Natural environments and mental health

Urban resilience reduces depressive symptoms among middle-aged and elderly adults: A multidimensional analysis based on China longitudinal healthy longevity survey

With the rapid urbanization and aging population, depression has become a severe public health issue globally, affecting millions of individuals and significantly impacting their quality of life and healthcare costs. Urban resilience refers to a city's ability to absorb, recover, and prepare for future shocks, ensuring sustainable development despite challenges. This study aims to explore the impact of urban resilience on depressive symptoms among middle-aged and elderly adults. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed five dimensions of urban resilience: economic, social, ecological, institutional, and infrastructural resilience. The results of cox proportional hazards model indicate that high levels of urban resilience significantly reduce the risk of depressive symptoms (HR = 0.875, 95% CI: 0.832-0.920, P < 0.001). Specifically, economic resilience (HR = 0.883, 95% CI: 0.846-0.921, P < 0.001), social resilience (HR = 0.916, 95% CI: 0.876-0.958, P < 0.001), ecological resilience (HR = 0.670, 95% CI: 0.516-0.869, P = 0.003), institutional resilience (HR = 0.922, 95% CI: 0.886-0.960, P < 0.001), and infrastructural resilience (HR = 0.875, 95% CI: 0.826-0.926, P < 0.001) all show significant negative correlations with depressive symptoms. Furthermore, the mitigation of depressive symptoms risk resulting from improved urban resilience disproportionately benefits vulnerable groups and those with healthy living habits. These findings provide scientific evidence for urban planning and policy formulation, contributing to the promotion of mental health and healthy aging among middle-aged and elderly populations.

Through the Eyes of a Young Carer: A Photo Elicitation Study of Protective Resilience

Caregiving is recognised as a source of stress with potential for negative health impacts as well as positive outcomes and development of resilience. For young carers, children, and adolescents providing care for close family members, adaptation through resilience is crucial, yet work using a resilience approach is limited. This study explored protective factors and pathways to resilience in a sample of young carers, through application of the socioecological model in caring relationships. An in-depth qualitative approach was used, with in-person interviews facilitated by auto-driven photo elicitation. Deductive thematic analysis was applied, framed by three levels (individual, community, and society) of the socioecological model of resilience. Twelve participants (nine girls and three boys) aged 5-18 years, each providing care to a family member, were recruited using opportunity and volunteer sampling via carers' centres in the southwest of England. Ten key themes were identified, four at the individual level: pre-empting challenges and planning, cognitive strategies, emotional strategies, and seeking solitude; three at the community level: family support, friendships, and pets and inanimate objects; and three at the society level: professional support, access to caregiver activities and community, and being outdoors. The location of themes at each level indicated relevance of the socioecological model to identification of protective factors in a young carer population. These findings have important applications for guidance to charities and organisations supporting young carers. Identification of factors that promote resilience offers support for the development of well-informed interventions, which harness these protective factors to develop resilience and improve health for young carers.

Built Environment, Natural Environment, and Mental Health

Mental health disorders have become a global problem, garnering considerable attention. However, the root causes of deteriorating mental health remain poorly understood, with existing literature predominantly concentrating on socioeconomic conditions and psychological factors. This study uses multi-linear and geographically weighted regressions (GWR) to examine the associations between built and natural environmental attributes and the prevalence of depression in US counties. The findings reveal that job sprawl and land mixed use are highly correlated with a lower risk of depression. Additionally, the presence of green spaces, especially in urban area, is associated with improved mental health. Conversely, higher concentrations of air pollutants, such as PM2.5 and CO, along with increased precipitation, are linked to elevated depression rates. When considering spatial correlation through GWR, the impact of population density and social capital on mental health displays substantial spatial heterogeneity. Further analysis, focused on two high depression risk clustering regions (northwestern and southeastern counties), reveals nuanced determinants. In northwestern counties, depression rates are more influenced by factors like precipitation and socioeconomic conditions, including unemployment and income segregation. In southeastern counties, population demographic characteristics, particularly racial composition, are associated with high depression prevalence, followed by built environment factors. Interestingly, job growth and crime rates only emerge as significant factors in the context of high depression risks in southeastern counties. This study underscores the robust linkages and spatial variations between built and natural environments and mental health, emphasizing the need for effective depression treatment to incorporate these multifaceted factors.

Radiative cooling and indoor light management enabled by a transparent and self-cleaning polymer-based metamaterial

Transparent roofs and walls offer a compelling solution for harnessing natural light. However, traditional glass roofs and walls face challenges such as glare, privacy concerns, and overheating issues. In this study, we present a polymer-based micro-photonic multi-functional metamaterial. The metamaterial diffuses 73% of incident sunlight, creating a more comfortable and private indoor environment. The visible spectral transmittance of the metamaterial (95%) surpasses that of traditional glass (91%). Furthermore, the metamaterial is estimated to enhance photosynthesis efficiency by ~9% compared to glass roofs. With a high emissivity (~0.98) close to that of a mid-infrared black body, the metamaterial is estimated to have a cooling capacity of ~97 W/m2 at ambient temperature. The metamaterial was about 6 °C cooler than the ambient temperature in humid Karlsruhe. The metamaterial exhibits superhydrophobic performance with a contact angle of 152°, significantly higher than that of glass (26°), thus potentially having excellent self-cleaning properties.

