Urban blue space and health and wellbeing in Hong Kong: Results from a survey of older adults

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.

Survey data linking coastal visit behaviours to socio-demographic and health profiles

Coastal destinations are highly popular for leisure, yet the effects of spending time at the coast on mental and physical health have remained underexplored. To accelerate the research about the effects of the coast on health, we compiled a dataset from a survey on a sample (N = 1939) of the adult Flemish population about their visits to the Belgian coast. The survey queried the number of days spent at the coast in the previous year or before and the following characteristics of their visits: how often they performed specific activities, which of the 14 municipal seaside resorts they visited, who they were with, what they mentally and physically experienced, and what reasons they had for not visiting the coast more often. The respondents' geo-demographic (including residential proximity to the coast), socio-economic, and health profile was also collected. We anticipate that investigations on the data will increase our understanding about the social structuring of coastal visits and give context to the effects of the coast on human health.

Exposure to blue space surroundings and depressive symptoms in young Chinese adults: The mediating role of sleep

OBJECTIVE

Existing evidence suggests that the natural environment can influence mental health. However, limited research has focused on the relationship between blue space and depressive symptoms in young adults. To investigate the association between blue space surroundings and depressive symptoms in young adults in China and explore the underlying mechanisms.

METHODS

The study was conducted between September and November 2019, including 2,743 young adults from China. We assessed the exposure to blue space around participants' living environments during June, July, and August 2019 using the Modified Normalized Difference Water Index (MNDWI). Blue indexes were calculated for 300 m, 1000 m, and 3000 m circular buffer zones near residential environments. Logistic regression models were employed to explore the associations between blue space exposures (quartiles) and depressive symptoms, exploring potential mechanisms through structural equation modeling (SEM), while accounting for potential confounders. Stratification analysis was used to identify sensitive populations.

RESULTS

Depressive symptoms were found in 148 (5.3%) of the 2,743 young adults in the study. We observed a negative correlation between depressive symptoms and average MNDWIs at participants' addresses (OR: 0.84; 95%CI: 0.72-0.98), within 300m (OR: 0.81; 95%CI: 0.70-0.95), 1000m (OR: 0.80; 95%CI: 0.69-0.93), and 3000m (OR:0.77; 95%CI: 0.66-0.89) buffer zones. Within the 1000m buffer zone, sleep was found to mediate 21% of the relationship between the presence of blue space and depressive symptoms. The stratified analysis revealed a stronger association between low MNDWI levels within the 1000m buffer zone and depressive symptoms in females (P < 0.05). Additionally, average MNDWI levels within the 3000m buffer zone were associated with depressive symptoms in both females and males.

CONCLUSIONS

Blue space could improve depressive symptoms, particularly in females, with sleep playing a mediating role. Incorporating blue spaces into environmental planning is important for improving 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.

Age-friendly neighbourhood environment, functional abilities and life satisfaction: A longitudinal analysis of older adults in urban China

The construction of age-friendly neighbourhoods is a priority for practice and policy to promote active ageing and increase life satisfaction for older adults. However, there has been a paucity of longitudinal evidence on the interaction effects of age-friendly neighbourhood environment and functional abilities on life satisfaction among older adults in urban China. This study makes the first attempt to examine the effect of person-environment fit on life satisfaction by the accumulative effects of age-friendliness of the baseline neighbourhood environment (measured within the WHO Age-Friendly City framework) on functional abilities and life satisfaction trajectories and the long-term effects of functioning changes on life satisfaction, drawing from four waves of longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and latent growth curve modelling. Results indicated that the age-friendliness of transportation was positively associated with functional abilities, and housing was the primary factor that shaped life satisfaction at the baseline. Better maintenance of functional abilities could promote life satisfaction over time. For older adults living in recently built neighbourhoods, social environment factors such as associations and facilities for social participation were more important in functional abilities, and communication and information were more important in life satisfaction. For those living in neighbourhoods built before 2000, physical environment factors such as transportation were essential in functional abilities, and housing was more essential in life satisfaction; health-related facilities and services at baseline exerted a cumulative effect on maintaining functional abilities in the long run. Our findings inform policymakers about how to effectively allocate public resources to enhance older adults' life satisfaction in the Chinese urban context.

Nature visits, but not residential greenness, are associated with reduced income-related inequalities in subjective well-being

Nature exposure can promote human health and well-being. Additionally, there is some, albeit mixed, evidence that this relationship is stronger for socio-economically disadvantaged groups (equigenesis). Using a cross-sectional survey of the Austrian population (N = 2300), we explored the relationships between both residential greenness and recreational nature visits, and affective (WHO-5 Well-Being Index) and evaluative (Personal Well-Being Index-7) subjective well-being. Partially supporting the equigenesis hypothesis, regression analyses controlling for potential confounders found that recreational visit frequency, but not residential greenness, moderated the effect of income-related disparities in both subjective well-being metrics. Results suggest that merely making neighborhoods greener may not itself help reduce inequalities in subjective well-being. Additionally, greater efforts are also needed to support individuals from all sectors of society to access natural settings for recreation as this could significantly improve the well-being of some of the poorest in society.

The impact of outdoor blue spaces on the health of the elderly: A systematic review

Research on natural health has identified the potential benefit of outdoor blue spaces for human health and wellbeing. However, the existing evidence has relatively limited attention to the elderly. This study aims to review the available evidence on outdoor blue spaces and health outcomes among older individuals and identify knowledge gaps. In accordance with the PRISMA guidelines, specific keywords were used to search for articles published in English from inception to October 2023. Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched, and 22 studies were identified in this review. We classified articles based on elderly health as general health (e.g., self-reported, perceived health and wellbeing), physical health (e.g., physical activity, physical function index), and mental health and wellbeing (e.g., depression). The findings indicated a positive correlation between outdoor blue space and the health of the elderly. In terms of the characteristics of exposure to outdoor blue spaces, direct contact (e.g., sensory-based) has not been well documented compared to indirect contact (e.g., distance, percentage, region-based). Although encouraging, the available body of evidence is limited and lacks consistency. Future research is needed to provide complementary evidence between outdoor blue spaces and elderly health.

How do weather conditions and environmental characteristics influence aesthetic preferences of freshwater environments?

Freshwater (inland) blue space environments provide a range of public health benefits to visitors. However, health related exposure outcomes are dynamic and can vary depending on several factors, including the environmental characteristics of freshwater environments and their surroundings. Developing and managing inland blue spaces to promote health and wellbeing therefore requires an understanding of whether specific freshwater attributes, and prevailing weather conditions, enhance or devalue landscape aesthetics. The aim of this study was to utilise a mixed-methods research approach to investigate aesthetic preferences of inland blue spaces. A three-phase data collection method was adopted involving (i) analysis of a national-scale landscape image dataset; in combination with (ii) a national-scale online survey; and (iii) a series of in-person focus groups. We found environmental characteristics associated with the waterbody itself, as well as the characteristics of the nearby green space, to have a significant impact on the overall aesthetic appeal of inland blue spaces. Strong preference was demonstrated for inland blue spaces perceived to be of a high environmental quality and which have a natural, rather than human-modified, appearance. The findings highlight the need to conserve the quality of both the waterbody and waterside environment to encourage frequent recreational use and maintain the beneficial public health outcomes associated with inland blue spaces.

