Linking green space to neighborhood social capital in older adults: The role of perceived safety

Utilizing regression model to characterize the impact of urban green space features on the subjective well-being of older adults

Based on the background of rapid global ageing, research exploring urban green spaces and the subjective well-being of urban residents has become one of the key research interests. However, the evidence for assessing the real benefits of urban green spaces on the subjective well-being of older adults by comprehensively examining the features of urban green spaces is limited. We surveyed older urban green space users (n = 536) aged 60 years and older in Nanjing, China, and evaluated the impacts of spatial, green, and grey features of urban green spaces on older people's overall satisfaction with urban green spaces and subjective well-being. The results of the multiple linear regression model showed a strong association between the three types of urban green space features, overall satisfaction with urban green space, and subjective well-being of older adults. The study results indicated that the grey feature of urban green spaces emerged as the most influential factor (p = 0.004) among the three features of urban green spaces in relation to their effect on the subjective well-being of older adults. This implies that it is essential to focus on the importance of grey s of urban green spaces in the planning and design of urban green spaces for older adults' use of different urban green spaces and their sense of well-being. These results contribute to the development of healthy ageing policies and age-friendly urban green space management strategies in rapid ageing countries around the world.

Simulating the impact of greenspace exposure on metabolic biomarkers in a diverse population living in San Diego, California: A g-computation application

Introduction

Growing evidence exists that greenspace exposure can reduce metabolic syndrome risk, a growing public health concern with well-documented inequities across population subgroups. We capitalize on the use of g-computation to simulate the influence of multiple possible interventions on residential greenspace on nine metabolic biomarkers and metabolic syndrome in adults (N = 555) from the 2014-2017 Community of Mine Study living in San Diego County, California.

Methods

Normalized difference vegetation index (NDVI) exposure from 2017 was averaged across a 400-m buffer around the participants' residential addresses. Participants' fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, systolic and diastolic blood pressure, hemoglobin A1c (%), waist circumference, and metabolic syndrome were assessed as outcomes of interest. Using parametric g-computation, we calculated risk differences for participants being exposed to each decile of the participant NDVI distribution compared to minimum NDVI. Differential health impacts from NDVI exposure by sex, ethnicity, income, and age were examined.

Results

We found that a hypothetical increase in NDVI exposure led to a decrease in hemoglobin A1c (%), glucose, and high-density lipoprotein cholesterol concentrations, an increase in fasting total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations, and minimal changes to systolic and diastolic blood pressure, waist circumference, and metabolic syndrome. The impact of NDVI changes was greater in women, Hispanic individuals, and those under 65 years old.

Conclusions

G-computation helps to simulate the potential health benefits of differential NDVI exposure and identifies which subpopulations can benefit most from targeted interventions aimed at minimizing health disparities.

Can good neighbourhood perception magnify the positive effect of favourable built environment on recreational walking in China?

BACKGROUND

It remains unknown whether good neighbourhood perception can enhance the benefits of favourable built environment to physical activity. Moreover, the moderation pattern is less understood in developing countries.

OBJECTIVES

This work aims to examine the moderation effects of perceived neighbourhood safety and aesthetics on the relationship between built environment and time for recreational walking.

METHODS

We performed the examination using a sample of 760 residents in Fuzhou City, China. The Negative Binomial Regression Model was developed to examine the moderation roles of neighbourhood safety and aesthetics on the impact of built environment, adjusting for the effects of location, socioeconomic, personal preferences and social environment factors. Moreover, two sensitivity analyses were performed to test whether the moderators found are robust to the control of residential self-selection, and differential measures of conceptually-comparable aspects of built environment.

RESULTS

We found stronger associations of time for recreational walking with road density and proportion of parks and squares POIs for residents with high perception of neighbourhood safety, compared to those with low perception of neighbourhood safety. There was a greater effect of the proportion of parks and squares POIs, when perceived aesthetics was high than when perceived aesthetics was low. The findings of neighbourhood safety and aesthetics as moderator, were robust in the two sensitivity analyses. No significant moderation effect was found for land use diversity.

CONCLUSIONS

High perceived neighbourhood safety can magnify the positive effects of road connectivity and accessibility to parks and squares. Neighbourhood aesthetics positively moderates the association of time for recreational walking with accessibility to parks and squares. The findings emphasize the need to consider safety- and aesthetics-specific differences in estimates of built environment effects. Improvements in neighbourhood safety and aesthetics are key to effective interventions in built environment to better promote physical activity.

Is social capital higher in areas with a higher density of historic assets? Analyses of 11,112 adults living in England

AIMS

Previous evidence suggests that engagement with heritage such as visiting heritage sites provides benefits for people's mental and social wellbeing, and helps to establish social capital. However, far less is known about whether living in areas of historic built environment also helps build social capital. Furthermore, it remains unclear how the association between historic built environment and social capital may vary across heritage engagement frequency and areas of deprivation levels. This study was therefore designed to explore the cross-sectional relationship between historic built environment and social capital.

METHODS

Analysis was based on three datasets: Understanding Society: The UK Household Longitudinal Study Waves 5 (2013/2015) and 6 (2014/2016), 2019 National Heritage List for England, and 2015 English Index of Multiple Deprivation (IMD). Ordinary least squares (OLS) regressions were applied to estimate the relationships between historic built environment (listed buildings, scheduled monuments, and registered parks and gardens) and social capital (personal relationships, social network support, civic engagement, and trust and cooperative norms).

