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

Exposure to residential greenness, perceived stress, and depressive symptoms in a North American preconception cohort

BACKGROUND

Studies suggest that greater exposure to natural vegetation (i.e., greenness) is associated with better mental health. However, there is limited research on greenness and mental health in the preconception period, a critical window of exposure in the life course. We investigated the associations of residential greenness with perceived stress and depressive symptoms using cross-sectional data from a cohort of pregnancy planners.

METHODS

From 2013 to 2019, we enrolled female-identified participants aged 21-45 years who were trying to conceive without the use of fertility treatment into a North American preconception cohort study (Pregnancy Study Online [PRESTO]). On the baseline questionnaire, participants completed the 10-item Perceived Stress Scale (PSS) and the Major Depression Inventory (MDI). Using geocoded addresses, we estimated residential greenness exposure via satellite imagery (Normalized Difference Vegetation Index [NDVI]) in a 100m buffer. We estimated mean differences and 95% confidence intervals for the association of greenness with perceived stress and depression scores using linear regression models, adjusting for individual and neighborhood sociodemographic characteristics. We also evaluated the extent to which associations were modified by urbanicity and neighborhood socioeconomic status (SES).

RESULTS

Among 9718 participants, mean age was 29.9 years, 81.5% identified as non-Hispanic White, 25% had household incomes <$50,000, and mean neighborhood income was $61,932. In adjusted models, higher greenness was associated with lower stress and depression scores (mean difference per interquartile range in greenness: -0.20, 95% CI: -0.39, -0.01; and -0.19, 95% CI: -0.48, 0.10, respectively). The association was stronger among residents of lower SES neighborhoods in urban areas (PSS: -0.57, 95% CI: -1.00, -0.15; MDI: -0.72, 95% CI: -1.40, -0.04).

CONCLUSIONS

Higher greenness exposure was associated with lower stress and depressive symptoms among pregnancy planners, particularly in lower-SES neighborhoods.

Spatiotemporal variability of the association between greenspace exposure and depression in older adults in South Korea

BACKGROUND

A number of studies based on young to middle aged adult and child samples have found that exposure to greenspace and bluespace can have a positive impact on mental health and well-being. However, there is limited research among older adults and the extant studies have provided mixed results. The present study was designed to examine how the association between these forms of exposure and depressive symptoms among older adults varies as a function of different spatially and temporally resolved exposure metrics.

METHODS

The sample consisted of 617 individuals (46.19% female) aged ≥ 60 years of age. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Individuals' greenspace exposure was quantified using spatially and temporally resolved metrics, including monthly and annual averaged satellite-derived normalized difference vegetation index (NDVI) across multiple buffer distances (250 m to 2,000 m) centered at participants' home address. We also quantified exposure to blue-greenspace from a highly detailed land use and land cover dataset. A multivariable logistic regression model assessed the association between greenspace and blue-greenspace exposure and depressive symptoms, adjusting for age, sex, income, education, marital status, current smoking, alcohol status, medical conditions, temperature, crime rate, population density, and per capita park area.

RESULTS

We found a significant association between exposures to greenspace and blue-greenspace and depressive symptoms (CES-D cutoff ≥ 4) among older adults. After adjusting for confounding variables, the odds of depressive symptoms were significantly decreased by an IQR increment in residential exposure to greenspace [odds ratio (OR) = 0.67; 95% confidence interval (95% CI), 0.49 ~ 0.91] and blue-greenspace (OR = 0.59; 95% CI, 0.41 ~ 0.84) measured nearby their home address (i.e., as close as 250 m). When stratified by household income level, the association was only significant among low-income individuals. We also found temporal variation in the association between depressive symptoms and monthly NDVI-based greenspace exposure, in which the odds of depressive symptoms were the lowest for greenspace in cold months (i.e., January, February, and March).

CONCLUSIONS

Our findings suggest that neighborhood greenspace may serve as a protective factor against depression among older adults, but the benefits may depend on the spatial and temporal context. More investigation is needed to replicate our findings on the spatial and temporal variations of greenspace exposure metrics and their effects on depressive symptoms.

Assessing the impact of urban road transport development on haze pollution in the Yangtze River Delta region

The aim of this paper is to explore whether and how urban road transport (URT) development affects haze pollution. One of the innovations of this paper is that URT development is measured by road accessibility with novel digital elevation model datasets, which have been used by few scholars. The endogenous problem caused by revere causality issue in the relationship between URT development and haze pollution is also considered. Based on the panel data of prefecture-level cities of Yangtze River Delta (YRD) region in China from 2011 to 2018, this paper uses long-lagged values of URT development as the instrumental variable, employing the two-stage least squares (2SLS) method. The study shows that URT development leads to an increase of haze pollution. Moreover, mechanism tests based on moderating and mediating models support the finding that decreasing haze pollution resulted from better connection effects, while rising agglomeration effects tend to bring about increasing haze pollution, and the latter effect is larger in magnitude than the former. Current URT development may have long-term negative consequences for livability of YRD cities, and urban decision makers should reconsider the effectiveness of the current road transport investment and construction.

Do environmental attitudes and personal characteristics influence how people perceive their exposure to green spaces?

Background

This study explores the relationship between perceived and objective greenspace exposure, and how sociodemographic traits and environmental attitudes influence peoples' perceptions of greenspace.

Methods

We leveraged a cross-sectional survey on greenspace exposure among residents of Denver, CO that ran from November 2019 through April 2021. We measured objective greenspace using the average NDVI (normalized difference vegetation index), average percent vegetation, and median GVI (green view index) within 300, 500, and 1,000 m of participants' residences, and in participant-drawn polygons representing their neighborhoods. We measured perceived greenspace exposure using survey responses from questions about greenspace abundance, visibility, access, usage, and quality near participants' homes. We assessed relationships between perceived and objective greenspace measures using linear models. Then, we used latent class analysis to create perceived greenspace exposure classes, and used linear models to evaluate the relationship between these classes and sociodemographic and environmental attitude variables.

Results

We found that the relationship between perceived and objective measures (NDVI in the 300-meter buffer) was strongest for abundance (OR: 5.14, [4.0, 6.28]) and visibility (OR: 3.71, [2.58, 4.84]) compared to perceived access (OR: 2.17, [1.02, 3.32]), usage (OR: 2.28, [1.19, 3.37]), and quality (OR: 2.33, [1.25, 3.41]). In fully adjusted models, objective greenspace exposure and environmental attitudes predicted perceived greenspace exposure classes, but sociodemographic variables-other than age-did not.

Conclusion

Our work suggests that objective greenspace exposure is only one factor influencing peoples' perceived greenspace exposure, and that environmental attitude variables may play an additional role in shaping peoples' perceptions.

Green spaces and respiratory, cardiometabolic, and neurodevelopmental outcomes: An individual-participant data meta-analysis of >35.000 European children

Studies evaluating the benefits and risks of green spaces on children's health are scarce. The present study aimed to examine the associations between exposure to green spaces during pregnancy and early childhood with respiratory, cardiometabolic, and neurodevelopmental outcomes in school-age children. We performed an Individual-Participant Data (IPD) meta-analysis involving 35,000 children from ten European birth cohorts across eight countries. For each participant, we calculated residential Normalized Difference Vegetation Index (NDVI) within a 300 m buffer and the linear distance to green spaces (meters) during prenatal life and childhood. Multiple harmonized health outcomes were selected: asthma and wheezing, lung function, body mass index, diastolic and systolic blood pressure, non-verbal intelligence, internalizing and externalizing problems, and ADHD symptoms. We conducted a two-stage IPD meta-analysis and evaluated effect modification by socioeconomic status (SES) and sex. Between-study heterogeneity was assessed via random-effects meta-regression. Residential surrounding green spaces in childhood, not pregnancy, was associated with improved lung function, particularly higher FEV1 (β = 0.06; 95 %CI: 0.03, 0.09 I2 = 4.03 %, p < 0.001) and FVC (β = 0.07; 95 %CI: 0.04, 0.09 I2 = 0 %, p < 0.001) with a stronger association observed in females (p < 0.001). This association remained robust after multiple testing correction and did not change notably after adjusting for ambient air pollution. Increased distance to green spaces showed an association with lower FVC (β = -0.04; 95 %CI: -0.07, -0.02, I2 = 4.8, p = 0.001), with a stronger effect in children from higher SES backgrounds (p < 0.001). No consistent associations were found between green spaces and asthma, wheezing, cardiometabolic, or neurodevelopmental outcomes, with direction of effect varying across cohorts. Wheezing and neurodevelopmental outcomes showed high between-study heterogeneity, and the age at outcome assessment was only associated with heterogeneity in internalizing problems.. This large European meta-analysis suggests that childhood exposure to green spaces may lead to better lung function. Associations with other respiratory outcomes and selected cardiometabolic and neurodevelopmental outcomes remain inconclusive.