Neighborhood Built Environments and Health in Later Life: A Literature Review

Objectives: This literature review aims to assess the current state of the field linking neighborhood environments to later-life health and wellbeing. Methods: We used electronic databases (e.g., PubMed, Google Scholar, and ProQuest) to search for studies published between 2010 and 2022 examining associations between neighborhood built environmental variables and later-life physical, cognitive, mental, and social health outcomes. Results: Among 168 studies reviewed, the majority were quantitative (n = 144) and cross-sectional (n = 122). Neighborhood environmental variables significantly associated with later-life health outcomes included population density/rurality, walkability/street connectivity, access to services and amenities, neighborhood quality and disorder, and parks/green/blue/open space. Neighborhoods operated through behavioral and biological pathways including hazardous exposures, affective states (e.g., stress and restoration), and lifestyle (e.g., exercise, socialization, and diet). Discussion: Neighborhoods and healthy aging research is a burgeoning interdisciplinary and international area of scholarship. Findings can inform upstream community interventions and strengthen clinical care.

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Beside the Seaside: Reflections on Local Green and Blue Spaces from Adults Aged over 50 in a Coastal Community

This qualitative study examined the perceptions of potential wellbeing benefits of local green and blue spaces for adults aged over 50 years in a coastal town in North West England. At a population level, living close to green and blue spaces is associated with better mental and physical health, with the strength of the benefits being inversely related to the economic prosperity of an area. However, living in economically disadvantaged coastal communities may be associated with poorer health and wellbeing, particularly for older adults, despite the proximity to blue (and often green) space. Exploring this apparent paradox was the aim of the present study. Through semi-structured interviews with members of a community group, we gained insight into lived experiences of local green and blue spaces. The main themes we developed from analysis of the conversations were accessibility, amenities, social connections, quality of environment, and recuperation and escape. Our findings illustrate that participants valued natural spaces that were local and accessible, particularly when they felt connected to them, and were less likely to visit spaces that were further away and that were perceived as being less welcoming or accessible. This study provides insights into the experiences of adults aged over 50 living in coastal areas and suggests that policies and interventions aimed at promoting wellbeing in this demographic should consider the value of hyper-local green and blue spaces and their potential to promote connectedness to nature.

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.

Association between urban green space and postpartum depression, and the role of physical activity: a retrospective cohort study in Southern California

Background

Little research exists regarding the relationships between green space and postpartum depression (PPD). We aimed to investigate the relationships between PPD and green space exposure, and the mediating role of physical activity (PA).

Methods

Clinical data were obtained from Kaiser Permanente Southern California electronic health records in 2008-2018. PPD ascertainment was based on both diagnostic codes and prescription medications. Maternal residential green space exposures were assessed using street view-based measures and vegetation types (i.e., street tree, low-lying vegetation, and grass), satellite-based measures [i.e., Normalized Difference Vegetation Index (NDVI), land-cover green space, and tree canopy cover], and proximity to the nearest park. Multilevel logistic regression was applied to estimate the association between green space and PPD. A causal mediation analysis was performed to estimate the proportion mediated by PA during pregnancy in the total effects of green space on PPD.

Findings

In total, we included 415,020 participants (30.2 ± 5.8 years) with 43,399 (10.5%) PPD cases. Hispanic mothers accounted for about half of the total population. A reduced risk for PPD was associated with total green space exposure based on street-view measure [500 m buffer, adjusted odds ratio (OR) per interquartile range: 0.98, 95% CI: 0.97-0.99], but not NDVI, land-cover greenness, or proximity to a park. Compared to other types of green space, tree coverage showed stronger protective effects (500 m buffer, OR = 0.98, 95% CI: 0.97-0.99). The proportions of mediation effects attributable to PA during pregnancy ranged from 2.7% to 7.2% across green space indicators.

Interpretation

Street view-based green space and tree coverage were associated with a decreased risk of PPD. The observed association was primarily due to increased tree coverage, rather than low-lying vegetation or grass. Increased PA was a plausible pathway linking green space to lower risk for PPD.

Funding

National Institute of Environmental Health Sciences (NIEHS; R01ES030353).

The climate adaptive characteristics of urban inside/outside water bodies based on their cooling effect in Poyang and Dongting lake regions, China

Most publications have focused on the cooling effect of urban inside water bodies. However, the climate adaptive characteristics of urban inside/outside water bodies is seldom studied. In this paper, three types of water bodies, i.e., urban inside water bodies, urban outside discrete water bodies and large water bodies are identified according to their relative spatial relationships with built-up areas. The climate adaptive landscape characteristics of water bodies are analyzed based on water bodies' cooling effect (WCE) inside and outside cities in the Poyang Lake and Dongting Lake regions. Seventy-three Landsat TM/OLI/TIRS images acquired from 1989 to 2019 are employed. Landscape scale characteristics of urban inside/outside water bodies are described by area, water depth, perimeter to area ratio (PARA) and distance-weighted area index (DWAI). Three temperature-related parameters are calculated to estimate the WCE in different conditions. Climate adaptive characteristics of water bodies inside/outside cities are determined by correlation and regression analysis. Results show that: 1) The long river shape, depth, orientation and fluidity of urban inside water bodies are benefit to enhance their cooling effect; 2) the distance of urban outside water bodies from built-up areas are positive correlated with their cooling effect; 3) the optimal acreage of large water bodies are >2500 km² and 1111-1287.5 km² for climate adaption of Poyang Lake and Dongting Lake, respectively. Simultaneously, the WCE of urban outside large water bodies is related with human activities and climate conditions. The results of our study provide a significant contribution to blue-space planning in cities, and provide insights into actionable climate adaption planning in inland large lake areas.

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries

The effects of 'nature' on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

Can Views and Contact with Nature at Home Help Combat Anxiety and Depression during the Pandemic? Results of the GreenCOVID study

BACKGROUND

The COVID-19 pandemic and the lockdown measures have had important consequences on the mental health of the population, although little is known about the role played by nature and its benefits.

OBJECTIVES

The present study aims to evaluate the risk of anxiety and depression during the first wave of the COVID-19 pandemic in Spain and to identify the factors most strongly associated with anxiety and depression, including sociodemographic, household characteristics, and access to or contact with natural environment.

METHODS

GreenCOVID is an online cross-sectional study promoted by the Health & Territory Research (HTR) of the University of Seville in Spain, Maynooth University in Ireland, and the University of Winchester in the United Kingdom. This study includes only data from Spain which were collected between April 8, 2020 and April 27, 2020. Binary logistic regression was conducted to identify the factors associated with anxiety and depression through the HADS scale.

