Residential greenness and indicators of stress and mental well-being in a Canadian national-level survey

Intra-neighborhood associations between residential greenness and blood pressure

INTRODUCTION

Previous investigations have reported that individuals living in greener neighborhoods have better cardiovascular health. It is unclear whether the effects reported at large geographic scales persist when examined at an intra-neighborhood level. The effects of greenness have not been thoroughly examined using high-resolution metrics of greenness exposure, and how they vary with spatial scales of assessment or participant characteristics.

METHODS

We conducted a cross-sectional assessment of associations between blood pressure and multiple high-resolution measures of residential area greenness in spatially concentrated HEAL Study cohort of the Green Heart Project. We employed generalized linear models, accounting for individual-level covariates, to examine associations between different high-resolution measures of greenness and blood pressure among 667 participants in a 4 sq. mile contiguous neighborhood area in Louisville, KY.

RESULTS

In adjusted models, we observed significant inverse associations between residential greenness, measured by leaf area index (LAI), and systolic blood pressure (SBP) within 150-250 m and 500 m of homes, but not for Normalized Difference Vegetation Index (NDVI) or grass cover. Weaker associations were also found with diastolic blood pressure (DBP). Significant positive associations were observed between LAI and SBP among participants who reported being female, White, without obesity, non-exercisers, non-smokers, younger age, of lower income, and who had high nearby roadway traffic. We found few significant associations between grass cover and SBP, but an inverse association in those with obesity, but positive associations for those without obesity.

CONCLUSIONS

We found that leaf surface area of trees around participants home is strongly associated with lower blood pressure, with little association with grass cover. These effects varied with participant characteristics and spatial scales. More research is needed to test causative links between greenspace types and cardiovascular health and to develop population-, typology-, and place-based evidence to inform greening interventions.

Health and wellbeing benefits of urban forests in winter: a narrative review

Urban trees and green spaces, hereafter, urban forests, are known to contribute to human health and wellbeing. However, research has predominantly focused on warm seasons. To understand whether these benefits extend to winter months, when vegetation is dormant, we conducted a narrative review of the health outcomes associated with urban forests in winter in cities with cold climates. We synthesized findings from 21 studies originating from Asia, Europe and North America. The most studied health outcomes were mental health, physical activity and physiological relaxation, all showing a positive relationship with urban forest exposure. These finding appear similar to those observed in warmer seasons. However, more studies are needed, on a diversity of health outcomes, to draw more robust conclusions in this emerging research field. Future research on urban forests should therefore consider winter and the effect of seasonality to improve health and wellbeing of urban dwellers in all seasons.

STROBE-GEMA: a STROBE extension for reporting of geographically explicit ecological momentary assessment studies

CONTEXT

While a growing body of research has been demonstrating how exposure to social and built environments relate to various health outcomes, specific pathways generally remain poorly understood. But recent technological advancements have enabled new study designs through continuous monitoring using mobile sensors and repeated questionnaires. Such geographically explicit momentary assessments (GEMA) make it possible to link momentary subjective states, behaviors, and physiological parameters to momentary environmental conditions, and can help uncover the pathways linking place to health. Despite its potential, there is currently no review of GEMA studies detailing how location data is used to measure environmental exposure, and how this in turn is linked to momentary outcomes of interest. Moreover, a lack of standard reporting of such studies hampers comparability and reproducibility.

AIMS

The objectives of this research were twofold: 1) conduct a systematic review of GEMA studies that link momentary measurement with environmental data obtained from geolocation data, and 2) develop a STROBE extension guideline for GEMA studies.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria consisted of a combination of repeated momentary measurements of a health state or behavior with GPS coordinate collection, and use of these location data to derive momentary environmental exposures. To develop the guideline, the variables extracted for the systematic review were compared to elements of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and CREMAS (CRedibility of Evidence from Multiple Analyses of the Same data) checklists, to provide a new guideline for GEMA studies. An international panel of experts participated in a consultation procedure to collectively develop the proposed checklist items. RESULTS AND DEVELOPED TOOLS: A total of 20 original GEMA studies were included in the review. Overall, several key pieces of information regarding the GEMA methods were either missing or reported heterogeneously. Our guideline provides a total of 27 categories (plus 4 subcategories), combining a total of 70 items. The 22 categories and 32 items from the original STROBE guideline have been integrated in our GEMA guideline. Eight categories and 6 items from the CREMAS guideline have been included to our guideline. We created one new category (namely "Consent") and added 32 new items specific to GEMA studies.

CONCLUSIONS AND RECOMMENDATIONS

This study offers a systematic review and a STROBE extension guideline for the reporting of GEMA studies. The latter will serve to standardize the reporting of GEMA studies, as well as facilitate the interpretation of results and their generalizability. In short, this work will help researchers and public health professionals to make the most of this method to advance our understanding of how environments influence health.