Multiple Environmental Exposures and the Development of Hypertension in a Prospective US-Based Cohort of Female Nurses: A Mixture Analysis

We investigated the independent and joint associations between multiple environmental exposures and incident hypertension in a US nationwide prospective cohort of women: the Nurses' Health Study II. We followed 107,532 nonhypertensive participants from 1989 to diagnosis of hypertension, loss to follow-up, death, or end of follow-up in June 2019. We applied Cox proportional hazards models to assess associations of incident hypertension with time-varying residential exposure to air pollution, noise, surrounding greenness, temperature, and neighborhood socioeconomic status (nSES), adjusting for potential confounders and coexposures. We evaluated the joint association of simultaneous exposure using quantile g-computation. We observed 38,175 hypertension cases over 2,062,109 person-years. Increased hypertension incidence was consistently associated with lower nSES and higher levels of fine particles (PM2.5) and nighttime noise exposures: hazard ratio (HRs) and 95% confidence intervals (CIs) of 1.06 (1.04, 1.08), 1.04 (1.01, 1.07), and 1.01 (1.00, 1.03), respectively, per interquartile range change. Joint HR for a one-quartile change in simultaneous exposure to the mixture was 1.05 (95% CI: 1.02, 1.09), assuming additivity, or 1.13 (95% CI: 1.06, 1.20), considering potential interactions within the mixture. Hypertension prevention should focus on enhancing nSES and reducing PM2.5 and noise levels, recognizing that reducing the overall exposures may yield additional benefits.

Urban heatwave, green spaces, and mental health: A review based on environmental health risk assessment framework

Utilizing the framework of environmental health risk assessment and healing, the article reviews the effectiveness and potential of green space systems in mitigating the impact of high temperatures, promoting mental health, and improving the risk characteristics of high-temperature heat waves. We utilized CiteSpace software to conduct a time-zone analysis of the relationship between heatwaves, green spaces, and health using clustered data from 2001 to 2023. This study evaluates the role of green space systems in mitigating high temperatures and enhancing mental health within the environmental health risk assessment framework. Using CiteSpace software, we analyzed literature from 2001 to 2023, focusing on the interactions among heatwaves, green spaces, and health. Our results indicate that most existing research concentrates on hazard identification, with insufficient exploration of the dose-response relationships between green spaces and temperature reduction. Quantitative studies on green space design and spatial optimization are scarce, and guidance on effective configurations remains limited. Additionally, the health impacts of heatwaves vary by region, with a noticeable imbalance in research focus; Asia and Africa, in particular, are underrepresented in studies addressing heatwave effects. We conclude that effective mitigation strategies require: (1) a comprehensive environmental health risk assessment framework that integrates advanced methods like big data analysis and geospatial simulations to improve green space planning and design; (2) further theoretical exploration into the mechanisms by which green spaces regulate temperature and mental health, including detailed analysis of spatiotemporal patterns and the functional optimization of green space structures; and (3) the development of robust parameterized design guidance based on specific therapeutic dosages (green space stimulus) to optimize configurations and enhance the effectiveness of green spaces in mitigating adverse mental health impacts from deteriorating thermal environments. Future research should prioritize underrepresented regions, focusing on exposure levels, dose-response relationships, and high-temperature warning systems while fostering multidisciplinary collaboration to develop effective urban planning and climate adaptation strategies.

Socioeconomic disparities and green space associated with myopia among Chinese school-aged students: A population-based cohort study

Background

There is increasing evidence on the link between environmental factors and myopia in children and adolescents, yet with inconsistent conclusions. We investigated the associations between socioeconomic inequalities and green space with myopia in school-aged students participating in the Tianjin Child and Adolescent Research of Eye (TCARE) study.

Methods

We obtained data from a population-based dynamic cohort study conducted in Tianjin, China, in 2021 and followed up in 2022. We included 1 245 271 participants from 16 districts with an average age of 11.6 years (standard deviation = 3.3) in our analysis. We synthesized their area-level SES through a prediction model that combined economic, educational, and health care variables and assessed the greenness levels surrounding the school using the Normalized Difference Vegetation Index (NDVI) based on data obtained through satellite remote sensing. We performed generalised linear mixed effects analyses for each myopia outcome separately, with adjustments for students' sex, years of education completed, and the school's geographical location.

Results

We observed that students living in low SES areas had the highest prevalence of myopia (60.7%) in the last screening in 2022, as well as a higher incidence of one-year myopia (26.4%) compared to those residing in middle SES areas (22.7%). With a 0.1 increase in the 250, 500, and 1000 m buffer NDVI, the prevalence of myopia dropped by 6.3% (odds ratio (OR) = 0.937; 95% confidence interval (CI) = 0.915, 0.960), 7.7% (OR = 0.923; 95% CI = 0.900, 0.946), and 8.7% (OR = 0.913; 95% CI = 0.889, 0.937), respectively. The interaction analysis showed that low SES and low greenness exacerbate the prevalence of myopia. Findings from longitudinal analyses consistently demonstrated a correlation between higher values of NDVI and a slower progression of myopia. These findings remained robust across sensitivity analyses, including for variables on parental myopia and students' behaviors.

Conclusions

Exposure to green spaces could play a crucial role in slowing the progression of myopia among school-aged students. Myopia control policies should prioritise young populations residing in low SES areas with limited access to green spaces, as they face the highest potential risks.

Greenness, air pollution, and temperature exposure effects in predicting premature mortality and morbidity: A small-area study using spatial random forest model

BACKGROUND

Although studies have provided negative impacts of air pollution, heat or cold exposure on mortality and morbidity, and positive effects of increased greenness on reducing them, a few studies have focused on exploring combined and synergetic effects of these exposures in predicting these health outcomes, and most had ignored the spatial autocorrelation in analyzing their health effects. This study aims to investigate the health effects of air pollution, greenness, and temperature exposure on premature mortality and morbidity within a spatial machine-learning modeling framework.

METHODS

Years of potential life lost reflecting premature mortality and comparative illness and disability ratio reflecting chronic morbidity from 1673 small areas covering Greater Manchester for the year 2008-2013 obtained. Average annual levels of NO2 concentration, normalized difference vegetation index (NDVI) representing greenness, and annual average air temperature were utilized to assess exposure in each area. These exposures were linked to health outcomes using non-spatial and spatial random forest (RF) models while accounting for spatial autocorrelation.

RESULTS

Spatial-RF models provided the best predictive accuracy when accounted for spatial autocorrelation. Among the exposures considered, air pollution emerged as the most influential in predicting mortality and morbidity, followed by NDVI and temperature exposure. Nonlinear exposure-response relations were observed, and interactions between exposures illustrated specific ranges or sweet and sour spots of exposure thresholds where combined effects either exacerbate or moderate health conditions.

CONCLUSION

Air pollution exposure had a greater negative impact on health compared to greenness and temperature exposure. Combined exposure effects may indicate the highest influence of premature mortality and morbidity burden.

Having a tree in front of one's home is associated with GREATER subjective wellbeing in adult residents in Melbourne, Australia, and Toronto, Canada

While urban trees can be important determinants of human health and wellbeing in world cities, the specific influence of nearby urban trees upon human wellbeing has not been adequately explored. While many studies have associated urban greenery abundance with wellbeing scores, many measures of urban greenery do not specify the type of vegetation or the impact of co-location. Here we fill this gap by associating self-reported measures of the presence of nearby trees (tree in front of one's home) with validated subjective wellbeing (SWB) scores. We also tested for the mediating role of what people thought about trees and nature, with a focus on the values people associate with urban trees and nature relatedness (NR). We used electronic panel survey data based on a demographic and geographical representative sample of more than 3400 residents living in Toronto, Canada, and Melbourne, Australia. We analysed these data using regression-based mediation and path analyses. We found that having a tree in front of one's home was strongly and positively associated with SWB scores in both cities with similar results (Melbourne, β = 0.17, p < 0.05; Toronto, β = 0.18, p < 0.05), while accounting for NR, values associated with urban trees, and demographics (e.g., age, education, home ownership). The mediating role of NR and values was small. The specific pathways of association between tree in front of one's home, SWB, NR, and values, varied by city, when accounting for demographics. We discuss how increasing the abundance of nearby urban trees in cities may also increase human wellbeing.

Residential greenness and chronic obstructive pulmonary disease in a large cohort in southern China: Potential causal links, risk trajectories, and mediation pathways

INTRODUCTION

Residential greenness may influence COPD mortality, but the causal links, risk trajectories, and mediation pathways between them remain poorly understood.

OBJECTIVES

We aim to comprehensively identify the potential causal links, characterize the dynamic progression of hospitalization or posthospital risk, and quantify mediation effects between greenness and COPD.

METHODS

This study was conducted using a community-based cohort enrolling individuals aged ≥ 18 years in southern China from January 1, 2009 to December 31, 2015. Greenness was characterized by normalized difference vegetation index (NDVI) around participants' residential addresses. We applied doubly robust Cox proportional hazards model, multi-state model, and multiple mediation method, to investigate the potential causal links, risk trajectories among baseline, COPD hospitalization, first readmission due to COPD or COPD-related complications, and all-cause death, as well as the multiple mediation pathways (particulate matter [PM], temperature, body mass index [BMI] and physical activity) connecting greenness exposure to COPD mortality.