RESULTS

Of the total of 2,464 adults who participated in GreenCOVID Spain, mean age was 38.1 years, 72.6% were female, 58.1% were at risk of anxiety, and 32.3% of depression. In the multivariable logistic regression, the factors associated with risk of anxiety were female: gender, being a student and problems at home. Regarding the risk of depression, the factors most associated were being a student, female gender, problems at home, worse evaluation of views from home and less help from outside views to cope with lockdown.

CONCLUSIONS

Our findings show that during COVID-19 pandemic, in addition to sociodemographic factors female gender and being a student, problems at home, lack of natural elements in the home, and worse appreciation of views from home were associated with mental health problems. Thus, housing conditions and access to the natural environment were important for mental health during COVID-19 lockdown.

Sea swimming and snorkeling in tropical coastal blue spaces and mental well-being: Findings from Indonesian island communities during the COVID-19 pandemic

The COVID-19 pandemic has considerable mental health impacts. Immersive nature-based interventions, such as swimming or snorkeling, may help mitigate the global mental health crisis caused by the pandemic. To investigate this, we collected cross-sectional data from residents of coastal villages (n = 308) in Kepulauan Selayar, Indonesia. Analysis of Covariance (ANCOVA) was used with mental well-being as the outcome variable, operationalized as the Mental Component Summary (MCS) scores from the SF-12 (12-item Short Form Health Survey). After adjusting for covariates, the activity of sea swimming or snorkeling was found to be significantly associated with better mental well-being (η² = 0.036; p < 0.01). Predictive margins analysis revealed that those who engaged in sea swimming or snorkeling for one to three days a week gained a 2.7 increase in their MCS scores, compared to those who did not. A non-linear dose-response relationship was detected: for those swimming or snorkeling more than three days per week, there was only an increase of 1.7 MCS score compared to the 0-day. Overall this study contributes to the expanding of evidence base, showing that interactions with blue spaces can be beneficial for mental health, especially in a potentially stressful time such as the current pandemic.

Management implications

The positive association between the activity of swimming or snorkeling in open seas and the mental well-being of rural coastal communities in Indonesia during the COVID-19 pandemic indicates that access to coastal blue spaces is important in a time of uncertainties and high stress. Ensuring that local communities have continuous access to these spaces is the key challenge for all relevant stakeholders, particularly in light of the growing privatization of the local coastal environment for the sake of tourism. However, considering the importance that these blue spaces hold for the mental well-being of local communities, intensive dialogue amongst these stakeholders must be pursued to ensure that the development of the area does not jeopardize the collective well-being of the people already living there.

COVID-19: Reducing the risk via diet and lifestyle

This review shows that relatively simple changes to diet and lifestyle can significantly, and rapidly, reduce the risks associated with coronavirus disease 2019 (COVID-19) in terms of infection risk, severity of disease, and even disease-related mortality. A wide range of interventions including regular exercise, adequate sleep, plant-based diets, maintenance of healthy weight, dietary supplementation, and time in nature have each been shown to have beneficial effects for supporting more positive health outcomes with COVID-19, in addition to promoting better overall health. This paper brings together literature from these areas and presents the argument that non-pharmaceutical approaches should not be overlooked in our response to COVID-19. It is noted that, in several cases, interventions discussed result in risk reductions equivalent to, or even greater than, those associated with currently available vaccines. Where the balance of evidence suggests benefits, and the risk is minimal to none, it is suggested that communicating the power of individual actions to the public becomes morally imperative. Further, many lives could be saved, and many harms from the vaccine mandates avoided, if we were willing to embrace this lifestyle-centred approach in our efforts to deal with COVID-19.

Exploring the Association between Neighborhood Blue Space and Self-Rated Health among Elderly Adults: Evidence from Guangzhou, China

Blue spaces is associated with self-rated health (SRH), but little is known about the pathways underlying this association among Chinese urban elderly individuals. Based on neighborhood effect theory, this study examined the relationship between neighborhood blue spaces and SRH among elderly individuals using data from a questionnaire survey conducted in Guangzhou, remote sensing images, street views, and environmental information in the context of a Chinese megacity. In addition, multilevel linear model and mediating effect model empirical analyses were performed. Results showed that first, the SRH of the elderly was associated with individual- and neighborhood-level factors. Second, the multilevel mediation model revealed that multiple biopsychosocial pathways existed between neighborhood blue spaces and the SRH of the elderly, specifically, the blue space characteristics related to the SRH of the elderly via the mediating effect of stress. Third, owing to demographic characteristics and socioeconomic status, the stratified analyses also indicated a strong association between neighborhood blue spaces and SRH outcomes in the older and low-income groups. The mediating effect of stress in the age and income groups was also observed, and the mediation pathways and group differences were confirmed in the context of Chinese cities. This research enriches the empirical literature on blue spaces and elderly health from a multidisciplinary perspective and suggests the need for "healthy neighborhood" and "health-aging" planning in Chinese settings.

Integrated analysis of doubly disadvantaged neighborhoods by considering both green space and blue space accessibility and COVID-19 infection risk

The ongoing COVID-19 pandemic has taken a heavy toll on the physical and mental health of the public. Nevertheless, the presence of green and blue spaces has been shown to be able to encourage physical activities and alleviate the mental distress caused by COVID-19. However, just as the impact of COVID-19 varies by geographical region and area, the distribution of green and blue spaces is also different across different neighborhoods and areas. By using Hong Kong as the study area, we determine the local neighborhoods that suffer from both high COVID-19 infection risk as well as low green and blue space accessibility. The results show that some of the poorest neighborhoods in the territory such as Sham Shui Po, Kwun Tong and Wong Tai Sin are also among the most doubly disadvantaged in terms of COVID-19 infection risk as well as green and blue space accessibility.

Country-level factors in a failing relationship with nature: Nature connectedness as a key metric for a sustainable future

Climate change and biodiversity loss show that the human-nature relationship is failing. That relationship can be measured through the construct of nature connectedness which is a key factor in pro-environmental behaviours and mental well-being. Country-level indicators of extinction of nature experience, consumption and commerce, use and control of nature and negativistic factors were selected. An exploratory analysis of the relationship between these metrics and nature connectedness across adult samples from 14 European countries was conducted (n = 14,745 respondents). The analysis provides insight into how affluence, technology and consumption are associated with the human-nature relationship. These findings motivate a comparison of how nature connectedness and composite indicators of prosperity, progress, development, and sustainability relate to indicators of human and nature's well-being. In comparison to composite indexes, it is proposed that nature connectedness is a critical indicator of human and nature's well-being needed to inform the transition to a sustainable future.