Mental health is positively associated with biodiversity in Canadian cities

Cities concentrate problems that affect human well-being and biodiversity. Exploring the link between mental health and biodiversity can inform more holistic public health and urban planning. Here we examined associations between bird and tree species diversity estimates from eBird community science datasets and national forest inventories with self-rated mental health metrics from the Canadian Community Health Survey. We linked data across 36 Canadian Metropolitan Areas from 2007-2022 at a postal code level. After controlling for covariates, we found that bird and tree species diversity were significantly positively related to good self-reported mental health. Living in a postal code with bird diversity one standard deviation higher than the mean increased reporting of good mental health by 6.64%. Postal codes with tree species richness one standard deviation more than the mean increased reporting of good mental health by 5.36%. Our results suggest that supporting healthy urban ecosystems may also benefit human well-being.

Associations between residential greenness and obesity phenotypes among adults in Southwest China

BACKGROUND

Although exposure to greenness has generally benefited human metabolic health, the association between greenness exposure and metabolic obesity remains poorly studied. We aimed to investigate the associations between residential greenness and obesity phenotypes and the mediation effects of air pollutants and physical activity (PA) level on the associations.

METHODS

We used the baseline of the China Multi-Ethnic Cohort (CMEC) study, which enrolled 87,613 adults. Obesity phenotypes were defined based on obesity and metabolic status, including metabolically unhealthy obesity (MUO), non-obesity (MUNO), metabolically healthy obesity (MHO), and non-obesity (MHNO). Greenness exposure was measured as the 3-year mean values of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) within the 500-m buffer zones around the participants' residence. Multivariable logistic regression was used to estimate the associations between greenness and obesity phenotypes. Stratified analyses by age, sex, educational level, and urbanicity were performed to identify how the effect varies across different subgroups. Causal mediation analysis was used to examine the mediation effects of air pollutants and PA level.

RESULTS

Compared with MHNO, each interquartile range (IQR) increase in greenness exposure was associated with reduced risks of MHO (ORNDVI [95% CI] = 0.87 [0.81, 0.93]; OREVI = 0.91 [0.86, 0.97]), MUO (ORNDVI = 0.83 [0.78, 0.88]; OREVI = 0.86 [0.81, 0.91]), and MUNO (ORNDVI = 0.88 [0.84, 0.91]; OREVI = 0.89 [0.86, 0.92]). For each IQR increase in both NDVI and EVI, the risks of MHO, MUO, and MUNO were reduced more in men, participants over 60 years, those with a higher level of education, and those living in urban areas, compared to their counterparts. Concentrations of particulate matter (PM) and PA level partially mediated the associations between greenness exposure and obesity phenotypes.

CONCLUSIONS

Exposure to residential greenness was associated with decreased risks of MHO, MUO, and MUNO, which was mediated by concentrations of PM and PA level, and modified by sex, age, educational level, and urbanicity.

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 Green Heart Project: Objectives, Design, and Methods

The Green Heart Project is a community-based trial to evaluate the effects of increasing greenery on urban environment and community health. The study was initiated in 2018 in a low-to-middle-income mixed-race residential area of nearly 28,000 residents in Louisville, KY. The 4 square mile area was surveyed for land use, population characteristics, and greenness, and assigned to 8 paired clusters of demographically- and environmentally matched "target" (T) and adjacent "control" (C), clusters. Ambient levels of ultrafine particles, ozone, oxides of nitrogen, and environmental noise were measured in each cluster. Individual-level data were acquired during in-person exams of 735 participants in Wave 1 (2018-2019) and 545 participants in Wave 2 (2021) to evaluate sociodemographic and psychosocial factors. Blood, urine, nail, and hair samples were collected to evaluate standard cardiovascular risk factors, inflammation, stress, and pollutant exposure. Cardiovascular function was assessed by measuring arterial stiffness and flow-mediated dilation. After completion of Wave 2, more than 8,000 mature, mostly evergreen, trees and shrubs were planted in the T clusters in 2022. Post planting environmental and individual-level data were collected during Wave 3 (2022) from 561 participants. We plan to continue following changes in area characteristics and participant health to evaluate the long-term impact of increasing urban greenery.

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.

On the relationship between green space and civic engagement: The roles of well-being, outgroup trust, and activity level

Much research has been devoted to the positive effect of green space on prosociality, but little is known about its impact on civic engagement. It is also unclear how the effect takes place. This research fills the voids by regressing 2440 US citizen's civic engagement on the vegetation density and park area in their neighborhoods. It further examines if the effect is due to changes in well-being, interpersonal trust, or activity level. Park area predicts higher civic engagement, which is mediated by higher trust in outgroups. However, the data is inconclusive about the effect of vegetation density and the well-being mechanism. In contrast to the activity hypothesis, the effect of parks on civic engagement is stronger in unsafe neighborhoods, suggesting that they are valuable resources to combat neighborhood problems. The results bring insights into how individuals and communities can benefit the most from green spaces in the neighborhood.