Brighten up the Rainbow: Ecology-Based Group Work for LGBTQ+ People

This research was carried out as a pretest-posttest experimental study in order to evaluate the effect of ecology-based group work on 18 LGBTQ+ people living in different districts of Istanbul. The study group of the research carried out between July 2022 and August 2022 consists of 18 LGBTQ+ people, between the ages of 19-22. Study participants were randomly selected for each group and assigned to the experimental and control groups. In addition to the Personal Information Form, the Flourishing Scale, the Nature Relatedness Scale, and the Depression Stress and Anxiety Scale (DASS21) were applied to the study group as pretest-posttest. Socializing, hiking, gardening, and human-animal interaction activities were held in the group work sessions consisting of 6 sessions on Saturdays at 13.00. In addition to all these activities, some documentaries on ecology were also suggested for the participants to watch, to be discussed in different sessions. The collected data were analyzed in the SPSS 22.0 package program. At the end of the group work, it was observed that there was a significant difference in the total scores of the Flourishing Scale, the Nature Relatedness Scale, and Depression Stress and Anxiety Scale (DASS21) of LGBTQ+ people in the experimental group.

Indigenous and Non-Indigenous Theories of Wellbeing and Their Suitability for Wellbeing Policy

A growing interest among governments in policies to promote wellbeing has the potential to revive a social view of health promotion. However, success may depend on the way governments define wellbeing and conceptualize ways to promote it. We analyze theories of wellbeing to discern twelve types of wellbeing theory and assess the suitability of each type of theory as a basis for effective wellbeing policies. We used Durie's methodology of working at the interface between knowledge systems and Indigenous dialogic methods of yarning and deep listening. We analyzed selected literature on non-Indigenous theories and Indigenous theories from Australia, New Zealand, Canada and the United States to develop a typology of wellbeing theories. We applied political science perspectives on theories of change in public policy to assess the suitability of each type of theory to inform wellbeing policies. We found that some theory types define wellbeing purely as a property of individuals, whilst others define it in terms of social or environmental conditions. Each approach has weaknesses regarding the theory of change in wellbeing policy. Indigenous relational theories transcend an 'individual or environment' dichotomy, providing for pluralistic approaches to health promotion. A broad theoretic approach to wellbeing policy, encompassing individual, social, equity-based and environmental perspectives, is recommended.

A Transmissive Theory of Brain Function: Implications for Health, Disease, and Consciousness

Identifying a complete, accurate model of brain function would allow neuroscientists and clinicians to make powerful neuropsychological predictions and diagnoses as well as develop more effective treatments to mitigate or reverse neuropathology. The productive model of brain function, which has been dominant in the field for centuries, cannot easily accommodate some higher-order neural processes associated with consciousness and other neuropsychological phenomena. However, in recent years, it has become increasingly evident that the brain is highly receptive to and readily emits electromagnetic (EM) fields and light. Indeed, brain tissues can generate endogenous, complex EM fields and ultraweak photon emissions (UPEs) within the visible and near-visible EM spectra. EM-based neural mechanisms, such as ephaptic coupling and non-visual optical brain signaling, expand canonical neural signaling modalities and are beginning to disrupt conventional models of brain function. Here, we present an evidence-based argument for the existence of brain processes that are caused by the transmission of extracerebral, EM signals and recommend experimental strategies with which to test the hypothesis. We argue for a synthesis of productive and transmissive models of brain function and discuss implications for the study of consciousness, brain health, and disease.

Positive Psychology: Looking Back and Looking Forward

Envisioning the future of positive psychology (PP) requires looking at its past. To that end, I first review prior critiques of PP to underscore that certain early problems have persisted over time. I then selectively examine recent research to illustrate progress in certain areas as well as draw attention to recurrent problems. Key among them is promulgation of poorly constructed measures of well-being and reliance on homogeneous, privileged research samples. Another concern is the commercialization of PP, which points to the need for greater oversight and quality control in profit-seeking endeavors. Looking ahead, I advocate for future science tied to contemporary challenges, particularly ever-widening inequality and the pandemic. These constitute intersecting catastrophes that need scientific attention. Such problems bring into focus "neglected negatives" that may be fueling current difficulties, including greed, indifference, and stupidity. Anger, which defies easy characterization as positive or negative, also warrants greater scientific study. Going forward I advocate for greater study of domains that likely nurture good lives and just societies - namely, participation in the arts and encounters with nature, both currently under study. Overall, my entreaty to PP is to reckon with persistent problems from its past, while striving toward a future that is societally relevant and virtuous.

Campus community gardens and student health: A case study of a campus garden and student well-being

Objective The purpose of this study was to explore the relationship between working at a campus community garden and student volunteers' wellbeing. Participants: 76 undergraduate students at a large urban university in the San Francisco Bay area. Methods: A Web-based survey was conducted. Using an email mailing list of current and former garden volunteers, the study questionnaire was sent to survey participants multiple times to promote higher response rate. Results: Bootstrap regression revealed that both connectedness to nature and general health were significant predictors of a general well-being variable. Conclusions: University leaders might consider that campus natural spaces contribute to student success and may be among the few opportunities that urban college students have to engage with nature.

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.

Nature-Based Citizen Science as a Mechanism to Improve Human Health in Urban Areas

The world is becoming increasingly urbanised, impacting human interactions with natural environments (NEs). NEs take a number of forms, ranging from pristine, modified, to built NEs, which are common in many urban areas. NEs may include nature-based solutions, such as introducing nature elements and biological processes into cities that are used to solve problems created by urbanisation. Whilst urbanisation has negative impacts on human health, impacting mental and physical wellbeing through a number of mechanisms, exposure to NEs may improve human health and wellbeing. Here, we review the mechanisms by which health can be improved by exposure to NEs, as explained by Stress Reduction Theory, Attention Restoration Theory, and the 'Old Friends'/biodiversity hypothesis. Such exposures may have physiological and immunological benefits, mediated through endocrine pathways and altered microbiota. Citizen Science, which often causes exposure to NEs and social activity, is being increasingly used to not only collect scientific data but also to engage individuals and communities. Despite being a named component of scientific and environmental strategies of governments, to our knowledge, the intrinsic health benefits of Citizen Science in NEs do not form part of public health policy. We contend that Citizen Science programs that facilitate exposure to NEs in urban areas may represent an important public health policy advance.