Effect modifications of green space and blue space on heat-mortality association in Hong Kong, 2008-2017

BACKGROUND

Despite emerging recognition of the benefits of green and blue spaces on human health, evidence for their effect modifications on heat-mortality associations is limited. We aimed to investigate the effect modifications of green and blue spaces on heat-mortality associations among different age and sex groups and at different heat levels.

METHODS

Daily mortality and meteorological data from 2008 to 2017 in Hong Kong, China were collected. The Normalized Difference Vegetation Index and distance to coast were used as proxies for green and blue space exposure, respectively. Time-series analyses was performed using fitting generalized linear mixed models with an interaction term between heat and levels of exposure to either green or blue space. Age-, sex-, and heat level-stratified analyses were also conducted.

RESULTS

With a 1 °C increase in temperature above the 90th percentile (29.61 °C), mortality increased by 5.7% (95% confidence interval [CI]: 1.6, 10.1%), 5.4% (1.4, 9.5%), and 4.6% (0.8, 8.9%) for low, medium and high levels of green space exposure, respectively, and by 7.5% (3.9, 11.2%) and 3.5% (0.3, 6.8%) for low and high levels of blue space exposure, respectively. Significant effect modifications of green and blue spaces were not observed for the whole population or any specific age and sex group, either at a moderate heat level or a heat level (Ps > 0.05).

CONCLUSIONS

No significant effect modifications of green and blue spaces on heat-related mortality risk were observed in Hong Kong. These findings challenge the existing evidence on the prominent protective role of green and blue spaces in mitigating heat-related mortality risks.

The mental health benefits of visiting canals and rivers: An ecological momentary assessment study

Existing evidence shows positive effects of being in nature on wellbeing, but we know little about the mental health benefits of spending time near canals and rivers specifically. This study investigates the association between visits to canals and rivers and mental wellbeing. We addressed the following questions: Are visits to canals and rivers associated with higher levels of mental wellbeing? Does this association depend on age and gender? Does this association vary between people with and without a diagnosis on mental illness? We used Urban Mind, a flexible smartphone application for examining the impact of different aspects of the built and social environment on mental wellbeing, a strong predictor of mental health. Participants were invited to complete an ecological momentary assessment three times a day for fourteen days. Each assessment included questions about their surrounding environment and mental wellbeing. A total of 7,975 assessments were completed by 299 participants including 87 with a diagnosis of mental illness. Multilevel regression models were used to analyse the data. We found positive associations between visits to canals and rivers and mental wellbeing (p < .05) when compared to being anywhere else and when compared to being in green spaces. Increases in mental wellbeing were still evident after the visit had taken place. These effects remained significant after adjusting for age, gender, ethnicity and education, and were consistent in people with and without a diagnosis of mental illness. Spending time near canals and rivers is associated with better mental wellbeing. These findings have potential implications for mental health as well as urban planning and policy. Visits to canals and rivers could become part of social prescribing schemes, playing a role in preventing mental health difficulties and complementing more traditional interventions.

Change of Residents’ Attitudes and Behaviors toward Urban Green Space Pre- and Post- COVID-19 Pandemic

The COVID-19 pandemic has changed and influenced people’s attitudes and behaviors toward visiting green spaces. This paper aims to explore the association between residents’ health and urban green spaces (UGS) through an in-depth study of changes in residents’ use of UGS under the influence of the COVID-19 pandemic. The Wuhan East Lake Greenway Park was selected as the location for the field survey and in-depth interviews. At the same time, an online survey was also conducted (total number = 302) regarding participants’ physical and mental health and their attitude and behavior toward the UGS. A paired sample t-test and binary logistic regression were performed to investigate the association between participants’ health and UGS during COVID-19. The results show that: (1) the COVID-19 pandemic has primarily changed the leisure patterns of parks, with potential impacts on the physical and mental health of participants; (2) the purpose, frequency, timing, and preferred areas of participants’ park visits have changed to varying degrees after the pandemic, highlighting the important role and benefits of UGSs; (3) the physical and mental health of participants and urban development issues reflected by UGS use are prominent. This study reveals that awareness of the construction and protection of UGSs is an important prerequisite for ensuring the health of urban residents.

Using an Exposome-Wide Approach to Explore the Impact of Urban Environments on Blood Pressure among Adults in Beijing-Tianjin-Hebei and Surrounding Areas of China

Existing studies mostly explored the association between urban environmental exposures and blood pressure (BP) in isolation, ignoring correlations across exposures. This study aimed to systematically evaluate the impact of a wide range of urban exposures on BP using an exposome-wide approach. A multicenter cross-sectional study was conducted in ten cities of China. For each enrolled participant, we estimated their urban exposures, including air pollution, built environment, surrounding natural space, and road traffic indicator. On the whole, this study comprised three statistical analysis steps, that is, single exposure analysis, multiple exposure analysis and a cluster analysis. We also used deletion-substitution-addition algorithm to conduct variable selection. After considering multiple exposures, for hypertension risk, most significant associations in single exposure model disappeared, with only neighborhood walkability remaining negatively statistically significant. Besides, it was observed that SBP (systolic BP) raised gradually with the increase in PM_2.5, but such rising pattern slowed down when PM_2.5 concentration reached a relatively high level. For surrounding natural spaces, significant protective associations between green and blue spaces with BP were found. This study also found that high population density and public transport accessibility have beneficially significant association with BP. Additionally, with the increase in the distance to the nearest major road, DBP (diastolic BP) decreased rapidly. When the distance was beyond around 200 m, however, there was no obvious change to DBP anymore. By cluster analysis, six clusters of urban exposures were identified. These findings reinforce the importance of improving urban design, which help promote healthy urban environments to optimize human BP health.

Effects of Landscape Types and Complexity Along Path on Mental Restoration

AIM

This study checked the effects of landscape types and complexity along path in urban green spaces on perceived restorativeness, so as to provide guidance for path landscape design.

BACKGROUND

Paths in urban green spaces are not only the connections between places but also places for visitors reducing mental stress and seeking psychological well-being. However, there is a lack of evidence-based research on the effects of landscape composition along the path on restorative quality, failing to provide a cohesive guideline for practice.

METHODS

Fourteen videos representing the popular path landscapes in urban green spaces were produced using computer software by adding or/and deleting elements and controlling environmental components. The restorative quality of these videos was measured by Short-version Revised Restoration Scale (SRRS). Statistical analysis was employed to treat the data and checked the effects of different landscape types and complexity on restorative quality.

RESULTS

(1) A significant difference in restorative quality between 14 path landscapes was found, comparatively, the path containing lawn or(and) forest was much better than that containing bamboo and waterscape, and bamboo was a negative predictor of restorative quality; (2) waterscape generally reduced the restorative quality of vegetated path landscape, especially when the landscape possessed higher restorative quality; (3) path landscape complexity had a weak influence on restorative quality.

CONCLUSIONS

This study explains how path landscapes affect mental restoration of users, and these findings contribute to enhancing the restorative quality of urban green spaces and have applications for path landscape design.

