Nature Contact and Human Health: A Research Agenda

Profiles of Wellbeing in Soft and Hard Mountain Hikers

The aim of the study was to analyze the wellbeing profiles in a group of Polish mountain hikers. The study involved 242 young people (M = 23.50; SD = 4.40) who completed various wellbeing scales: The Oxford Happiness Questionnaire (OHQ), Meaning of Life Questionnaire (MLQ), Positive and Negative Affect Scale (PANAS), Time Satisfaction Scale (TSS), Hope Scale, General Self-Efficiency Scale, Ego Resiliency Scale, Revised Life Orientation Test (LOT-R), and Adventure-Seeking Behavior Scale. Cluster analyses revealed two types of mountain hikers: hard adventure hikers and soft adventure hikers, with different profiles of subjective wellbeing. Hard adventure hikers most often revealed high levels of life satisfaction, control of life, meaning of life, and positive emotions, along with low levels of negative emotions. Moreover, these hikers revealed high levels of satisfaction in various time perspectives (past, present, and future) and a high level of psychological capital. On the other hand, soft adventure hikers most often revealed an average level of satisfaction with life, control of life, and positive emotions, average satisfaction in the past and present time perspective, and average levels of psychological capital. Soft adventure hikers also revealed higher levels of negative emotions and satisfaction in the future time perspective. The present research indicated that mountain hikers are not a homogenous group. The profiles of wellbeing in the hikers varied depending on the type of stimulating behavior in a natural environment.

An international comparative study of active living environments and hospitalization for Wales and Canada

Rationale: Previous studies indicate active living environments (ALEs) are associated with higher physical activity levels across different geographic contexts, and could lead to reductions in hospital burden. Both Wales UK and Canada have advanced data infrastructure that allows record linkage between survey data and administrative health information.

Objective

To assess the relationship between ALEs and hospitalization in Wales and Canada.

Methods

We performed a population-based comparison using individual-level survey data from the Welsh Health Survey (N = 9968) linked to the Patient Episode Database for Wales, and the Canadian Community Health Survey (N = 40,335) linked to the Discharge Abstract Database. Using equivalent protocols and open-source data for street networks, destinations, and residential density, we derived 5-class measures of the ALE for Wales and Canada (classed 1 through 5, considered least favourable to most favourable for active living, respectively). We evaluated relationships of ALEs to health, behaviours and hospitalization using multivariate regression (reference group was the lowest ALE class 1, considered least favourable for active living).

Results

For Canada, those living in the highest ALE class 5 had lower odds of all-cause hospitalization (OR 0.66, 95% CI 0.54 to 0.81; as compared to the lowest ALE class 1). In contrast, those living in the highest ALE class 5 in Wales had higher odds of all-cause hospitalization (OR 1.37, 95% CI 1.04 to 1.80). The relationship between ALEs and cardiometabolic hospitalization was inconclusive for Canada (OR 0.75, 95% CI 0.50 to 1.12), but we observed higher odds of cardiometabolic hospitalization for respondents living in higher ALE classes for Wales (OR 1.46, 95% CI 1.10 to 1.78; comparing ALE class 4 to ALE class 1).

Conclusion

Canadian respondents living in high ALE neighbourhoods that are understood to be favourable for active living had lower odds of all-cause hospitalization, whereas Welsh respondents living in high ALEs that were deemed favourable for active living exhibited higher odds of all-cause hospitalization. Environments which promote physical activity in one geographic context may not do so in another. There remains a need to identify relevant context-specific factors that encourage active living.

Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being During COVID-19

Shifts in activity patterns during the COVID-19 pandemic might have impacted the benefits of outdoor activities for mental health. By leveraging an existing mobile application, we collected self-reported data on daily outdoor activities, emotional well-being, and the influence of COVID-19 on participant's outdoor activity levels during April-July 2020. Individuals reporting outdoor activities, in greenspaces or in their residence, had higher well-being scores and this effect increased with age. Self-reported impacts of COVID-19 on emotional well-being were associated with lower well-being scores. This work suggests that outdoor activities may have improved mental health during the COVID-19 pandemic.

Human-Nature Interactions during and after the COVID-19 Pandemic in Moscow, Russia: Exploring the Role of Contact with Nature and Main Lessons from the City Responses

Urban green spaces (UGS) as essential elements of the urban environment provide multiple ecosystem services including benefits for physical and mental health. Impacts of the COVID-19 pandemic and related restrictions have influenced human relationships with nature. Based on empirical research, this article explores the pathways and implications of human-nature interactions during and after COVID-19 and how human health and well-being could be supported by contact with nature. The article discusses the reasons that attract people to visit UGS (value of UGS, their perceptions, ways of contact with urban nature, etc.). It also analyses the effects of social isolation on the usage and perception of UGS during and after the COVID-19 pandemic. The research revealed current needs for UGS and their role in adaptation of urban development and greening strategy. For this purpose, an online questionnaire survey among residents of Moscow was conducted in April–July of 2020 when restrictive measures were imposed in the city in response to the COVID-19 pandemic. Additionally, non-participatory observations and photo documentation were used to supplement the data on UGS visitation and use. The GIS mapping method was applied to analyze the UGS provision (availability and accessibility of UGS). Moreover, expert interviews were conducted aiming to explore the implications of the COVID-19 pandemic on the urban fabric and life of the citizens. The aim was to reveal the main tendencies that can be used in the adaptation of urban development plans, especially regarding UGS and human-nature interactions. The results show that citizens (both survey respondents and experts) highly value urban nature as a tool for coping with COVID-19 challenges. They underlined a need for accessible UGS, most notably for breathing fresh air, reducing stress, relaxing, and observing and enjoying nature. The survey also revealed the particular health effects resulting from the reduction of UGS visitations due to COVID-19 restrictions. Several changes in human-nature interactions were also observed: many respondents especially missed spending time outdoors and meeting other people. That highlights the fact that while UGS normally provides places for social integration and socializing, during the COVID-19 isolation UGS were especially valued in regard to physical health and well-being (self-recovery). Both respondents and experts expressed their opinions regarding the future development of UGS network and how the UGS’s structure and design should be adapted to the current challenges. The claimed interests/preferences included the need for providing all residents equal access to UGS in a time of pandemics and post pandemics. A set of limitations and directions for future research of UGS was suggested.

