Inverse relationship between urban green space and childhood autism in California elementary school districts

Mapping associations of polygenic scores with autistic and ADHD traits in a single city region

BACKGROUND

The genetic and environmental aetiology of autistic and Attention Deficit Hyperactivity Disorder (ADHD) traits is known to vary spatially, but does this translate into variation in the association of specific common genetic variants?

METHODS

We mapped associations between polygenic scores for autism and ADHD and their respective traits in the Avon Longitudinal Study of Parents and Children (N = 4,255-6,165) across the area surrounding Bristol, UK, and compared them to maps of environments associated with the prevalence of autism and ADHD.

RESULTS

Our results suggest genetic associations vary spatially, with consistent patterns for autistic traits across polygenic scores constructed at different p-value thresholds. Patterns for ADHD traits were more variable across thresholds. We found that the spatial distributions often correlated with known environmental influences.

CONCLUSIONS

These findings shed light on the factors that contribute to the complex interplay between the environment and genetic influences in autistic and ADHD traits.

Associations of neighborhood greenspace, and active living environments with autism spectrum disorders: A matched case-control study in Ontario, Canada

BACKGROUND

Increasing evidence links early life residential exposure to natural urban environmental attributes and positive health outcomes in children. However, few studies have focused on their protective effects on the risk of autism spectrum disorder (ASD). The aim of this study was to investigate the associations of neighborhood greenspace, and active living environments during pregnancy with ASD in young children (≤6 years).

METHODS

We conducted a population-based matched case-control study of singleton term births in Ontario, Canada for 2012-2016. The ASD and environmental data was generated using the Ontario Autism Spectrum Profile, the Better Outcomes Registry & Network Ontario, and Canadian Urban Environmental Health Research Consortium. We employed conditional logistic regressions to estimate the odds ratio (OR) between ASD and environmental factors characterizing selected greenspace metrics and neighborhoods conducive to active living (i.e., green view index (GVI), normalized difference vegetation index (NDVI), tree canopy, park proximity and active living environments index (ALE)).

RESULTS

We linked 8643 mother-child pairs, including 1554 cases (18%). NDVI (OR 1.034, 0.944-1.024, per Inter Quartile Range [IQR] = 0.08), GVI (OR 1.025, 95% CI 0.953-1.087, per IQR = 9.45%), tree canopy (OR 0.992, 95% CI 0.903-1.089, per IQR = 6.24%) and the different categories of ALE were not associated with ASD in adjusted models for air pollution. In contrast, living closer to a park was protective (OR 0.888, 0.833-0.948, per 0.06 increase in park proximity index), when adjusted for air pollution.

CONCLUSIONS

This study reported mixed findings showing both null and beneficial effects of green spaces and active living environments on ASD. Further investigations are warranted to elucidate the role of exposure to greenspaces and active living environments on the development of ASD.

Exposure to greenness during pregnancy and the first three years after birth and autism spectrum disorder: A matched case-control study in shanghai, China

Causes of autism spectrum disorder (ASD) have not been fully understood. Previous studies have linked environmental factors with ASD. However, evidence for the greenness-ASD association is limited, especially in China. To fill this gap, we conducted a matched case-control study to examine the association between greenness and ASD in China. Participants in this study were 84,934 children aged 3-12 years in Shanghai, China, selected using a multi-stage cluster sampling method. ASD cases were firstly screened by questionnaires completed by both children's parents and teachers, and were then confirmed by clinical examinations. Further, 10 healthy controls were randomly selected to match each ASD case by age and sex. The final analyses included 146 ASD cases and 1460 healthy controls. Participants' exposure to greenness before and after birth was assessed by normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) from NASA's Earth Observing System according to their residential locations. We used conditional logistic regression to examine the ASD-greenness association. Per interquartile range (IQR) increase in EVI500m and NDVI500m during the year before birth were associated with lower risks of ASD with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of 0.96 (95%CI: 0.946, 0.975, IQR = 0.074) and 0.937 (95%CI: 0.915, 0.959, IQR = 0.101). Exposure to greenness during the first 3 years after birth was also significantly associated with lower risk of ASD [IQR ORs for EVI500m and NDVI500m were 0.935 (95%CI: 0.91, 0.962, IQR = 0.06) and 0.897 (95%CI: 0.861, 0.935, IQR = 0.09), respectively]. Air pollution showed mediation effects on thegreenness-ASD association. Greenness was observed to have stronger beneficial effects on children without historical diseases and term birth. More greenness exposure before and after birth were significantly associated with lower risks of ASD in children. Our results highlight the importance of greenness in urban planning.