Does Bird Diversity Affect Public Mental Health in Urban Mountain Parks?-A Case Study in Fuzhou City, China

Intensified urbanization has caused a linear decline in the quality of urban biodiversity and indirectly harms our current human settlement environment. Urban mountain parks provide a refuge for the animals and plants and play a vital role in satisfying residents’ lives. At present, few studies are focusing on the impact of biodiversity on human mental health benefits of urban mountain parks in high-density construction areas along the coast of the Eastern Hemisphere. Here, we examined the relationship between bird abundance, Shannon diversity, Simpson diversity, and Richness and momentary mental health (positive, negative, and anxiety) in urban mountain parks. The timed species counts method was used to conduct three surveys of birds in urban mountain parks, and linear regression was performed on the relationship between bird diversity and mental health among sites. According to the regression model results, we found no significant correlation in any disturbance levels. As urban mountain parks are an essential part of the human settlement environment, how to improve the biodiversity and mental health of urban mountain parks is one of the focuses of research on biodiversity well-being in the future. Urban planning authorities and public mental health researchers should pay attention to the importance of biodiversity in urban development and consider how to realize the beautiful vision of the harmonious coexistence of humans, animals, plants, and the environment in which we live.

Amount of and proximity to blue spaces and general health among older Chinese adults in private and public housing: A national population study

A growing body of research indicates that exposure to outdoor blue spaces is associated with better physical and mental health. However, few studies have explored the associations between different blue space indicators (e.g., amount of and proximity to freshwater and seawater) and general health. Moreover, research has rarely attempted to address the residential selection bias associated with the salutogenic effect of access to blue spaces. Therefore, this study explores the associations between the amount (percentage of blue space within a 1 km circular buffer) of and proximity (Euclidean distance to the edge of the nearest blue space) to blue space and older adults' general health across the entire country of China using the micro-data sample of one-percent national population sample survey in 2015. It adds to the existing literature by taking into account the neighbourhood selection mechanism for different housing tenures and examining the salutogenic effect of blue spaces separately for public housing residents and private housing residents. The results indicated that greater neighbourhood seawater coverage and living near a coastline were associated with better general health among older adults in both private and public housing, while the percentage of freshwater blue spaces within neighbourhoods and the distance to freshwater blue spaces were associated with better general health among private housing residents only. The blue spaces-general health associations were stronger among urban participants, participants in deprived neighbourhoods, males, participants aged under 80 years, and low- and medium-educated participants. Our findings indicated that living near the coast was beneficial to older adults' health, and residential selection bias confounded the association between freshwater blue spaces and health.

Association of Residential Proximity to the Coast With Incident Myocardial Infarction: A Prospective Cohort Study

Background

Little is known about how the residential distance to the coast is associated with incident myocardial infarction (MI) and which mechanisms may explain the association. We aim to explore this association using data from a prospective, population-based cohort with unprecedented sample size, and broad geographical coverage.

Methods

In this study, 377,340 participants from the UK Biobank were included.

Results

It was shown that 4,059 MI occurred during a median 8.0 years follow-up. Using group (<1 km) as reference, group (20–50 km) was associated with a lower risk of MI (hazard ratio, HR 0.79, 95% CI 0.64–0.98) and a U-shaped relation between distance to the coast and MI was shown with the low-risk interval between 32 and 64 km (p_non−linear = 0.0012). Using participants of the intermediate region (32–64 km) as a reference, participants of the offshore region (<32 km) and inland region (>64 km) were both associated with a higher risk of incident MI (HR 1.12, 95% CI 1.04–1.21 and HR 1.09, 95% CI 1.01–1.18, respectively). HR for offshore region (<32 km) was larger in subgroup with low total physical activity (<24 h/week) (HR 1.24, 95% CI 1.09–1.42, p_interaction = 0.043). HR for inland region (>64 km) was larger in subgroup in urban area (HR 1.12, 95% CI 1.03–1.22, p_interaction = 0.065) and in subgroup of high nitrogen dioxide (NO₂) air pollution (HR 1.29, 95% CI 1.11–1.50, p_interaction = 0.021).

Conclusion

We found a U-shaped association between residential distance to the coast and incident MI, and the association was modified by physical activity, population density, and air pollution.

Connecting to the oceans: supporting ocean literacy and public engagement

Improved public understanding of the ocean and the importance of sustainable ocean use, or ocean literacy, is essential for achieving global commitments to sustainable development by 2030 and beyond. However, growing human populations (particularly in mega-cities), urbanisation and socio-economic disparity threaten opportunities for people to engage and connect directly with ocean environments. Thus, a major challenge in engaging the whole of society in achieving ocean sustainability by 2030 is to develop strategies to improve societal connections to the ocean. The concept of ocean literacy reflects public understanding of the ocean, but is also an indication of connections to, and attitudes and behaviours towards, the ocean. Improving and progressing global ocean literacy has potential to catalyse the behaviour changes necessary for achieving a sustainable future. As part of the Future Seas project (https://futureseas2030.org/), this paper aims to synthesise knowledge and perspectives on ocean literacy from a range of disciplines, including but not exclusive to marine biology, socio-ecology, philosophy, technology, psychology, oceanography and human health. Using examples from the literature, we outline the potential for positive change towards a sustainable future based on knowledge that already exists. We focus on four drivers that can influence and improve ocean literacy and societal connections to the ocean: (1) education, (2) cultural connections, (3) technological developments, and (4) knowledge exchange and science-policy interconnections. We explore how each driver plays a role in improving perceptions of the ocean to engender more widespread societal support for effective ocean management and conservation. In doing so, we develop an ocean literacy toolkit, a practical resource for enhancing ocean connections across a broad range of contexts worldwide.

Community planning for a "healthy built environment" via a human-environment nexus? A multifactorial assessment of environmental characteristics and age-specific stroke mortality in Hong Kong

With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM₁₀, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.

Connecting to the oceans: supporting ocean literacy and public engagement

Improved public understanding of the ocean and the importance of sustainable ocean use, or ocean literacy, is essential for achieving global commitments to sustainable development by 2030 and beyond. However, growing human populations (particularly in mega-cities), urbanisation and socio-economic disparity threaten opportunities for people to engage and connect directly with ocean environments. Thus, a major challenge in engaging the whole of society in achieving ocean sustainability by 2030 is to develop strategies to improve societal connections to the ocean. The concept of ocean literacy reflects public understanding of the ocean, but is also an indication of connections to, and attitudes and behaviours towards, the ocean. Improving and progressing global ocean literacy has potential to catalyse the behaviour changes necessary for achieving a sustainable future. As part of the Future Seas project (https://futureseas2030.org/), this paper aims to synthesise knowledge and perspectives on ocean literacy from a range of disciplines, including but not exclusive to marine biology, socio-ecology, philosophy, technology, psychology, oceanography and human health. Using examples from the literature, we outline the potential for positive change towards a sustainable future based on knowledge that already exists. We focus on four drivers that can influence and improve ocean literacy and societal connections to the ocean: (1) education, (2) cultural connections, (3) technological developments, and (4) knowledge exchange and science-policy interconnections. We explore how each driver plays a role in improving perceptions of the ocean to engender more widespread societal support for effective ocean management and conservation. In doing so, we develop an ocean literacy toolkit, a practical resource for enhancing ocean connections across a broad range of contexts worldwide.