RESULTS

Our final analysis included 581,785 participants (52.52% female; average age: 48.36 [Standard Deviation (SD): 17.56]). Each interquartile range (IQR: 0.06) increase in NDVI was associated with a reduced COPD mortality risk, yielding a hazard ratio (HR) of 0.88 (95 % CI: 0.81, 0.96). Furthermore, we observed per IQR (0.04) increase in NDVI was inversely associated with the risk of multiple transitions (baseline - COPD hospitalization, baseline - death, and readmission - death risks), especially a declined risk of all-cause death after readmission (HR = 0.66 [95 %CI: 0.44, 0.99]). Within the observed association between greenness and COPD mortality, three mediators were identified, namely PM, temperature, and BMI (HR for the total indirect effect: 0.773 [95 % CI: 0.703, 0.851]), with PM showing the highest mediating effect.

CONCLUSIONS

Our findings revealed greenness may be a beneficial factor for COPD morbidity, prognosis, and mortality. This protective effect is primarily attributed to the reduction in PM concentration.

Impact of "blue-green diet" on human health and wellbeing: A systematic review of potential determinants in shaping the effectiveness of blue-green infrastructure (BGI) in urban settings

Discourses concerning the potential health benefits of blue-green infrastructure (BGI) have gained momentum, highlighting its positive influence on human health and wellbeing. While studies have explored the concept of "Nature Pyramid" and the role of exposure to natural environments in promoting health, the role of water elements remains underexplored. Rooted in this concept, this study proposed a notion of "blue-green diet" as a framework to understand the intricate mechanisms and determinants of optimal blue-green exposure. Understanding the relationship between these determinants and their health-related impacts can facilitate the enhancement of BGI design, leading to greater effectiveness in promoting health and wellbeing and supporting sustainable urban development strategies. To enhance the comprehension of the "blue-green diet", this study conducted a systematic literature review to grasp the underlying mechanisms behind its beneficial effects, focusing on two key determinants of "blue-green diet", which are also derived from the concept of the "Nature Pyramid": (1) the type of BGI and (2) the mode of interaction with and within BGIs. Under the search of BGI's overall health impacts, this study selected 54 journal publications concerning BGI's type and interaction mode from Web of Science and Scopus since 2010. The review revealed significant disparities in the health benefits provided by different types of BGI (in terms of artificial extent and scale) and between active and passive interaction modes. It examines how to balance natural and artificial elements for enhancing the benefits of BGI and discusses the attributes of BGI that encourage diverse and meaningful interaction patterns. These efforts collectively aim to optimize BGI design and planning, increase its capacity to promote health, and extend its benefits to a wider range of individuals. Future research should encompass a broader spectrum of determinants, such as diverse BGI settings, visit frequency and duration, and user's social-cultural backgrounds.

Quantitative evaluation of urban green exposure and its impact on human health: A case study on the 3-30-300 green space rule

BACKGROUND AND AIMS

Urban green spaces offer various health benefits, yet the impact of comprehensive green exposure criteria on multidimensional health remains unclear. The 3-30-300 green space rule represents the green exposure indicators with specific thresholds. This study aims to quantitatively evaluate urban green exposure in cities and can support investigation of its relationship with human health.

METHODS

We conducted a cross-sectional study based on 902 investigated individuals in 261 residential locations aged 11-95 years from Xiamen City, China. 3-30-300 green exposure was calculated using field surveys, GIS, and Baidu Maps Application Programming Interface (API). Physical health data was based on Occupational Stress Indicator (OSI)-2. Mental health was from the 12-item General Health Questionnaire (GHQ-12). Social health was from a self-constructed evaluation questionnaire. Statistical analyses were conducted using Geographically Weighted Regression and Geographically Weighted Logistic Regression for global and local effects on green exposure and multidimensional health.

RESULT

Among the investigated individuals, only 3.55 % (32/902) fully meet the 3-30-300 rule in Xiamen. Global results show that individuals achieved at least 30 % vegetation coverage (Yes) is associated with better physical (β: 0.76, p < 0.01) and social (β: 0.5, p < 0.01) health. GWLR global results indicate that individuals can "see at least 3 trees from home" meeting one (OR = 0.46, 95%CI: 0.25-0.86, p < 0.05) or two (OR = 0.41, 95%CI: 0.22,0.78, p < 0.01; OR = 0.24, 95%CI: 0.07-0.77, p < 0.05) 3-30-300 rule components are significantly associated with reduced medical visits and hospitalizations refer to not met these criterias. In the GWR local analysis, achieved 30 % vegetation cover is significantly related to improved social health at all locations. Meeting any two indicators also contribute to improved social health (n = 511, β: 0.46-0.51, P < 0.05).

CONCLUSION

Green exposure indicators based on the 3-30-300 rule guiding healthy urban green space development. We observed multidimensional health benefits when 1/3 or 2/3 of the indicators were met.

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

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

Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999-2018: A spatiotemporal perspective

Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67-0.56), and an increase in greenness exposure (0.34-0.41) in Hong Kong during 1999-2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051-1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950-1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827-0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763-0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.

Individual and Neighborhood Level Predictors of Children's Exposure to Residential Greenspace

Inequities in urban greenspace have been identified, though patterns by race and socioeconomic status vary across US settings. We estimated the magnitude of the relationship between a broad mixture of neighborhood-level factors and residential greenspace using weighted quantile sum (WQS) regression, and compared predictive models of greenspace using only neighborhood-level, only individual-level, or multi-level predictors. Greenspace measures included the Normalized Difference Vegetation Index (NDVI), tree canopy, and proximity of the nearest park, for residential locations in Shelby County, Tennessee of children in the CANDLE cohort. Neighborhood measures include socioeconomic and education resources, as well as racial composition and racial residential segregation. In this sample of 1012 mother-child dyads, neighborhood factors were associated with higher NDVI and tree canopy (0.021 unit higher NDVI [95% CI: 0.014, 0.028] per quintile increase in WQS index); homeownership rate, proximity of and enrollment at early childhood education centers, and racial composition, were highly weighted in the WQS index. In models constrained in the opposite direction (0.028 unit lower NDVI [95% CI: - 0.036, - 0.020]), high school graduation rate and teacher experience were highly weighted. In prediction models, adding individual-level predictors to the suite of neighborhood characteristics did not meaningfully improve prediction accuracy for greenspace measures. Our findings highlight disparities in greenspace for families by neighborhood socioeconomic and early education factors, and by race, suggesting several neighborhood indicators for consideration both as potential confounders in studies of greenspace and pediatric health as well as in the development of policies and programs to improve equity in greenspace access.

A Review on Recent Deep Learning-Based Semantic Segmentation for Urban Greenness Measurement

Accurate urban green space (UGS) measurement has become crucial for landscape analysis. This paper reviews the recent technological breakthroughs in deep learning (DL)-based semantic segmentation, emphasizing efficient landscape analysis, and integrating greenness measurements. It explores quantitative greenness measures applied through semantic segmentation, categorized into the plan view- and the perspective view-based methods, like the Land Class Classification (LCC) with green objects and the Green View Index (GVI) based on street photographs. This review navigates from traditional to modern DL-based semantic segmentation models, illuminating the evolution of the urban greenness measures and segmentation tasks for advanced landscape analysis. It also presents the typical performance metrics and explores public datasets for constructing these measures. The results show that accurate (semantic) segmentation is inevitable not only for fine-grained greenness measures but also for the qualitative evaluation of landscape analyses for planning amidst the incomplete explainability of the DL model. Also, the unsupervised domain adaptation (UDA) in aerial images is addressed to overcome the scale changes and lack of labeled data for fine-grained greenness measures. This review contributes to helping researchers understand the recent breakthroughs in DL-based segmentation technology for challenging topics in UGS research.

Current methodologies of greenspace exposure and mental health research-a scoping review

Introduction

Greenspaces can provide an important resource for human mental health. A growing body of literature investigates the interaction and the influence of diverse greenspace exposures. In order to gain a comprehensive understanding of the complex connection between greenspace and mental health, a variety of perspectives and methodological combinations are needed. The aim of this review is to assess the current methodologies researching greenspace and mental health.

Methods

A scoping review was conducted. Four electronic databases (Pubmed, Embase, PsycInfo, Web of Science) were searched for relevant studies. A wide range of greenspace and mental health keywords were included to provide a comprehensive representation of the body of research. Relevant information on publication characteristics, types of greenspaces, mental health outcomes, and measurements of greenspace exposure and mental health was extracted and assessed.

Results

338 studies were included. The included studies encompassed a multitude of methods, as well as outcomes for both greenspace and mental health. 28 combinations were found between seven categories each for greenspace and mental health assessment. Some pairings such as geoinformation systems for greenspace assessment and questionnaires investigating mental health were used much more frequently than others, implying possible research gaps. Furthermore, we identified problems and inconsistences in reporting of greenspace types and mental health outcomes.

Discussion

The identified methodological variety is a potential for researching the complex connections between greenspace and mental health. Commonly used combinations can provide important insights. However, future research needs to emphasize other perspectives in order to understand how to create living environments with mental health benefits. For this purpose, interdisciplinary research is necessary.