Effects of residential greenness and genetic predisposition on hemoglobin A1c and type 2 diabetes: Gene-environment interaction analysis from a nationwide study

BACKGROUND

Current evidence on the relations of residential greenness with glucose homeostasis and type 2 diabetes (T2D) remained largely uncertain. Most importantly, no prior studies have investigated whether genetic predisposition modifies the above associations.

METHODS

We leveraged data from the UK Biobank prospective cohort study, with participants enrolled between 2006 and 2010. Residential greenness was assessed by using the Normalized Difference Vegetation Index, and the weighting T2D-specific genetic risk score (GRS) was constructed based on previously published genome-wide association studies. Linear regression models and logistic regression models were used to investigate associations of residential greenness with glycated hemoglobin (HbA_1c) and T2D prevalence, respectively. Interaction models explored whether genetic predisposition modifies greenness-HbA_1c/T2D associations.

RESULTS

Among 315,146 individuals (mean [SD] age, 56.59 [8.09] years), each one-unit increase in residential greenness was associated with reduction in HbA_1c (β: -0.87, 95% CI: -1.16 to -0.58) and a 12% decrease in odds of T2D (OR: 0.88, 95% CI: 0.79 to 0.98), respectively. Additionally, interaction analyses further demonstrated that residential greenness and genetic risk had cumulative effects on HbA_1c and T2D. Compared with individuals who were exposed to low greenness and had high GRS, participants with low GRS and high greenness had a significant decline in HbA_1c (β: -2.96, 95% CI: -3.10 to -2.82, P for interaction = 0.04) and T2D (OR: 0.47, 95% CI: 0.45 to 0.50, P for interaction = 0.09).

CONCLUSIONS

We add novel evidence that residential greenness has protective effects on glucose metabolism and T2D, and those beneficial effects can be amplified by low genetic risk. Our findings may facilitate the improvement of the living environment and the development of prevention strategies by considering genetic susceptibility to T2D.

Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales

Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index β =  - 1.84, 95% confidence interval (CI) - 3.63, - 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none β = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14-70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.

Neighbourhood greenness moderates the association between physical activity and geriatric-relevant health outcomes: an analysis of the CLSA

BACKGROUND

The purpose of this analysis was to evaluate the relationship between baseline physical activity levels of older adults and geriatric-relevant health outcomes at 3-year follow-up, and to determine whether baseline neighbourhood characteristics alter this association.

METHODS

Data from the Canadian Longitudinal Study on Aging (CLSA) were used to assess geriatric-relevant outcomes of physical impairment, medication use, severity of daily pain, and depressive symptoms. Data from the Canadian Active Living Environments (Can-ALE) and the Normalized Difference Vegetative Index (NDVI) were used to determine neighbourhood walkability and greenness, respectively. The analytic sample included adults who were 65 years or older at baseline [Formula: see text]. Adjusted odds ratios and 95% confidence intervals for the base relationships were calculated using proportional odds logistic regression (physical impairment, pain, medication use), and linear regression (depressive symptoms). Moderation effects of environmental factors were assessed using greenness and walkability.

RESULTS

The base relationships showed protective associations between each additional hour per week of total physical activity and physical impairment [Formula: see text] daily pain severity [Formula: see text] medication use [Formula: see text], and depressive symptoms [Formula: see text]. Additive moderation effects were seen when greenness was added to physical impairment [Formula: see text], daily pain severity [Formula: see text], and depressive symptoms [Formula: see text] but no moderation was seen with walkability. Sex differences were observed. For example, greenness moderation was found in severity of daily pain in males but not in females.

CONCLUSION

Future research investigating geriatric-relevant health outcomes and physical activity should consider neighbourhood greenness as a potential moderator.

Association of greenness with COVID-19 deaths in India: An ecological study at district level

BACKGROUND

The world has witnessed a colossal death toll due to the novel coronavirus disease-2019 (COVID-19). A few environmental epidemiology studies have identified association of environmental factors (air pollution, greenness, temperature, etc.) with COVID-19 incidence and mortality, particularly in developed countries. India, being one of the most severely affected countries by the pandemic, still has a dearth of research exploring the linkages of environment and COVID-19 pandemic.

OBJECTIVES

We evaluate whether district-level greenness exposure is associated with a reduced risk of COVID-19 deaths in India.

METHODS

We used average normalized difference vegetation index (NDVI) from January to March 2019, derived by Oceansat-2 satellite, to represent district-level greenness exposure. COVID-19 death counts were obtained through May 1, 2021 (around the peak of the second wave) from an open portal: covid19india.org. We used hierarchical generalized negative binomial regressions to check the associations of greenness with COVID-19 death counts. Analyses were adjusted for air pollution (PM_2.5), temperature, rainfall, population density, proportion of older adults (50 years and above), sex ratio over age 50, proportions of rural population, household overcrowding, materially deprived households, health facilities, and secondary school education.