Increasing the Livability of Open Public Spaces during Nighttime: The Importance of Lighting in Waterfront Areas

The contemporary way of life influences the forms and time framework of outdoor activities in open public spaces, shifting their focus to nighttime usage. The aim of this study is to demonstrate the limits of existing outdoor lighting design standards and recommendations in terms of livability. As an exploratory case study, the Sava waterfront in New Belgrade, Serbia was chosen. The methodology consisted of theoretical research and specific analysis, which included: (1) mapping the spatial distribution of users during several periods of the day; (2) criteria and indicator network analysis of outdoor lighting quality, and (3) a survey with a questionnaire conducted among the users of the waterfront area. The results showed that lighting design can influence overall open public space usage during nighttime through its parameters. It can affect the spatial distribution of users and their sense of safety and comfort, as well as the duration, frequency, and manner of usage. This study could improve planning and design practices regarding outdoor lighting, enabling more active and inclusive usage of open public spaces, thus increasing the overall livability of spaces and their social sustainability.

Forest 404: Using a BBC drama series to explore the impact of nature's changing soundscapes on human wellbeing and behavior

Extensive ecosystem degradation and increasing urbanization are altering human relationships with nature. To explore these trends, we created a transdisciplinary, narrative-led podcast series produced by the BBC, called Forest 404. The series explored the implications of a world without nature. An online experimental component mobilized audience participation (n = 7,596) to assess responses to natural soundscapes with and without abiotic, biotic, and poetic elements across five biomes. Conditions featuring the sounds of wildlife, such as bird song, were perceived to be more psychologically restorative than those without. Participants' personal lived experiences were strongly related to these outcomes; those who had memories triggered by the sounds were more likely to find them psychologically restorative and exhibited a greater motivation to preserve them. Moreover, the effects of both soundscape composition and memories on preservation behavior were partially mediated by restorative potential; respondents were more likely to want to protect the sounds they heard if they thought they might offer therapeutic outcomes. Our findings highlight the value of art-science collaborations and demonstrate how maintaining contact with the natural world can promote wellbeing and foster behaviors that protect planetary health.

Simulated Forest Immersion Therapy: Methods Development

Shinrin-yoku, forest bathing, may provide relief from chronic and breakthrough pain in patients with axial spondyloarthritis and improve immune function through increasing NK cell numbers and activity and their downstream effectors, perforin and granulysin, after chemo- or radiation therapy in breast and prostate cancer patients. The aim of this paper is to describe the study protocol for a simulated forest immersion therapy using virtual reality and atomized phytoncides, volatile organic compounds found in forested areas designed to effect positive change for these two patient populations. The setting, including the room set up and samples with inclusion/exclusion specific to this type of intervention, is outlined. Measures and calibration procedures pertinent to determining the feasibility of simulated forest immersion therapy are presented and include: ambient and surface room temperatures and relative humidity in real time, ambient ultrafine particulate matter, ambient droplet measurement that coincides with volatile organic compounds, specific phytoncides, and virtual reality and atomization of phytoncide set up. Particular lessons learned while training and setting up the equipment are presented. Simulated forest immersion therapy is possible with attention to detail during this early phase when development of methods, equipment testing, and feasibility in deploying the intervention become operational. The expected outcome of the development of the methods for this study is the creation of a standardized approach to simulating forest therapy in a controlled laboratory space.

Social Isolation in Older Adults: A Qualitative Study on the Social Dimensions of Group Outdoor Health Walks

Physical distancing practices during the COVID-19 global pandemic contributed to a high degree of social isolation among older adults. To reduce loneliness and other ill effects of social isolation, public health experts recommended outdoor social gathering, with physical distancing. Adopting a case study approach, we explored how social aspects of group outdoor health walks (GOHWs) mitigate social isolation for older adults and improve individual social wellbeing. We used semi-structured interviews to understand the experiences of social isolation and social relationships in nine older (50-80 s) adults participating in a GOHW in Scotland, United Kingdom (UK). Verbatim transcripts were analysed through an iterative process of thematic analysis carried out by an interdisciplinary team of qualitative researchers from environmental psychology, medicine, and geography. Themes provide insight into the social dimensions of GOHWs, the mediating effects of social experiences, and the contribution these make to individual social wellbeing. GOHWs provide opportunities to be part of a group and attend to the needs of inexperienced or physically challenged individuals. Being part of the group walk fosters casual interpersonal interactions through spontaneous mixing during and after the walk. This programmatic structure counters loneliness, engenders pleasurable anticipation of regular contact with others, supports physical activity, and fosters group cohesion. These in turn contribute to individual social wellbeing, including expanding social networks, meaningful relationships, a sense of belonging, and acting on empathy for others. GOWHs may be beneficial for mitigation of social isolation as we emerge from the COVID-19 pandemic. Findings were used to propose a conceptual model to parse social constructs and inform selection or development of quantitative social measures for future studies of nature-based interventions such as GOHWs.

Reducing Anxiety with Nature and Gardening (RANG): Evaluating the Impacts of Gardening and Outdoor Activities on Anxiety among U.S. Adults during the COVID-19 Pandemic

The COVID-19 pandemic impacted mental health. Growing research has identified the mental health benefits of nature contact, including gardening. We used a cross-sectional survey to investigate the association between gardening and other outdoor activities with anxiety among U.S. adults. The RANG (Reducing Anxiety with Nature and Gardening) survey was distributed online from June−September 2020 through social media (Twitter and Facebook) and a national Master Gardeners listserv. Survey questions captured demographics, COVID-19 experiences, gardening, outdoor activities, and anxiety using the Generalized Anxiety Disorder 7-item scale. Data were analyzed using chi-square, Fisher’s exact, and Kruskal−Wallis tests, as well as logistic regression. Among participants, 46% reported anxiety symptoms. Participants who had gardened ≥ 15 years and those gardening > 8 h over two weeks had lower anxiety scores. Spending more time outdoors on weekdays also decreased anxiety scores. After adjusting for covariates, lower odds of anxiety were identified for 50−69 and 70−89-year-olds vs. 18−29-year-olds; males vs. females; and Texas vs. Maryland residents. These findings confirm increased anxiety during the COVID-19 pandemic and suggest that sustained gardening and other outdoor activities could help reduce anxiety.

Park access and mental health among parents and children during the COVID-19 pandemic

BACKGROUND

Time spent outdoors and in nature has been associated with numerous benefits to health and well-being. We examined relationships between park access and mental health for children and parents during the COVID-19 pandemic. We also explored associations between park access and co-participation of parent and child in time outdoors, and child and parent physical activity.