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

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

Critical windows of greenness exposure during preconception and gestational periods in association with birthweight outcomes

Few studies have examined the association between greenness exposure and birth outcomes. This study aims to identify critical exposure time windows during preconception and pregnancy for the association between greenness exposure and birth weight. A cohort of 13 890 pregnant women and newborns in Shanghai, China from 2016-2019 were included in the study. We assessed greenness exposure using Normalized Difference Vegetation Index (NDVI) during the preconception and gestational periods, and evaluated the association with term birthweight, birthweight z-score, small-for-gestational age, and large-for-gestational age using linear and logistic regressions adjusting for key maternal and newborn covariates. Ambient temperature, relative humidity, ambient levels of fine particles (PM2.5) and nitrogen dioxide (NO2) assessed during the same period were adjusted for as sensitivity analyses. Furthermore, we explored the potential different effects by urbanicity and park accessibility through stratified analysis. We found that higher greenness exposure at the second trimester of pregnancy and averaged exposure during the entire pregnancy were associated with higher birthweight and birthweight Z-score. Specifically, a 0.1 unit increase in second trimester averaged NDVI value was associated with an increase in birthweight of 10.2 g (95% CI: 1.8-18.5 g) and in birthweight Z-score of 0.024 (0.003-0.045). A 0.1 unit increase in an averaged NDVI during the entire pregnancy was associated with 10.1 g (95% CI: 1.0-19.2 g) increase in birthweight and 0.025 (0.001-0.048) increase in birthweight Z-score. Moreover, the associations were larger in effect size among urban residents than suburban residents and among residents without park accessibility within 500 m compared to those with park accessibility within 500 m. Our findings suggest that increased greenness exposure, particularly during the second trimester, may be beneficial to birth weight in a metropolitan area.

The use of Enhanced Vegetation Index for assessing access to different types of green space in epidemiological studies

BACKGROUND

Exposure to green space can protect against poor health through a variety of mechanisms. However, there is heterogeneity in methodological approaches to exposure assessments which makes creating effective policy recommendations challenging.

OBJECTIVE

Critically evaluate the use of a satellite-derived exposure metric, the Enhanced Vegetation Index (EVI), for assessing access to different types of green space in epidemiological studies.

METHODS

We used Landsat 5-8 (30 m resolution) to calculate average EVI for a 300 m radius surrounding 1.4 million households in Wales, UK for 2018. We calculated two additional measures using topographic vector data to represent access to green spaces within 300 m of household locations. The two topographic vector-based measures were total green space area stratified by type and average private garden size. We used linear regression models to test whether EVI could discriminate between publicly accessible and private green space and Pearson correlation to test associations between EVI and green space types.

RESULTS

Mean EVI for a 300 m radius surrounding households in Wales was 0.28 (IQR = 0.12). Total green space area and average private garden size were significantly positively associated with corresponding EVI measures (β = < 0.0001, 95% CI: 0.0000, 0.0000; β = 0.0001, 95% CI: 0.0001, 0.0001 respectively). In urban areas, as average garden size increases by 1 m2, EVI increases by 0.0002. Therefore, in urban areas, to see a 0.1 unit increase in EVI index score, garden size would need to increase by 500 m2. The very small β values represent no 'measurable real-world' associations. When stratified by type, we observed no strong associations between greenspace and EVI.

IMPACT

It is a widely implemented assumption in epidiological studies that an increase in EVI is equivalent to an increase in greenness and/or green space. We used linear regression models to test associations between EVI and potential sources of green reflectance at a neighbourhood level using satellite imagery from 2018. We compared EVI measures with a 'gold standard' vector-based dataset that defines publicly accessible and private green spaces. We found that EVI should be interpreted with care as a greater EVI score does not necessarily mean greater access to publicly available green spaces in the hyperlocal environment.

How does multiscale greenspace exposure affect human health? Evidence from urban parks in the central city of Beijing

While the health benefits of exposure to urban greenspace have been widely discussed at different spatial scales, the comprehensive health effects of multiscale greenspace exposure are far from understood. There is a lack of quantified evidence when conducting cost-effective greenspace management practices for promoting human health and well-being. This study proposed a conceptual model that links objective and subjective greenspace exposure metrics at different spatial scales with self-rated health of residents. The model attempted to deconstruct and explore the associations between multiscale greenspace exposure and human health, and a cross-sectional study was conducted to examine the model. Taking urban parks in the central city of Beijing as case study area, the objective greenspace exposure metrics at both the site and subdistrict scales were spatial explicitly assessed, and the subjective exposure metrics and self-rated health status of 1017 respondents were obtained through questionnaire survey and spatial positioning. The results of multiple regression analyses and path analyses suggested that greenspace exposure metrics at both site and subdistrict scales were significantly associated with the respondents' self-rated health status, with the exposure metrics at the site scale being more important than those at the subdistrict scale in affecting human health. The contribution of urban parks to self-rated physical and mental health of respondents varied across spatial scales. Specifically, the aesthetic value of urban parks at site scale contributed the most to mental health by promoting respondents' resting behaviors in urban parks, and the density of urban parks at subdistrict scale had the most significant effects on self-rated physical health by increasing the usage frequency of urban parks. Findings of this study can contribute to understanding the complex associations between urban greenspace and human health from a multiscale perspective, and are also expected to provide quantified information for health-oriented urban greenspace planning and management practices.

Associations of residential green space with internalizing and externalizing behavior in early childhood

BACKGROUND

Green space exposures may promote child mental health and well-being across multiple domains and stages of development. The aim of this study was to investigate associations between residential green space exposures and child mental and behavioral health at age 4-6 years.

METHODS

Children's internalizing and externalizing behaviors in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort in Shelby County, Tennessee, were parent-reported on the Child Behavior Checklist (CBCL). We examined three exposures-residential surrounding greenness calculated as the Normalized Difference Vegetation Index (NDVI), tree cover, and park proximity-averaged across the residential history for the year prior to outcome assessment. Linear regression models were adjusted for individual, household, and neighborhood-level confounders across multiple domains. Effect modification by neighborhood socioeconomic conditions was explored using multiplicative interaction terms.

RESULTS

Children were on average 4.2 years (range 3.8-6.0) at outcome assessment. Among CANDLE mothers, 65% self-identified as Black, 29% as White, and 6% as another or multiple races; 41% had at least a college degree. Higher residential surrounding greenness was associated with lower internalizing behavior scores (-0.66 per 0.1 unit higher NDVI; 95% CI: -1.26, -0.07) in fully-adjusted models. The association between tree cover and internalizing behavior was in the hypothesized direction but confidence intervals included the null (-0.29 per 10% higher tree cover; 95% CI: -0.62, 0.04). No associations were observed between park proximity and internalizing behavior. We did not find any associations with externalizing behaviors or the attention problems subscale. Estimates were larger in neighborhoods with lower socioeconomic opportunity, but interaction terms were not statistically significant.

CONCLUSIONS

Our findings add to the accumulating evidence of the importance of residential green space for the prevention of internalizing problems among young children. This research suggests the prioritization of urban green spaces as a resource for child mental health.

Anthropogenic impacts on urban blue space and its reciprocal effect on human and socio-ecological health

Quantifying anthropogenic impacts on blue space (BS) and its effect on human and socio-ecological health was least explored. The present study aimed to do this in reference to the urban BS transformation scenario of Eastern India. To measure BS transformation, Landsat image-based water indices were run from 1990 to 2021. Anthropogenic impact score (AIS) and 7 components scores of 78 selected BS on 70 parameters related data driven from the field. Total 345 respondents were taken for human and socio-ecological health assessment. For this, depression (DEP), anxiety (ANX), stress (STR), physical activities (PA), social capital (SC), therapeutic landscape (TL) and environment building (EB) parameters were taken. The result exhibited that BS was reduced. About 50% of urban core BS was reported highly impacted. Human and socio-ecological health was identified as good in proximity to BS, but it was observed better in the cases of larger peripheral BS. AIS on BS was found to be positively associated with mental health (0.47-0.63) and negatively associated with PA, SC, TL and EB (-0.50 to -0.90). Standard residual in ordinary least square was reported low (-1.5 to 1.5) in 95% BS. Therefore, BS health restoration and management is crucial for sustaining the living environment.

The relation between proximity to and characteristics of green spaces to physical activity and health: A multi-dimensional sensitivity analysis in four European cities

INTRODUCTION

Non-communicable diseases are the global disease burden of our time, with physical inactivity identified as one major risk factor. Green spaces are associated with increased physical activity of nearby residents. But there are still gaps in understanding which proximity and what characteristics of green spaces can trigger physical activity. This study aims to unveil these differences with a rigorous sensitivity analysis.

METHODS

We gathered data on self-reported health and physical activity from 1365 participants in selected neighbourhoods in Porto, Nantes, Sofia, and Høje-Taastrup. Spatial data were retrieved from OpenStreetMap. We followed the PRIGSHARE guidelines to control for bias. Around the residential addresses, we generated seven different green space indicators for 15 distances (100-1500 m) using the AID-PRIGSHARE tool. We then analysed each of these 105 green space indicators together with physical activity and health in 105 adjusted structural equation models.

RESULTS

Green space accessibility and green space uses indicators showed a pattern of significant positive associations to physical activity and indirect to health at distances of 1100 m or less, with a peak at 600 m for most indicators. Greenness in close proximity (100 m) had significant positive effects on physical activity and indirect effects on health. Surrounding greenness showed positive direct effects on health at 500-1100 m and so do green corridors in 800 m network distance. In contrast, a high quantity of green space uses, and surrounding greenness measured in a larger radius (1100-1500 m) showed a negative relationship with physical activity and indirect health effects.

CONCLUSIONS

Our results provide insight into how green space characteristics can influence health at different scales, with important implications for urban planners on how to integrate accessible green spaces into urban structures and public health decision-makers on the ability of green spaces to combat physical inactivity.

