes from clinical diagnoses, as well as anthropometric and blood sample measures. Exposure data on green spaces density at different buffer sizes were derived from the land cover distribution map of Madrid. Results showed an association between the density of green spaces within 300 and 500 m buffers with high cholesterol and diabetes, and an association between the density of green spaces within 1500 m buffer with hypertension. However, all of these associations were significant only in women. Study results, along with other evidence, may help policy-makers creating healthier environments that could reduce cardiovascular disease burden and reduce gender health inequities. Further research should investigate the specific mechanisms behind the differences by gender and buffer size of the relationship between green spaces and cardiovascular risk factors.

The East Flanders Prospective Twin Survey (EFPTS): 55 Years Later

The East Flanders Prospective Twin Survey (EFPTS) is a registry of multiple births in the province of East Flanders, Belgium. Since its start in 1964, over 10,000 twin-pairs have been registered. EFPTS has several unique features: it is population-based and prospective, with the possibility of long-term follow-up; the twins (and higher order multiple births) are recruited at birth; basic perinatal data are recorded; chorion type and zygosity are established; since 1969, placental biopsies have been taken and frozen at -20°C for future research. Since its origin, the EFPTS has included placental data and allows differentiation of three subtypes of monozygotic twins based on the time of the initial zygotic division: the dichorionic-diamniotic pairs (early, with splitting before the fourth day after fertilization), the monochorionic-diamniotic pairs (intermediate, splitting between the fourth- and the seventh-day postfertilization) and the monochorionic-monoamniotic pairs (late, splitting after the eighth day postfertilization). Studies can be initiated taking into account primary biases, those originating 'in utero'. Such studies could throw new light on the consequences of early embryological events and the gene-environment interactions as far as periconceptional and intrauterine environment are concerned.

Neonatal blood pressure in association with prenatal air pollution exposure, traffic, and land use indicators: An ENVIRONAGE birth cohort study

Elevated blood pressure (BP) in early life may lead to cardiovascular morbidity and mortality in later life. Air pollution exposure has been associated with increased BP in adults and children, but the contribution of prenatal air pollution exposure has rarely been assessed. In addition, we are not aware of any study on neonatal BP and maternal residential traffic and land use indicators during pregnancy. We investigated the association between newborn BP and prenatal air pollution, traffic and land use indicators, using data from 427 term (gestational age > 36 weeks) births from the ENVIRONAGE birth cohort. Newborn BP was measured using an automated device within 4 days after birth. Daily maternal residential air pollutants during pregnancy, including particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM_2.5) and ≤10 μm (PM₁₀), black carbon (BC), and nitrogen dioxide (NO₂), were modelled using a high-resolution spatial-temporal model. The association between newborn BP and air pollution during the last 15 weeks of pregnancy was assessed using distributed lag models. Each 5 μg/m³ increment in prenatal PM_2.5 exposure was associated with a 2.4 mm Hg (95% CI, 0.5 to 4.2) higher systolic and a 1.8 mm Hg (95% CI, 0.2 to 3.5) higher diastolic BP at birth. Overall estimates for PM₁₀ were similar but those for NO₂ and BC did not reach significance. Associations between newborn BP and exposures during the last 4 to 5 weeks of pregnancy were significant for all pollutants. An IQR (20.3%) increment in percentage residential greenness in a 5 km radius was associated with a 1.2 mm Hg (95% CI, -2.5 to 0.1; p = 0.07) lower systolic and a 1.2 mm Hg (95% CI, -2.4 to -0.0; p = 0.05) lower diastolic BP. An IQR (4.1%) increment in percentage industrial area in a 5 km radius was associated with a 1.0 mm Hg (95% CI, 0.1 to 1.9; p = 0.03) higher diastolic BP. Residential traffic indicators did not significantly associate with newborn BP. Prenatal air pollution exposure, greenness, and industrial area at maternal residence may affect offspring BP from birth onwards.

Nature and mental health: An ecosystem service perspective

A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

Nature and mental health: An ecosystem service perspective

A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

Community greenness, blood pressure, and hypertension in urban dwellers: The 33 Communities Chinese Health Study

BACKGROUND

Living in greener areas has many health benefits, but evidence concerning the effects on blood pressure remains mixed. We sought to assess associations between community greenness and both blood pressure and hypertension in Chinese urban dwellers, and whether the associations were mediated by air pollution, body mass index, and physical activity.

METHODS

We analyzed data from 24,845 adults participating in the 33 Communities Chinese Health Study, which was conducted in Northeastern China during 2009. We measured each participant's blood pressure according to a standardized protocol. We assessed community greenness using two satellite-derived vegetation indexes - the Normalized Difference Vegetation Index (NDVI) and the Soil Adjusted Vegetation Index (SAVI). Particulate matter ≤2.5 μm and nitrogen dioxide were used as proxies of ambient air pollution. We applied generalized linear mixed models to investigate the association between greenness and blood pressure. We also performed mediation analyses.