METHODS

We used data from 1,000 respondents to a nationally representative U.S. survey of parent-child dyads during October-November 2020. Park access was defined as an affirmative response to: "do you have a park that you can safely walk to within 10 min of your home?" Child mental health was operationalized as the Strengths and Difficulties Questionnaire (SDQ) total difficulties score. The Patient Health Questionnaire-4 (PHQ-4) total score assessed parent mental health and the International Physical Activity Questionnaire (IPAQ) assessed parent physical activity. Child physical activity and co-participation in outdoor activity were reported as number of days in the prior week. Linear regression was used to examine relationships between park access and health outcomes in models adjusted for child and parent characteristics and COVID-19 impact.

RESULTS

Our sample included 500 parents of children ages 6-10 years, and 500 parent-child dyads of children ages 11-17 years. Park access was associated with a lower SDQ total score among children (β: -1.26, 95% CI: -2.25, -0.27) and a lower PHQ-4 total score among parents (β: -0.89, 95% CI: -1.39, -0.40). In models stratified by child age, these associations were observed for SDQ scores among adolescents ages 11-17 and for PHQ-4 scores among parents of children ages 6-10 years. Park access was also associated with 0.50 more days/week of co-participation in outdoor time (95% CI: 0.16, 0.84), and higher levels of parent physical activity (β: 1009 MET-min/week, 95% CI: 301, 1717), but not child physical activity (β: 0.31 days/week, 95% CI: -0.03, 0.66).

CONCLUSIONS

Park access was associated with better mental health among children and parents, and more parent physical activity and parent-child co-participation in outdooractivity during the COVID-19 pandemic. Access to nearby parks may be an important resource to promote health and well-being, for both individuals and families.

Assessment of Subjective Well-Being in a Cohort of University Students and Staff Members: Association with Physical Activity and Outdoor Leisure Time during the COVID-19 Pandemic

Time spent outdoors and physical activity (PA) promote mental health. To confirm this relationship in the aftermath of COVID-19 lockdowns, we explored individual levels of anxiety, depression, stress and subjective well-being (SWB) in a cohort of academic students and staff members and tested their association with sport practice, PA at leisure time and time spent outdoors. Our cross-sectional study collected data during the COVID-19 outbreak (April−May 2021) on 939 students and on 238 employees, who completed an online survey on sociodemographic and lifestyle features, depression, anxiety, stress, and SWB. Results showed that the students exhibited higher levels of anxiety, depression, and stress, and lower levels of SWB (p < 0.001 for all domains) compared to the staff members. Correlation analysis confirmed that PA and time spent in nature were associated to high mental health scores among staff and, more consistently, among students. Finally, mediation analyses indicated that the time spent in nature, social relationships, and levels of energy play a mediator role in the relationship between sport practice and SWB. Our evidence reinforces the protective role of time spent in nature in improving mental health, and provides support for policymakers to make appropriate choices for a better management of COVID-19 pandemic consequences.

The Relative Role of Knowledge and Empathy in Predicting Pro-Environmental Attitudes and Behavior

Planet Earth is undergoing unprecedented levels of environmental degradation and destruction at a global scale. Incentivizing people to adopt behaviors that are compatible with a sustainable future will help address the current ecological crisis. However, it is first necessary to understand the psychological drivers of pro-environmental behavior. Here, we examined whether greater levels of environmental knowledge and empathy predicted higher levels of pro-environmental behavior in an Australian population sample. We aimed to advance our understanding of the psychological variables that motivate people to act in pro-environmental ways, while also advancing the ongoing debate amongst conservation scientists regarding the relative importance of fostering empathy. Correlational analyses revealed that objective, verifiable knowledge was a strong predictor of pro-environmental attitudes and behavior. Empathy also correlated positively with pro-environmental attitudes and behavior, but with a dissociation with respect to its cognitive and affective components. Multivariate analyses revealed that knowledge was a stronger predictor of both pro-environmental attitudes and behavior after controlling for individual variation in cognitive and affective empathy. This finding casts doubt on the claim by compassionate conservationists that fostering empathy is the key to solving the current environmental conservation crisis. Future research should aim to extend the present findings by testing whether a more exhaustive test of participants’ environmental knowledge and other measures of empathy, including empathic competencies and the recently developed Emotional and Cognitive Scale of the Human–Nature Relationship (ECS-HNR), yield the same dominance of knowledge over empathy.

A Preferred Road to Mental Restoration in the Chinese Classical Garden

The impact that classical gardens have on the well-being and quality of life of visitors, especially city dwellers, is an important topic. Scholars have previously focused on landscape aspects, such as water bodies, plants, rocks, chairs, pavilions, and public squares, in various green spaces but have overlooked the road settings that visitors walk on. This study used the Du Fu Thatched Cottage Museum as the subject region and employed a convenience sampling method (n = 730) to analyze the preference and mental restoration of different road settings of Chinese classical gardens. According to the findings, the majority of visitors felt that the road settings in these classical gardens provided psychological recovery, and half of the roads received a preference score of five or above. The regression results indicated that nature, culture, space, refuge, and serene were found to be important predictive dimensions for both mental restoration and preference. Furthermore, this study divides landscape elements in road settings into two major categories (natural and artificial elements) and eight subcategories (trees, shrubs, lawns, roads, fences, walls, decorations, and buildings) to investigate the relationship between various types of specific road setting elements and visitors’ perceived preferences as well as restorability. The correlation results showed that in terms of preference, tree > lawn > path > fence > shrub > wall; in terms of restoration, tree > lawn > shrub > fence > path > decoration > building > wall. Overall, the findings of this research can improve visitor preferences and restoration in a given environmental setting, resulting in a more enjoyable experience.

Context, classification and study methodologies in research into nature-based therapies: protocol for a scoping review

INTRODUCTION

Nature provides an array of health benefits, and recent decades have seen a resurgence in nature-based interventions (NBI). While NBI have shown promise in addressing health needs, the wide variety of intervention approaches create difficulty in understanding the efficacy of NBI as a whole. This scoping review will (1) identify the different nomenclature used to define NBI, (2) describe the interventions used and the contexts in which they occurred and (3) describe the methodologies and measurement tools used in NBI studies.

METHODS AND ANALYSIS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews, four databases will be searched (PubMed, Web of Science, Scopus, ProQuest Dissertations and Theses Global) as well as cross-referencing for published and unpublished (masters theses and dissertations) studies on NBI in humans. Eligible studies must employ intervention or observational designs, and an English-language abstract will be required. Database searches will occur from inception up to the date of the search. Animal-based therapies and virtual-reality therapies involving simulated nature will be excluded. Independent dual screening and data abstraction will be conducted. Results will be analysed qualitatively as well as with simple descriptive statistics (frequencies and percentages).