RESULTS

Our analyses found a significant association between greenness and reduced risk of COVID-19 deaths. Compared to the districts with the lowest NDVI (quintile 1), districts within quintiles 3, 4, and 5 have respectively, around 32% [MRR = 0.68 (95% CI: 0.51, 0.88)], 39% [MRR = 0.61 (95% CI: 0.46, 0.80)], and 47% [MRR = 0.53 (95% CI: 0.40, 0.71)] reduced risk of COVID-19 deaths. The association remains consistent for analyses restricted to districts with a rather good overall death registration (>80%).

CONCLUSION

Though cause-of-death statistics are limited, we confirm that exposure to greenness was associated with reduced district-level COVID-19 deaths in India. However, material deprivation and air pollution modify this association.

Associations of ambient temperature with mortality for ischemic and hemorrhagic stroke and the modification effects of greenness in Shandong Province, China

BACKGROUND

Evidence is scant on the relative and attributable contributions of ambient temperature on stroke subtypes mortality. Few studies have examined modification effects of multiple greenness indicators on such contributions, especially in China. We quantified the associations between ambient temperature and overall, ischemic, and hemorrhagic stroke mortality; further examined whether the associations were modified by greenness.

METHODS

We conducted a multicenter time-series analysis from January 1, 2013 to December 31, 2019. we adopted a distributed lag non-linear model to evaluate county-specific temperature-stroke mortality associations. We then applied a random-effects meta-analysis to pool county-specific effects. Attributable mortality was calculated for cold and heat, defined as temperatures below and above the minimum mortality temperature (MMT). Finally, We conducted a multivariate meta-regression to determine associations between greenness and stroke mortality risks for cold and heat, using normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) as quantitative indicators of greenness exposure.

RESULTS

In the study period, 138,749 deaths from total stroke were reported: 86,873 ischemic and 51,876 hemorrhagic stroke. We observed significant W-shaped relationships between temperature and stroke mortality, with substantial differences among counties and regions. With MMT as the temperature threshold, 17.16 % (95 % empirical CI, 13.38 %-19.75 %) of overall, 20.05 % (95 % eCI, 16.46 %-22.70 %) of ischemic, and 12.55 % (95 % eCI, 5.59 %-16.24 %) of hemorrhagic stroke mortality were attributable to non-optimum temperature (combining cold and heat), more mortality was caused by cold (14.94 %; 95 % eCI, 11.57 %-17.34 %) than by heat (2.22 %; 95 % eCI, 1.54 %-2.72 %). Higher levels of NDVI, SAVI and EVI were related to mitigated effects of non-optimum temperatures-especially heat.

CONCLUSIONS

Exposure to non-optimum temperatures aggravated stroke mortality risks; increasing greenness could alleviate that risks. This evidence has important implications for local communities in developing adaptive strategies to minimize the health consequences of adverse temperatures.

The Differences by Sex and Gender in the Relationship Between Urban Greenness and Cardiometabolic Health: A Systematic Review

In an increasingly urbanized world, where cardiometabolic issues in cities have raised public health concerns, urban greenness is known to be beneficial for some of the most common health issues. However, the examination of the contribution of sex and gender regarding the benefits of urban greenness for people's cardiometabolic health is lacking. For that reason, we conducted a systematic review of previous literature on the topic following the PRISMA methodology. Additionally, we assessed the quality of the included articles, which we found satisfactory as most papers were of very good or good quality. We explored the relationship between urban greenness exposure and cardiovascular risk factors, cardiovascular diseases, and mortality from cardiovascular diseases. Results suggest that urban greenness is protective against cardiovascular risk factors, diseases, and mortality. When stratifying results by sex and gender, findings point to urban greenness being more beneficial for women and females in stroke and cardiovascular risk factors, except for hypertension and lipid accumulation product. On the other hand, males were more protected by urban greenness in terms of cardiovascular diseases and CVD-related mortality, thus proving that sex and gender health inequalities exist. Furthermore, looking towards the future, research needs to use the proper terminology for sex and gender and policy makers should design urban greenness with a gender perspective.

Association between smoking and hypertension under different PM2.5 and green space exposure: A nationwide cross-sectional study

Background

Smoking has been widely reported to have a significant relationship with hypertension, but the past description of this relationship has not been uniform. In addition, there has been a lack of research to discuss the impact of environmental exposure on the relationship between smoking and hypertension. Therefore, this study estimates the association between smoking and hypertension in middle aged and elderly people in China under different PM_2.5 (fine particulate matter) concentrations and the green space exposure conditions.

Methods

Individual sample data from the China Health and Retirement Longitudinal Study in 2018 and the long-term average exposure concentration of fine particles and green space exposure for all participants were used with a multilevel binary logistic mixed effects model. Adjustments were made for sociodemographic characteristics and other health behaviors including drinking, physical activity, and social activity. The normalized difference vegetation index (NDVI) and PM_2.5 concentration stratification were assigned with the median of the population exposure concentration as the dividing line, and the dual environmental factor stratification was assigned in combination with the two types of environmental exposure. The analysis was also stratified using age groups.