Assessing the impact of blue and green spaces on mental health of disabled children: A scoping review

During recent decades, there has been a growing consideration of the role of blue and green spaces on mental health of children, but there is insufficient attention in the literature to the mental health of children with disabilities. This paper presents an overview of the evidence on how blue and green spaces affect the mental health of children with various disabilities. A database search found twenty studies eligible for the review, after several consecutive screening stages. Most studies used a cross-sectional design and were carried out in Europe. The results consistently indicate that blue and green space can reduce emotional, behavioral, and social problems in disabled children. A protective association was found between the level of blue or greenness and depressive and anxiety symptoms. Moreover, in most of the studies there were no significant changes in the result after adjusting for socioeconomic confounders. Generally, there is an identified need for more short-term exposure studies in this area, focusing on the impact of landscape design elements on mental health of disabled children. The findings of this scoping review call on urban planners, health care workers and decision makers to consider appropriate measures and interventions providing more blue and green space exposure to disabled children.

Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents

Today more than half of the world's population lives in urban areas. Children spend about 40 h a week in the school environment. Knowing the influence of school exposure to green/blue spaces could improve the children's health, creating healthier environments and preventing exposure to legal/illegal drugs. This systematic review summarized the main results of published studies on active or passive exposure to green or blue spaces in different domains of child neurodevelopment. In August 2022, five databases were searched and twenty-eight eligible studies were included in the analysis. Cognitive and/or academic performance was the most frequently studied (15/28). Most studies evaluate passive exposure to green/blue spaces (19/28) versus active exposure (9/28). Only three studies addressed the relationship between blue space and neurodevelopment. The main results point toward mixed evidence of a protective relationship between green/blue space exposure and neurodevelopment, especially in improving cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting "greener" capacities for school environmental health could improve children's neurodevelopment. There was great heterogeneity in methodologies and adjustment for confounding factors across studies. Future research should seek a standardized approach to delivering school environmental health interventions beneficial to children's development.

Greenspace and health outcomes in children and adolescents: A systematic review

An increasing body of evidence has linked greenspace and various health outcomes in children and adolescents, but the conclusions were inconsistent. For this review, we comprehensively summarized the measurement methods of greenspace, resultant health outcomes, and potential mechanisms from epidemiological studies in children and adolescents (aged ≤19 years). We searched for studies published and indexed in MEDLINE and EMBASE (via Ovid) up to April 11, 2022. There were a total of 9,291 studies identified with 140 articles from 28 countries finally assessed and included in this systematic review. Over 70% of the studies were conducted in highly urbanised countries/regions, but very limited research has been done in low-and middle-income countries and none in Africa. Measures of greenspace varied. Various health outcomes were reported, including protective effects of greenspace exposure on aspects of obesity/overweight, myopia, lung health, circulatory health, cognitive function, and general health in children and adolescents. The associations between greenspace exposure and other health outcomes were inconsistent, especially for respiratory health studies. We pooled odds ratios (OR) using random-effects meta-analysis for health outcomes of asthma (OR = 0.94, 95%CI: 0.84 to 1.06), allergic rhinitis (OR = 0.95; 95% CI: 0.73 to 1.25), and obesity/overweight (OR = 0.91, 95%CI: 0.84 to 0.98) with per 0.1 unit increase in normalized difference in vegetation index (NDVI). These associations have important implications for the assessment and management of urban environment and health in children and adolescents.

The Impact of the Urban Built Environment on the Play Behavior of Children with ASD

Anxiety caused by the lack of social skills is the biggest problem faced by children with ASD. Playing can improve children's social skills and relieve anxiety. This study aimed to explore the influence of urban built environments on ASD children's play behavior. The participants in this study were 57 parents of children with ASD. An anonymous questionnaire was used to collect and analyze data. At the same time, retrospective semi-structured interviews with 31 parents of ASD children were performed to validate the data analysis results. The results showed that lower residential building density, higher residential greening and higher destination accessibility have positive effects on ASD children's play behavior. Excellent transportation facilities and high NDVI vegetation coverage have positive effects on the play behavior of children with ASD. More recreational facilities and recreational playability have positive impacts on the play behavior of children with ASD. The population density and number of children in the destination, as well as public facilities, influence the play behavior of children with ASD. The research results can promote the integration of this group into urban life and further promote social equity. At the same time, with the social needs of autistic children as an intermediary, it is expected to further explore new directions for sustainable urban development. Finally, combined with the research results, parents of ASD children are given proposals for how to increase the likelihood of children's play behavior by choosing appropriate urban built environments.

The complex relationship between greenspace and well-being in children with and without autism

Greenspace (defined here as canopy coverage) positively correlates with improved well-being in typically developing individuals, but this relationship has not been established in children with autism spectrum disorder (ASD). To investigate this relationship, the current study merged data from the National Survey of Children's Health (2012) with the National Land Cover Database. Across typically developing children, children with ASD, and non-autistic children with special healthcare needs (CSHCN), greenspace unexpectedly negatively correlated with well-being. Further, compared with typically developing children, children with ASD or CSHCN status had lower well-being. Interestingly, typically developing children with conduct problems displayed an unexpected negative relationship (i.e. as greenspace increased whereas well-being decreased), though those without conduct problems showed no relationship. Children with ASD displayed no relationship between greenspace independent of conduct problems. CSHCN displayed non-significant trends suggesting mild positive relationships between greenspace and well-being. These data indicate the relationship between greenspace and well-being is more complex than expected and may depend on the diagnostic traits of the population studied.