ETHICS AND DISSEMINATION

Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed journal. This protocol has been registered with Open Science Framework (https://osf.io/mtzc8).

The impact of nature exposure on body image and happiness: an experience sampling study

Exposure to nature is associated with improved psychological well-being and positive body image. Here, we examined whether everyday exposure to natural environments is associated with state body image outcomes (and, for comparative reasons, state happiness) using an experience sampling method. One-hundred-and-seven participants completed a 30-day experience sampling phase in which they reported their state body image (body weight, body shape, and physical appearance satisfaction), state happiness, and features of the surrounding environment (total = 6,025 responses) at three random time-points each day. Results indicated that being outdoors was associated with significantly higher state body image on all three indicators, but effect sizes were lower compared to effects on state happiness. Specific environment type was also important, with blue-spaces and wood- and grasslands, respectively, having stronger effects than other environments. These results provide evidence that everyday exposure to natural environments is associated with more positive state body image and greater happiness.

Impact of neighborhood socioeconomic status, income segregation, and greenness on blood biomarkers of inflammation

BACKGROUND

Neighborhood deprivation is linked with inflammation, which may explain poorer health across populations. Behavioral risk factors are assumed to largely mediate these relationships, but few studies have examined this. We examined three neighborhood contextual factors that could exert direct effects on inflammation: (1) neighborhood socioeconomic status, (2) an index of concentration at extremes (that measures segregation), and (3) surrounding vegetation (greenness).

METHODS

Using blood samples and addresses collected from prospective cohorts of 7,930 male (1990-1994) and 16,183 female (1986-1990) health professionals with at least one inflammatory marker, we prospectively linked neighborhood contextual factors to inflammatory biomarkers (adiponectin, C-reactive protein, interleukin-6, soluble tumor necrosis factor receptor-2). Log-transformed, z-scaled component measures were used to calculate an inflammation score. Neighborhood socioeconomic status and index of concentration of extremes were obtained from the 1990 decennial census and linked to participant addresses. Surrounding greenness was assessed from satellite data and focal statistics were applied to generate exposures within 270 m and 1230 m of the participants' address. We fit multiple linear regression models adjusting for demographic, clinical, and behavioral risk factors.

RESULTS

Higher neighborhood socioeconomic status was associated with lower inflammation score in women (β for interquartile range increase = -27.7%, 95% CI: -34.9%, -19.8%) and men (β = -21.2%, 95% CI: -31.0%, -10.1%). Similarly, participants in neighborhoods with higher concentrations of high-income households were associated with lower inflammation score in women (β = -27.8%, 95% CI: -35.8%, -18.7%) and men (β = -16.4%, 95% CI: -29.7%, -0.56%). Surrounding greenness within 270 m of each participant's address was associated with lower inflammation score in women (β = -18.9%, 95% CI: -28.9%, -7.4%) but not men. Results were robust to sensitivity analyses to assess unmeasured confounding and selection bias.

DISCUSSION

Our findings support the hypothesis that adverse neighborhood environments may contribute to inflammation through pathways independent of behavioral risk factors, including psychosocial stress and toxic environments.

Healthy cities after COVID-19 pandemic: the just ecofeminist healthy cities approach

The COVID-19 pandemic crisis has compromised the 'healthy cities' vision, as it has unveiled the need to give more prominence to caring tasks while addressing intersectional social inequities and environmental injustices. However, much-needed transdisciplinary approaches to study and address post-COVID-19 healthy cities challenges and agendas have been scarce so far. To address this gap, we propose a 'just ecofeminist healthy cities' research approach, which would be informed by the caring city, environmental justice, just ecofeminist sustainability and the healthy cities paradigms and research fields. Our proposed approach aims to achieve the highest standards of human health possible for the whole population-yet putting the health of socially underprivileged residents in the centre-through preserving and/or improving the existing physical, social and political environment. Importantly, the proposed approach recognises all spheres of daily life (productive, reproductive, personal and political) and their connections with inequities, justice and power dynamics. Last, the just ecofeminist healthy cities approach understands human health as interconnected with the health of non-human animals and the ecosystem. We illustrate the proposed new approach focusing on the implications for women's health and public green spaces research and propose principles and practices for its operationalisation.

The Potential for Outdoor Nature-Based Interventions in the Treatment and Prevention of Depression

There is growing interest in nature-based interventions (NBI) to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature-depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or 'active ingredients' in NBIs is crucial to understand what works and for whom. Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts.

“Like Nothing I’ve Seen Before”: A Qualitative Inquiry Into the Lived Experience of Competing in a Trail Running Event

Background

A recent upsurge in nature-based exercise research demonstrates the potential added benefits of exercising in this context compared to more urban ones. Yet there is a lack of qualitative research investigating the lived experiences of those who participate in nature-based exercise events.

Objective

To explore the lived experience of individuals who were first-time participants in a nature-based running event.

Method

Six participants who completed the Run Forrest trail run for the first time were individually interviewed. Semi-structured interviews were devised, and participants were invited to talk about their experiences of running in the event. Interviews were analysed using interpretative phenomenological analysis.

Results

Following data analysis, two superordinate themes were constructed to resemble participant experiences. “Maintaining good health is vital” reflected participants’ personal theory of health and their perceived benefits of exercise. “Nature as a special place” reflected the atmospheric characteristics of the event, including the pre-event set-up and the actual running event itself.

Conclusion

Analysis suggests that participants considered the event and natural environment to provide unique value adding opportunities that encouraged positive experiences. These results also reaffirm the positive benefits associated with nature-based exercise, including potential benefits to individual wellbeing. Further research in this context may strengthen our collective understanding regarding individual motivation towards such events.

Development and validation of self-efficacy and intention measures for spending time in nature

PURPOSE

The purpose of this study was to develop and evaluate the reliability and validity of self-efficacy and intentions measures for time spent in nature (TSN). TSN is related to improvement in psychological well-being and health, yet most American adults spend very little time in such settings. Theory-based interventions have been effective in increasing physical activity, a related behavior, and may be one mechanism to increase TSN. Self-efficacy and intentions have been shown to be strong predictors of health behaviors and are used across several theories. However, scales to measure these factors have not yet been developed and are needed to facilitate effective interventions.