Results

A total of 10,600 participants over the age of 45 were included in the study. The effects of smoking on hypertension were diverse under different environmental exposure conditions. There was a significant relationship between smoking behavior and hypertension in the Low-NDVI group, and the effect value of this relationship was significantly different from that in the High-NDVI group. Furthermore, for respondents exposed to low green spaces and high PM_2.5 environments at the same time (Low-NDVI/High-PM_2.5 group), their smoking behavior may lead to an increase in the risk of hypertension. In addition, the risk of hypertension caused by smoking in the middle-aged (45-64) was significant under low green space exposure, but the effect difference between the different age groups was not significant.

Conclusions

The relationship between smoking and hypertension was different under different environmental exposure conditions. Exposure to low green spaces may strengthen the association between smoking and hypertension risk. When participants were exposed to both low green spaces and high PM_2.5 concentrations, the risk of hypertension caused by smoking was significantly higher than that of those who were exposed to high green spaces and low PM_2.5 concentrations.

Residential greenness attenuated association of long-term air pollution exposure with elevated blood pressure: Findings from polluted areas in Northern China

Background

Evidence on the hypertensive effects of long-term air pollutants exposure are mixed, and the joint hypertensive effects of air pollutants are also unclear. Sparse evidence exists regarding the modifying role of residential greenness in such effects.

Methods

A cross-sectional study was conducted in typically air-polluted areas in northern China. Particulate matter with diameter < 1 μm (PM₁), particulate matter with diameter < 2.5 μm (PM_2.5), particulate matter with diameter < 10 μm (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃) were predicted by space-time extremely randomized trees model. We used the Normalized Difference Vegetation Index (NDVI) to reflect residential green space. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined. We also calculated the pulse pressure (PP) and mean arterial pressure (MAP). Generalized additive model and quantile g-computation were, respectively, conducted to investigate individual and joint effects of air pollutants on blood pressure. Furthermore, beneficial effect of NDVI and its modification effect were explored.

Results

Long-term air pollutants exposure was associated with elevated DBP and MAP. Specifically, we found a 10-μg/m³ increase in PM_2.5, PM₁₀, and SO₂ were associated with 2.36% (95% CI: 0.97, 3.76), 1.51% (95% CI: 0.70, 2.34), and 3.54% (95% CI: 1.55, 5.56) increase in DBP; a 10-μg/m³ increase in PM_2.5, PM₁₀, and SO₂ were associated with 1.84% (95% CI: 0.74, 2.96), 1.17% (95% CI: 0.52, 1.83), and 2.43% (95% CI: 0.71, 4.18) increase in MAP. Air pollutants mixture (one quantile increase) was positively associated with increased values of DBP (8.22%, 95% CI: 5.49, 11.02) and MAP (4.15%, 95% CI: 2.05, 6.30), respectively. These identified harmful effect of air pollutants mainly occurred among these lived with low NDVI values. And participants aged ≥50 years were more susceptible to the harmful effect of PM_2.5 and PM₁₀ compared to younger adults.

Conclusions

Our study indicated the harmful effect of long-term exposure to air pollutants and these effects may be modified by living within higher green space place. These evidence suggest increasing residential greenness and air pollution control may have simultaneous effect on decreasing the risk of hypertension.

Residential greenness, air pollution, and incident ischemic heart disease: A prospective cohort study in China

Greener residential surroundings are associated with beneficial health outcomes, whereas higher air pollution exposure is linked with elevated risks of chronic diseases. To date, limited studies have explored the interaction between residential greenness and air pollution on the risk of ischemic heart disease (IHD). We performed a prospective cohort study that included 29,141 adult participants recruited from Yinzhou District, Ningbo, China. Normalized Difference Vegetation Index (NDVI) around each participant's residence was calculated to measure residential greenness exposure. Land-use regression models were conducted to estimate long-term individual exposure to air pollutants, including nitrogen dioxide (NO₂) and particulate matter with aerodynamic diameters ≤ 2.5 μm (PM_2.5) and ≤10 μm (PM₁₀). Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations of residential greenness and air pollutants with the risk of incident IHD. During 101,172.5 person-years of follow-up, 1392 incident IHD cases were reported in the study population. Residential greenness, expressed as an interquartile range (IQR) increase in NDVI within 250 m, was inversely associated with incident IHD (HR = 0.89, 95%CI: 0.81,0.98). However, long-term exposures to air pollution were associated with higher IHD incidence (HR = 1.21, 95%CI:1.10,1.33 per IQR increase for PM_2.5; HR = 1.12, 95%CI:1.03,1.22 per IQR increase for PM₁₀; HR = 1.09, 95%CI:1.02,1.16 per IQR increase for NO₂). Mediation analyses suggested that the beneficial effect of residential greenness on incident IHD could be partly mediated by reducing the exposure to PM_2.5. These findings suggested that higher greenness was associated with decreased risk of IHD, while air pollutants were positively associated with incident IHD. Meanwhile, residential greenness may decrease the risk of IHD by reducing exposure to PM_2.5.