The association between prenatal greenspace exposure and Autism spectrum disorder, and the potentially mediating role of air pollution reduction: A population-based birth cohort study

BACKGROUND

Autism spectrum disorder (ASD) incidence has increased in past decades. ASD etiology remains inconclusive, but research suggests genetic, epigenetic, and environmental contributing factors and likely prenatal origins. Few studies have examined modifiable environmental risk factors for ASD, and far fewer have examined protective exposures. Greenspace has been associated with positive child development, but very limited greenspace research has examined ASD risk or prenatal exposures. Only one ecological study in 2017 has evaluated the association between greenspace and ASD, observing protective benefits. Greenspace may have direct effects on ASD risk and indirect effects by reducing air pollution exposure, a growing suspected ASD risk factor.

OBJECTIVES

To measure the association between prenatal greenspace exposure and ASD risk and examine if reduced air pollution levels in areas of higher greenspace mediate this association.

METHODS

We linked a population-based birth cohort of all deliveries in Metro Vancouver, Canada, from 2004 to 2009, with follow-up to 2014. Diagnoses were based on Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised instruments. Greenspace was quantified as the average of the annual mean Normalized Difference Vegetation Index (NDVI) within a 250 m buffer of a residential postal code. Air pollutant exposures-particulate matter with a diameter less than 2.5 µm (PM_2.5), nitric oxide (NO), and nitrogen dioxide (NO₂)-were derived from previously developed and temporally adjusted land use regression models. We estimated air pollutant exposures as the mean concentration per month during pregnancy. We calculated odds ratios (ORs) using logistic regression per NDVI interquartile range (IQR) increase, adjusting for child sex, birth month and year, maternal age and birthplace, and neighborhood-level urbanicity and income. To estimate the health impact of greenspace on ASD at the population level, we used the logistic regression model and marginal standardization to derive risk differences (RDs). Lastly, to quantify the mediating effect of greenspace on ASD risk through air pollution reduction, we used marginal structural models and a potential outcomes framework to calculate marginal risk differences (RDs) to decompose the total effect of greenspace on ASD into natural direct and indirect effects.

RESULTS

Of 129,222 births, 1,921 (1.5 %) children were diagnosed with ASD. The adjusted OR for ASD per NDVI IQR (0.12) increase was 0.96 (95 % CI: 0.90, 1.02) in 250 m buffer zones and 0.94 (95 % CI: 0.89, 1.00) in 100 m buffer zones. On the additive scale, the adjusted RDs were null. Natural direct, natural indirect, and total effect RDs were null for PM_2.5, NO, and NO₂ mediation models.

CONCLUSION

Prenatal greenspace exposure was associated with reduced odds of ASD, but in the additive scale, this effect was null at the population level. No mediating effect was observed through reduced air pollution, suggesting that air pollution may act as a confounder rather than as a mediator.

Comprehensive Intervention and Effect of Martial Arts Routines on Children with Autism

Autism in children is a representative disease of pervasive developmental disorder, and there is currently no matching treatment. In the course of treatment, people generally use special education training, but this training mode cannot meet the comprehensive development of children. The traditional treatment mode cannot meet the changing new situation due to its poor adaptability. Martial arts routine movements are the soul of martial arts training, which can lay the foundation for movement training. Based on this, this article takes children with autism as research objects and aims to analyze the comprehensive intervention effect of martial arts routines on autism so as to provide some references for the treatment of children with autism. The article first analyzes the intervention forms of martial arts routine movements and realizes the combination of martial arts routine movements and children's autism intervention treatment from a theoretical point of view. Then, the article randomly divides the experimental subjects into the experimental group and the control group and conducts an evaluation and analysis of various indicators before and after the training of children with autism. Finally, the article falls back from the experimental results to related theories, aiming to provide a scientific basis for the comprehensive intervention treatment of children with autism. The experimental results showed that the scale evaluation results of the experimental group are different from those of the control group, and various indicators have been improved and improved, including language, perception, and social skills. Among them, the language and behavior of children with autism increased by 19.1%. The perception ability increased by 20.7%, and the social ability increased by 5.9%. The above experiments and analysis fully demonstrated that martial arts routines have a good effect in the intervention and treatment of children with autism, which can well improve the comprehensive quality of patients.

The influence of early-life residential exposure to different vegetation types and paved surfaces on early childhood development: A population-based birth cohort study

BACKGROUND

Growing evidence suggests that exposure to green space is associated with improved childhood health and development, but the influence of different green space types remains relatively unexplored. In the present study, we investigated the association between early-life residential exposure to vegetation and early childhood development and evaluated whether associations differed according to land cover types, including paved land.