METHODS

TSN self-efficacy and intentions scales were developed using a sequential nine-step procedure: identification of the domain and item generation; content validity; pre-testing of questions; sampling and survey administration; item reduction; extraction of factors; tests of dimensionality; tests of reliability; and tests of validity. The 14-member multidisciplinary, researcher and practitioner investigative team generated 50 unique items for self-efficacy and 24 unique items for intentions. After subjecting items to content validity and pre-testing, item sets were reduced to 21 assessing self-efficacy and nine assessing intentions. A nationwide sample of 2109 adult participants (49.7% female, Mean Age = 58.1; 59.8% White, 18.4% Hispanic, 13.3% Black) answered these items via an on-line survey.

RESULTS

Using split-half measures, principal components analysis indicated a one-factor solution for both scales. The factor structure was upheld in confirmatory factor analyses and had high internal consistency (α = .93 self-efficacy; .91 intentions). The scales were moderately correlated with each other (r = .56, p < .001) and were strongly related to TSN with large effect sizes (eta2 > .20).

CONCLUSIONS

The study resulted in reliable and valid self-efficacy (14 items) and intentions (8 items) scales that can be used to develop future theory-based interventions to increase TSN and thereby improve population health.

Developing a model linking self-reported nature exposure and positive body image: A study protocol for the body image in nature survey (BINS)

Exposure to natural environments has been shown to be associated with more positive body image, but much of the existing research is limited to Western European nations and little is known about the robustness of these associations in other national contexts. In this protocol paper, we present a conceptual model of the direct and indirect associations (i.e., via self-compassion, connectedness to nature, and restorative experiences in nature) between nature exposure and body appreciation. This model brings together conceptualisations from existing research, but also extends it in a number of important ways. The model will be tested through the Body Image in Nature Survey (BINS), a researcher-crowdsourced project involving researchers in multiple nations worldwide. Data collection began in December 2020 and is expected to be completed in February 2022. Data will be analysed to examine the extent to which our conceptual model is robust across nations, as well as other sociodemographic characteristics. We will also determine the extent to which key variables included in our survey are invariant across nations and associated with cultural, socioeconomic, and gender-related factors. The BINS will likely have important implications for the development of nature-based interventions to promote healthier body appreciation in diverse national contexts.

Exposure to urban green space may both promote and harm mental health in socially vulnerable neighborhoods: A neighborhood-scale analysis in New York City

BACKGROUND

There is growing evidence that exposure to green space can impact mental health, but these effects may be context dependent. We hypothesized that associations between residential green space and mental health can be modified by social vulnerability.

METHOD

We conducted an ecological cross-sectional analysis to evaluate the effects of green space exposure on mental disorder related emergency room (ER) visits in New York City at the level of census tract. To objectively represent green space exposure at the neighborhood scale, we calculated three green space exposure metrics, namely proximity to the nearest park, percentage of green space, and visibility of greenness. Using Bayesian hierarchical spatial Poisson regression models, we evaluated neighborhood social vulnerability as a potential modifier of greenness-mental disorder associations, while accounting for the spatially correlated structures.

RESULTS

We found significant associations between green space exposure (involving both proximity and visibility) and total ER visits for mental disorders in neighborhoods with high social vulnerability, but no significant associations in neighborhoods with low social vulnerability. We also identified specific neighborhoods with particularly high ER utilization for mental disorders.

CONCLUSIONS

Our findings suggest that exposure to green space is associated with ER visits for mental disorders, but that neighborhood social vulnerability can modify this association. Future research is needed to confirm our finding with longitudinal designs at the level of individuals.

Effects of Nature-Based Intervention in Occupational Health Care on Stress – A Finnish Pilot Study Comparing Stress Evaluation Methods

Purpose

To assess methodology and its limitations for measuring effects of nature-based intervention (NBI).

Patients and Methods

Participants were 11 middle-aged female health care workers with lowered capacity to work. NBI included six group appointments in six months study period. Heart rate variability (HRV) and self-reported pain and work exhaustion were measured pre-post study period. Salivary α-amylase samples were collected immediately before and after three individual interventions. Salivary cortisol samples were collected on the same three interventions, on three consecutive days starting from the day of intervention, to assess (a) month effect (pre-post study period) and (b) day effect (intervention day vs non-intervention day).

Results

Individual interventions resulted in increase in α-amylase activity. However, the average fold increase decreased from the 3.05 ± 1.20 of the first intervention to 1.91 ± 1.00 and 1.46 ± 0.77 in the second and third intervention, respectively (p < 0.001). Cortisol concentrations were lower on intervention days vs non-intervention days, the difference being indicative (p = 0.050). Pain and work exhaustion decreased during the study period, as well as HRV, although any of these changes was not statistically significant.

Conclusion

For a large-scale study, it would be ideal to select assays for both major pathways: hypothalamic-pituitary-adrenal axis can be measured by cortisol, whereas response via autonomic nervous system can be measured by HRV, when roles of sympathetic and parasympathetic nervous systems can be pinpointed separately. Salivary α-amylase can be used when continuous monitoring is not possible. Psychological well-being of participants should be surveyed, as well as their activities and moods on sampling days recorded.

The Mediating Effect of Nature Restorativeness, Stress Level, and Nature Connectedness in the Association between Nature Exposure and Quality of Life

This study aimed to test the mediating effects of nature restorativeness, stress, and nature connectedness in the association between nature exposure and quality of life (QoL). Urban and rural Lithuanian inhabitants (n = 924; 73.6% were women), mean age of 40.0 ± 12.4 years (age range of 18–79) participated in the study. In total, 31% of the respondents lived in rural areas. Study participants completed an online survey form with measures on sociodemographic factors, nature proximity, nature exposure, nature connectedness, and nature restorativeness, stress, and QoL assessed by the abbreviated version of the World Health Organization’s Quality of Life Questionnaire’s (WHOQOL-BREF). Path analysis was conducted to test the mediating effects of nature restorativeness, stress, and nature connectedness in the model of nature exposure and QoL. Nature exposure was directly associated with a greater QoL (β = 0.14; B = 2.60; SE = 0.57; p < 0.001) and mediated the association between nature proximity and QoL. Nature restorativeness and lower stress levels were mediators between nature exposure and QoL. Nature connectedness was a mediator between nature exposure and QoL. A path model was invariant across genders and the urban and rural place of residence groups: patterns of loadings of the pathways were found to be similar. Nature restorativeness (β = 0.10–0.12; p < 0.01) had a positive effect on the psychological, physical, social, and environmental domains of QoL. Connectedness to nature positively predicted psychological (β = 0.079; p < 0.05) and environmental (β = 0.082; p < 0.05) domains of QoL. Enhancing nature exposure and nature connectedness might help strengthen QoL in urban and rural inhabitants.