Spirituality and Well-Being: Theory, Science, and the Nature Connection

The links between spirituality and eudaimonic well-being are examined, beginning with a look at theoretical issues as to whether spirituality is best construed as part of well-being, or as a possible influence on well-being. A brief review of scientific findings from the MIDUS study linking religion and spirituality to well-being and other outcomes is then provided to show recent empirical work on these topics. Suggestions for future work are also provided. The third section is forward-thinking and addresses the power of nature to nurture spirituality and well-being, beginning with a look at how current research has linked nature to human flourishing. Issues of spirituality are rarely mentioned in this literature, despite evidence that nature has long been a source of inspiration in poetry, literature, art, and music. These works reveal that the natural world speaks to the human soul. To explore such ideas, parts of Jungian psychology are revisited: the soul's longing for poetry, myth, and metaphor; the importance of animism, which sees nature as a field inhabited by spirit; and the devaluing of ancient cultures. The final section considers the wisdom of the indigenous peoples who saw spirit in everything. Their inputs, exemplified with "Two-Eyed Seeing", offer new visions for thinking about the interplay of spirituality, well-being, and the natural world.

Viewing Nature Lets Your Mind Run Free: Three Experiments about the Influence of Viewing a Nature Video on Cognitive Coping with Psychological Distress

Viewing nature has restorative qualities that might help people cope with their personal struggles. Three lab experiments (N = 506) studied whether environment (nature vs. built) influences cognitive coping with psychological distress. Psychological distress was induced with an autobiographical recall task about serious regret, whereafter participants were randomly assigned to view a nature or built video. Cognitive coping (i) Quantity, (ii) Content, and (iii) Quality were hereafter assessed as well as extent and vividness of the regretful memory during the video. Results showed a higher cognitive coping Quantity (Study 1 and 3) and a higher cognitive coping Quality (All studies) for the nature (vs. built) condition. Regarding cognitive coping Content, results varied across the studies. Additionally, participants reported to have thought about the experienced psychological distress to a greater extent while viewing the nature (vs. built) video. Yet they did rate viewing nature as more relaxing. We propose a two-step pathway as an underlying mechanism of restoration. In the first step the capacity for directed attention replenishes. Secondly, this renewed capacity is directed towards internal processes, creating the optimal setting for reflection. Hence, viewing nature allows people to truly process whatever is occupying their minds, which is ultimately relieving and beneficial for mental health.

The Mood-Improving Effect of Viewing Images of Nature and Its Neural Substrate

It has been recently suggested that contact with nature improves mood via reducing the activity of the prefrontal cortex. However, the specific regions within the prefrontal cortex that underlie this effect remain unclear. In this study, we aimed to identify the specific regions involved in the mood-improving effect of viewing images of nature using a 52-channel functional near-infrared spectroscopy (fNIRS). Specifically, we focused on the orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (dlPFC), two regions associated with affective processing and control. In a randomized controlled crossover experiment, we assigned thirty young adults to view images of nature and built environments for three minutes each in a counterbalanced order. During image viewing, participants wore a fNIRS probe cap and had their oxyhemoglobin (oxy-Hb) measured. Immediately following each image viewing, participants indicated their mood in terms of comfortableness, relaxation, and vigor. Results showed that viewing images of nature significantly increased comfortableness and relaxation but not vigor compared to viewing images of built environments, with a large effect size. Meanwhile, the concentration of oxy-Hb in only the right OFC and none of the other regions significantly decreased while viewing the images of nature compared to built environments, with a medium effect size. We speculate that viewing images of nature improves mood by reducing the activity of or calming the OFC. Since the OFC is hyperactive in patients with depression and anxiety at rest, contact with nature might have therapeutic effects for them.

Hitchhiking microbes: Declining biodiversity & emerging zoonoses

The connection between nature conservation and human wellbeing is well known, however, the role of declining biodiversity and emerging diseases is relatively less studied. The presence of a thriving biological diversity is known to have therapeutic effects on human health. On the other hand, human economic activities have contributed to a sharp decline in species, resulting in poor ecosystem health. Several studies have shown how microorganisms have switched from animals to humans, leading to novel diseases. This review describes studies on zoonotic diseases and biodiversity, with examples from India. It is argued that conservation of biodiversity and ecosystems and changes in economic activities must be made to ward off new diseases, and why cooperation between ministries is critical to restrict the decline of biological diversity in a megadiverse country like India.

Understanding the Differential Impact of Vegetation Measures on Modeling the Association between Vegetation and Psychotic and Non-Psychotic Disorders in Toronto, Canada

Considerable debate exists on whether exposure to vegetation cover is associated with better mental health outcomes. Past studies could not accurately capture people's exposure to surrounding vegetation and heavily relied on non-spatial models, where the spatial autocorrelation and latent covariates could not be adjusted. Therefore, a suite of five different vegetation measures was used to separately analyze the association between vegetation cover and the number of psychotic and non-psychotic disorder cases in the neighborhoods of Toronto, Canada. Three satellite-based and two area-based vegetation measures were used to analyze these associations using Poisson lognormal models under a Bayesian framework. Healthy vegetation cover was found to be negatively associated with both psychotic and non-psychotic disorders. Results suggest that the satellite-based indices, which can measure both the density and health of vegetation cover and are also adjusted for urban and environmental perturbations, could be better alternatives to simple ratio- and area-based measures for understanding the effect of vegetation on mental health. A strong dominance of spatially structured latent covariates was found in the models, highlighting the importance of adopting a spatial approach. This study can provide critical guidelines for selecting appropriate vegetation measures and developing spatial models for future population-based epidemiological research.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

The environmental enrichment model revisited: A translatable paradigm to study the stress of our modern lifestyle