Waterscapes for Promoting Mental Health in the General Population

The WHO estimates that, with the development of urbanization, 25% of the population is suffering from psychological and mental distress. Preliminary evidence has suggested that aquatic environments and riparian areas, i.e., waterscapes, can benefit psychological and mental wellbeing. The aim of this study was to identify the processes of waterscape psychological and mental health promotion through aliterature review. We propose a design framework of waterscapes for achieving psychological and mental health in the general population that often visits waterscapes, which has the function of therapeutic landscapes through values of accessibility, versatility, habitats, and biodiversity. According to theories, waterscapes can improve psychological and mental health to divert negative emotions through mitigation (e.g., reduced urban heat island), instoration (e.g., physical activity and state of nature connectedness), and restoration (e.g., reduced anxiety/attentional fatigue). By accessing water (e.g., streams, rivers, lakes, wetlands, and the coast) and riparian areas, people can get in close contact with nature and spend more time in activities (e.g., walking, exploring, talking, and relaxing). Waterscapes with healing effects can enhance psychological resilience to promote people's psychological and mental health. Future research should focus on ensuring an adequate supply of waterscapes and promoting the efficiency of waterscape ecosystem services on mental health. Moreover, fora deep understanding of the complexity of nature-human health associations, it is necessary to explore more consistent evidence for therapeutic waterscapes considering the characteristics and functional mechanisms of waterscape quality, in terms of freshness, luminescence, rippling or fluidity, and cultural value, to benefit public health and biodiversity conservation.

Bird diversity and psychological wellbeing: A comparison of green and coastal blue space in a neotropical city

Accelerating rates of urbanisation are contributing to biodiversity declines worldwide. However, urban green (e.g. parks) and blue spaces (e.g. coast) provide important habitat for species. Emerging evidence also shows that green and blue spaces can benefit human psychological wellbeing, although few studies originate from the Global South and it is unclear whether more biodiverse spaces offer greater wellbeing gains. We examine how bird diversity (abundance, species richness, Shannon diversity, and community composition) in green and coastal blue space in Georgetown, Guyana, is associated with people's wellbeing (positive and negative affect, anxiety) in situ, using point counts and questionnaires. Bird community composition differed between green and coastal sites, and diversity was significantly higher in green sites. Positive affect and anxiety did not differ between green and coastal sites, but negative affect was higher in coastal sites. Mixed-effect models showed no associations between biodiversity and wellbeing, implying other features are contributing to people's positive wellbeing. Despite no association between biodiversity and wellbeing, both green and coastal blue sites are important for wellbeing and supporting different bird communities. City planning authorities and public health professionals should ensure these social and environmental needs are met in developing cities in the Global South.

Influence of the Belgian Coast on Well-Being During the COVID-19 Pandemic

There is increasing evidence that blue spaces, particularly coastal environments, are beneficial for well-being. During the first-wave lockdown of the COVID-19 pandemic in Belgium, access to the coast was restricted due to restraint in circulation. Making use of this unique opportunity, this study investigated whether access and visits to the coast were positively associated with well-being by using a quasi-experimental design. The emotions of awe and nostalgia were studied as potential mediators between coastal visits and well-being. A total of 687 Flemish adults took part in an online survey that was launched end of April until beginning of June 2020. After controlling for covariates, results showed that access to the coast, but not visit frequency, was positively associated with well-being. More specifically, coastal residents reported less boredom and worry, and more happiness than inland residents. Awe and nostalgia were not significantly associated with coastal visits, but awe was negatively correlated with boredom. The study suggests a potential buffer effect of residential proximity to the coast against negative psychological consequences of the COVID-19 pandemic, supporting the notion that the coast has a positive impact on well-being.

Relationship between Green and Blue Spaces with Mental and Physical Health: A Systematic Review of Longitudinal Observational Studies

There is growing interest in the ways natural environments influence the development and progression of long-term health conditions. Vegetation and water bodies, also known as green and blue spaces, have the potential to affect health and behaviour through the provision of aesthetic spaces for relaxation, socialisation and physical activity. While research has previously assessed how green and blue spaces affect mental and physical wellbeing, little is known about the relationship between these exposures and health outcomes over time. This systematic review summarised the published evidence from longitudinal observational studies on the relationship between exposure to green and blue space with mental and physical health in adults. Included health outcomes were common mental health conditions, severe mental health conditions and noncommunicable diseases (NCDs). An online bibliographic search of six databases was completed in July 2020. After title, abstract and full-text screening, 44 eligible studies were included in the analysis. Depression, diabetes and obesity were the health conditions most frequently studied in longitudinal relationships. The majority of exposures included indicators of green space availability and urban green space accessibility. Few studies addressed the relationship between blue space and health. The narrative synthesis pointed towards mixed evidence of a protective relationship between exposure to green space and health. There was high heterogeneity in exposure measures and adjustment for confounding between studies. Future policy and research should seek a standardised approach towards measuring green and blue space exposures and employ theoretical grounds for confounder adjustment.

A Qualitative Analysis of UK Wetland Visitor Centres as a Health Resource

The health benefits associated with spending time in natural environments have been highlighted during the COVID-19 pandemic. Lockdowns and restrictions to safeguard public health have exacerbated the pre-existing mental health crisis and rise of non-communicable diseases. Thus, the importance of nature as a health resource has been elevated, hastening calls for a better understanding of how health benefits might differ across user groups and nature provisions. In this regard, urban green spaces have become the greatest research focus; however, blue spaces, especially inland freshwater (e.g., wetlands), remain less studied. First-hand user experiences are also under-represented. This exploratory study examines the motivations and benefits of active wetland centre users in the UK, both during and after visits. Responses to three open-ended questions were collated online from 385 participants, and a qualitative content analysis was conducted based on an existing taxonomy from users of urban green spaces. The results showed strong motivations to visit due to the biodiversity at the site (mainly the birdlife), while less tangible nature (e.g., fresh air) and amenities were also important. In contrast to other studies on natural environments, physical activity was a less influential motivation. Salient derived effects included positive and intensely positive emotions, relaxation and mental restoration. After visits to wetland centres, feelings of vitality and satisfaction were the most prominent effects that emerged. For decision-makers looking to leverage inland blue spaces for public health benefit, our results highlight the broad range and relative prominence of the reasons for use and the associated perceived health benefits derived by users of UK wetland centres. They highlight how biodiversity, abiotic nature and good amenities are important qualities to consider when planning, managing and encouraging people to use natural environments for health benefit, qualities that may also provide important environmental co-benefits.