RESULTS

We found that people living in places with greater historic built environment experienced higher levels of personal relationships, social network support, and civic engagement. However, these associations were attenuated once rurality was adjusted. Individuals living in areas of greater levels of historic built environment displayed higher levels of trust and cooperative norms, even after adjusting for all relevant covariates. Heritage engagement frequency was found to moderate the association between historic built environment and personal relationships. Similarly, IMD was also found to moderate the association between historic built environment and trust and cooperative norms.

CONCLUSION

These findings highlight the importance of neighbourhood environment in building social capital in communities. Particularly, areas with heritage assets may provide both socially inviting and aesthetically pleasing environments that could help strengthen community and restore pride in place.

Exploring the pathways linking visual green space to depression in older adults in Shanghai, China: using street view data

OBJECTIVES

To examine (1) how visual green space quantity and quality affect depression among older adults; (2) whether and how the links may be mediated by perceived stress, physical activity, neighbourhood social cohesion, and air pollution (PM2.5); and (3) whether there are differences in the mediation across visual green space quantity and quality.

METHOD

We used older adults samples (aged over 65) from the WHO Study on Global Ageing and Adult Health in Shanghai, China. Depression was quantified by two self-reported questions related to the diagnosis of depression and medications or other treatments for depression. Visual green space quantity and quality were calculated using street view images and machine learning methods (street view green space = SVG). Mediators included perceived stress, social cohesion, physical activity, and PM2.5. Multilevel logistic and linear regression models were applied to understand the mediating roles of the above mediators in the link between visual green space quantity and quality and depression in older adults.

RESULTS

SVG quantity and quality were negatively related to depression. Significant partial mediators for SVG quality were social cohesion and perceived stress. For SVG quantity, there was no evidence that any of the above mediators mediated the association.

CONCLUSION

Our results indicated that visual green space quantity and quality may be related to depression in older adults through different mechanisms.

The Dynamic Relationship between Social Cohesion and Urban Green Space in Diverse Communities: Opportunities and Challenges to Public Health

Social cohesion is a key factor within social determinants of health and well-being. Urban green spaces can provide environments that potentially facilitate meaningful and positive social interactions that promote social cohesion, equity, human health, and well-being. However, the lack of integration of existing research on social cohesion, urban green spaces, and public health in diverse (e.g., racially and ethnically) communities limits culturally relevant strategies to address health disparities. In this manuscript, we synthesize research on the potential of urban green spaces to promote social cohesion and public health in historically excluded communities. Particularly, we explore the development of social cohesion as it relates to the social environment, built environment, leisure opportunities, green space maintenance, safety, and green gentrification. We highlight key factors and their application to meet opportunities and challenges to social and public health. A conceptual framework is presented to provide an overview and illustrate connections found in the literature.

Access to urban green spaces and use of social services and institutional long-term care among older people in Malmö, Sweden: a longitudinal register study

BACKGROUND

Finding ways to prolong independence in daily life among older people would be beneficial for both individuals and society. Urban green spaces have been found to improve health, but only a few studies have evaluated the association between urban green spaces and independence in daily life. The aim of this study was to assess the long-term effect of urban green spaces on independence in daily life, using social services and support, mobility aids, and relocation to institutional long-term care as proxies, among community dwelling people 65 + years.

METHODS

We identified 40 357 people 65 + years living in the city of Malmö, Sweden in 2010. Using geographical information systems (GIS), we determined the amount of urban green spaces (total, public, and quiet) within 300 m of each person's residence. All three measures were categorized based on their respective percentiles, so that the first quartile represented the 25% with the least access and the fourth quartile the 25% with the most access. In 2015 and 2019, we assessed the outcomes minor assistance (non-personal support), major assistance (personal support), and relocation into institutional long-term care. These three outcome measures were used as proxies for independence in daily life. The effect of amount of urban green spaces in 2010 on the three outcomes in 2015 and 2019, respectively, was assessed by pairwise comparing the three highest quartiles to the lowest.

RESULTS

Compared to the lowest quartile, those in the highest quartile of quiet green spaces in 2010 were less likely to receive minor assistance in both 2015 and 2019. Besides this, there were no indications that any of the measures of urban green space affected independence in daily life at the five- and nine-year follow-up, respectively.

CONCLUSION

Although urban green spaces are known to have positive impact on health, physical activity, and social cohesion among older people, we found no effect of total, public, or quiet green spaces on independence in daily life. This could possibly be a result of the choice of measures of urban green spaces, including spatial and temporal aspects, an inability to capture important qualitative aspects of the green spaces, or the proxy measures used to assess independence in daily life.

Common home hazards among healthy older aged adults and potential modifications required for age-friendly housing

INTRODUCTION

The creation of age-friendly home environments enables middle-aged and older aged people to live independently at home while adapting to age-related changes. Little is currently known about existing home hazards that may potentially hinder healthy older people as they age.

METHODS

Prospective cohort study of healthy adults who received an age-friendly home environment assessment conducted by an occupational therapist. Adults aged 60 and over, without significant disability, living in homes within metropolitan Adelaide, South Australia were recruited through community advertising.

RESULTS

Sixty age-friendly home environment assessments were conducted. Common areas where potential hazards were identified, and modifications recommended were bathrooms, toilets and backyards. Gardens were commonly identified as potentially requiring modifications in the future. Participants were more likely to consider moving to new housing if additional modifications were needed to their homes.