METHODS

Early childhood development was assessed via kindergarten teacher-ratings on the Early Development Instrument (EDI) in a large population-based birth cohort (n = 27,539) in Metro Vancouver, Canada. The residential surrounding environment was characterized using a high spatial resolution land cover map that was linked to children by six-digit residential postal codes. Early-life residential exposure (from birth to time of EDI assessment, mean age = 5.6 years) was calculated as the mean of annual percentage values of different land cover classes (i.e., total vegetation, tree cover, grass cover, paved surfaces) within a 250 m buffer zone of postal code centroids. Multilevel models were used to analyze associations between respective land cover classes and early childhood development.

RESULTS

In adjusted models, one interquartile range increase in total vegetation percentage was associated with a 0.33 increase in total EDI score (95% CI: 0.21, 0.45). Similar positive associations were observed for tree cover (β-coefficient: 0.26, 95% CI: 0.15, 0.37) and grass cover (β-coefficient: 0.12, 95% CI: 0.02, 0.22), while negative associations were observed for paved surfaces (β-coefficient: -0.35, 95% CI: -0.47, -0.23).

CONCLUSIONS

Our findings indicate that increased early-life residential exposure to vegetation is positively associated with early childhood developmental outcomes, and that associations may be stronger for residential exposure to tree cover relative to grass cover. Our results further indicate that childhood development may be negatively associated with residential exposure to paved surfaces. These findings can inform urban planning to support early childhood developmental health.

Outdoor light at night and autism spectrum disorder in Shanghai, China: A matched case-control study

BACKGROUND

Several environmental factors have been identified to be associated with autism spectrum disorder (ASD) over the past decades. However, evidence is limited for the effect of exposure to outdoor light at night (LAN) on ASD in China and even elsewhere in the world.

METHODS

Participants in this study were from a multi-stage sampling survey on ASD conducted between June 2014 and October 2014 among children aged 3-12 years in Shanghai, China. All participants underwent a two-stage screening of ASD via questionnaire, and then, suspected cases were finally diagnosed by clinical examination. For data analyses, each ASD case was randomly matched with 10 healthy controls by age and sex. The LAN data were extracted from the stable lights product of the US Defense Meteorological Satellite Program's Operational Linescan System (DMSP-OLS) according to geolocation information of residential addresses. Mean levels of exposure to LAN during the 3 years after birth and 1 year before birth were calculated. We used conditional logistic regression models to examine the association between LAN and ASD.

RESULTS

We investigated 84,934 children from 96 kindergartens, 55 primary schools, and 28 special education schools, and 203 children were diagnosed as ASD cases. A total of 1727 children (157 ASD cases and 1570 healthy controls) were included in the final analyses. Brighter LAN exposures after and before birth were significantly associated with higher risk of ASD. After adjusting for potential covariates, adjusted odd ratios and 95% confidence intervals associated with per unit increase in LAN were 1.066 (1.027, 1.107) during the 3 years after birth and 1.046 (1.018, 1.075) during the 1 year before birth.

CONCLUSIONS

Results of our study concluded brighter LAN exposure was significantly associated with higher risk of ASD among Chinese children, which suggested that outdoor LAN could be a potential risk factor of ASD.

Occupational performance of children with autism spectrum disorder and quality of life of their mothers

OBJECTIVES

Limited studies were found to investigate the occupational performance of autistic children and their parents' quality of life. Therefore, this study aimed to investigate occupational performance of children with Autism Spectrum Disorder (ASD) and QoL of their mothers.

RESULTS

In this study, 88 participants were selected from autism centers in Arak, Iran, 2020. The Canadian Occupational Performance Measure (COPM) and the parent version of Quality of Life in Autism Questionnaire (QoLA-P) were used to assess the occupational performance of ASD children and their mothers QoL. QoLA-P consists of parts A which is related to the quality of life and part-B related to the problems that these children have and are related to the parents or their caregivers. Regarding occupational performance, the first priority of mothers is self-care with frequency 64.8%. The finding suggested a significant correlation between total function score of COPM and the score of part-A (r = 0.227, p = 0.033) of QoLA-P. Also, the results revealed a significant correlation between the total satisfaction score of COPM and the score of part-A (r = 0.236, p = 0.026) and part-B of QoLA-P questionnaire (r = 0.231, p = 0.030). The mothers' first priority is self-care and, the total satisfaction and function score of COPM showed a significant correlation with mothers' QoL.