Exposure to green space and pollen allergy symptom severity: A case-crossover study in Belgium

BACKGROUND

The prevalence of pollen allergy has increased due to urbanization, climate change and air pollution. The effects of green space and air pollution on respiratory health of pollen allergy patients are complex and best studied in spatio-temporal detail.

METHODS

We tracked 144 adults sensitized to Betulaceae pollen during the tree pollen season (January-May) of 2017 and 2018 and assessed their spatio-temporal exposure to green space, allergenic trees, air pollutants and birch pollen. Participants reported daily symptom severity scores. We extracted 404 case days with high symptom severity scores and matched these to 404 control days. The data were analyzed using conditional logistic regression with a 1:1 case-crossover design.

RESULTS

Case days were associated with exposure to birch pollen concentration (100 grains/m³) [adjusted odds ratio 1.045 and 95% confidence interval (1.014-1.078)], O₃ concentration (10 μg/m³) [1.504 (1.281-1.766)] and PM₁₀ concentration (10 μg/m³) [1.255 (1.007-1.565)] on the day of the severe allergy event and with the cumulative exposure of one and two days before. Exposure to grass cover (10% area fraction) [0.655 (0.446-0.960)], forest cover (10% area fraction) [0.543 (0.303-0.973)] and density of Alnus (10%) [0.622 (0.411-0.942)] were protective for severe allergy, but only on the day of the severe allergy event. Increased densities of Betula trees (10%) were a risk factor [unadjusted OR: 2.014 (1.162-3.490)].

CONCLUSION

Exposure to green space may mitigate tree pollen allergy symptom severity but only when the density of allergenic trees is low. Air pollutants contribute to more severe allergy symptoms. Spatio-temporal tracking allows for a more realistic exposure assessment.

Is Living in a U.S. Coastal City Good for One's Health?

Background: Evidence suggests that living close to “blue spaces” (water features), particularly coastlines, has salutary effects on human health. Methods: We analyzed five years of annual, self-reported general health and unhealthy days data from the Behavioral Risk Factor Surveillance System of the U.S. Centers for Disease Control and Prevention for 165 urban areas across the contiguous U.S. We compared health self-reports for people living in coastal vs. non-coastal urban areas and for residents of the disaster-prone Gulf of Mexico region vs. other locations. Coastal urban areas were defined as those having ≥50% of their population living within 20 km of a coast. Results: We found no overall health advantage of residing in a coastal urban location when all urban areas were considered. However, residents from non-Gulf of Mexico coastal urban areas reported modestly better health than residents from non-coastal areas. In contrast, self-reported health of Gulf coastal urban residents was significantly poorer than that of residents from other urban areas. Conclusions: The frequency of disasters and history of health and socioeconomic disparities in the Gulf region may be responsible, at least in part, for the apparent lack of health promoting effects of coastal location there.

Effects of Evocative Audio-Visual Installations on the Restorativeness in Urban Parks

Road traffic noise is responsible for several negative health effects for citizens in modern cities. Inside urban parks, which citizens use for social inclusion and cohesion, psychological and physical restoration, and physical activities, road traffic noise may significantly reduce the potential of these places to induce or enhance well-being. Although access restriction schemes and screens could be effective solutions to limit noise inside urban park areas, preserving their potential regenerative role may engender mobility, social, aesthetic, and architectural issues. Due to the positive effects that natural elements and water sounds can have on human perception, and based on the previous findings of the beneficial effects of audio-visual installations, this paper investigates the possibility of using audio-visual installations that simply evoke some natural features to improve the restoration of individuals inside urban parks. The study has been carried out using immersive virtual environments in two different experimental laboratory sessions in Hong Kong (China) and Aversa (Italy). The results showed that the positive effects provided by evocative installations were similar to those provided by traditional installations. Furthermore, the effects on the restoration increased as the installations became larger and included enveloping shapes. Furthermore, we found that the amount of evocative water installations’ material was responsible for changes in restoration. In contrast, the Chinese groups were less influenced by these installations.

Health Behavior and Planetary Health

Abstract. Health and environmental psychology have long been walking side by side. These two disciplines of psychology have imported and applied common psychological frameworks and each of them developed specific theories and methodologies. At a time when humankind faces tremendous challenges ahead (climate change, global warming, ocean sickness, the reemergence of infections pandemics), environmental health is more and more a crucial domain of research. Both environmental psychology and health psychology need to be engaged in environmental health issues in order to enhance planetary health. Environmental psychology traditional fields of research provide understanding about how natural or constructed environments impact human identity, attitudes, and behaviors (more recently, environmental psychology is also investing in determinants of pro-environmental behaviors). On the other hand, health psychology has an extensive comprehensive framework about how to promote healthy habits (i.e., automatically activated behaviors). We live in a global and extremely complex and interconnected world, which promotes syndemic phenomena (several interactive epidemics sharing common etiological factors), also resulting in accelerated depletion of natural resources. This current scenario might justify the development of an Environmental Health Psychology discipline, joining together tools from both environmental psychology and health psychology in a synergic and strategic way.

Mental Health Outcome Measures in Environmental Design Research: A Critical Review

AIM

During the last several decades, researchers have produced abundant evidence of the environmental impacts on stress, attention, and physical activity. More recently, scholars have turned their focus to the influence environments have on mental wellness. Therefore, a critical review of this more recent research is both timely and crucial for setting the future research agenda.

METHODS

In this article, we examined 65 papers published between 2008 and 2019 that examined the environmental correlates of a wide variety of mental health outcomes. We coded each study by type of environment, research design, mental health measurement scale used, and p-value.

RESULTS

We categorized the research studies into six groups based on mental health outcomes: emotions, moods, vitality, executive function, stress, and general well-being. Our review revealed several trends among the studies, including a heavy focus on nature and outdoor environments with little attention to workplace or residential environments; a lack of consensus on how to operationalize the environment; a heavy reliance on self-reported ratings using a wide variety of scales, many focused on the same outcome; and a disproportionate focus on short-term health effects.

CONCLUSIONS

There is a need for greater consensus on research constructs and health outcome measurements, focused on a wider variety of environmental settings and scales, in order to better inform evidence-based environmental design practice.