CONCLUSION

Affordable and accessible age-friendly housing is required to support an ageing population. Education on age-friendly housing for healthy middle and older aged people is required enabling proactive planning rather than awaiting health crises.

Associations between residential greenness and air pollution and the incident metabolic syndrome in a Thai worker cohort

Increasing air pollution and decreasing exposure to greenness may contribute to the metabolic syndrome (MetS). We examined associations between long-term exposure to residential greenness and air pollution and MetS incidence in the Bangkok Metropolitan Region, Thailand. Data from 1369 employees (aged 52-71 years) from the Electricity Generating Authority of Thailand cohort from 2002 to 2017 were analyzed. The greenness level within 500 m of each participant's residence was measured using the satellite-derived Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). The kriging approach was used to generate the average concentration of each air pollutant (PM10, CO, SO2, NO2, and O3) at the sub-district level. The average long-term exposure to air pollution and greenness for each participant was calculated over the same period of person-time. Cox proportional hazards models were used to analyze the greenness-air pollution-MetS associations. The adjusted hazard ratio of MetS was 1.42 (95% confidence interval (CI): 1.32, 1.53), 1.22 (95% CI: 1.15, 1.30), and 2.0 (95% CI: 1.82, 2.20), per interquartile range increase in PM10 (9.5 μg/m3), SO2 (0.9 ppb), and CO (0.3 ppm), respectively. We found no clear association between NDVI or EVI and the incidence of MetS. On the contrary, the incident MetS was positively associated with NDVI and EVI for participants exposed to PM10 at concentrations more than 50 μg/m3. In summary, the incidence of MetS was positively associated with long-term exposure to air pollution. In areas with high levels of air pollution, green spaces may not benefit health outcomes.

Third Places for Older Adults' Social Engagement: A Scoping Review and Research Agenda

BACKGROUND AND OBJECTIVES

Neighborhood places that facilitate older residents to meet and interact (third places) receive an increasing research interest as studies have consistently shown the benefits of social engagement for older adults' health. This scoping review synthesized the findings of studies examining the role of third places in older adults' social engagement.

RESEARCH DESIGN AND METHODS

Searching 5 databases (CINAHL, Medline, PsycInfo, Scopus, and Web of Science) in October 2021, this study identified quantitative and qualitative studies that examined the relationships between third places and social engagement (interaction and network) among older adults.

RESULTS

A total of 32 studies (12 quantitative and 20 qualitative studies) met the eligibility criteria. These studies examined 4 types of third place, namely, community facilities, local businesses, open/green spaces, and transition spaces. More than two thirds of the studies reviewed found that access to community facilities, local businesses, and open/green spaces were related to older adults' social interaction. For the relationships between third places and social networks, the importance of accessible local businesses and the quality of open/green spaces was supported by fewer studies.

DISCUSSION AND IMPLICATIONS

The findings of quantitative and qualitative studies suggest that local places that are convenient to visit and comfortable to stay in for older adults are likely to enhance their social interaction and network. However, more specific evidence is needed to inform the planning and design of third places. The review discusses future research topics that address the gaps identified in the current literature.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Neighborhood walkability, neighborhood social health, and self-selection among U.S. adults

OBJECTIVES

Neighborhood walkability is favorably related to multiple physical health outcomes, but associations with social health are less clear. Present analyses examined how neighborhood walkability was related to neighborhood social health and explored the potential confounding role of neighborhood self-selection.

METHODS

Cross-sectional data were analyzed for 1745 adults, ages 20-66, recruited from two US regions. We created a walkability index around each participant's home (1 km street network buffer) based on residential density, street intersection density, mixed land use, and retail floor area ratio. Neighborhood social health outcomes included reported social interactions with neighbors and sense of community. Two mixed model regressions were conducted for each outcome, with and without adjusting for walkability-related reasons for moving to the neighborhood (self-selection). Covariates included sex, age, socioeconomic status, white/nonwhite race/ethnicity, marital status, and time living in the neighborhood.

RESULTS

Neighborhood walkability was positively related to social interactions with neighbors, both without (b = 0.13, p < .001) and with adjustment for self-selection (b = 0.09, p = .008). Neighborhood walkability was positively associated with sense of community, but only before adjusting for self-selection (b = 0.02, p = .009).

CONCLUSION

Neighborhood walkability may promote specific aspects of neighborhood social health, which together are beneficial for physical and mental health. These findings provide additional impetus for enhancing walkability of US communities.

Restoration in mental health after visiting urban green spaces, who is most affected? Comparison between good/poor mental health in four European cities

Several mechanisms have been proposed to explain the association between green space and health, and one of these is the restoration theory, based on the idea that it is possible to increase mental health and decrease stress visiting a natural environment. The aims of the present study were to understand what activities are most related to restoration and if these are the same for people with poorer and better mental health. A questionnaire was administered in four European cities and data about restoration outcomes, type of activity carried out in green spaces and mental health were collected and analyzed. A cross sectional design was used and total of 3134 respondents participated to the questionnaire. The restoration experience was measured with the restoration outcome score, and the mental health was evaluated with a subscale related to mental health of the Medical Outcome Short Form. Participants were divided in two groups according to mental health score. A multiple regression analysis was performed to investigate the association between mental health, type of activity and restoration. The cities showed a similar trend in the association between restoration and type of activity performed in green environment. People with poorer mental health seem to be more sensitive to the positive effect of visiting the green environment and restoration was more evident in these people than in those with better mental health. At the same time, the type of activity was less evident in people with better mental health, and they seemed to be less influenced by the visiting of green space. Green prescription is important for the entire population: people with poorer mental health could have important restorative effects and people with better mental health could continue to protect their well-being using green space.