Mounting evidence shows that physical activity, social interaction and sensorimotor stimulation provided by environmental enrichment (EE) exert several neurobehavioural effects traditionally interpreted as enhancements relative to standard housing (SH) conditions. However, this evidence rather indicates that SH induces many deficits, which could be ameliorated by exposing animals to an environment vaguely mimicking some features of their wild habitat. Rearing rodents in social isolation (SI) can aggravate such deficits, which can be restored by SH or EE. It is not surprising, therefore, that most preclinical stress models have included severe and unnatural stressors to produce a stress response prominent enough to be distinguishable from SH or SI-frequently used as control groups. Although current stress models induce a stress-related phenotype, they may fail to represent the stress of our urban lifestyle characterized by SI, poor housing and working environments, sedentarism, obesity and limited access to recreational activities and exercise. In the following review, we discuss the stress of living in urban areas and how exposures to and performing activities in green environments are stress relievers. Based on the commonalities between human and animal EE, we discuss how models of housing conditions (e.g., SI-SH-EE) could be adapted to study the stress of our modern lifestyle. The housing conditions model might be easy to implement and replicate leading to more translational results. It may also contribute to accomplishing some ethical commitments by promoting the refinement of procedures to model stress, diminishing animal suffering, enhancing animal welfare and eventually reducing the number of experimental animals needed.

A critical review of the epidemiological evidence of effects of air pollution on dementia, cognitive function and cognitive decline in adult population

Dementia is arguably the most pressing public health challenge of our age. Since dementia does not have a cure, identifying risk factors that can be controlled has become paramount to reduce the personal, societal and economic burden of dementia. The relationship between exposure to air pollution and effects on cognitive function, cognitive decline and dementia has stimulated increasing scientific interest in the past few years. This review of the literature critically examines the available epidemiological evidence of associations between exposure to ambient air pollutants, cognitive performance, acceleration of cognitive decline, risk of developing dementia, neuroimaging and neurological biomarker studies, following Bradford Hill guidelines for causality. The evidence reviewed has been consistent in reporting associations between chronic exposure to air pollution and reduced global cognition, as well as impairment in specific cognitive domains including visuo-spatial abilities. Cognitive decline and dementia incidence have also been consistently associated with exposure to air pollution. The neuro-imaging studies reviewed report associations between exposure to air pollution and white matter volume reduction. Other reported effects include reduction in gray matter, larger ventricular volume, and smaller corpus callosum. Findings relating to ischemic (white matter hyperintensities/silent cerebral infarcts) and hemorrhagic (cerebral microbleeds) markers of cerebral small vessel disease have been heterogeneous, as have observations on hippocampal volume and air pollution. The few studies available on neuro-inflammation tend to report associations with exposure to air pollution. Several effect modifiers have been suggested in the literature, but more replication studies are required. Traditional confounding factors have been controlled or adjusted for in most of the reviewed studies. Additional confounding factors have also been considered, but the inclusion of these has varied among the different studies. Despite all the efforts to adjust for confounding factors, residual confounding cannot be completely ruled out, especially since the factors affecting cognition and dementia are not yet fully understood. The available evidence meets many of the Bradford Hill guidelines for causality. The reported associations between a range of air pollutants and effects on cognitive function in older people, including the acceleration of cognitive decline and the induction of dementia, are likely to be causal in nature. However, the diversity of study designs, air pollutants and endpoints examined precludes the attribution of these adverse effects to a single class of pollutant and makes meta-analysis inappropriate.

Visual features influence thought content in the absence of overt semantic information

It has recently been shown that the perception of visual features of the environment can influence thought content. Both low-level (e.g., fractalness) and high-level (e.g., presence of water) visual features of the environment can influence thought content in real-world and experimental settings where these features can make people more reflective and contemplative in their thoughts. It remains to be seen, however, if these visual features retain their influence on thoughts in the absence of overt semantic content, which could indicate a more fundamental mechanism for this effect. In this study, we removed this limitation by creating scrambled edge versions of images, which maintain edge content from the original images but remove scene identification. Nonstraight edge density is one visual feature that has been shown to influence many judgements about objects and landscapes and has also been associated with thoughts of spirituality. We extend previous findings by showing that nonstraight edges retain their influence on the selection of a Spiritual & Life Journey topic after scene-identification removal. These results strengthen the implication of a causal role for the perception of low-level visual features on the influence of higher order cognitive function, by demonstrating that in the absence of overt semantic content, low-level features, such as edges, influence cognitive processes.

Associations between growing up in natural environments and subsequent psychiatric disorders in Denmark

Natural environments have been associated with mental health benefits worldwide. However, how different elements and types of natural environments associate with mental health is still largely unknown. In this study, we perform a detailed analysis on a large, nation-wide data set of mental health records (908 553 individuals) for Denmark combined with remotely-sensed land cover and vegetation density data. We explore associations between growing up surrounded by different environments and rates of a spectrum of 18 psychiatric disorders. Childhood land cover exposure for urban, agricultural, near-natural green space, and blue space was determined around the residence of each individual. Vegetation density and air pollution were evaluated as potential pathways. Cox proportional hazards models were used to estimate rates as hazard ratios and then adjusted for potential confounding from other known risk factors. For 12 of 18 disorders, rates were lower for children growing up in environments with more natural elements (near-natural green space, blue space, and agriculture) compared to children growing up in urban environments. High vegetation density was associated with lower rates for most disorders within all the examined environments, whereas mitigation of air pollution by natural environments seemed a less important potential pathway. Rates were not notably changed by adjustment for urbanization, parental and municipal socioeconomic status, family history of mental illness, and parents' age. In conclusion, we found that growing up surrounded by a range of natural environments such as near-natural green space, blue space, and agriculture may lower rates of psychiatric disorders. Our results show the importance of ensuring access to natural environments from as nature-based solutions for improved public health and sustainable, livable cities.