Types of coastlines and the evacuees' mental health: A repeated cross-sectional study in Northeast Japan

Although the health risks and benefits of coastal areas have long been researched, these effects of the different types of coastlines have rarely been explored on the evacuees living near the coast, in a post-disaster context. Thus, this study aimed to explore, with the passing of years after a disaster, what kind of coastline is a useful public health resource as a post-disaster reconstruction approach in coastal environments that have suffered significantly from the tsunami disaster in northeast Japan in 2011. This study compared the evacuees' mental health based on proximity to the coast and the types of coastlines (artificial, semi-natural, and natural). Data were drawn from the Miyagi Prefectural Government surveys, which targeted almost all evacuees of the 2011 Great East Japan Earthquakes and Tsunami (n = 96,203). We applied a pooled Poisson regression model to a repeated cross-sectional dataset of evacuees' mental health between 2012 and 2016. Moderate psychological distress, measured via the Kessler Psychological Distress Scale (K6) score, was the dependent variable, while proximity to the coast and type of coastline were the independent variables. The estimated main effects of type of coastline indicated that overall associations between K6 ≥5 and all types of coastlines within a 1.6 km buffer of participants' residential space were not statistically significant (p > 0.05). However, among types of coastlines, the interaction terms of semi-natural coastline × year (2015 and 2016) were significantly associated with lower incidence rate ratios (IRR), which decreased in 2015 and 2016 (IRR: 0.88, 95%CI: 0.79-0.98; IRR: 0.78, 95%CI: 0.68-0.90, respectively). Further, we computed the marginal effects of coastline types for each year to observe differences in the impact on moderate psychological distress depending on different accessible coastline types within a distance of 1.6 km from the participants' living space. We found that, after the revision of the coastal act in 2014, the moderate mental stress of participants who lived around semi-natural coastlines significantly tended to be low (dy/dx: -0.04, 95%CI: -0.08-0.01 in 2015; dy/dx: -0.07, 95%CI: -0.11-0.04 in 2016). This finding can encourage policymakers to manage coastal areas with green infrastructure in the post-disaster reconstruction sustainably.

Associations between green/blue spaces and mental health across 18 countries

Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.

Mechanisms of Impact of Blue Spaces on Human Health: A Systematic Literature Review and Meta-Analysis

Blue spaces have been found to have significant salutogenic effects. However, little is known about the mechanisms and pathways that link blue spaces and health. The purpose of this systematic review and meta-analysis is to summarise the evidence and quantify the effect of blue spaces on four hypothesised mediating pathways: physical activity, restoration, social interaction and environmental factors. Following the PRISMA guidelines, a literature search was conducted using six databases (PubMed, Scopus, PsycInfo, Web of Science, Cochrane Library, EBSCOHOST/CINAHL). Fifty studies were included in our systematic review. The overall quality of the included articles, evaluated with the Qualsyst tool, was judged to be very good, as no mediating pathway had an average article quality lower than 70%. Random-effects meta-analyses were conducted for physical activity, restoration and social interaction. Living closer to blue space was associated with statistically significantly higher physical activity levels (Cohen’s d = 0.122, 95% CI: 0.065, 0.179). Shorter distance to blue space was not associated with restoration (Cohen’s d = 0.123, 95% CI: −0.037, 0.284) or social interaction (Cohen’s d = −0.214, 95% CI: −0.55, 0.122). Larger amounts of blue space within a geographical area were significantly associated with higher physical activity levels (Cohen’s d = 0.144, 95% CI: 0.024, 0.264) and higher levels of restoration (Cohen’s d = 0.339, 95% CI: 0.072, 0.606). Being in more contact with blue space was significantly associated with higher levels of restoration (Cohen’s d = 0.191, 95% CI: 0.084, 0.298). There is also evidence that blue spaces improve environmental factors, but more studies are necessary for meta-analyses to be conducted. Evidence is conflicting on the mediating effects of social interaction and further research is required on this hypothesised pathway. Blue spaces may offer part of a solution to public health concerns faced by growing global urban populations.

Testing the reliability and effectiveness of a new tool for assessing urban blue spaces: The BlueHealth environmental assessment tool (BEAT)

In order to understand how blue spaces may influence health-promoting behaviours, a reliable and effective assessment tool is needed. The Blue Health Environment Assessment Tool (BEAT) was developed to meet this need. A two-stage approach to testing the reliability of the tool is presented here. At Stage-1, one common and several different expert assessors rated 16 sites independently and their results compared. In Stage-2, two assessors rated 21 sites independently and their results were compared. The Inter-class correlation coefficient (ICC) was calculated to assess inter-rater reliability to both stages. Stage-2 results showed greater reliability after enhanced training of the assessors. To demonstrate the effectiveness of the tool at revealing differences between sites and for identifying health promoting affordances we carried out intra and inter-site comparisons of a subset of six sites for the Stage-1 and 18 sites for Stage-2. The results showed that overall the tool performs consistently and compares well to the reliability shown by other similar tools. The tool is also highly effective in identifying site-specific differences across the test sample of blue spaces. The results demonstrate that the tool can be used reliably (with training and guidance) and that it provides meaningful data to help planners and designers assess different sites.

Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health

There is growing evidence that ecosystem services and especially the exposure to the natural world (blue-green spaces) have potential benefits for mental health and well-being. The COVID-19 pandemic and the measures adopted to control it provide a natural experiment to investigate the links between nature exposure and mental health under extreme conditions. Using a survey distributed online, we tested the following hypotheses: 1) People will show greater symptoms of depression and anxiety under lockdown conditions that did not allow contact with outdoor nature spaces; 2) Where access to public outdoor nature spaces was strictly restricted, (2a) those with green/blue nature view or (2b) access to private outdoor spaces such as a garden or balcony will show fewer symptoms of depression and anxiety, and a more positive mood. Based on 5218 responses from 9 countries, we found that lockdown severity significantly affected mental health, while contact with nature helped people to cope with these impacts, especially for those under strict lockdown. People under strict lockdown in Spain (3403 responses), perceived that nature helped them to cope with lockdown measures; and emotions were more positive among individuals with accessible outdoor spaces and blue-green elements in their views. These findings can help decision-makers in developing potential future lockdown measures to mitigate the negative impacts, helping people to be more resilient and maintain better mental health, using the benefits that ecosystem services are providing us.

Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health

There is growing evidence that ecosystem services and especially the exposure to the natural world (blue-green spaces) have potential benefits for mental health and well-being. The COVID-19 pandemic and the measures adopted to control it provide a natural experiment to investigate the links between nature exposure and mental health under extreme conditions. Using a survey distributed online, we tested the following hypotheses: 1) People will show greater symptoms of depression and anxiety under lockdown conditions that did not allow contact with outdoor nature spaces; 2) Where access to public outdoor nature spaces was strictly restricted, (2a) those with green/blue nature view or (2b) access to private outdoor spaces such as a garden or balcony will show fewer symptoms of depression and anxiety, and a more positive mood. Based on 5218 responses from 9 countries, we found that lockdown severity significantly affected mental health, while contact with nature helped people to cope with these impacts, especially for those under strict lockdown. People under strict lockdown in Spain (3403 responses), perceived that nature helped them to cope with lockdown measures; and emotions were more positive among individuals with accessible outdoor spaces and blue-green elements in their views. These findings can help decision-makers in developing potential future lockdown measures to mitigate the negative impacts, helping people to be more resilient and maintain better mental health, using the benefits that ecosystem services are providing us.