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.

Perceptions of neighborhood environment and loneliness among older Chinese adults: the mediator role of cognitive and structural social capital

OBJECTIVE

This study aimed to examine the mediating role of social capital in the association between perceived physical neighborhood environment and loneliness among older adults in urban China.

METHOD

Data were derived from face-to-face interviews with people (n = 472) aged 60 or older in urban communities of Shanghai, China, in 2020. Loneliness was measured by the 6-item De Jong Gierveld Scale. A multiple mediator model was adopted to examine the research hypotheses.

RESULTS

Cognitive social capital played a full mediation role in the association between perceived community health care (β = -.061, p < .05), safety (β = -.168, p < .001), recreational services (β = -.058, p < .05), and loneliness. Structural social capital was associated with loneliness (β = -.102, p < .05), whereas its mediator effect was not significant. Perceived transportation convenience had neither a direct nor an indirect effect on loneliness among older adults.

CONCLUSION

Findings indicate that older adults' perceptions of healthcare services, safety, and recreational resources could help alleviate their loneliness via fostering cognitive social capital. Interventions improving older adults' perceptions of community health care, safety, and recreation, and their social capital level could help reduce the prevalence of loneliness.

Residential greenness and kidney function: A cohort study of Thai employees

Higher residential greenness is associated with a lower risk of chronic kidney disease, but evidence on the association between greenness exposure and kidney function has not been conducted. Using cohort data from Electricity Generating Authority of Thailand (EGAT) employees, we investigated the association between long-term exposure to greenness and kidney function using estimated glomerular filtration rate (eGFR) in Bangkok Metropolitan Region (BMR), Thailand. We analyzed data from 2022 EGAT workers (aged 25-55 years at baseline) from 2009 to 2019. The level of greenness was calculated using the satellite-derived Enhanced Vegetation Index (EVI) and Normalized Difference Vegetation Index (NDVI). From 2008 to 2019, the average concentration of each air pollutant (PM₁₀, O₃, NO₂, SO₂, and CO) at the sub-district level in BMR was generated using the Kriging method. Long-term exposure for each participant was defined as the 1-year average concentrations before the date of the physical examination in 2009, 2014, and 2019. We employed linear mixed effects models to evaluate associations of NDVI and EVI with eGFR. The robustness of the results was also tested by including air pollutants in the models. After relevant confounders were controlled, the interquartile range increase in NDVI was associated with higher eGFR [1.03% (95%CI: 0.33, 1.74)]. After PM₁₀ and SO₂ were included in the models, the associations between NDVI and eGFR became weaker. The additions of O₃, NO₂, and CO strengthened the associations between them. In contrast, we did not find any association between EVI and eGFR. In conclusion, there was a positive association between NDVI and eGFR, but not for EVI. Air pollutants had a significant impact on the relationship between NDVI and eGFR. Additional research is needed to duplicate this result in various settings and populations to confirm our findings.

Comparison of static and dynamic exposures to air pollution, noise, and greenness among seniors living in compact-city environments

GPS technology and tracking study designs have gained popularity as a tool to go beyond the limitations of static exposure assessments based on the subject's residence. These dynamic exposure assessment methods offer high potential upside in terms of accuracy but also disadvantages in terms of cost, sample sizes, and types of data generated. Because of that, with our study we aim to understand in which cases researchers need to use GPS-based methods to guarantee the necessary accuracy in exposure assessment. With a sample of 113 seniors living in Barcelona (Spain) we compare their estimated daily exposures to air pollution (PM2.5, PM10, NO2), noise (dB), and greenness (NDVI) using static and dynamic exposure assessment techniques. Results indicate that significant differences between static and dynamic exposure assessments are only present in selected exposures, and would thus suggest that static assessments using the place of residence would provide accurate-enough values across a number of exposures in the case of seniors. Our models for Barcelona's seniors suggest that dynamic exposure would only be required in the case of exposure to smaller particulate matter (PM2.5) and exposure to noise levels. The study signals to the need to consider both the mobility patterns and the built environment context when deciding between static or dynamic measures of exposure assessment.

Integrating knowledge on green infrastructure, health and well-being in ageing populations: Principles for research and practice

Ageing and urbanisation pose significant challenges for public health and urban planning. Ageing populations are at particular risk from hazards arising from urbanisation processes, some of which are in turn exacerbated by climate change. One approach for mitigating the negative effects of urbanisation on ageing populations is the leveraging of the beneficial effects of urban green infrastructure as a public health intervention in the planning process. We assessed the potential of available theoretical frameworks to provide the context for such leverage. This involved active engagement with academics and practitioners specialising in ageing, green infrastructure and health and well-being through a knowledge-brokering approach. We concluded that an integrated and comprehensive framework on the socio-cultural-ecological determinants of health is lacking. To address this, we present a set of principles for overcoming challenges to knowledge integration when working at the intersection of green infrastructure, ageing, health and well-being. Our findings-and the co-production process used to generate them-have wider significance for trans-disciplinary research into the benefits of the natural environment to human health and well-being as well as other complex and interconnected topics associated with global grand challenges.