Nature-based therapeutics: A collaborative research agenda promoting equitable access and environmental stewardship

BACKGROUND

Given the duration and intensity of the COVID-19 pandemic, with strict emphasis on social distancing, many individuals and families are experiencing social isolation. The need to explore effective strategies for health promotion and wellness is clear.

AIM

The purpose of this report is to highlight evidence supporting the health benefits of nature-based therapeutics and to describe the exploratory and translational research agenda for a nurse-led program entitled RxPLORE^TM: Prescribing Life Outdoors and Real Exploration.

METHODS

Integrative review of the current state of evidence for nature-based therapeutics and operationalisation of a nature-based health promotion framework as the foundation of a PhD-DNP collaborative program of research.

DISCUSSION

Amidst the unfolding crisis of the COVID-19 pandemic, the value of nature-based therapeutics is becoming more widely recognised, as are layers of disparities in access to nature. A nurse-led team proposes a program of research outlining priorities for the translation of current evidence into practice and for the investigation of gaps in the evidence base that will inform future recommendations for nature-based health promotion. The initial population of focus is children and families.

CONCLUSION

Prescribing nature is a strategy to promote health and wellness throughout the lifespan. For all populations to experience the health-promoting benefits of nature, nurses engage community members and collaborate across sectors to advocate for equitable access to nature and environmental stewardship through conservation practices.

Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis

The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.

Perspectives on managing fisheries for community wellbeing in the face of climate change

Coastal communities are being impacted by climate change, affecting the livelihoods, food security, and wellbeing of residents. Human wellbeing is influenced by the heath of the environment through numerous pathways and is increasingly being included as a desired outcome in environmental management. However, the contributors to wellbeing can be subjective and the values and perspectives of decision-makers can affect the aspects of wellbeing that are included in planning. We used Q methodology to examine how a group of individuals in fisheries management prioritize components of wellbeing that may be important to coastal communities in the California Current social-ecological system (SES). The California Current SES is an integrated system of ecological and human communities with complex linkages and connections where commercial fishing is part of the culture and an important livelihood. We asked individuals that sit on advisory bodies to the Pacific Fisheries Management Council to rank 36 statements about coastal community wellbeing, ultimately revealing three discourses about how we can best support or improve wellbeing in those communities. We examine how the priorities differ between the discourses, identify areas of consensus, and discuss how these perspectives may influence decision-making when it comes to tradeoffs inherent in climate adaptation in fisheries. Lastly, we consider if and how thoughts about priorities have been affected by the COVID-19 pandemic.

How Perceived Sensory Dimensions of Forest Park Are Associated with Stress Restoration in Beijing?

A growing number of studies suggest that the perceived sensory dimensions (PSDs) of green space are associated with stress restoration offered by restorative environment. However, there is little known about PSDs and stress restoration as well as their relationship to forest park. To fill this gap, an on-site questionnaire survey was conducted in three forest parks in Beijing, as a result of which a total number of 432 completed responses were collected and analyzed. The mean values of PSDs were used to represent PSDs of forest park. Using independent sample t-test and ANOVA, this study analyzed the individual characteristics that affected PSDs and stress restoration. Linear mixed model was used to identify the relationship between PSDs and stress restoration of forest park, which took into account the interactions of stress level and PSDs. The results showed that: (1) the perceived degree of PSDs in forest park from strong to weak was Serene, Space, Nature, Rich in species, Prospect, Refuge, Social and Culture, which varied with visitors’ gender, age, level of stress, visit frequency, activity intensity, visit duration and commuting time; (2) in PSDs, Refuge, Serene, Social and Prospect had significantly positive effects on the stress restoration of forest parks (3) there was no significant difference in the effect of the eight PSDs on the stress restoration between different stress groups; (4) stress restoration was influenced by visitors’ gender, age, visit frequency and visit duration. These findings can offer references for managers to improve the health benefits of forest park for visitors, and can enrich the knowledge about PSDs and stress restoration.

What can we do when the smoke rolls in? An exploratory qualitative analysis of the impacts of rural wildfire smoke on mental health and wellbeing, and opportunities for adaptation

BACKGROUND

Extreme, prolonged wildfire smoke (WFS) events are becoming increasingly frequent phenomena across the Western United States. Rural communities, dependent on contributions of nature to people's quality of life, are particularly hard hit. While prior research has explored the physical health impacts of WFS exposure, little work has been done to assess WFS impacts on mental health and wellbeing, or potential adaptation solutions.

METHODS

Using qualitative methods, we explore the mental health and wellbeing impacts experienced by community members in a rural Washington State community that has been particularly hard hit by WFS in recent years, as well as individual, family, and community adaptation solutions. We conducted focus groups with residents and key informant interviews with local health and social service providers.

RESULTS

Participants identified a variety of negative mental health and wellbeing impacts of WFS events, including heightened anxiety, depression, isolation, and a lack of motivation, as well as physical health impacts (e.g., respiratory issues and lack of exercise). Both positive and negative economic and social impacts, as well as temporary or permanent relocation impacts, were also described. The impacts were not equitably distributed; differential experiences based on income level, outdoor occupations, age (child or elderly), preexisting health conditions, housing status, and social isolation were described as making some residents more vulnerable to WFS-induced physical and mental health and wellbeing challenges than others. Proposed solutions included stress reduction (e.g., meditation and relaxation lessons), increased distribution of air filters, development of community clean air spaces, enhancing community response capacity, hosting social gatherings, increasing education, expanding and coordination risk communications, and identifying opportunities for volunteering. Findings were incorporated into a pamphlet for community distribution. We present a template version herein for adaptation and use in other communities.

CONCLUSIONS

Wildfire smoke events present significant mental health and wellbeing impacts for rural communities. Community-led solutions that promote stress reduction, physical protection, and community cohesion have the opportunity to bolster resilience amid this growing public health crisis.