Associations of residential greenness, ambient air pollution, biological sex, and glucocorticoids levels in rural China

AIMS

To evaluate the associations between residential greenness and glucocorticoid levels and whether air pollutants and sex modify the relationship between greenness and glucocorticoid level in Chinese rural adults.

METHODS

We collected cross-sectional survey data from 6055 participants from the Henan Rural cohort. The three-year average residential greenness for participants was assessed using normalized difference vegetation index (NDVI) values from a satellite platform. Liquid chromatography-tandem mass spectrometry was employed to quantify the concentrations of glucocorticoids, which were measured by morning blood draw after at least 8 hr of fasting. A random forest model was employed to obtain the average concentrations of PM₁, PM_2.5, and PM₁₀. A general linear regression model was performed to estimate the associations of NDVI_500-m values with cortisol, 11-deoxycortisol, and cortisone. Furthermore, interaction plots were used to present the interaction effects of particulate matter, sex, and green space on glucocorticoid levels.

RESULTS

After adjusting for multiple variables, an elevated average NDVI_500-m value in the total population was associated with a decrease in cortisol levels (β = -0.063, 95 % confidence interval (CI): - 0.118, - 0.008), and 11-deoxycortisol levels (β = -0.118, 95 % CI: -0.190, -0.047), as well as an increase in cortisone levels (β = 0.130, 95 % CI: 0.079, 0.181). By adding the interaction terms of air pollutants and residential greenness into the regression model, interaction effects between air pollutants and residential greenness were found (cortisol, PM_2.5: P interaction=:0.018; PM₁₀: P interaction=0.016; 11-deoxycortisol, all pollutants: P interaction< 0.001), suggesting that the protective effect of residential greenness on serum glucocorticoids disappeared accompanying with increased concentrations of particulate matter. Moreover, trends towards modification in the association between green space and glucocorticoid levels were also evident by sex, but these did not reach statistical significance (for all glucocorticoids: P interaction> 0.05).

CONCLUSION

Long-term exposure to green space was negatively correlated with cortisol and 11-deoxycortisol levels, and positively correlated with cortisone levels. There may be sex differences in these associations. Moreover, the protective effect of residential greenness on serum glucocorticoids was altered by high levels of particulate matter.

Residential open space and the perception of health benefits: How much is the public willing to pay?

Emerging evidence suggests that residential open space (ROS) is beneficial for multiple health outcomes for urban residents. However, the general public's understanding of and demand for the health benefits related to ROS have not been widely explored. This study aims to examine the impact of residents' socioeconomic status and perceptions of landscape health benefits on their willingness to pay (WTP) for ROS and to evaluate the perceived monetary value of different residential landscape elements. An online survey with 1348 respondents was conducted between August 2020 and October 2021 in China using a contingent valuation (CV) method. Respondents perceived the landscape benefits related to mental health to be higher than those related to physical and social health. The perception of landscape health benefits positively affected WTP and the WTP value of ROS. Residents' monthly income was a significant influencing factor for WTP and the latter's value. For individuals with positive WTP, the average annual WTP for ROS was CNY 68.98 (USD 10.81), while for all the respondents, the estimated mean annual WTP for ROS was CNY 91.75 (USD 14.38). Moreover, the estimated WTP for plants was the highest, whereas the WTP for activity spaces was estimated as the lowest. These findings may improve city planners' and community managers' understanding of the perceived value of residential landscapes among the public and help them make effective decisions to build healthy communities.

Residential green space and mental health-related prescription medication sales: An ecological study in Belgium

BACKGROUND

Residential green space has been associated with mental health benefits, but how such associations vary with green space types is insufficiently known.

OBJECTIVE

We aimed to investigate associations between types and quantities of green space and sales of mood disorder medication in Belgium.

METHODS

We used aggregated sales data of psycholeptics and psychoanaleptics prescribed to adults from 2006 to 2014. Generalized mixed effects models were used to investigate associations between relative covers of woodland, low-green, grassland, and garden, and average annual medication sales. Models were adjusted for socio-economic background variables, urban-rural differences, and administrative region, and included random effects of latitude and longitude.

RESULTS

Urban census tracts were associated with 9-10% higher medication sales. In nationwide models, a 10% increase in relative cover of woodland, garden, and grass was associated with a 1-2% decrease in medication sales. The same association was found for low green but only for men. In stratified models, a 10% increase in relative cover of any green space type in urban census tracts was associated with a decrease of medication sales by 1-3%. In rural census tracts, no protective associations between green space and mood disorder medication sales were observed, with the exception of relative woodland cover for women (-1%), and low green was associated with higher medication sales (+6-7%).