Early-Life Exposure to Green Space and Mid-Childhood Cognition in the Project Viva Cohort, Massachusetts

The association between early-life greenness and child cognition is not well understood. Using prospective data from Project Viva (n = 857) from 1999-2010, we examined associations of early-life greenness exposure with mid-childhood cognition. We estimated residential greenness at birth, early childhood (median age 3.1 years), and mid-childhood (7.8 years) using 30-m resolution Landsat satellite imagery (normalized difference vegetation index). In early childhood and mid-childhood, we administered standardized assessments of verbal and nonverbal intelligence, visual-motor abilities, and visual memory. We used natural splines to examine associations of early life-course greenness with mid-childhood cognition, adjusting for age, sex, race, income, neighborhood socioeconomic status, maternal intelligence, and parental education. At lower levels of greenness (greenness <0.6), greenness exposure at early childhood was associated with a 0.48% increase in nonverbal intelligence and 2.64% increase in visual memory in mid-childhood. The association between early-childhood greenness and mid-childhood visual memory was observed after further adjusting for early childhood cognition and across different methodologies, while the association with nonverbal intelligence was not. No other associations between early life-course greenness and mid-childhood cognition were found. Early childhood greenness was nonlinearly associated with higher mid-childhood visual memory. Our findings highlight the importance of nonlinear associations between greenness and cognition.

Green Space Quality and Health: A Systematic Review

(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing. Both objectively and subjectively measured qualities demonstrated associations with health outcomes. (4) Conclusion: Experimental studies and longitudinal cohort studies will strengthen current evidence. Evidence was lacking for needs-specific or culturally-appropriate amenities and soundscape characteristics. Qualities that need more in-depth investigation include indices that account for forms, patterns, and networks of objectively and subjectively measured green space qualities.

Mapping the genetic and environmental aetiology of autistic traits in Sweden and the United Kingdom

Background

Autistic traits are influenced by both genetic and environmental factors, and are known to vary geographically in prevalence. But to what extent does their aetiology also vary from place to place?

Methods

We applied a novel spatial approach to data on autistic traits from two large twin studies, the Child and Adolescent Twin Study in Sweden (CATSS; N = 16,677, including 8307 twin pairs) and the Twins Early Development Study in the UK (TEDS; N = 11,594, including 5796 twin pairs), to explore how the influence of nature and nurture on autistic traits varies from place to place.

Results

We present maps of gene‐ and environment‐ by geography interactions in Sweden and the United Kingdom (UK), showing geographical variation in both genetic and environmental influences across the two countries. In Sweden genetic influences appear higher in the far south and in a band running across the centre of the country. Environmental influences appear greatest in the south and north, with reduced environmental influence across the central band. In the UK genetic influences appear greater in the south, particularly in more central southern areas and the southeast, the Midlands and the north of England. Environmental influences appear greatest in the south and east of the UK, with less influence in the north and the west.

Conclusions

We hope this systematic approach to identifying aetiological interactions will inspire research to examine a wider range of previously unknown environmental influences on the aetiology of autistic traits. By doing so, we will gain greater understanding of how these environments draw out or mask genetic predisposition and interact with other environmental influences in the development of autistic traits.

Nature and Children's Health: A Systematic Review

CONTEXT

Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.

OBJECTIVE

We systematically evaluated evidence regarding the relationship between nature contact and children's health.

DATA SOURCES

The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.

STUDY SELECTION

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.

DATA EXTRACTION

Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.

RESULTS

The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.

LIMITATIONS

Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.

CONCLUSIONS

Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.

Synthesis of Two Decades of US EPA's Ecosystem Services Research to Inform Environmental, Community, and Sustainability Decision Making

A conceptual framework is helpful to understand what types of ecosystem services (ES) information is needed to support decision making. Principles of structured decision making are helpful for articulating how ES consideration can influence different elements in a given decision context resulting in changes to the environment, human health, and well-being. This article presents a holistic view of an ES framework, summarizing two decades of the US EPA's ES research, including recent advances in final ES, those ES that provide benefits directly to people. Approximately 150 peer-reviewed publications, technical reports, and book chapters characterize a large ES research portfolio. In introducing framework elements and the suite of relevant US EPA research for each element, both challenges and opportunities are identified. Lessons from research to advance each of the final ES elements can be useful for identifying gaps and future science needs. Ultimately, the goal of this article is to help the reader develop an operational understanding of the final ES conceptual framework, an understanding of the state of science for a number of ES elements, and an introduction to some ES tools, models, and frameworks that may be of use in their case-study applications or decision-making contexts.

The association between natural environments and childhood mental health and development: A systematic review and assessment of different exposure measurements

BACKGROUND

Several studies have assessed the relationship between exposure to natural environments (NEs) and childhood mental health and development. In most cases, a positive association has been found, but results are inconsistent, and the strength of association is unclear. This inconsistency may reflect the heterogeneity in measurements used to assess NE.

OBJECTIVES

This systematic review aims to identify the most common NE metrics used in childhood mental health and development research. Our second aim is to identify the metrics that are most consistently associated with health and assess the relative strength of association depending on type of NE exposure measurement, in terms of metric used (i.e., measurement technique, such as remote sensing), but also rate (i.e., spatial and temporal exposure).

METHODS

We used the PRISMA protocol to identify eligible studies, following a set of pre-defined inclusion criteria based on the PECOS strategy. A number of keywords were used for retrieving relevant articles from Medline, Embase, PsychINFO, and Web of Science databases between January 2000-November 2020. From these, we extracted data on type of NE measurement and relative association to a number of indicators of childhood mental health and development. We conducted a systematic assessment of quality and risk of bias in the included articles to evaluate the level of evidence. Case studies and qualitative studies were excluded.