RESULTS

Living in greener areas was associated with lower blood pressure and hypertension prevalence; an interquartile range increase in both NDVI_500-m and SAVI_500-m were significantly associated with reductions in systolic blood pressure of 0.82 mm Hg (95% CI: -1.13, -0.51) and 0.89 mm Hg (95% CI: -1.21, -0.57), respectively. The same increases in greenness were also significantly associated with a 5% (95% CI: 1%, 8%) and 5% (95% CI: 1%, 9%) lower odds of having hypertension, respectively. These associations remained consistent in sensitivity analyses. The associations were stronger among women than men. Air pollutants and body mass index partly mediated the associations, but there was no evidence of mediation effects for physical activity.

CONCLUSIONS

Our findings indicate beneficial associations between community greenness and blood pressure in Chinese adults, especially for women. Air pollution and body mass index only partly mediated the associations.

Greenspace seems protective of both high and low blood pressure among residents of an Alpine valley

BACKGROUND

There is some data suggesting that residential greenspace may protect against high blood pressure in urbanized areas, but there is no evidence of effects on hypotension, in less urbanized areas, and in idiosyncratic geographic contexts such as mountain valleys.

OBJECTIVES

The current study aimed to investigate the associations between residential greenspace and blood pressure in an alpine valley in Austria.

METHODS

We conducted a cross-sectional survey of a representative sample of 555 adults living in the Lower Inn Valley, Austria. Several definitions of blood pressure were employed: continuously-measured systolic (SBP) and diastolic blood pressure (DBP), doctor-diagnosed hyper- and hypotension, and high- and low blood pressure medication use. Greenspace metrics considered were: Normalized Difference Vegetation Index (NDVI), Soil Adjusted Vegetation Index (SAVI), and tree cover as measures of surrounding greenness in circular buffers of 100 m, 300 m, 500 m, and 1000 m around the home; distance to different types of structured green space; and having a domestic garden and a balcony. Relationships were examined across different definitions of blood pressure and greenspace and evaluated for potential effect modification by demographic factors, presence of a domestic garden/balcony, adiposity, and traffic sensitivity.

RESULTS

Higher overall greenness was associated with 30-40% lower odds of hyper/hypotension and 2-3 mm Hg lower SBP. Similar pattern was revealed for tree cover, however, associations with hypertension were less consistent across buffers, and SBP and DBP were lower only in association with greenness in the 100-m buffer. Having a domestic garden also seemed protective of high DBP. Residing near to forests, agricultural land, or urban green spaces was not related to blood pressure. Higher NDVI_500-m was stronger associated with lower SBP in those having a domestic garden, while the effect on DBP was stronger in overweight/obese participants.

CONCLUSION

These findings support the idea that greenspace should be considered as protective of both high and low blood pressure, however, underlying mechanisms remain insufficiently understood.

Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces

INTRODUCTION

Natural environments and green spaces provide ecosystem services that enhance human health and well-being. They improve mental health, mitigate allergies and reduce all-cause, respiratory, cardiovascular and cancer mortality. The presence, accessibility, proximity and greenness of green spaces determine the magnitude of their positive health effects, but the role of biodiversity (including species and ecosystem diversity) within green spaces remains underexplored. This review describes mechanisms and evidence of effects of biodiversity in nature and green spaces on human health.

SOURCES OF DATA

We identified studies listed in PubMed and Web of Science using combinations of keywords including 'biodiversity', 'diversity', 'species richness', 'human health', 'mental health' and 'well-being' with no restrictions on the year of publication. Papers were considered for detailed evaluation if they were written in English and reported data on levels of biodiversity and health outcomes.

AREAS OF AGREEMENT

There is evidence for positive associations between species diversity and well-being (psychological and physical) and between ecosystem diversity and immune system regulation.

AREAS OF CONCERN

There is a very limited number of studies that relate measured biodiversity to human health. There is more evidence for self-reported psychological well-being than for well-defined clinical outcomes. High species diversity has been associated with both reduced and increased vector-borne disease risk.

GROWING POINTS

Biodiversity supports ecosystem services mitigating heat, noise and air pollution, which all mediate the positive health effects of green spaces, but direct and long-term health outcomes of species diversity have been insufficiently studied so far.

AREAS TIMELY FOR RESEARCH

Additional research and newly developed methods are needed to quantify short- and long-term health effects of exposure to perceived and objectively measured species diversity, including health effects of nature-based solutions and exposure to microbiota.