CONCLUSIONS

Taken together, these results suggest that living in green environments may be beneficial for adult mental health. Woodland exposure seemed the most beneficial, but the amount of green space was more important than the type. Results underline the importance of conserving green space in our living environment, for the conservation of biodiversity and for human health.

Factors Related to Life Satisfaction of Older Adults at Home: A Focus on Residential Conditions

This study examined which residential conditions increase older adults’ life satisfaction at home. We used data from 8903 participants over 65 years old who did not need help in their daily lives from a 2020 survey of older adults conducted by the Korea Institute for Health and Social Affairs. Data analysis was conducted using descriptive statistics, independent sample t-test, Pearson correlation analysis, and hierarchical multiple regression with weights. The final model explained 34.2% of life satisfaction in old age. Residential conditions that increased life satisfaction the most in old age were the community environment (β = 0.16, p < 0.001) and satisfaction with the house (β = 0.15, p < 0.001). Other conditions that significantly affected life satisfaction were safety (β = 0.08, p < 0.001), interaction with neighbors (β = 0.08, p < 0.001), distance from children or relatives (β = 0.08, p < 0.001), frequency and route of public transportation (β = 0.05, p < 0.001), and abundance and distance of green spaces (β = 0.02, p = 0.031). Housing welfare policies should consider these results to increase life satisfaction for an increasingly aging population. Moreover, these data can be used to design age-friendly community environments.

Air Pollution, Foreign Direct Investment, and Mental Health: Evidence From China

Recently, there has been interest in the relationship between mental health and air pollution; however, the results are inconsistent and the contribution of foreign direct investment (FDI) has received little attention. This article studies the effects of air pollution on mental health and the moderating role of FDI based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2015 and 2018 applying the fixed effects panel regression approach and the threshold model. The results show that mental health is adversely affected by air pollution, especially PM_2.5, PM₁₀, sulfur dioxide (SO₂), carbon monoxide (CO), and nitrogen dioxide (NO₂). Second, FDI has an alleviating influence on the negative relationship. Third, the effects of air pollution and FDI are heterogeneous based on regional characteristics, including location, medical resource and investment in science and technology, and individual characteristics covering education level, age, income, and physical health. Finally, the threshold effects show that FDI has a moderating effect when it is >1,745.59 million renminbi (RMB). There are only 11.19% of cities exceeding the threshold value in China. When the value of air quality index (AQI) exceeds 92.79, air pollution is more harmful to mental health. Government should actively introduce high-quality FDI at the effective level and control air pollution to improve mental health.

Increased urban greenness associated with improved mental health among middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVES

Some studies suggest that residential surrounding greenness is associated with improved mental health. Few of these studies have focussed on middle-aged and older adults, explored the modifying effects of social determinants of health, or accounted for the extent to which individuals interact with their neighbourhood environments.

METHODS

We analysed cross-sectional data collected from 26,811 urban participants of the Canadian Longitudinal Study of Aging who were between 45 and 86 years of age. Participants provided details on socioeconomic characteristics, health behaviours, and their frequency of neighbourhood interactions. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses at a buffer distance of 500 m. Four self-reported measures of mental health were considered: The Center for Epidemiologic Studies Depression Scale (CES-D-10; short scale), past diagnosis of clinical depression, perceptions of mental health, and the Satisfaction with Life Scale (SWLS). Regression models were used to describe associations between greenness and these outcomes, and spline models were fit to characterize the exposure-response function between greenness and CES-D-10 scores. Stratified analyses evaluated whether associations varied by sociodemographic status.

RESULTS

In adjusted models, we observed a 5% (Odds Ratio (OR) = 0.95; 95% CI = 0.90, 0.99) reduced odds of depressive symptoms in relation to an interquartile range increase of NDVI (0.06) within a 500 m buffer of the participant's residence. Similarly, we found an inverse association with a self-reported clinical diagnosis of depression (OR = 0.97; 95% CI = 0.92-1.01). Increases in surrounding greenness were associated with improved perceptions of mental health, and the SWLS. Our spline analyses found that beneficial effects between greenness and the CES-D-10 were strongest among those of lower income.

CONCLUSIONS

These findings suggest that residential greenness has mental health benefits, and that interventions to increase urban greenness can help reduce social inequalities in mental health.