Measuring the 3-30-300 rule to help cities meet nature access thresholds

The 3-30-300 rule offers benchmarks for cities to promote equitable nature access. It dictates that individuals should see three trees from their dwelling, have 30 % tree canopy in their neighborhood, and live within 300 m of a high-quality green space. Implementing this demands thorough measurement, monitoring, and evaluation methods, yet little guidance is currently available to pursue these actions. To overcome this gap, we employed an expert-based consensus approach to review the available ways to measure 3-30-300 as well as each measure's strengths and weaknesses. We described seven relevant data and processes: vegetation indices, street level analyses, tree inventories, questionnaires, window view analyses, land cover maps, and green space maps. Based on the reviewed strengths and weaknesses of each measure, we presented a suitability matrix to link recommended measures with each component of the rule. These recommendations included surveys and window-view analyses for the '3 component', high-resolution land cover maps for the '30 component', and green space maps with network analyses for the '300 component'. These methods, responsive to local situations and resources, not only implement the 3-30-300 rule but foster broader dialogue on local desires and requirements. Consequently, these techniques can guide strategic investments in urban greening for health, equity, biodiversity, and climate adaptation.

Association between greenspace exposure and suicide-related outcomes across the lifespan: A systematic review

A growing number of studies have linked greenspace exposure to suicide, but findings are inconsistent. We conducted a systematic review on the associations between greenspace exposure and suicide-related outcomes (namely, suicide mortality, self-harm, and suicidal ideation) up until January 6, 2023. We used the Mixed Methods Appraisal Tool (or MMAT) to assess the quality of the included studies. In total, 23 studies met our inclusion criteria, consisting of 14 ecological, four cross-sectional, three longitudinal, and two experimental studies. Most studies were published in 2022 and conducted in Europe (n = 10), Asia (n = 7), and North America (n = 5), with one worldwide analysis. Various indicators were used to assess greenspace exposure including objective measures (e.g., level of surrounding greenness, quantity, structural features, tree canopy coverage), and greenspace use (e.g., duration and frequency). Suicide mortality was the most studied outcome (n = 14). Quality assessment showed that most (87 %) of the included observational studies used representative samples. Protective associations of exposure to greenspace were reported for suicide mortality (9/14 or 64 %), self-harm (n = 3/5 or 60 %) and suicidal ideation (n = 4/6 or 67 %), with nine or 36 % studies reporting no association. Most of the included studies adjusted for key covariates such as age, sex, and socioeconomic status at various aggregate levels (e.g., household, city). For greenspace exposure and suicide mortality, studies stratified by sex (n = 10) showed larger protective associations for females (n = 7) than for males (n = 4). However, the included studies showed high heterogeneity in terms of exposure indicators and greenspace definitions. Experimental studies and studies using youth samples were rare. While more research is warranted, preliminary findings suggest protective associations between greenspace exposure and suicide-related outcomes.

Geographic uncertainties in external exposome studies: A multi-scale approach to reduce exposure misclassification

BACKGROUND

Many studies on environment-health associations have emphasized that the selected buffer size (i.e., the scale of the geographic context when exposures are assigned at people's address location) may affect estimated effect sizes. However, there is limited methodological progress in addressing these buffer size-related uncertainties.

AIM

We aimed to 1) develop a statistical multi-scale approach to address buffer-related scale effects in cohort studies, and 2) investigate how environment-health associations differ between our multi-scale approach and ad hoc selected buffer sizes.

METHODS

We used lacunarity analyses to determine the largest meaningful buffer size for multiple high-resolution exposure surfaces (i.e., fine particulate matter [PM2.5], noise, and the normalized difference vegetation index [NDVI]). Exposures were linked to 7.7 million Dutch adults at their home addresses. We assigned exposure estimates based on buffers with fine-grained distance increments until the lacunarity-based upper limit was reached. Bayesian Cox model averaging addressed geographic uncertainties in the estimated exposure effect sizes within the exposure-specific upper buffer limits on mortality. Z-tests assessed statistical differences between averaged effect sizes and those obtained through pre-selected 100, 300, 1200, and 1500 m buffers.

RESULTS

The estimated lacunarity curves suggested exposure-specific upper buffer size limits; the largest was for NDVI (960 m), followed by noise (910 m) and PM2.5 (450 m). We recorded 845,229 deaths over eight years of follow-up. Our multi-scale approach indicated that higher values of NDVI were health-protectively associated with mortality risk (hazard ratio [HR]: 0.917, 95 % confidence interval [CI]: 0.886-0.948). Increased noise exposure was associated with an increased risk of mortality (HR: 1.003, 95 % CI: 1.002-1.003), while PM2.5 showed null associations (HR:0.998, 95 % CI: 0.997-1.000). Effect sizes of NDVI and noise differed significantly across the averaged and prespecified buffers (p < 0.05).

CONCLUSIONS

Geographic uncertainties in residential-based exposure assessments may obscure environment-health associations or risk spurious ones. Our multi-scale approach produced more consistent effect estimates and mitigated contextual uncertainties.

Residential Greenness and Long-term Mortality Among Patients Who Underwent Coronary Artery Bypass Graft Surgery

BACKGROUND

Studies have reported inverse associations between exposure to residential greenness and mortality. Greenness has also been associated with better surgical recovery. However, studies have had small sample sizes and have been restricted to clinical settings. We investigated the association between exposure to residential greenness and all-cause mortality among a cohort of cardiac patients who underwent coronary artery bypass graft (CABG) surgery.

METHODS

We studied this cohort of 3,128 CABG patients between 2004 and 2009 at seven cardiothoracic departments in Israel and followed patients until death or 1st May 2021. We collected covariate information at the time of surgery and calculated the patient-level average normalized difference vegetation index (NDVI) over the entire follow-up in a 300 m buffer from the home address. We used Cox proportional hazards regression models to estimate associations between greenness and death, adjusting for age, sex, origin, socioeconomic status, type of hospital admission, peripherality, air pollution, and distance from the sea.

RESULTS

Mean age at surgery was 63.8 ± 10.6 for men and 69.5 ± 10.0 for women. During an average of 12.1 years of follow-up (37,912 person-years), 1,442 (46%) patients died. A fully adjusted Cox proportional hazards model estimated a 7% lower risk of mortality (HR: 0.93, 95% CI = [0.85, 1.00]) per 1 interquartile range width increase (0.04) in NDVI. Results were robust to the use of different buffer sizes (100 m-1,250 m from the home) and to the use of average NDVI exposure during the first versus the last 2 years of follow-up.

CONCLUSIONS

Residential greenness was associated with lower risk of mortality in CABG patients.

Assessment of street-level greenness and its association with housing prices in a metropolitan area

Rapid global urbanization has made environmental amenities scarce despite their considerable advantages, ranging from aesthetics to health benefits. Street greenness is a key urban environmental amenity. This study developed a green index as an objective measure of greenness using street view images and assessed its predictive power along with that of other environmental amenities for metropolitan housing prices. Spatial interpolation was used to transform point data into areal data, enabling effective analysis of a dataset covering an entire metropolis. A series of hedonic models revealed that (1) street greenness is significantly and negatively associated with housing prices, (2) a traditional greenness indicator and the green index provide complementary information, indicating that they could be used for different purposes, and (3) environmental amenities, in general, demonstrated significant relationships with housing prices. Our analysis strategy including spatial interpolation can be widely employed for studies using different types of data. The findings demonstrating a complementary relationship between our two greenness indicators provide valuable insights for policymakers and urban planners to improve street-level greenness and green accessibility. Considering the significance of environmental amenities, this study provides practical approaches for executing sustainable and healthy city development.

More than greening: Using a novel index to assess restorative nature and vulnerability relationships

Urban living limits access to nature yet spending time in nature is crucial for human health and well-being. To overcome this, urban planners and policymakers are actively looking for different ways to conserve and create more urban nature through parks, street trees, and other greening strategies. However, research shows that in most cities, these greening efforts are not equitably distributed, nor are they equal in terms of their quality or benefits they provide. Creating more equitable access to urban nature is a challenge and a priority in the next decade, and so is improving the quality of urban nature and associated benefits for urbanites. To address this challenge and contribute at both practical and conceptual levels, we propose a new Local Restorative Nature (LRN) index for geospatially assessing the "restorative quality" of urban nature that can support mental well-being. To contextualize the LRN index, we map the distribution of restorative nature in relation to social vulnerability in Vancouver, Canada. The novel LRN index provides critical insights showing that many neighborhoods with vulnerable populations in Vancouver have less exposure to restorative nature to support mental health and highlights where to strategically prioritize urban greening investment in areas that need it the most. The LRN index is scalable and can be used by urban planners in other cities and contexts to improve equitable distribution of restorative nature and better support urbanites' well-being.