Using engagement in sustainable construction to improve mental health and social connection in disadvantaged and hard to reach groups: a new green care approach

Background: The positive impact of the outdoors on physical and mental health is increasingly being evidenced. However, the impact on vulnerable and disadvantaged individuals engaging in group based sustainable building construction has not been examined.Aim: To provide the first pragmatic examination of the impact of engaging in a brief (8 days over 8 weeks) outdoor sustainable construction project on the mental health and social connectedness of hard to reach and disadvantaged groups.Methods: In study 1, 93 young people not in education, employment or training took part whilst study 2 comprised 55 adults who were asylum seekers, long-term unemployed or men with longstanding depression. Self-report data were collected at baseline and towards the end of the programme.Results: Those with poor mental health and social connection at baseline showed statistically and clinically significant improvements in depression, anxiety, resilience and social connection by the end of the brief intervention.Conclusion: Engagement in a group based sustainable construction project can provide significant mental health and social benefits to a range of vulnerable and hard to reach groups with difficulties in these areas. Building on these findings could be important for health and social care policy for marginalised groups.

Natural surroundings in childhood are associated with lower schizophrenia rates

High exposure to green space and natural environments has previously been associated with lower schizophrenia rates possibly through low air pollution and improved psychological restoration. Exposure to natural environments could explain the negative urban-rural gradient of schizophrenia, but it is unclear if all natural environments are associated with schizophrenia rates. We investigated the association between schizophrenia and growing up surrounded by environments classified as mainly urban, agricultural, near-natural green space, and blue space. Vegetation density and air pollution were assessed as potential pathways. We used the Danish population (943 027 people) and remotely-sensed environmental data to determine land cover exposure and vegetation density around each individual's residence. Effect sizes were estimated using Cox regression and adjusted for air pollution, socioeconomic status, and urbanization. Our results show that growing up surrounded by non-urban environments is associated with lower schizophrenia rates. Firstly, growing up surrounded by non-built-up areas (agricultural areas, near-natural green and blue space) is associated with lower schizophrenia rates compared to urban areas. Secondly, rates decrease with vegetation density in a dose-response relationship for urban and agricultural areas. Air pollution mitigation more strongly explained the protective association in near-natural green spaces, implying that restorative pathways together with air pollution mitigation may explain lower rates in natural environments. This study suggests that ensuring access to natural environments during childhood may be important for schizophrenia prevention, whilst being the first study to show that natural environments may influence schizophrenia rates through multiple pathways.

A Web- and Mobile App-Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study

BACKGROUND

The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app-based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions.

OBJECTIVE

This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app-based, lifestyle-focused mental health promotion intervention among a healthy adult cohort.

METHODS

Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard-fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the "mental health" and "vitality" subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale.

RESULTS

Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7.

CONCLUSIONS

A Web- and mobile app-based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.

Australian policies on water management and climate change: are they supporting the sustainable development goals and improved health and well-being?

BACKGROUND

Sustainable management of the natural environment is essential. Continued environmental degradation will lead to worsened health outcomes in countries and across generations. The Sustainable Development Goals (SDGs) provide a framework for viewing the preservation of natural environments and the promotion of health, well-being and health equity as interconnected pursuits. Within the SDG framework the goals of promoting environmental sustainability and human health are unified through attention to the social determinants of health and health equity (SDH/HE). This paper presents findings from a document analysis of all Australian environment sector policies and selected legislation to examine whether and how current approaches support progress toward achieving SDG goals on water, climate change, and marine ecosystems (Goals 6, 13 and 14), and to consider implications for health and health equity.

RESULTS

Consideration of a broad range of SDH/HE was evident in the analysed documents. Related collaborations between environment and health sectors were identified, but the bulk of proposed actions on SDH/HE were initiated by the environment sector as part of its core business. Strengths of Australian policy in regard to SDGs 6, 13 and 14 are reflected in recognition of the effects of climate change, a strong cohesive approach to marine park protection, and recognition of the need to protect existing water and sanitation systems from future threats. However, climate change strategies focus predominately on resilience, adaptation and heat related health effects, rather than on more comprehensive mitigation policies. The findings emphasise the importance of strengthened cross-sectoral action to address both the drivers and effects of environmental degradation. A lack of policy coherence between jurisdictions was also evident in several areas, compounded by inadequate national guidance, where vague strategies and non-specific devolution of responsibilities are likely to compromise coordination and accountability.

CONCLUSIONS

Evidence on planetary health recognises the interconnectedness of environmental and human health and, as such, suggests that ineffective management of climate change and water pose serious risks to both the natural environment and human well-being. To address these risks more effectively, and to achieve the SDGs, our findings indicate that cross-jurisdiction policy coherence and national coordination must be improved. In addition, more action to address global inequities is required, along with more comprehensive approaches to climate change mitigation.

Ethnic Differences in Home-Related Maternal Stress: Muslim and Jewish Mothers

Parental stresses are normal responses to raising children. They are affected by stresses parents and children accumulate and bring to their interrelations. Background factors like economic difficulties or the relations between the parents may affect parental stresses as well as demographic and environmental factors like noise and access to urban parks. Most studies on parental stress are based on a verified psychological questionnaire. We suggest using frequency domain heart rate variability index (HRV) to measure parental stress enabling, by thus, the measurement of physiological aspects of stress and risk to health. Parental stress is measured as the difference between HRV accumulated at home while staying with the children and without the husband and HRV measured in the neighborhood while staying without the children and the husband. We use the index to compare differences among Muslim and Jewish mothers in exposure to maternal stress at their homes and to expose the factors that predict differences in maternal stress. We found that Muslim mothers suffer from home-related maternal stress while Jewish mother do not. Number of children and ethnically related environmental aspects predict differences in maternal stress between Muslim and Jewish mothers. Muslims' lower access to parks stems from lack of home garden and parks in their neighborhoods in the Arab towns but mainly by restrictions on Muslim mothers' freedom of movement to parks. Despite differences in levels of noise at home and in the status of the mother in the household, these factors did not predict differences in maternal stress. Instead, the study highlights the crucial role of greenery and freedom of movement to parks in moderating home-related maternal stress.