Aging in Rural Communities

Purpose of Review

Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities.

Recent Findings

The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted.

Summary

Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

Greenspace exposure and poststroke disability: A nationwide longitudinal study

INTRODUCTION

Exposure to greenspace has been reported to reduce stroke mortality, but there is a lack of evidence regarding poststroke disability. This study aimed to investigate the association between long-term greenspace exposure and the risk of poststroke disability.

METHODS

Based on the China National Stroke Screening Survey from 2013 to 2019, a total of 65,892 visits from 28,085 stroke survivors with ≥ 2 visits were included in this longitudinal study. Long-term greenspace exposure was assessed by a 3-year average of the Normalized Difference Vegetation Index (NDVI) and the proportion of green land cover according to participants' residential communities. Poststroke functional status was assessed with the modified Ranking Score (mRS) at each visit; a cutoff score > 2 indicated disability. Fixed effects regressions were used to examine the association of greenspace exposure with continuous mRS scores or binary indicators for disability.

RESULTS

The annual mean NDVI value was 0.369 (standard deviation = 0.120) for all visits among stroke survivors. With full adjustments, each 0.05 increase in NDVI was associated with a 0.056-unit (95 % confidence interval (CI): 0.034, 0.079) decrease in the mRS score and a 46.6 % (95 % CI: 10.0 %, 68.3 %) lower risk of poststroke disability. An L-shaped curve was observed for the nonlinear associations between NDVI and mRS score or disability. Additionally, each 1 % increase in grasslands, savannas, forest, and croplands was associated with 0.008- (95 % CI: 0.002, 0.014), 0.003- (95 % CI: 0.001, 0.005), 0.001- (95 % CI: -0.015, 0.018), and 0.002-unit (95 % CI: -0.003, 0.007) decreases in the mRS score, respectively.

CONCLUSIONS

Increasing greenspace was inversely associated with mRS score. Greenspace planning can be a potential intervention to prevent poststroke disability.

The health equity characteristics of research exploring the unmet community mobility needs of older adults: a scoping review

BACKGROUND

Unmet community mobility needs of older adults, published since the announcement of the UN sustainable development goals was synthesised to describe the health equity characteristics of research identifying unmet community mobility needs of older adults.

METHODS

Searches were conducted in March and April 2020, 2275 articles were screened and 100 identified for data extraction.

RESULTS

Findings showed underrepresentation of articles considering rural settings [9%] and originating in the global South [14%]. Gender, disability, education, and transport / driving were identified as key health equity characteristics and only 10 articles provided detail on all four of these. External factors inhibiting community mobility included built environments, service availability, and societal attitudes. Internal factors included finances, fear and apprehension, and functional limitations.

CONCLUSIONS

The need for standardised reporting of participant characteristics in the community mobility of older adults was highlighted. These characteristics are required by research consumers to judge equity dimensions, and the extent to which findings represent minority or marginalised groups. 15 after the UN pledge to reduce inequalities, peer reviewed primary research does not reflect a global drive to end discrimination, exclusion and reduce the inequalities and vulnerabilities that leave people behind.

The Effect of Physical Activity Interventions Carried Out in Outdoor Natural Blue and Green Spaces on Health Outcomes: A Systematic Review

In the last few years, interest about the natural environment and its influences on health conditions has been growing. In particular, physical activity interventions carried out in blue and green environment are being investigated as a potential strategy to increase health outcomes in people with and without chronic conditions. Many recent studies reported positive results, but a high number of these studies were focused on people with mental or physical disorders. In this scenario, the present systematic review, conducted according to the PRISMA statement, was aimed at investigating the existing evidence regarding the effects of physical activity interventions carried out in green-blue space settings involving healthy people. A literature search was performed through PubMed, Cochrane, Cinahl, and Psychinfo, and the quality of each study was assessed. Out of 239 identified articles, 75 full texts were screened. Six eligible studies showed an improvement in health outcomes, such as well-being, mood, and physical performance, in the experimental group compared with the control group. No exhaustive conclusion can be drawn based on available evidence. However, this systematic review highlighted the need to extend this kind of intervention to reveal more robust evidence that green and blue exercises benefit health.

Relationship between the Duration of Urban Nature and a Lower Waist-Hip Ratio

Obesity is a prevalent health issue. Evidence suggests that the availability of urban nature may reduce the risks of obesity. However, several knowledge gaps remain. This study explores the relationships between the dose (distance, duration and frequency) of urban nature and demographic factors towards obesity risks among people in Thailand. A total of 111 participants in three urban and peri-urban nature locations answered a survey regarding their distance from green spaces, frequency of visits, and duration of their typical stay, as well as their socio-demographics, and waist-hip ratio (WHR). The results suggested that at least 1-2 h per typical visit to nature predicted low-risk WHR in women. Male participants are more likely to have a high-risk WHR. Increasing age predicted low-risk WHR. Spending more time in green spaces predicted lower odds of high-risk WHR, while distance did not predict the odds. This research is one of the first to study the relationship between time spent in nature and obesity, and one of the first nature and health studies conducted in Thailand. Given that Thailand is one of the countries most affected by obesity in Southeast Asia, this study is relevant and essential. Future research should explore the quality factors of the park with longer duration of stay.