Residential green and blue spaces and working memory in children aged 6-12 years old. Results from the INMA cohort

Availability of green and blue spaces in the area of residence has been related to various health outcomes during childhood, including neurodevelopment. Some studies have shown that children living in greener and/or bluer areas score better on cognitive tasks although the evidence is inconsistent. These protective effects are hypothesized to occur in part through reductions in air pollution exposure and odds of attention-deficit/hyperactivity disorder (ADHD). This study analysed the effects of residential green and blue spaces on working memory of children in the Spanish INfancia y Medio Ambiente (INMA) birth cohort and the potential joint mediating role of air pollution and ADHD. The study samples were composed of 1738 six-to eight-year-olds (M = 7.53, SD = 0.68, 49% female) and 1449 ten-to twelve-year-olds (M = 11.18, SD = 0.69, 50% female) living in Asturias, Gipuzkoa, Sabadell or Valencia, Spain. Individual Normalized Difference Vegetation Index (NDVI) values in 100-, 300- and 500-m buffers and availability of green and blue spaces >5000 m2 in 300-m buffers were calculated using Geographic Information Systems software. Individual NO2 values for the home environment were estimated using ESCAPE's land use regression models. ADHD diagnosis was reported by participants' parents via a questionnaire. Working memory was measured with numbers and colours (in the younger group only) N-back tests (2- and 3-back d'). Mixed-effects models informed of the beneficial effects of NDVI in a 300-m buffer on numerical working memory in the younger sample although the results were not consistent for all d' scores considered and failed to detect significant effects through the candidate mediators. Availability of major blue spaces did not predict working memory performance. Provision of green spaces may play a role in children's working memory but further research is required.

Calculating access to parks and other polygonal resources: A description of open-source methodologies

Public health studies routinely use simplistic methods to calculate proximity-based "access" to greenspace, such as by measuring distances to the geographic centroids of parks or, less frequently, to the perimeter of the park area. Although computationally efficient, these approaches oversimplify exposure measurement because parks often have specific entrance points. In this tutorial paper, we describe how researchers can instead calculate more-accurate access measures using freely available open-source methods. Specifically, we demonstrate processes for calculating "service areas" representing street-network-based buffers of access to parks within set distances and mode of transportation (e.g., 1-km walk or 20-minute drive) using OpenRouteService and QGIS software. We also introduce an advanced method involving the identification of trailheads or parking lots with OpenStreetMap data and show how large parks particularly benefit from this approach. These methods can be used globally and are applicable to analyses of a wide range of studies investigating proximity access to resources.

Measuring environmental exposures in people's activity space: The need to account for travel modes and exposure decay

BACKGROUND

Accurately quantifying people's out-of-home environmental exposure is important for identifying disease risk factors. Several activity space-based exposure assessments exist, possibly leading to different exposure estimates, and have neither considered individual travel modes nor exposure-related distance decay effects.

OBJECTIVE

We aimed (1) to develop an activity space-based exposure assessment approach that included travel modes and exposure-related distance decay effects and (2) to compare the size of such spaces and the exposure estimates derived from them across typically used activity space operationalizations.

METHODS

We used 7-day-long global positioning system (GPS)-enabled smartphone-based tracking data of 269 Dutch adults. People's GPS trajectory points were classified into passive and active travel modes. Exposure-related distance decay effects were modeled through linear, exponential, and Gaussian decay functions. We performed cross-comparisons on these three functional decay models and an unweighted model in conjunction with four activity space models (i.e., home-based buffers, minimum convex polygons, two standard deviational ellipses, and time-weighted GPS-based buffers). We applied non-parametric Kruskal-Wallis tests, pair-wise Wilcoxon signed-rank tests, and Spearman correlations to assess mean differences in the extent of the activity spaces and correlations across exposures to particulate matter (PM2.5), noise, green space, and blue space.

RESULTS

Participants spent, on average, 42% of their daily life out-of-home. We observed that including travel modes into activity space delineation resulted in significantly more compact activity spaces. Exposure estimates for PM2.5 and blue space were significantly (p < 0.05) different between exposure estimates that did or did not account for travel modes, unlike noise and green space, for which differences did not reach significance. While the inclusion of distance decay effects significantly affected noise and green space exposure assessments, the decay functions applied appear not to have had any impact on the results. We found that residential exposure estimates appear appropriate for use as proxy values for the overall amount of PM2.5 exposure in people's daily lives, while GPS-based assessments are suitable for noise, green space, and blue space.

SIGNIFICANCE

For some exposures, the tested activity space definitions, although significantly correlated, exhibited differing exposure estimate results based on inclusion or exclusion of travel modes or distance decay effect. Results only supported using home-based buffer values as proxies for individuals' daily short-term PM2.5 exposure.

[Urban green and blue spaces in times of climate change]

Both climate mitigation and adaptation are urgently needed as complementary strategies for sustainably reducing and managing urban health risks posed by climate change. The positive effects of urban green and blue spaces on physical and mental health are well-known since decades. However, there is intensive competition around the use of the urban space. Reflecting the European Aalborg Charta (1994), German building laws require development plans to be sustainable in this demanding context with human health being a concern of central importance. Reality, however, remains challenging. Although there are numerous best practice examples, research on the impact of urban green and blue spaces on human health and well-being is still required. Furthermore, all relevant policy fields need to develop awareness of the importance of green and blue spaces for quality of life and health, so that the issue of health is taken into consideration adequately as well as in a socially sensitive manner in urban decision processes.

Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data

Background

Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited.

Objectives

To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use.

Design

A retrospective, dynamic longitudinal panel study.

Setting

Wales, UK.

Participants

An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces.

Main outcome measures

Common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale.

Data sources

Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank.

Methods

Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders.

Results and conclusions

Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower.

Limitations

Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets.

Future work

Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.

Green sleep: Immediate residential greenspace and access to larger green areas are associated with better sleep quality, in a longitudinal population-based cohort

OBJECTIVE

Sleep is pivotal to health, wellbeing and functioning in daily life, but sleep difficulties are common and may be affected by modifiable qualities in the residential surrounding environment, in terms of greenspace. However, population-based studies on individual-level greenspace and sleep are limited. The objective of the current study was thus to investigate prospective associations between fine-grained individual-level residential greenspace and sleep, and moderating effects of life style (physical activity, work status) and sex, in a nationwide population-based Swedish cohort.

METHODS

Participants of the Swedish Longitudinal Occupational Survey of Health (SLOSH)-a population-based sample of adults in Sweden-were studied during 2014-2018 (19,375 individuals; 43,062 observations). Residential greenspace land cover, and coherent green area size, were assessed via high resolution geographic information systems, at 50, 100, 300, 500 and 1000 m buffers around residences. Prospective greenspace and sleep associations were assessed via multilevel general linear models, adjusting for demographic, socioeconomic (individual and neighborhood), life style and urban factors.

RESULTS

Higher greenspace availability in the immediate residential surroundings (50 m and 100 m buffer zones) was associated with less sleep difficulties, even after adjustment for confounders. Greenspace effects were generally greater among non-working individuals. Among the physically active, and among non-working, greenspace and green area size further away from home (300, 500 and 1000 m, i.e. dependent on mobility) were also associated with less sleep difficulties.

CONCLUSIONS

Residential greenspace in the immediate residential surroundings is associated with significantly less sleep difficulties. Greenspace further away from home was associated with better sleep especially among the physically active, and non-working individuals. The results highlight the importance of greenspace in the immediate residential-surrounding environment for sleep, and the need to integrate health and environmental policies, urban planning and greening.

Availability, accessibility, and use of green spaces and cognitive development in primary school children

Green spaces may have beneficial impacts on children's cognition. However, few studies explored the exposure to green spaces beyond residential areas, and their availability, accessibility and uses at the same time. The aim of the present study was to describe patterns of availability, accessibility, and uses of green spaces among primary school children and to explore how these exposure dimensions are associated with cognitive development. Exposures to green space near home, school, commuting route, and other daily activity locations were assessed for 1607 children aged 6-11 years from six birth cohorts across Europe, and included variables related to: availability (NDVI buffers: 100, 300, 500 m), potential accessibility (proximity to a major green space: linear distance; within 300 m), and use (play time in green spaces: hours/year), and the number of visits to green spaces (times/previous week). Cognition measured as fluid intelligence, inattention, and working memory was assessed by computerized tests. We performed multiple linear regression analyses on pooled and imputed data adjusted for individual and area-level confounders. Availability, accessibility, and uses of green spaces showed a social gradient that was unfavorable in more vulnerable socioeconomic groups. NDVI was associated with more playing time in green spaces, but proximity to a major green space was not. Associations between green space exposures and cognitive function outcomes were not statistically significant in our overall study population. Stratification by socioeconomic variables showed that living within 300 m of a major green space was associated with improved working memory only in children in less deprived residential areas (β = 0.30, CI: 0.09,0.51), and that more time playing in green spaces was associated with better working memory only in children of highly educated mothers (β per IQR increase in hour/year = 0.10; 95% CI: 0.01, 0.19). However, studying within 300 m of a major green space increased inattention scores in children in more deprived areas (β = 15.45, 95% CI: 3.50, 27.40).

Effect of neighbourhood greenness on the association between air pollution and risk of stroke first onset: A case-crossover study in shandong province, China

BACKGROUND

Higher neighbourhood greenness is associated with beneficial health outcomes, and short-term exposure to air pollution is associated with an elevated risk of stroke onset. However, little is known about their interactions.