Nature-Based Interventions for Mental Health Care: Social Network Analysis as a Tool to Map Social Farms and their Response to Social Inclusion and Community Engagement

Social farming represents a hybrid governance model in which public bodies, local communities, and economic actors act together to promote health and social inclusion in rural areas. Although relational variables are crucial to foster social farm performance, the relational system in which farms are embedded has still not been fully described. Using social network analysis, here we map the nature of the links of a selected sample of social farms operating in Northern Italy. We also explore possible network variations following specific actions taken to potentiate local social farming initiatives. The results show a certain degree of variability in terms of the extension and features of the examined networks. Overall, the actions taken appear to be significant to enlarge and diversify farms' networks. Social farming has the potential to provide important benefits to society and the environment and to contrast vulnerability in rural areas. Being able to create social and economic networks of local communities, social farming may also represent an innovative way to respond to the cultural shift from institutional psychiatry to community-based mental health care. This study emphasizes the critical role played by network facilitation in diversifying actors, promoting heterogeneous relationships, and, in turn, system complexity.

Sense of Coherence and Connectedness to Nature as Predictors of Motivation for Practicing Karate

Background: Physical activity yields exceptionally positive results when it takes place out in the open air, in contact with nature. Both contact with nature and practicing sport constitute a certain kind of philosophy of life and living by its rules plays a vital role in positive mental health―understood as maintaining a high sense of coherence. Martial arts are examples of sports that are rooted in a philosophy. The goal of this study was to explore the links between a sense of coherence and connectedness to nature in the context of motivations for practicing karate. Methods: A total of 127 practitioners of karate were examined using the Inventory of Physical Activity Objectives (IPAO), the Sense of Coherence Questionnaire, and the Connectedness to Nature Scale. Results: The most important objective for women training karate was a fit, shapely body, and for men the most important objective was physical fitness. Connectedness to nature had the strongest positive relationship with the measure of physical fitness (in both genders). A sense of comprehensibility increased men’s motivational conflict, whereas, in women, this IPAO dimension was positively related to feeling emotionally connected to the natural world. Connectedness to nature was related to motivational conflict positively in women and negatively in men. Feeling emotionally connected to the natural world correlated with a sense of comprehensibility, a sense of manageability, and a sense of meaningfulness. Sense of comprehensibility and sense of meaningfulness tended to increase with age. Conclusions: Understanding both the natural environment and the utility of setting sport-related goals led to increasing one’s efforts on the way to both successes and defeats, and, most of all, overcoming one’s weaknesses.

GOING GREEN: The Effectiveness of a 40-Day Green Exercise Intervention for Insufficiently Active Adults

Increasing physical activity and reducing sedentary behavior is an economic and health priority. This Green Exercise (GEx) study reports on a 40-day physical activity intervention to increase physical activity that primarily used outdoor recreation activities. Adherence, compliance, blood pressure (BP), total cholesterol, anthropometry, strength, dynamic stability, and cardiovascular fitness were assessed 1 week prior and immediately following the 40-day intervention. The results then were compared with a larger study that used the same methodologies but for the exception of primarily indoor physical activities. Results from this study showed similar improvements in health measures to the comparative indoor-based physical activity program with increased adherence and compliance. Improvements in wellbeing were also noted. This GEx study suggests that exercise programs that seek to increase physical activity levels of insufficiently active adults may benefit from including outdoor recreation activities within the program and may also increase participant mental health and general well-being.

[Forests and trees: A public health perspective]

Forests have historically supplied humans with timber, fuel, and forage. They have also provided goods and services associated with human physical, mental, social, and spiritual health. Given competing priorities for funding in healthcare, research on forests and health is important from a health economics perspective. Engagement with forests (including wilderness areas, managed production forests, and urban forests) for enhanced human health and wellbeing, and perhaps for illness prevention at a fraction of the cost of medical interventions, is a major opportunity for forest management in the 21st century. Despite this general recognition, there is a lack of information regarding public health policies and approaches that exist in relation to forests and trees. The available literature suggests that the majority in the field of public health view the natural environment with ambivalence. However, a paradigm shift is underway and there is an emerging field working with the positive impacts that trees and forests have on human health and wellbeing. While the value of forests has been noted by many health practitioners in Europe and Japan, health practitioners and the associated health industry in North America remain largely focused on treatment rather than preventative approaches. Largely as a result of advocacy from forestry and recreational organizations, this view is beginning to change, but the focus in the healthcare industry on treatment rather than prevention remains deeply entrenched.

The Relationship between Social Cohesion and Urban Green Space: An Avenue for Health Promotion

Social cohesion involves the interpersonal dynamics and sense of connection among people. Increased social cohesion can be associated with various physical and psychological health benefits. The presence of urban green spaces can encourage positive social interactions that cultivate social cohesion in ways that enhance health and well-being. Urban green spaces have also been linked to positive health behaviors and outcomes including increased physical activity and social engagement. Understanding the relationship between social cohesion and urban green space is important for informing holistic approaches to health. In this article, we discuss how positive interactions in urban green space can catalyze social cohesion, social capital and critical health-promoting behaviors that may enhance psychological health and well-being. We also summarize the strengths and limitations of previous studies and suggest directions for future research.

Physiological Effects of Viewing Bonsai in Elderly Patients Undergoing Rehabilitation

The benefits of various nature-derived stimuli that can be used for stress relief and relaxation has recently gained immense attention; however, there are very few studies about their influence on elderly patients. The present study aims to present the effects of viewing bonsai on autonomic nervous activity, prefrontal cortex activity, and subjective assessment findings of psychological relaxation in elderly patients undergoing rehabilitation. Fourteen participants aged 64⁻91 years (mean age ± standard deviation, 78.6 ± 9.6 years) participated in this study. Miniature potted 10-year-old Japanese cypress bonsai trees were used as visual stimuli. Participants viewed the bonsai for 1 min, and the control comprised of no experimental stimulus. Physiological effects on autonomic nervous activity were assessed by measuring the heart rate variability (HRV) and pulse rate. The effects on prefrontal cortex activity were determined using near-infrared spectroscopy, which involved assessment of oxyhemoglobin concentrations in the left and right prefrontal cortices. Subjective evaluations were achieved by the modified semantic differential method. Viewing bonsai resulted in a significant increase in parasympathetic nervous activity, a significant decrease in sympathetic nervous activity, and a significant increase in the perceptions of feeling "comfortable" and "relaxed." In conclusion, our findings indicated that viewing bonsai induces physiological and psychological relaxation.