Physical Activity Behavior, Motivation and Active Commuting: Relationships with the Use of Green Spaces in Italy

Many benefits of physical activity (PA) are observed with weekly average volumes of 150–300 min at moderate intensity. Public parks may be an attraction for many people living in the city and could help to achieve the recommended dose of PA. The present study aims to understand the motivation that drives people to a park and evaluate the amount of PA practiced by park-goers. A questionnaire was anonymously administered to 383 voluntary visitors to the Arcoveggio park (Bologna), aged 18–70 years. Sixty-one percent of participants practiced outdoor PA. Differences in park use between sexes and age groups were found. PA was higher in men than in women and in the 18–30 age group than in other age groups. Most participants travelled to the park in an active way (86.4%), resulting in easier attainment of the recommended amount of PA (64.5%). The main motivations for using the park were related to relaxation, performing PA, or both. According to a multiple regression model, the time per week spent at the park, the method of getting there, and the kind of PA were significant explanatory variables of the amount of PA practiced. In particular, the highest number of minutes of PA was achieved by those who travelled to the park by running, while those using vehicles presented the lowest number. All initiatives to promote active commuting and activities in the urban park represent an important strategy to improve health, supporting adults to lead an active lifestyle.

Long-term exposure to residential greenness and neurodegenerative disease mortality among older adults: a 13-year follow-up cohort study

BACKGROUND

Living in greener areas is associated with slower cognitive decline and reduced dementia risk among older adults, but the evidence with neurodegenerative disease mortality is scarce. We studied the association between residential surrounding greenness and neurodegenerative disease mortality in older adults.

METHODS

We used data from the 2001 Belgian census linked to mortality register data during 2001-2014. We included individuals aged 60 years or older and residing in the five largest Belgian urban areas at baseline (2001). Exposure to residential surrounding greenness was assessed using the 2006 Normalized Difference Vegetation Index (NDVI) within 500-m from residence. We considered all neurodegenerative diseases and four specific outcomes: Alzheimer's disease, vascular dementia, unspecified dementia, and Parkinson's disease. We fitted Cox proportional hazard models to obtain hazard ratios (HR) and 95% confidence intervals (CI) of the associations between one interquartile range (IQR) increment in surrounding greenness and neurodegenerative disease mortality outcomes, adjusted for census-based covariates. Furthermore, we evaluated the potential role of 2010 air pollution (PM_2.5 and NO₂) concentrations, and we explored effect modification by sociodemographic characteristics.

RESULTS

From 1,134,502 individuals included at baseline, 6.1% died from neurodegenerative diseases during follow-up. After full adjustment, one IQR (0.22) increment of surrounding greenness was associated with a 4-5% reduction in premature mortality from all neurodegenerative diseases, Alzheimer's disease, vascular and unspecified dementia [e.g., for Alzheimer's disease mortality: HR 0.95 (95%CI: 0.93, 0.98)]. No association was found with Parkinson's disease mortality. Main associations remained for all neurodegenerative disease mortality when accounting for air pollution, but not for the majority of specific mortality outcomes. Associations were strongest in the lower educated and residents from most deprived neighbourhoods.

CONCLUSIONS

Living near greener spaces may reduce the risk of neurodegenerative disease mortality among older adults, potentially independent from air pollution. Socioeconomically disadvantaged groups may experience the greatest beneficial effect.

The Use of Urban Parks by Older Adults in the Context of Perceived Security

The perception of urban greenery is determined by many aspects, including the personal security of different groups of city dwellers. The objective of this study was to investigate if there are differences between the sense of security of older adults and other groups of urban park users, and which factors play an important role in the evaluation of personal security and thus determine the use (or not) of parks. A survey questionnaire was administrated to a sample of randomly selected park users in Poland (n = 394), including seniors (s = 69). The results show statistically significant differences in security perception between respondents under the age of 60 and those over the age of 60 in the case of all questioned factors. At the same time, all of them are important for a sense of security in older adults. This knowledge is crucial for designing more inclusive and age-friendly urban parks, which should meet the needs and expectations of older adults and encourage them to engage in more activity.

Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver

BACKGROUND

The COVID-19 pandemic has impacted both physical and mental health. This study aimed to understand whether exposure to green space buffered against stress and distress during the COVID-19 pandemic while taking into account significant stressors of the pandemic.

METHODS

We leveraged a cross-sectional survey on green space exposure and mental health among residents of Denver, CO that ran from November 2019 through January 2021. We measured objective green space as the average NDVI (normalized difference vegetation index) from aerial imagery within 300m and 500m of the participant's residence. Perceived green space was measured through Likert scores on five questions about vegetation near the home that captured perceived abundance, visibility, access, usage, and quality of green space. We used generalized linear models to assess the relationship between each green space exposure variable and perceived stress (PSS-4), depression (CES-D-10), or anxiety (MMPI-2) adjusted for sociodemographic and COVID-19 impact variables.

RESULTS

We found significantly higher depression scores for all covid periods compared to the "before covid" period, and significantly higher anxiety scores during the "fall wave" compared to earlier periods. Adjusted for sociodemographic and pandemic stressors, we found that spending a lot of time in green space (usage) was significantly associated with lower anxiety and depression. We also observed significantly lower depression scores associated with NDVI in both buffers (objective abundance) and significantly lower anxiety scores with perceived abundance of green space. There was some evidence of lower anxiety scores for people reporting having high quality green spaces near the home (quality). We did not observe significant associations for any green space metric and perceived stress after adjustment for confounding variables.

CONCLUSION

Our work provides further evidence of mental health benefits associated with green space exposure during the COVID-19 pandemic even after adjustment for sociodemographic variables and significant pandemic-related stressors.