METHODS

Daily data on stroke first onset were collected from 20 counties in Shangdong Province, China, from 2013 to 2019. The enhanced vegetation index (EVI) and concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) were calculated for each individual at the village or community level based on their home address to measure their neighbourhood exposure to greenness and air pollution. EVI was categorised as low or high, and a time-stratified case-crossover design was used to estimate the percent excess risk (ER%) of stroke associated with short-term exposure to air pollution. We further stratified greenness on the basis of EVI values into quartiles and introduced interaction terms between air pollutant concentrations and the median EVI values of the quartiles to assess the effect of greenness on the associations between short-term exposure and stroke.

RESULTS

Individuals living in the high-greenness areas had weaker associations between total stroke risk and exposure to NO2 (low greenness: ER% = 1.765% [95% CI 1.205%-2.328%]; high greenness: ER% = 0.368% [95% CI -0.252% to 0.991%]; P = 0.001), O3 (low greenness: 0.476% [95% CI 0.246%-0.706%]; high greenness: ER% = 0.085% [95% CI -0.156% to 0.327%]; P = 0.011), and SO2 (low greenness: 0.632% [95% CI 0.138%-1.129%]; high greenness: ER% = -0.177% [95% CI -0.782% to 0.431%]; P = 0.035).

CONCLUSION

Residence in areas with higher greenness was related to weaker associations between air pollution and stroke risk, suggesting that effectively planning green spaces can improve public health.

In situ psycho-cognitive assessments support self-determined urban green exercise time

Prescribed nature walks frequently yield improvements to mood and cognition as observed in experimental studies. Research that uses real life settings such as self-determined time exercising outdoors for restorative health benefits may more accurately elicit effects than time-specified study protocols. This study examined in situ psycho-cognitive outcomes of routine walks in urban greenspace to test the concept that self-set exposure duration and not context alone is related to magnitude of psycho-cognitive benefit. Pre-post measurements taken on a diverse participant pool of individuals walking in urban parks and recruited on random days over a two-week period found significant associations between outdoor activity duration and cognitive and mood improvements. Greater outdoor walking duration linearly predicted stronger processing speeds but non-linearly in tests of other cognitive domains. Results of fixed effects model for mean mood change following green exercise show outdoor walking influenced mood change at highest levels of significance, even after accounting for individual level variability in duration. Mood improved for all durations of outdoor walking under a random effects model with high significance. Untethering fixed intervals of outdoor exercise from formal study design revealed briefer but more frequent nature engagement aligned with nature affinity. The influence of unmeasured factors, e.g., nature affinity or restorative conditioning, for prescriptive durations of urban green exercise merits further investigation toward designing wellbeing interventions directed at specific urban populations.

Preferred reporting items in green space health research. Guiding principles for an interdisciplinary field

The relationship between green spaces and health is attracting more and more societal and research interest. The research field is however still suffering from its differing monodisciplinary origins. Now in a multidisciplinary environment on its way to a truly interdisciplinary field, there is a need for a common understanding, precision in green space indicators, and coherent assessment of the complexity of daily living environments. In several reviews, common protocols and open-source scripts are considered a high priority to advance the field. Realizing these issues, we developed PRIGSHARE (Preferred Reporting Items in Greenspace Health Research). It is accompanied by an open-source script that supports non-spatial disciplines in assessing greenness and green space on different scales and types. The PRIGSHARE checklist contains 21 items that have been identified as a risk of bias and are necessary for understanding and comparison of studies. The checklist is divided into the following topics: objectives (3 items), scope (3 items), spatial assessment (7 items), vegetation assessment (4 items), and context assessment (4 items). For each item, we include a pathway-specific (if relevant) rationale and explanation. The PRIGSHARE guiding principles should be helpful to support a high-quality assessment and synchronize the studies in the field while acknowledging the diversity of study designs.

Satisfaction with urban trees associates with tree canopy cover and tree visibility around the home

Many world cities want to expand the number of urban trees. How this expansion occurs should consider what people expect from trees based on how they experience and perceive these trees. Therefore, we need a better understanding of how people perceptually respond to urban tree abundance. This research examined whether people's satisfaction with urban trees and satisfaction with the management of those trees were related to objective measures of greenery such as the Normalized Difference Vegetation Index (NDVI), percent tree canopy cover, and the Viewshed Greenness Visibility Index (VGVI) for trees. We used a demographically and geographically representative survey of 223 residents in Toronto, Canada, and calculated NDVI, canopy cover, and VGVI at three neighbourhood sizes. We analysed the data using generalized linear regression. We found that canopy cover and VGVI had a positive association with satisfaction with urban trees. The associations were comparatively stronger at larger neighbourhood scales than at smaller scales. There were no statistically significant associations with NDVI or satisfaction with the management of urban trees.

Gene-environment interaction in the association of residential greenness and 25(OH) vitamin D

There is increasing awareness for beneficial health effects of green space surrounding the home, but the underlying mechanisms are not yet fully understood and challenging to study given the correlation with other exposures. Here, the association of residential greenness and vitamin D including a gene-environment interaction is investigated. 25-hydroxyvitamin D (25(OH)D) was measured by electrochemiluminescence at ages 10 and 15 years in participants of two German birth cohorts GINIplus and LISA. Greenness was measured using the Landsat-derived Normalized Difference Vegetation Index (NDVI) in a 500 m buffer surrounding the home. Linear and logistic regression models were applied at both time points adjusted for several covariates (N_10Y = 2,504, N_15Y = 2,613). In additional analyses vitamin D-related genes, physical activity, time spent outdoors, supplements, and measurement season were investigated as potential confounders or effect modifiers. A 1.5-SD increase in NDVI was significantly associated with increased 25(OH)D values at ages 10 and 15 years (β_10y = 2.41 nmol/l, p=<0.01; β_15y = 2.03 nmol/l, p = 0.02). In stratified analyses, the associations were not seen in participants spending more than 5 h/day outside in summer, having a high physical activity level, taking supplements, or being examined during the winter season. In a subset (n = 1,732) with genetic data, a significant gene-environment interaction of NDVI with CYP2R1, an upstream gene in 25(OH)D synthesis, was observed at age 10 years. When investigating 25(OH)D sufficiency, defined as values above 50 nmol/l, a 1.5-SD increase in NDVI was associated with significantly higher odds of having sufficient 25 (OH)D levels at age 10 years (OR = 1.48, 1.19-1.83). In conclusion, robust associations between residential greenness and 25 (OH)D levels were observed in children and adolescents independent of other confounders and additionally supported by the presence of a gene-environment interaction. Effects of NDVI were stronger in those having lower vitamin D levels at age 10 years due to their covariate profile or genetically lower 25(OH)D synthesis.

Spatial machine learning for predicting physical inactivity prevalence from socioecological determinants in Chicago, Illinois, USA

The increase in physical inactivity prevalence in the USA has been associated with neighborhood characteristics. While several studies have found an association between neighborhood and health, the relative importance of each component related to physical inactivity or how this value varies geographically (i.e., across different neighborhoods) remains unexplored. This study ranks the contribution of seven socioecological neighborhood factors to physical inactivity prevalence in Chicago, Illinois, using machine learning models at the census tract level, and evaluates their predictive capabilities. First, we use geographical random forest (GRF), a recently proposed nonlinear machine learning regression method that assesses each predictive factor's spatial variation and contribution to physical inactivity prevalence. Then, we compare the predictive performance of GRF to geographically weighted artificial neural networks, another recently proposed spatial machine learning algorithm. Our results suggest that poverty is the most important determinant in the Chicago tracts, while on the other hand, green space is the least important determinant in the rise of physical inactivity prevalence. As a result, interventions can be designed and implemented based on specific local circumstances rather than broad concepts that apply to Chicago and other large cities.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10109-023-00415-y.

Greenness and equity: Complex connections between intra-neighborhood contexts and residential tree planting implementation

Associations between neighborhood greenness and socioeconomic status (SES) are established, yet intra-neighborhood context and SES-related barriers to tree planting remain unclear. Large-scale tree planting implementation efforts are increasingly common and can improve human health, strengthen climate adaptation, and ameliorate environmental inequities. Yet, these efforts may be ineffective without in-depth understanding of local SES inequities and barriers to residential planting. We recruited 636 residents within and surrounding the Oakdale Neighborhood of Louisville, Kentucky, USA, and evaluated associations of individual and neighborhood-level sociodemographic indicators with greenness levels at multiple scales. We offered no-cost residential tree planting and maintenance to residents within a subsection of the neighborhood and examined associations of these sociodemographic indicators plus baseline greenness levels with tree planting adoption among 215 eligible participants. We observed positive associations of income with Normalized Difference Vegetation Index (NDVI) and leaf area index (LAI) within all radii around homes, and within yards of residents, that varied in strength. There were stronger associations of income with NDVI in front yards but LAI in back yards. Among Participants of Color, associations between income and NDVI were stronger than with Whites and exhibited no association with LAI. Tree planting uptake was not associated with income, education, race, nor employment status, but was positively associated with lot size, home value, lower population density, and area greenness. Our findings reveal significant complexity of intra-neighborhood associations between SES and greenness that could help shape future research and equitable greening implementation. Results show that previously documented links between SES and greenspace at large scales extend to residents' yards, highlighting opportunities to redress greenness inequities on private property. Our analysis found that uptake of no-cost residential planting and maintenance was nearly equal across SES groups but did not redress greenness inequity. To inform equitable greening, further research is needed to evaluate culture, norms, perceptions, and values affecting tree planting acceptance among low-SES residents.