Physical Activity, Residential Environment, and Nature Relatedness in Young Men-A Population-Based MOPO Study

Background: In general, nature relatedness is positively associated with physical activity, health, and subjective well-being. However, increased residence in urban areas, and the decrease in natural spaces, may affect the younger generation most adversely. The associated environmental changes can increase youths’ risk of spending most of their time indoors, and weaken their nature relatedness, making them less likely to enjoy nature’s health benefits. This is a serious public health issue, since inadequate physical activity, combined with minimum time spent in green space, can affect health across the whole lifespan. Thus, to develop effective interventions for physical activation and promote health and well-being among young men, further knowledge of the determinants of their nature relatedness is necessary. Aims: To explore factors related to nature relatedness, including physical activity, physical activity with parents, and residential environment. Methods: The study population consisted of all 914 young men (mean—17.8 years; SD—0.5) who participated in mandatory call-ups for military service and completed the study questionnaire in 2013. The questionnaire inquired about their nature relatedness, demographic characteristics, socioeconomic status, physical activity, health, and subjective well-being. A geographic information system (GIS) was used to assess the features of their residential environments. Multivariable linear regression was used to analyze the data. Results: Physical activity (p = 0.021) and physical activity with parents at primary school age (p = 0.007), and currently (p = 0.001) as well as good self-rated health (p = 0.001), and father’s higher socioeconomic status (p = 0.041), were positively connected to nature relatedness. Conclusions: Physical activity in general, physical activity with parents, and nature relatedness were positively related. This knowledge can be utilized in promoting physical activity and health among young men.

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.

Mental health benefits of interactions with nature in children and teenagers: a systematic review

Background

It is commonly believed that nature has positive impacts on children’s health, including physical, mental and social dimensions. This review focuses on how accessibility to, exposure to and engagement with nature affects the mental health of children and teenagers.

Methods

Ten academic databases were used to systematically search and identify primary research papers in English or French from 1990 to 1 March 2017. Papers were included for review based on their incorporation of nature, children and teenagers (0–18 years), quantitative results and focus on mental health.

Results

Of the 35 papers included in the review, the majority focused on emotional well-being and attention deficit disorder/hyperactivity disorder. Other outcome measures included overall mental health, self-esteem, stress, resilience, depression and health-related quality of life. About half of all reported findings revealed statistically significant positive relationships between nature and mental health outcomes and almost half reported no statistical significance.

Conclusions

Findings support the contention that nature positively influences mental health; however, in most cases, additional research with more rigorous study designs and objective measures of both nature and mental health outcomes are needed to confirm statistically significant relationships. Existing evidence is limited by the cross-sectional nature of most papers.

Levels of Nature and Stress Response

A growing number of studies have shown that visiting green spaces and being exposed to natural environments can reduce psychological stress. A number of questions concerning the effects of natural environments on levels of stress remain including, "Are activities engaged in natural environments more or less beneficial at reducing stress when compared to those done in more urban settings?" This study examined this question from the perspective of "levels of nature". That is, data on levels of stress were collected from three sites, one site having wilderness-like characteristics, a second site representing a municipal-type park, and a third site representing a built environment (indoor exercise facility) within a city. Data were generated using biophysical markers (cortisol and amylase) and a psychological measure within a pre- and post-visit format. Findings suggest that visiting natural environments can be beneficial in reducing both physical and psychological stress levels, with visitors to a natural environment reporting significantly lower levels of stress than their counterparts visiting a more urbanized outdoor setting or indoor exercise facility.

Advanced Metrics for Assessing Holistic Care: The "Epidaurus 2" Project

In response to the challenge of military traumatic brain injury and posttraumatic stress disorder, the US military developed a wide range of holistic care modalities at the new Walter Reed National Military Medical Center, Bethesda, MD, from 2001 to 2017, guided by civilian expert consultation via the Epidaurus Project. These projects spanned a range from healing buildings to wellness initiatives and healing through nature, spirituality, and the arts. The next challenge was to develop whole-body metrics to guide the use of these therapies in clinical care. Under the "Epidaurus 2" Project, a national search produced 5 advanced metrics for measuring whole-body therapeutic effects: genomics, integrated stress biomarkers, language analysis, machine learning, and "Star Glyphs." This article describes the metrics, their current use in guiding holistic care at Walter Reed, and their potential for operationalizing personalized care, patient self-management, and the improvement of public health. Development of these metrics allows the scientific integration of holistic therapies with organ-system-based care, expanding the powers of medicine.

A thought in the park: The influence of naturalness and low-level visual features on expressed thoughts

Prior research has shown that the physical characteristics of one's environment have wide ranging effects on affect and cognition. Other research has demonstrated that one's thoughts have impacts on mood and behavior, and in this three-part research program we investigated how physical features of the environment can alter thought content. In one study, we analyzed thousands of journal entries written by park visitors to examine how low-level and semantic visual features of the parks correlate with different thought topics. In a second study, we validated our ecological results by conducting an online study where participants were asked to write journal entries while imagining they were visiting a park, to ensure that results from Study 1 were not due to selection bias of park visitors. In the third study, we experimentally manipulated exposure to specific visual features to determine if they induced thinking about the same thought topics under more generalized conditions. Results from Study 3 demonstrated a potential causal role for perceived naturalness and high non-straight edges on thinking about "Nature", with a significant positive interaction. Results also showed a potential causal effect of naturalness and non-straight edges on thinking about topics related to "Spiritual & Life Journey", with perceived naturalness having a negative relationship and non-straight edges having a positive relationship. We also observed a significant positive interaction between non-straight edge density and naturalness in relation to "Spiritual & Life Journey". These results have implications for the design of the built environment to influence human reflection and well-being.