Residential greenness and prevalence of chronic kidney disease: Findings from the China National Survey of Chronic Kidney Disease

Green space is associated with many health benefits, but evidence concerning the effects on chronic kidney disease (CKD) has not been investigated. Using the nationwide cross-sectional study of 47,204 adults from the China National Survey of Chronic Kidney Disease dataset and residential greenness assessed by the normalized difference vegetation index (NDVI), this study evaluated the association between residential greenness and CKD prevalence. An interquartile range increase in NDVI_1000m (0.26) was associated with decreased odds of CKD for all participants with an odds ratio (OR) of 0.79 (95% confidence interval [CI]: 0.73-0.86). Subgroup analyses demonstrated more apparent inverse associations in younger adults <65 years, male participants, people in higher socio-economic status, as well as people with smoking and alcohol drinking habit. In addition, more apparent inverse associations were found in regions with higher fine particulate matter (PM_2.5) concentration levels, with OR of 0.56 (95% CI: 0.49, 0.65) for higher pollution regions, and OR of 0.95 (95% CI: 0.83, 1.09) for lower pollution regions (P for interaction <0.001). The exposure-response curves captured more apparent declines in OR of CKD when in lower NDVI_1000m exposure ranges (<0.6), even controlling for the PM_2.5 concentration. Our results indicated that residential greenness might be beneficial for the prevention and control of CKD at the population level, suggesting the positive significance of strengthening green space construction, particularly in regions with low greenness.

Population Health Effects of Air Pollution: Fresh Evidence From China Health and Retirement Longitudinal Survey

The effects of air pollution on population health are currently a hot topic. However, few studies have examined the physical and mental health effects of air pollution jointly in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, this study explores how air pollution affects the physical and mental health of middle-aged and elderly residents. The empirical results highlight that air pollution can negatively affect both physical and mental health. In terms of physical health, those exposed to chronic shock are likely to suffer more adverse effects from air pollution than those exposed to acute shock. In terms of mental health, those exposed to depression suffer greater adverse effects than those exposed to episodic memory and mental cognition. Besides, heterogeneity analysis also shows that air pollution affects the mental and physical health of males more than females. Furthermore, the increase in air pollution is expected to result in huge hospitalization costs. Therefore, the Chinese government should formulate differentiated public health policies to reduce the effects of air pollution on the health of middle-aged and elderly residents.

Long-term ozone exposure and mortality from neurological diseases in Canada

BACKGROUND

There is increasing interest in the health effects of air pollution. However, the relationships between ozone exposure and mortality attributable to neurological diseases remain unclear.

OBJECTIVES

To assess associations of long-term exposure to ozone with death from Parkinson's disease, dementia, stroke, and multiple sclerosis.

METHODS

Our analyses were based on the 2001 Canadian Census Health and Environment Cohort. Census participants were linked with vital statistics records through 2016, resulting in a cohort of 3.5 million adults/51,045,700 person-years, with 8,500/51,300/43,300/1,300 deaths from Parkinson's/dementia/stroke/multiple sclerosis, respectively. Ten-year average ozone concentrations estimated by chemical transport models and adjusted by ground measurements were assigned to subjects based on postal codes. Cox proportional hazards models were used to calculate hazard ratios (HRs) for deaths from the four neurological diseases, adjusting for eight common demographic and socioeconomic factors, seven environmental indexes, and six contextual covariates.

RESULTS

The fully adjusted HRs for Parkinson's, dementia, stroke, and multiple sclerosis mortalities related to one interquartile range increase in ozone (10.1 ppb), were 1.09 (95% confidence interval 1.04-1.14), 1.08 (1.06-1.10), 1.06 (1.04-1.09), and 1.35 (1.20-1.51), respectively. The covariates did not influence significance of the ozone-mortality associations, except airshed (i.e., broad region of Canada). During the period of 2001-2016, 5.66%/5.01%/ 3.77%/19.11% of deaths from Parkinson's/dementia/stroke/multiple sclerosis, respectively, were attributable to ozone exposure.

CONCLUSIONS

We found positive associations between ozone exposure and mortality due to Parkinson's, dementia, stroke, and multiple sclerosis.

Green spaces, quality of life, and citizen perception in European cities

Urban green spaces generate a number of perceived benefits toward human health and well-being, including an overall improvement in the quality of life. To date, processes underlying these benefits are mostly investigated at city level, while very little research has been conducted at a larger scale, such as the European level. Evidence is lacking on the association between green spaces and citizens' perceived benefits based on variations among cities with different socio-economic conditions. This study aims to disentangle the relationship between greenness, citizens' perceived quality of life, the environment, social inclusion and urban management in 51 European cities, as well as the role of per capita income in moderating the effects of greenness on overall perceived quality of life. Through structural equation modeling, the effect of greenness was tested on citizens' perceived overall quality of life (i.e., on the environment, social inclusion, and urban management). The role of metropolitan gross domestic product per capita in moderating the relationship between greenness and citizens' perceptions on overall quality of life was investigated. Our findings confirm the influence of greenness on citizens' quality of life. More importantly, the influence of greenness on the overall perception of quality of life was considerably more marked in lower-income cities. This study represents one of the first attempts at exploring the complex mechanisms underlying the association between green space and citizens' well-being at continent level. Practical implications for European urban planners and policy makers are discussed.