RESULTS

After screening of title (283 studies included), abstract, and full article, 45 studies were included in our review. A majority of which were conducted in North America and Europe (n = 36; 80%). The majority of studies used land use or land covers (LULC, n = 24; 35%) to determine exposures to NEs. Other metrics included the normalized difference vegetation index (NDVI), expert measures (e.g., surveys of data collection done by experts), surveys (e.g., self-reported assessments), and use of NE (e.g., measures of a participant's use of NE such as through GPS tracts or parent reports). Rate was most commonly determined by buffer zones around residential addresses or postal codes. The most consistent association to health outcomes was found for buffers of 100 m, 250 m, 500 m, and within polygons boundaries (e.g., census tracts). Six health categories, academic achievement, prevalence of doctor diagnosed disorders, emotional and behavioral functioning, well-being, social functioning, and cognitive skills, were created post hoc. We found sufficient evidence between NDVI (Landsat) and emotional and behavioral well-being. Additionally, we found limited evidence between LULC datasets and academic achievement; use of NE, parent/guardian reported greenness, and expert measures of greenness and emotional and behavioral functioning; and use of NE and social functioning.

DISCUSSION

This review demonstrates that several NE measurements must be evaluated further before sufficient evidence for a potential association between distinct NE exposure metrics and childhood mental health and development can be established. Further, we suggest increased coordination between research efforts, for example, by replication of studies and comparing different NE measurements systematically, so that effect sizes can be confirmed for various health outcomes. Finally, we recommend implementing research designs that assess underlying pathways of nature-health relations and utilize measurement techniques that adequately assess exposure, access, use, and perception of NEs in order to contribute to a better understanding of health impacts of surrounding natural environments.

Understanding urbanicity: how interdisciplinary methods help to unravel the effects of the city on mental health

Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at the neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population-based studies, neuroscience, experimental and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus.

Associations between Nature Exposure and Health: A Review of the Evidence

There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

Measuring Neighborhood Landscapes: Associations between a Neighborhood's Landscape Characteristics and Colon Cancer Survival

Landscape characteristics have been shown to influence health outcomes, but few studies have examined their relationship with cancer survival. We used data from the National Land Cover Database to examine associations between regional-stage colon cancer survival and 27 different landscape metrics. The study population included all adult New Jersey residents diagnosed between 2006 and 2011. Cases were followed until 31 December 2016 (N = 3949). Patient data were derived from the New Jersey State Cancer Registry and were linked to LexisNexis to obtain residential histories. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI95) for the different landscape metrics. An increasing proportion of high-intensity developed lands with 80–100% impervious surfaces per cell/pixel was significantly associated with the risk of colon cancer death (HR = 1.006; CI95 = 1.002–1.01) after controlling for neighborhood poverty and other individual-level factors. In contrast, an increase in the aggregation and connectivity of vegetation-dominated low-intensity developed lands with 20–<40% impervious surfaces per cell/pixel was significantly associated with the decrease in risk of death from colon cancer (HR = 0.996; CI95 = 0.992–0.999). Reducing impervious surfaces in residential areas may increase the aesthetic value and provide conditions more advantageous to a healthy lifestyle, such as walking. Further research is needed to understand how these landscape characteristics impact survival.

Greenspace Inversely Associated with the Risk of Alzheimer's Disease in the Mid-Atlantic United States

Alzheimer’s disease (AD) is a chronic neurodegenerative disease and the most common form of dementia in older adults. Treatment of AD symptoms is very challenging and expensive. Appropriate diet as well as mental and physical activity may delay or reduce the occurrence of AD. It is unknown whether environmental factors offer potentially protective effects against the development of AD. We explored the possible beneficial effects of greenspace (trees and herbaceous cover) on the rate of AD in the mid-Atlantic US. Data for initial AD medical claims during 2011–2013 were obtained from Medicare records for 2999 ZIP codes. The percentages of land cover classes in each ZIP code were calculated based on high-resolution land cover imagery. Associations between AD and greenspace, blue space (water), and other variables were examined using zero-inflated Poisson models. The rate of AD was negatively associated with greenspace (for a greenspace increase of 10%, risk ratio (RR) = 0.91, 95% confidence interval (CI): 0.89–0.94), and blue space (for a water area increase of 10%, RR = 0.85, 95% CI: 0.81–0.89). The inverse relationships between greenspace and the risk of AD held across season, gender, and race. The rate of AD was positively associated with the concentration of fine particulate matter (PM2.5) (RR = 1.03, 95% CI: 1.02–1.05 for an increase in PM2.5 of 1 μg/m³). Our results suggest that greenspace may have protective effects for AD, although potential mechanisms are unclear and require further investigation.

Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotional development in children

BACKGROUND

Existing research indicates that spending time in nature is associated with diverse aspects of children's health and wellbeing. Although fundamental to later life chances and health, no systematic reviews, to our knowledge, have focused specifically on the effects of interaction with nature on socioemotional functioning in childhood.

OBJECTIVES

Amongst children, what is the consistency of associations between the availability of or spending time in nature on socioemotional function and development? Furthermore, which child behaviours and states independently associate with socioemotional function and availability of or spending time in nature, and what is the consistency of associations between these behaviours and states and contact with nature?

DATA SOURCES

Embase, Environment Complete, MEDLINE, and APA PsycINFO. Eligible studies were backward and forward snowball-searched.

STUDY ELIGIBILITY CRITERIA

Studies investigating effects of, or associations between, availability of or interaction with nature on socioemotional or proximal outcomes in children under the age of 12 years were included in this review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The internal validity of studies investigating socioemotional outcomes were based on assessments of elements of study design, conduct, and reporting to identify potential issues related to confounding or other biases. The number of analyses indicating positive, negative, and non-significant associations between availability or interaction with green space and the outcomes were summed.

RESULTS

A total of 223 eligible full-texts, of which 43 pertained to socioemotional outcomes and 180 to proximal outcomes, met eligibility criteria. Positive associations between availability of and spending time in green space were found with children's intra- and interpersonal socioemotional function and development. Proportions of positive findings ranged from 13.9% to 55% across experimental and observational research, exposures, populations, and contexts. Modifying and mediating factors were identified. We found consistent evidence for improved aspects of cognition and, for children over six years, reduced risk of obesity and overweight in association with green space; consistent links between movement behaviours in the experimental, but not observational research; tentative trends suggesting associations with play, motor skills, language, screen time, and communication skills; little evidence for positive associations between green space and mood, physical wellbeing, and stress; some evidence for associations with healthy birth outcomes, and little evidence for direct associations between availability of green space and asthma and allergy prevalence, however, mediation via, for example, air pollution was likely.

LIMITATIONS

We identified few studies without either probable or severe risk of bias in at least one item. Improved study quality may therefore result in different results. Restricting analyses to include only studies considered at low risk of bias indicated similar or slightly lower proportions of positive findings. Risk of bias in proximal outcomes was not assessed.

CONCLUSIONS

The empirical evidence for benefits of availability of and interaction green space for child socioemotional function and development must currently be considered limited. A number of proximal indicators were identified. Systematic review registration number.

PROSPERO ID

CRD42019135016.

Urban Trees and Human Health: A Scoping Review

The urban forest is a green infrastructure system that delivers multiple environmental, economic, social and health services, and functions in cities. Environmental benefits of urban trees are well understood, but no review to date has examined how urban trees affect human health. This review provides a comprehensive summary of existing literature on the health impacts of urban trees that can inform future research, policy, and nature-based public health interventions. A systematic search used keywords representing human health, environmental health, and urban forestry. Following screening and appraisal of several thousand articles, 201 studies were conceptually sorted into a three-part framework. Reducing Harm, representing 41% of studies, includes topics such as air pollution, ultraviolet radiation, heat exposure, and pollen. Restoring Capacities, at 31%, includes attention restoration, mental health, stress reduction, and clinical outcomes. Building Capacities, at 28%, includes topics such as birth outcomes, active living, and weight status. The studies that were reviewed show substantial heterogeneity in purpose and method yet indicate important health outcomes associated with people’s exposure to trees. This review will help inform future research and practice, and demonstrates why urban forest planning and management should strategically promote trees as a social determinant of public health.

Spatio-temporal analysis of the risk of depression at district-level and association with greenness based on the Heinz Nixdorf Recall Study

In urban health studies where spatial and temporal changes are of importance, spatio-temporal variations are usually neglected. For the Heinz Nixdorf Recall Study, we investigate spatio-temporal variation in analyses of effects of urban greenness on depression by including spatio-temporal random effect terms in a Poisson model on district level. Our results show negative associations between greenness and depression. The findings suggest strong temporal autocorrelation and weak spatial effects. Even if the weak spatial effects are suggestive of neglecting them, as in our case, spatio-temporal random effects should be taken into account to provide reliable inference in urban health studies.

Spatial dimensions of the influence of urban green-blue spaces on human health: A systematic review

BACKGROUND

There is an increasing volume of literature investigating the links between urban environments and human health, much of which involves spatial conceptualisations and research designs involving various aspects of geographical information science. Despite intensifying research interest, there has been little systematic investigation of pragmatic methodological concerns, such as how studies are realised in terms of the types of data that are gathered and the analytical techniques that are applied, both of which have the potential to impact results. The aim of this systematic review is, therefore, to understand how spatial scale, datasets, methods, and analytics are currently applied in studies investigating the relationship between green and blue spaces and human health in urban areas.

METHOD

We systematically reviewed 93 articles following PRISMA protocol, extracted information regarding different spatial dimensions, and synthesised them in relation to various health indicators.