Physiological Effects of Visual Stimulation with Forest Imagery

This study was aimed to clarify the physiological effects of visual stimulation using forest imagery on activity of the brain and autonomic nervous system. Seventeen female university students (mean age, 21.1 ± 1.0 years) participated in the study. As an indicator of brain activity, oxyhemoglobin (oxy-Hb) concentrations were measured in the left and right prefrontal cortex using near-infrared time-resolved spectroscopy. Heart rate variability (HRV) was used as an indicator of autonomic nervous activity. The high-frequency (HF) component of HRV, which reflected parasympathetic nervous activity, and the ratio of low-frequency (LF) and high-frequency components (LF/HF), which reflected sympathetic nervous activity, were measured. Forest and city (control) images were used as visual stimuli using a large plasma display window. After sitting at rest viewing a gray background for 60 s, participants viewed two images for 90 s. During rest and visual stimulation, HRV and oxy-Hb concentration in the prefrontal cortex were continuously measured. Immediately thereafter, subjective evaluation of feelings was performed using a modified semantic differential (SD) method. The results showed that visual stimulation with forest imagery induced (1) a significant decrease in oxy-Hb concentrations in the right prefrontal cortex and (2) a significant increase in perceptions of feeling "comfortable," "relaxed," and "natural."

Urban Mind: Using Smartphone Technologies to Investigate the Impact of Nature on Mental Well-Being in Real Time

Existing evidence on the beneficial effects of nature on mental health comes from studies using cross-sectional designs. We developed a smartphone-based tool (Urban Mind; www.urbanmind.info) to examine how exposure to natural features within the built environment affects mental well-being in real time. The tool was used to monitor 108 individuals who completed 3013 assessments over a 1-week period. Significant immediate and lagged associations with mental well-being were found for several natural features. These associations were stronger in people with higher trait impulsivity, a psychological measure of one's tendency to behave with little forethought or consideration of the consequences, which is indicative of a higher risk of developing mental-health issues. Our investigation suggests that the benefits of nature on mental well-being are time-lasting and interact with an individual's vulnerability to mental illness. These findings have potential implications from the perspectives of global mental health as well as urban planning and design.

Nature exposure sufficiency and insufficiency: The benefits of environmental preservation

Increasing industrialization, urbanization, and a failure of many world leaders to appreciate the consequences of climate change are deleteriously impacting quality of life as well as diminishing the prospects for long term survival. Economic competitiveness and corporate profitability often pre-empt environmental concerns. The calving of an iceberg in Antarctica and the hurricane activity in the Caribbean during 2017 are unfortunate illustrations of the continuing escalation of environmental issues. We provide historical and current evidence for the importance of Nature Exposure (NE) and introduce the continuum Nature Exposure Sufficiency (NES) and Insufficiency (NEI). Insufficiency includes impoverished environments (e.g., slums and prisons) where nature exposure is very limited. Nature Exposure Sufficiency (NES) is an optimal amount of exposure to nature where many benefits such as reinvigoration can be obtained by everyone. NES also has several benefits for individuals with various health conditions such as arthritis, dementia, or depression. The benefits of NE are not just derivable from parks, forests, and other natural settings. Interiors of buildings and homes can be enhanced with plants and even pictures or objects from nature. Additionally, there is abundant evidence indicating that virtual and artificial environments depicting nature can provide substantial NE and therefore contribute to general wellbeing. Besides the difficulty in achieving cooperation amongst nations, corporations, and other collectives in developing and implementing long range plans to deal with climate change, there is also sometimes an aversion at the individual level whereby people are unwilling to experience nature due to insects and other discomforts. Such individuals are often averse to supplanting the comforts of home, even temporarily, with inadequate facilities that are seemingly less pleasant than their typical dwellings. We propose using the term Nature Exposure Aversion (NEA) to describe such behavior and propose that the aversion is largely due to conditioning. Such behavior may be addressed through desensitization in virtual environments which in turn may contribute to an endorsement of the view that climate change is occurring and must be dealt with. The issues of Nature Exposure Sufficiency and Insufficiency are intertwined with the sustainability of the planet and future planning and efforts to deal with the environment. If the outcome is unfavorable, the descent of civilization will be more rapid than the ascent.

A Multimodal Intervention for Improving the Mental Health and Emotional Well-being of College Students

This study examined the effectiveness of a 10-week multimodal intervention for improving the mental health and emotional well-being of college students when included as a mandatory component of the students' course of study. A total of 67 students (20.9 ± 5.4 years, 30 male/37 female) participated in the intervention that introduced a variety of evidence-based strategies for improving mental health and emotional well-being from the Lifestyle Medicine and Positive Psychology literature. Significant reductions were recorded in symptoms of depression (-28%, P < .05), anxiety (-31%, P < .05), and stress (-28%, P < .01), whereas significant improvements were observed in mental health (18%, P < .01), vitality (14%, P < .01) and overall life satisfaction (8%, P < .05). Effect sizes were larger than those reported by studies that have examined the individual effectiveness of the strategies incorporated into the intervention, suggesting a compounding effect. Stratified analyses indicated that participants with the lowest measures of mental health and emotional well-being at baseline experienced the greatest benefits. The findings of the study suggest that meaningful improvements in the mental health and emotional well-being of college students can be achieved, and potentially magnified, by utilizing a multidisciplinary approach involving evidence-based strategies from Lifestyle Medicine and Positive Psychology.