Assessing streetscape greenery with deep neural network using Google Street View

The importance of greenery in urban areas has traditionally been discussed from ecological and esthetic perspectives, as well as in public health and social science fields. The recent advancements in empirical studies were enabled by the combination of 'big data' of streetscapes and automated image recognition. However, the existing methods of automated image recognition for urban greenery have problems such as the confusion of green artificial objects and the excessive cost of model training. To ameliorate the drawbacks of existing methods, this study proposes to apply a patch-based semantic segmentation method for determining the green view index of certain urban areas by using Google Street View imagery and the 'chopped picture method'. We expect that our method will contribute to expanding the scope of studies on urban greenery in various fields.

Street Trees for Bicyclists, Pedestrians, and Vehicle Drivers: A Systematic Multimodal Review

Multimodal Complete Streets have emerged as a prominent aspiration of urban planning to ensure safe access for all users of streets including pedestrians, bicyclists, motorists, and transit users. Concurrently, municipal leaders are pursuing ambitious tree planting initiatives. These co-arising trends are potentially good news, as trees are important elements of livable cities and Complete Streets. Yet, street trees may have different health and safety benefits and disbenefits for various circulation modes. To advance a multimodal approach to research and practice, we undertook a systematic literature review with goals to (1) identify the scholarly literature addressing links between street trees, human health, and safety for pedestrians, bicyclists, and vehicle drivers; (2) depict the principal disciplines, themes, and conceptual scope of this research; and (3) discuss the implications for urban planning and design practice and research. This review drew upon 13 scholarly databases and yielded 63 relevant articles spanning 15 countries, of which 49 constituted original research. The systematic analysis covers eight research categories. Findings show exponential growth in related scholarship over the past two decades, especially for pedestrians. Journals oriented toward interdisciplinary planning and public health and safety are leading this rise, and benefits far outweigh disbenefits. Yet, there are multimodal tensions especially as it relates to the role of street trees in relationship to drivers and pedestrians. Implications for research and practice are discussed, with an eye towards governance, design, and equity.

Relationship between Physical Environment Satisfaction, Neighborhood Satisfaction, and Quality of Life in Gyeonggi, Korea

This study examined the relationship between physical environment satisfaction, neighborhood satisfaction, and quality of life (QoL) in Gyeonggi, Korea. As previous QoL studies have rarely dealt with residential environments or examined the interactions between the physical and social factors in residential environments, to close these knowledge gaps, this study took physical and social environment satisfaction factors as relevant influences on QoL. This study also verified the moderating effect of neighborhood satisfaction on QoL through physical environment satisfaction. This study analyzed a Quality of Life Survey that was conducted in Gyeonggi, Korea. The total number of samples in the survey was 20,000, covering all 31 districts in Gyeonggi Province. In addition, multistage stratified sampling based on the number of household members and housing types was applied to the sample design. This increases the representation of the data. As a result, it was found that higher satisfaction with the physical and neighborhood factors positively affected QoL, with satisfaction with the facilities having the most obvious effect. Neighborhood satisfaction was found to have a moderating effect between safety satisfaction and QoL. Many developing countries have tended to pursue quantitative growth with a focus on economic aspects, which has undermined overall urban sustainability. However, recent urban management has also emphasized qualitative growth, such as resident QoL, as being just as important for urban sustainability. Therefore, this study’s results have important policy implications for qualitative urban growth.

Attitudes towards Green Urban Space: A Case Study of Two Italian Regions

Green spaces are defined as open spaces of ground, covered by vegetation, including parks and gardens. This kind of environment is linked to many positive effects and its importance is growing due to increasing urbanization. Understanding what drives people to use green urban space is fundamental to creating appropriate campaigns to develop the use of such spaces and improve the citizens’ quality of life. A questionnaire on the attitude towards green space was developed and submitted to people from two Italian regions. Emilia-Romagna and Veneto are two regions in the North of Italy with different territorial policies. Three hundred and ten surveys were collected (167 in Emilia-Romagna and 143 in Veneto). Significant differences were observed between regions, age groups and in relation to the kind of work (p < 0.05). People from Emilia-Romagna have higher scores of attitudes towards green space than people from Veneto, underlining the importance of territorial policies. Moreover, younger participants (18–30 years) seem to be less attracted to green urban space. Being an employee seems to influence the attitude towards green space. Particular attention should be given to subjects of the younger age groups and to the number of hours spent at work. This could be an important element for future research, so that political action can be implemented with these categories in mind.

Impact of Different Types of Physical Activity in Green Urban Space on Adult Health and Behaviors: A Systematic Review

This systematic review aimed to investigate the type of physical activity carried out in green urban spaces by the adult population and to value its impact on the population’s health. Additionally, another purpose was to examine if the presence of outdoor gyms in green urban spaces can promote participation in physical activity among adults. Searches of electronic databases, with no time restrictions and up to June 2020, resulted in 10 studies meeting the inclusion criteria. A quantitative assessment is reported as effect size. Many people practiced walking activity as a workout, which showed improvements in health. Walking is the most popular type of training due to its easy accessibility and it not requiring equipment or special skills. Outdoor fitness equipment has been installed in an increasing number of parks and has become very popular worldwide. Further, outdoor fitness equipment provides free access to fitness training and seems to promote physical activity in healthy adults. However, other studies about outdoor fitness equipment efficiency are needed. People living near to equipped areas are more likely to perform outdoor fitness than those who live further away. The most common training programs performed in green urban spaces included exercises with free and easy access, able to promote physical health and perception.