Connecting to nature through community engaged scholarship: Community gardens as sites for collaborative relationships, psychological, and physiological wellbeing

Community gardens are recognized as being associated with a range of benefits for participants that include enhanced outcomes in physical and affective domains and community building. The purpose of this study was to research the impact of the New South Wales Royal Botanic Gardens (RBG) Community Greening (CG) program and to inform the ongoing development of this community outreach program. The organic community partnerships inherent in the design and the relationships between the Community Greening program participants and researchers is examined through the lens of Community Engaged Scholarship (CES). Over a seven-month period, the CG team implemented a community garden development program in six sites. Mixed-method research on the impact of the program found that the community gardening participants experienced positive changes in physical activity, psychological wellbeing and motivation for social engagement, and these outcomes were facilitated as a result of their relationships with members of the CG team. This paper examines how such programs, when explicitly framed as CES, could assist in consolidating nature-based community health and wellbeing programs and further legitimize community partnerships in development of community garden and green spaces as academically sound investigation and socio-economically justified activity. Expansion of this nature-based collaboration model may also enhance community engagement in green exercise, psychological wellbeing and community cohesion, and in turn support advocacy for greener environments locally, regionally and nationally.

Relative risk of gastrointestinal cancers in Isfahan County, Iran, 2005–2010

Background:

Spatial disease mapping is a widespread tool in ecological analysis to obtain accurate estimates for incidence, relative risks (RRs), prevalence, or mortality rates regarding to increase the incidence of gastrointestinal (GI) cancer in Isfahan in recent years. This study aimed to inspect the RR of GI cancer in Isfahan counties using empirical and full Bayesian model.

Materials and Methods:

Data of this ecological study were GI cancer cases which registered in health-care system of Isfahan University of Sciences during 2005–2010. We applied shared component model to model the spatial variation incidence rates of the GI cancers. We compared three models such as Gamma–Poisson, lognormal, and Besag, York, and Mollie (BYM) Bayesian. WinBUGS and GIS 10.1 software were used.

Results:

According to the fitted model, BYM model had best fit to the data. However, in general, ranks of RRs in most counties are identical; counties with higher RR in one map have higher RR in other maps. Geographical maps for three cancers in women were smoother than men. Isfahan has high RR in women, whereas this point is slightly different in men. Daran, FreidoonShahr, and Isfahan are cities which have high RR in esophagus, stomach, and colon cancer, respectively.

Conclusions:

Lognormal and BYM maps had very similar results. Despite some differences in estimation values, in nearly all maps arias Isfahan had high RR in GI cancer. It is recommended to promote the use of screening programs and increase awareness of people in high RR areas to reduce the incidence of GI cancer.

Oceans and society: feedbacks between ocean and human health

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

SUPPLEMENTARY INFORMATION

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

Spatial changes in park visitation at the onset of the pandemic

The COVID-19 pandemic disrupted the mobility patterns of a majority of Americans beginning in March 2020. Despite the beneficial, socially distanced activity offered by outdoor recreation, confusing and contradictory public health messaging complicated access to natural spaces. Working with a dataset comprising the locations of roughly 50 million distinct mobile devices in 2019 and 2020, we analyze weekly visitation patterns for 8,135 parks across the United States. Using Bayesian inference, we identify regions that experienced a substantial change in visitation in the first few weeks of the pandemic. We find that regions that did not exhibit a change were likely to have smaller populations, and to have voted more republican than democrat in the 2020 elections. Our study contributes to a growing body of literature using passive observations to explore who benefits from access to nature.

A Framework for Pediatric Health Care Providers to Promote Active Play in Nature for Children

Aim:

Time outdoors and contact with nature are positively associated with a broad range of children’s health outcomes. Pediatricians are uniquely positioned to promote active play in nature (APN) but may face challenges to do so during well child visits. The objective of this study was to understand barriers to children’s APN, before and during the COVID-19 pandemic, and how health care providers could promote APN.

Methods:

Focus groups were conducted with 14 pediatric providers and interviews with 14 parents (7 in English, 7 in Spanish) of children ages 3 to 10 on public insurance. Dedoose was used for coding and content analysis. We contextualized this work within the WHO’s Commission on Social Determinants of Health conceptual framework.

Results:

Parents mentioned a range of material circumstances (time, finances, family circumstances, access to safe outdoor play spaces and age-appropriate activities) and behavioral/psychosocial factors (previous experiences in nature, safety, and weather concerns), many of which were exacerbated by the pandemic, that serve as barriers to children’s APN. Providers said they were motivated to talk to families about children’s APN but mentioned barriers to this conversation such as time, other pressing priorities for the visit, and lack of resources to give families.

Conclusions:

Many pre-pandemic barriers to APN were exacerbated by the COVID-19 pandemic. Well-child visits may be an effective setting to discuss the benefits of APN during and beyond the pandemic, and there is a need for contextually appropriate resources for pediatric providers and families.

Oceans and society: feedbacks between ocean and human health

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

SUPPLEMENTARY INFORMATION

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

Climate Adaptive Silviculture for the City: Practitioners and Researchers Co-create a Framework for Studying Urban Oak-Dominated Mixed Hardwood Forests

Urban forested natural areas are an important component of the forest and tree canopy in northeastern United States urban areas. Although similar to native forests in surrounding regions in structure, composition, and function, these natural areas are threatened by multiple, co-occurring biological and climate stressors that are exacerbated by the urban environment. Furthermore, forests in cities often lack application of formal silvicultural approaches reliant upon evidence-based applied ecological sciences. These include both urban- and climate-adapted silvicultural techniques to increase the resilience and sustainability of native forests in cities. With this in mind, we convened a group of urban forest practitioners and researchers from along a latitudinal gradient in the northeastern United States to participate in a workshop focused on co-developing long-term, replicated ecological studies that will underlie the basis for potential silvicultural applications to urban forests. In this article we review the process and outcomes of the workshop, including an assessment of forest vulnerability, and adaptive capacity across the region, as well as shared management goals and objectives. We discuss the social and ecological challenges of managing urban oak-dominated mixed hardwood forests relative to non-urban forests and identify potential examples of urban- and climate-adapted silviculture strategies created by practitioners and researchers. In doing so, we highlight the challenges and need for basic and long-term applied ecological research relevant to silvicultural applications in cities.