Exploring links between greenspace and sudden unexpected death: A spatial analysis

Greenspace has been increasingly recognized as having numerous health benefits. However, its effects are unknown concerning sudden unexpected death (SUD), commonly referred to as sudden cardiac death, which constitutes a large proportion of mortality in the United States. Because greenspace can promote physical activity, reduce stress and buffer air pollutants, it may have beneficial effects for people at risk of SUD, such as those with heart disease, hypertension, and diabetes mellitus. Using several spatial techniques, this study explored the relationship between SUD and greenspace. We adjudicated 396 SUD cases that occurred from March 2013 to February 2015 among reports from emergency medical services (EMS) that attended out-of-hospital deaths in Wake County (central North Carolina, USA). We measured multiple greenspace metrics in each census tract, including the percentages of forest, grassland, average tree canopy, tree canopy diversity, near-road tree canopy and greenway density. The associations between SUD incidence and these greenspace metrics were examined using Poisson regression (non-spatial) and Bayesian spatial models. The results from both models indicated that SUD incidence was inversely associated with both greenway density (adjusted risk ratio [RR] = 0.82, 95% credible/ confidence interval [CI]: 0.69-0.97) and the percentage of forest (adjusted RR = 0.90, 95% CI: 0.81-0.99). These results suggest that increases in greenway density by 1 km/km2 and in forest by 10% were associated with a decrease in SUD risk of 18% and 10%, respectively. The inverse relationship was not observed between SUD incidence and other metrics, including grassland, average tree canopy, near-road tree canopy and tree canopy diversity. This study implies that greenspace, specifically greenways and forest, may have beneficial effects for people at risk of SUD. Further studies are needed to investigate potential causal relationships between greenspace and SUD, and potential mechanisms such as promoting physical activity and reducing stress.

A Review of Epidemiologic Studies on Greenness and Health: Updated Literature Through 2017

PURPOSE OF REVIEW

Many studies suggest that exposure to natural vegetation, or greenness, may be beneficial for a variety of health outcomes. We summarize the recent research in this area.

RECENT FINDINGS

We observed consistent and strong evidence of associations for higher greenness with improvements in birth weights and physical activity, as well as lower mortality rates. Recent studies also suggested that exposure to greenness may lower levels of depression and depressive symptoms. The evidence on greenness and cardiovascular health remains mixed. Findings are also inconsistent for greenness measures and asthma and allergies. Our knowledge of the impacts of greenness on a wide variety of health outcomes continues to evolve. Future research should incorporate information on specific species and some qualities of natural greenness that might drive health outcomes, integrate exposure assessments that incorporate personal mobility into analyses, and include prospective designs to add to the growing evidence that nature exposure positively affects health.

A Review of Epidemiologic Studies on Greenness and Health: Updated Literature Through 2017

PURPOSE OF REVIEW

Many studies suggest that exposure to natural vegetation, or greenness, may be beneficial for a variety of health outcomes. We summarize the recent research in this area.

RECENT FINDINGS

We observed consistent and strong evidence of associations for higher greenness with improvements in birth weights and physical activity, as well as lower mortality rates. Recent studies also suggested that exposure to greenness may lower levels of depression and depressive symptoms. The evidence on greenness and cardiovascular health remains mixed. Findings are also inconsistent for greenness measures and asthma and allergies. Our knowledge of the impacts of greenness on a wide variety of health outcomes continues to evolve. Future research should incorporate information on specific species and some qualities of natural greenness that might drive health outcomes, integrate exposure assessments that incorporate personal mobility into analyses, and include prospective designs to add to the growing evidence that nature exposure positively affects health.

Telomere tracking from birth to adulthood and residential traffic exposure

BACKGROUND

Telomere attrition is extremely rapid during the first years of life, while lifestyle during adulthood exerts a minor impact. This suggests that early life is an important period in the determination of telomere length. We investigated the importance of the early-life environment on both telomere tracking and adult telomere length.

METHODS

Among 184 twins of the East Flanders Prospective Twin Survey, telomere length in placental tissue and in buccal cells in young adulthood was measured. Residential addresses at birth and in young adulthood were geocoded and residential traffic and greenness exposure was determined.

RESULTS

We investigated individual telomere tracking from birth over a 20 year period (mean age (SD), 22.6 (3.1) years) in association with residential exposure to traffic and greenness. Telomere length in placental tissue and in buccal cells in young adulthood correlated positively (r = 0.31, P < 0.0001). Persons with higher placental telomere length at birth were more likely to have a stronger downward shift in telomere ranking over life (P < 0.0001). Maternal residential traffic exposure correlated inversely with telomere length at birth. Independent of birth placental telomere length, telomere ranking between birth and young adulthood was negatively and significantly associated with residential traffic exposure at the birth address, while traffic exposure at the residential address at adult age was not associated with telomere length.

CONCLUSIONS

Longitudinal evidence of telomere length tracking from birth to adulthood shows inverse associations of residential traffic exposure in association with telomere length at birth as well as accelerated telomere shortening in the first two decades of life.