RESULTS AND DISCUSSION

We found a preponderance of the use of neighbourhood-scale in these studies, and a majority of the studies utilised land-use and vegetation indices gleaned from moderate resolution satellite imagery. We also observed the frequent adoption of fixed spatial units for measuring exposure to green and blue spaces based on physical proximity, typically ranging between 30 and 5000 m. The conceptual frameworks of the studies (e.g., the focus on physical vs. mental health or the definition of exposure to green space) were found to have an influence on the strength of association between exposure and health outcomes. Additionally, the strength and significance of associations also varied by study design, something which has not been considered systematically.

CONCLUSION

On the basis of our findings, we propose a set of recommendations for standardised protocols and methods for the evaluation of the impact of green-blue spaces on health. Our analysis suggests that future studies should consider conducting analyses at finer spatial scales and employing multiple exposure assessment methods to achieve a comprehensive and comparable evaluation of the association between greenspace and health along multiple pathways.

Association of sociodemographic factors and internet query data with pertussis infections in Shandong, China

This study explored how internet queries vary in facilitating monitoring of pertussis, and the effects of sociodemographic characteristics on such variation by city in Shandong province, China. We collected weekly pertussis notifications, Baidu Index (BI) data and yearly sociodemographic data at the city level between 1 January 2009 and 31 December 2017. Spearman's correlation was performed for temporal risk indices, generalised linear models and regression tree models were developed to identify the hierarchical effects and the threshold between sociodemographic factors and internet query data with pertussis surveillance. The BI was correlated with pertussis notifications, with a strongly spatial variation among cities in temporal risk indices (composite temporal risk metric (CTRM) range: 0.59–1.24). The percentage of urban population (relative risk (RR): 1.05, 95% confidence interval (CI) 1.03–1.07), the proportion of highly educated population (RR: 1.27, 95% CI 1.16–1.39) and the internet access rate (RR: 1.04, 95% CI 1.02–1.05) were correlated with CTRM. Higher RRs in the three identified sociodemographic factors were associated with higher stratified CTRM. The percentage of highly educated population was the most important determinant in the BI with pertussis surveillance. The findings may lead to spatially-specific criteria to inform development of an early warning system of pertussis infections using internet query data.

Community greenness and neurobehavioral health in children and adolescents

BACKGROUND

Neighborhood greenness appears to be beneficial to human health. However, there are few studies on the relationship between greenness of children's residential communities and their neurobehavioral health.

OBJECTIVE

In this cross-sectional study, we examined the association between neighborhood greenness of children's residential area and their neurobehavioral health.

METHODS

We used a population-representative sample of school children (n = 1817) from 2012 and 2013 in South Korea. Parents or guardians of children completed the Child Behavior Checklist (CBCL) to assess their children's neurobehavioral health. As a measurement for greenness, the modified soil-adjusted vegetation index (MSAVI) at a 30-m resolution was retrieved from the Landsat satellite data operated by NASA. The MSAVI values were categorized into tertiles (low, moderate, high greenness) and each child was assigned the mean MSAVI within a 1.6-km radius of residence. We applied survey regressions of the CBCL transformed scores on the 3 levels of greenness, controlling for age, sex, physical activity, monthly family income, exposure to second-hand smoke, exposure to NO₂, and blood lead level.

RESULTS

High greenness was associated with a lower Total CBCL score compared to low greenness (-2.33, 95% CI, -4.10 to -0.56). Externalizing Behavior showed a slightly stronger association with greenness than did Internalizing Behavior. The inverse relationship with greenness was strongest for Attention Problems (-1.32; 95% CI: -2.58, -0.06). The magnitudes of the association were strongest when the buffer distance was 1600 m.

CONCLUSIONS

Greenness of residential neighborhood was associated with lower problematic behavior scores in children, especially aggressive behaviors and attention problems.

Impact of Green Space Exposure on Children's and Adolescents' Mental Health: A Systematic Review

In recent years, the interest in the relationship between exposure to green spaces and children’s and adolescents’ mental health has risen. This systematic review aims to provide an overview of observational studies assessing the association between empirical green space exposure with standardized outcome measures of mental health problems, mental well-being and developmental problems in children, adolescents and young adults. The PRISMA statement guidelines for reporting systematic reviews were followed. A PubMed and Scopus search resulted in the inclusion of 21 studies. The evidence consistently suggests a beneficial association between green space exposure and children’s emotional and behavioral difficulties, particularly with hyperactivity and inattention problems. Limited evidence suggests a beneficial association with mental well-being in children and depressive symptoms in adolescents and young adults. These beneficial associations are resistant to adjustment for demographic and socio-economic confounders, which thus may represent independent links. Mediating factors and the variability of this association between different age groups are discussed. From a precautionary principle, evidence up to now demands the attention of policy makers, urban planners and mental healthcare workers in order to protect children’s and adolescents’ mental health in light of rapid global urbanization by providing sufficient exposure to green spaces.

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

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

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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