The impact of residential greenness on psychological distress among Hurricane Katrina survivors

Residential greenness may support mental health among disaster-affected populations; however, changes in residential greenness may disrupt survivors' sense of place. We obtained one pre- and three post-disaster psychological distress scores (Kessler [K]-6) from a cohort (n = 229) of low-income mothers who survived Hurricane Katrina in New Orleans, Louisiana, USA. Greenness was assessed using average growing season Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) in the 300 m around participants' homes at each time point. We used multivariable logistic regressions to evaluate two hypotheses: 1) that cross-sectional greenness (above vs. below median) was associated with reduced psychological distress (K6≥5); and 2) that changes in residential greenness were associated with adverse mental health. When using EVI, we found that a change in level of greenness (i.e., from high to low [high-low], or from low to high [low-high] greenness, comparing pre- and post-Katrina neighborhoods) was associated with increased odds of distress at the first post-storm survey, compared to moving between or staying within low greenness neighborhoods (low-high odds ratio [OR] = 3.48; 95% confidence interval [CI] = 1.40, 8.62 and high-low OR = 2.60; 95% CI: 1.05, 6.42). Results for NDVI were not statistically significant. More research is needed to characterize how residential greenness may impact the health of disaster survivors, and how these associations may change over time.

Street-view and traditional greenness metrics with adults' sitting time in high-density living in Hong Kong: Comparing associations, air pollution and noise roles, and population heterogeneity

BACKGROUND

Emerging evidence suggests neighborhood greenness is associated with physical activity; however, the sitting-specific associations with multi-source greenness metrics remain unclear, especially in high-density cities.

OBJECTIVES

This cross-sectional study examined: 1) the associations of street-view greenness (SVG) and traditional greenness metrics (i.e., Normalized Difference Vegetable Index (NDVI) and park density) with sitting time; 2) the potential moderating/mediating roles of objective/perceived air pollution and perceived roadside noise; and 3) how the associations vary by demographics and socioeconomic status.

METHODS

Interview survey data of 1977 adults in Hong Kong from 2014 and 2015 was linked to environmental data. Using an object-based image classification algorithm, SVG was derived from Google Street View images, capturing human-viewed street-level greenery. NDVI was derived from Landsat 8 satellite images using the normalized difference between the near-infrared and red bands. Park density was calculated by point density. In the main analyses including regressions, parallel mediation, interaction, and stratified models, the environmental metrics were measured within a 1000-m Euclidean buffer of residence.

RESULTS

SVG and park density were negatively associated with sitting time after adjusting for covariates including physical activity while NDVI was not significantly associated with sitting time, and results were robust with 800-1800 m Euclidean and 1400-1800 m network distance. Greenness-sitting associations were not moderated/mediated by perceived air pollution/roadside noise while SVG-sitting associations were moderated by objective NO₂, O₃, and PM_2.5 and mediated by O₃. SVG-sitting associations differed by age, having under-school-aged children, birthplace, education, and occupation type while associations between traditional greenness metrics and prolonged sitting showed no significant population heterogeneity.

CONCLUSIONS

SVG appears to be more accurate in estimating exposure than traditional metrics to reflect greenness-sitting associations, objective air pollution moderating and mediating roles, and population heterogeneity, which emphasizes the importance of street-level greenness planning for health promotion in terms of reducing sitting time.

Relations of residential green and blue spaces with new-onset chronic kidney disease

OBJECTIVE

We investigated the associations of residential green and blue spaces with chronic kidney disease (CKD) incidence, which have rarely been examined.

METHODS

A total of 346,697 participants from UK Biobank without CKD at baseline were included. Land coverage percentages of residential green and blue spaces at 300 m and 1000 m buffer were estimated using land use data. The primary outcome was new-onset CKD ascertained through linkage to health administrative datasets.

RESULTS

During a median follow-up of 12.0 years, 10,101 new-onset CKD were documented. Overall, there were significant inverse associations of residential green space coverage at 300 m (per SD [21.7 %] increment, HR,0.96, 95%CI, 0.94-0.98) and 1000 m (per SD [20.7 %] increment, HR, 0.96, 95%CI, 0.94-0.98) buffer, and blue space at 300 m (per SD [1.1 %] increment, HR, 0.97, 95%CI, 0.95-1.00) and 1000 m (per SD [1.2 %] increment, HR, 0.97, 95%CI, 0.95-1.00) buffer with the risk of new-onset CKD. Moreover, at 300 m buffer, a significantly lower risk of new-onset CKD (HRs ranging from 0.88 to 0.90) was found in participants with both higher green space and higher blue space (both of them in the 2nd or 3rd tertile, and at least one in the 3rd tertile). At 1000 m buffer, a significantly lower risk of new-onset CKD (HRs ranging from 0.79 to 0.89) was found in participants with either higher green space or higher blue space (either one in the 2nd or 3rd tertile). Furthermore, PM2.5 did not significantly modify the association of exposure to green and blue space with the risk of CKD (all P for interactions >0.05).

CONCLUSIONS

Residential green and blue spaces, especially at larger buffer sizes, might be protective factors against new-onset CKD.

Associations between Residential Greenspace and Fecundability in a North American Preconception Cohort Study

BACKGROUND

Residential green space can have positive physiological effects on human health through various mechanisms, including reducing stress and/or depression or facilitating physical activity. Although green space has been consistently associated with improved birth outcomes in several studies, there has been limited study of its effect on other reproductive outcomes, including fertility.

OBJECTIVE

We examined associations between residential green space and fecundability, the per-cycle probability of conception.

METHODS

We analyzed data from 8,563 female participants enrolled between 2013 and 2019 in Pregnancy Study Online (PRESTO), a prospective preconception cohort study of North American couples attempting conception. Participants completed a baseline questionnaire on sociodemographic, behavioral, and reproductive factors, and bimonthly follow-up questionnaires for up to 12 months to ascertain pregnancies. Using geocoded addresses, we calculated residential green space exposure using the Normalized Difference Vegetation Index (NDVI) within 50-, 100-, 250-, and 500 -m buffers across multiple temporal scales: annual maximum, seasonal maximum, and seasonal mean. We used proportional probabilities regression models to estimate fecundability ratios (FRs), adjusting for sociodemographic, behavioral, and neighborhood characteristics. We also evaluated the extent to which associations were mediated by reductions in perceived stress or depressive symptoms and increased physical activity.

RESULTS

When comparing the highest (≥ 0.8 ) with the lowest (< 0.2 ) NDVI exposures within 50 m , we observed positive associations in the annual maximum NDVI [FR: 1.33; 95% confidence interval (CI): 1.06, 1.67] and seasonal maximum NDVI (FR: 1.19; 95% CI: 1.00, 1.41) models, but little association in the seasonal mean NDVI models (FR: 0.98; 95% CI: 0.73, 1.30). Restricted cubic splines showed evidence of nonlinearity in this association. Results were similar across buffer distances. Perceived stress, depressive symptoms, and physical activity explained ≤ 5 : 0 % of mediation across all NDVI metrics.

DISCUSSION

In this cohort, greater residential green space was associated with a modest increase in fecundability. https://doi.org/10.1289/EHP10648.

Does the quality of street greenspace matter? Examining the associations between multiple greenspace exposures and chronic health conditions of urban residents in a rapidly urbanising Chinese city

BACKGROUND

Numerous studies have demonstrated that greenspace(GS) exposure is associated with health improvements in individuals with hypertension and diabetes. However, studies examining the associations between multiple GS exposures and chronic health conditions in developing countries are limited.

METHODS

Geospatial data and spatial analysis were employed to objectively measure the total neighbourhood vegetative cover (mean value of normalised difference vegetation index [NDVI] within specific buffer zone) and proximity to park-based GS (network distance from home to the entrance of park-based GS). Street view imagery and machine learning techniques were used to measure the subjective perceptions of street GS quality. A multiple linear regression model was applied to examine the associations between multiple GS exposures and the prevalence of hypertension and diabetes in neighbourhoods located in Qingdao, China.

RESULTS

The model explained 29.8% and 28.2% of the prevalence of hypertension and diabetes, respectively. The results suggested that: 1) the total vegetative cover of the neighbourhood was inversely correlated with the prevalence of hypertension (β = -0.272, p = 0.013, 95% confidence interval (CI): [-1.332, -0.162]) and diabetes (β = -0.230, p = 0.037, 95% CI: [-0.720, -0.008]). 2) The street GS quality was negatively correlated with the prevalence of hypertension (β = -0.303, p = 0.007, 95% CI: [-2.981, -0.491]) and diabetes (β = -0.309, p = 0.006, 95% CI: [-1.839, -0.314]). 3) Proximity to park-based GS and the prevalence of hypertension and diabetes mellitus were not significantly correlated.

CONCLUSIONS

This study used subjective and objective methods to comprehensively assess the greenspace exposure from overhead to eye level, from quantity, proximity to quality. The results demonstrated the beneficial relationships between street GS quality, total vegetative cover, and chronic health in a rapidly urbanising Chinese city. Furthermore. the effect of street GS quality was more pronounced in potentially mitigating chronic health problems, and improving the quality of street GS might be an efficient and effective intervention pathway for addressing chronic health issues in densely populated cities.