Quantitative Impact Analysis of Climate Change on Residents' Health Conditions with Improving Eco-Efficiency in China: A Machine Learning Perspective

Climate change affects public health, and improving eco-efficiency means reducing the various pollutants that are the result of economic activities. This study provided empirical evidence of the quantitative impact analysis of climate change on the health conditions of residents across China due to improvements that have been made to eco-efficiency. First, the indicators that were collected present adequate graphical trends and regional differences with a priori evidence about their relationships to each other; second, the present study applied Sensitivity Evaluation with Support Vector Machines (SE-SVM) to Chinese provincial panel data, taking the Visits to Hospitals, Outpatients with Emergency Treatment, and Number of Inpatients as proxy variables for the health conditions of the residents in each area and temperature, humidity, precipitation, and sunshine as the climate change variables, simultaneously incorporating the calculated eco-efficiency with six controlling indicators; third, we compared in-sample forecasting to acquire the optimal model in order to conduct elasticity analysis. The results showed that (1) temperature, humidity, precipitation, and sunshine performed well in forecasting the health conditions of the residents and that climate change was a good forecaster for resident health conditions; (2) from the national perspective, climate change had a positive relationship with Visits to Hospitals and Outpatients with Emergency Treatment but a negative relationship with the Number of Inpatients; (3) An increase in regional eco-efficiency of 1% increase the need for Visits to Hospitals and Outpatients with Emergency Treatment by 0.2242% and 0.2688%, respectively, but decreased the Number of Inpatients by 0.6272%; (4) increasing the regional eco-efficiency did not show any positive effects for any individual region because a variety of local activities, resource endowment, and the level of medical technology available in each region played different roles. The main findings of the present study are helpful for decision makers who are trying to optimize policy formulation and implementation measures in the cross-domains of economic, environmental, and public health.

How Do Nature-Based Solutions’ Color Tones Influence People’s Emotional Reaction? An Assessment via Virtual and Augmented Reality in a Participatory Process

Simulations of urban transformations are an effective tool for engaging citizens and enhancing their understanding of urban design outcomes. Citizens’ involvement can positively contribute to foster resilience for mitigating the impact of climate change. Successful integration of Nature-Based Solutions (NBS) into the urban fabric enables both the mitigation of climate hazards and positive reactions of citizens. This paper presents two case studies in a southern district of Milan (Italy), investigating the emotional reaction of citizens to existing urban greenery and designed NBS. During the events, the participants explored in Virtual Reality (VR) (n = 48) and Augmented Reality (AR) (n = 63) (i) the district in its current condition and (ii) the design project of a future transformation including NBS. The environmental exploration and the data collection took place through the exp-EIA© method, integrated into the mobile app City Sense. The correlations between the color features of the viewed landscape and the emotional reaction of participants showed that weighted saturation of green and lime colors reduced the unpleasantness both in VR and AR, while the lime pixel area (%) reduced the unpleasantness only in VR. No effects were observed on the Arousal and Sleepiness factors. The effects show high reliability between VR and AR for some of the variables. Implications of the method and the benefits for urban simulation and participatory processes are discussed.

Sports in Natural Environment, Sports in Urban Environment: An fMRI Study about Stress and Attention/Awareness

This study aimed to explore, on one side, the differences between a group of athletes exercising outdoor (OG) and another group exercising indoor (IG) in stress and awareness, and, on the other side, between-group differences in the fMRI activations during the visualization of natural environment images versus urban images. In addition, we aimed to analyze the associations between the resulting task-related brain activations and stress and attention-awareness in each group separately. All the participants (N = 49; OG = 21, 11 females, mean age = 40, SD = 6.49; and IG = 25, 11 females, mean age = 40; 6.19) underwent an fMRI scan and completed the Perceived Stress Scale and the Mindful Attention Awareness Scale. Besides, we collected a sample of hair cortisol. Participants viewed three types of images: water nature, green nature and urban images. Two-sample t-test with corrected p=0.001 values were carried out. Further correlational analyses were performed to estimate the associations between task-related brain activations and our pyscho-emotional measures in each group. Fisher tests were used to explore for potential between-group differences in the correlational indexes. In OG, compared to IG, we found a higher activation of the middle occipital cortex and a cluster comprising the supplementary motor area (SMA), the premotor cortex and the pre-SMA while viewing green nature images versus urban images. In OG, more than in IG, the higher activation of the left SMA cluster negatively correlated with perceived stress, while in the IG, more than in OG, the higher premotor cortex activation was positively related to the total score on MAAS. No significant association was found with the hair cortisol levels. Exercising outdoor would relate to better psycho-emotional outcomes, also for athletes. On the other side, the exposition to green nature led to higher activation of brain areas related to motor planning, but also to emotion regulation and emotional response.

Simulated nature and positive body image: A comparison of the impact of exposure to images of blue and green spaces

Previous research has shown that exposure to simulated natural environments, such as still images and film, promotes more positive state body image. However, this body of work has not distinguished between different types of natural environment, with the distinction between blue and green spaces being notable. Here, we asked a sample of 168 university students from the United Kingdom to complete a measure of state body appreciation before and after being randomly assigned to one of three groups in which they viewed images of blue spaces, green spaces, or built environments, respectively. A mixed analysis of variance showed that exposure to images of the natural environments, but not the built environments, significantly elevated state body appreciation. In addition, exposure to images of blue spaces had a stronger effect on state body appreciation than exposure to images of green spaces. These results replicate previous work showing that exposure to simulated natural environments promotes more positive state body image, but additionally shows that blue spaces may be more effective than green spaces. Implications of the present findings for the development of imagery-based interventions aimed at promoting healthier body image are discussed.

Psychosocial and Biological Outcomes of Immersive, Mindfulness-Based Treks in Nature for Groups of Young Adults and Caregivers Affected by Cancer: Results from a Single Arm Program Evaluation from 2016-2021

The COVID-19 pandemic has left many individuals suffering from “connection deficit disorder” given changes to the way we work, go to school, socialize, and engage in daily activities. Young adults affected by cancer between the ages of 18–39 have known this connection deficit long before the pandemic. Being diagnosed and treated for cancer during this time can significantly disrupt engagement in important educational, career, social, and reproductive pursuits, and contribute to increased stress, anxiety, depression, and other negative outcomes. Experiencing meaningful connection—with nature, with peers who understand, and with oneself, may help assuage this adverse effect of disconnect. A single arm within-subjects program evaluation was conducted to examine outcomes following participation in immersive, multi-night, mindfulness-based treks in nature in a sample of young adults (n = 157) and caregivers (n = 50) affected by cancer from 2016–2021. Pre to post-trek changes included significant (p < 0.001) self-reported improvements in feeling connected to nature (d = 0.93–0.95), peers (d = 1.1–1.3), and oneself (d = 0.57–1.5); significant (p < 0.001) improvements on PROMIS Anxiety (d = 0.62–0.78), Depression (d = 0.87–0.89), and Sleep Disturbance (d = 0.37–0.48) short forms; and significant (p < 0.05) changes in pro-inflammatory biomarkers (d = 0.55–0.82). Connection-promoting experiences like this have the potential to improve health and wellbeing in this population and serve as a model for others.