Neighborhood Urban Design and Outdoor Later Life: An Objective Assessment of Out-of-Home Time and Physical Activity Among Older Adults in Barcelona

This study explores how older adults' time out-of-home and physical activity (PA) are associated with the provision of urban open spaces (green spaces, plazas, and boulevards) and microelements (street trees and benches) in their neighborhoods. The authors used data from 103 residents in Barcelona and matched it to official geospatial data. The authors adjusted a set of mixed-effects linear regressions, both for the entire sample and also stratified by age and gender. For the entire sample, the percentage of green spaces showed a positive association with neighborhood time out-of-home and PA, while participants' PA also showed a positive association with the presence of benches. Outdoor time among older women was not associated with any of the measured exposures. For men, the provision of green spaces and benches was positively associated with time out-of-home and PA. These results could inform the design of urban spaces that aim to encourage outdoor activity among older adults.

Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors

BACKGROUND

Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors.

METHODS

In total, 693 participants aged 66-97 were sampled from two US locales in 2005-2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles.

RESULTS

More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC).

CONCLUSIONS

Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

Expanding Social, Psychological, and Physical Indicators of Urbanites' Life Satisfaction toward Residential Community: A Structural Equation Modeling Analysis

Attention on, and interest in, life satisfaction has increased worldwide. However, research on life satisfaction focused toward the urban dwellers' residential community is mainly from western countries, and the limited research from China is solely focused on the geriatric population via a narrowly constrained research perspective. This study, therefore, aimed to investigate urbanites' life satisfaction toward their community, combining the psychological (behavioral community engagement, mental state of flow, and cognitive community identity), physical (PREQIs-perceived residential environment quality indicators: e.g., green area), and social perspectives (social capital). The proposed conceptual model was tested on a regionally representative sample of 508 urban community residents in the city of Chengdu, Sichuan province, China. Data were analyzed via a structure equation modelling approach in AMOS software. Findings suggested that all of the psychological, physical and social factors contributed to a prediction of life satisfaction. Specifically, social capital mediated the path from community engagement and flow to life satisfaction, and community identity mediated the path from flow experience and green area to life satisfaction. Additionally, social capital contributed to predict life satisfaction through its influence on community identity. Findings provide suggestions for urban designers and policymakers to focus on creating an urban community equipped with green area, which helps to promote physical activities that are flow-productive, to enhance residents' identification to their residential community and, therefore, increase life satisfaction.

Long-Term Exposure to Residential Greenspace and Healthy Ageing: a Systematic Review

PURPOSE OF REVIEW

We systematically reviewed the available observational evidence on the association between long-term exposure to residential outdoor greenspace and health at older age and rated the evidence as sufficient, limited, or inadequate.

RECENT FINDINGS

We identified 59 studies, ranging from poor to very good quality. The health outcomes included mental health (N = 12, of which three were longitudinal studies and eight were rated to be of good quality), cognitive function (N = 6; two longitudinal studies, five of good/very good quality), physical capability (N = 22; five longitudinal studies, six of good/very good quality), cardiometabolic risk (N = 9; one longitudinal study, five of good/very good quality), morbidity (N = 11; three longitudinal studies, six of good/very good quality) and perceived wellbeing (N = 9; all cross-sectional, two of good quality). The evidence for a beneficial association with greenspace was rated limited for morbidity and inadequate for mental health, cognitive function, physical capability, cardiometabolic risk and perceived wellbeing. The reviewed studies provided inadequate/limited but suggestive evidence for a beneficial association between greater long-term greenspace exposure and healthy ageing. This review highlights the need of longitudinal studies that assess the association between long-term greenspace exposure and the trajectory of objective indicators of ageing.

Measuring perceptions of social environments for walking: A scoping review of walkability surveys

The neighborhood pedestrian environment is an important determinant of physical activity and health. Despite widespread acknowledgment that neighborhoods' social and physical characteristics contribute to a walkable place, constructs and metrics remain focused primarily on the built environment. This scoping review documents the current state of the practice to measure perceived social elements of pedestrian environments in order to identify measurement strategies to understand and support walking, particularly in socially diverse neighborhoods. We identified 20 survey instruments focused on pedestrian environments, walkability, or physical activity at the local (neighborhood) scale and designed to capture residents' perceptions of outdoor walking environments. Across the 20 instruments, we identified and categorized 182 distinct items that measured social environments into four domains (social capital, personal safety, physical signifiers, and general neighborhood descriptors) and thirteen subdomains. Many items emphasized negative social elements, such as crime and disorder. Only a few items focused on community identity. Most instruments cover some aspects of the social environment well, but few provide a holistic inventory of the social environment across domains and subdomains. We also observe that the state of the practice seems frozen, with most instruments in use having originated in 2010 or earlier.

How to Find Vacant Green Space in the Process of Urban Park Planning: Case Study in Ningbo (China)

Nature-based recreation in urban areas is essential for the well-being of citizens. Park green space (PGS) is a necessary urban infrastructure and a critical step of urban planning and policy-making. The existing research on PGS only focuses on service allocation problems existing in the current urban development, ignoring changes in residential communities accessibility. This research provides new ideas to evaluate PGS. Based on parks and residential communities' data, we adopt an improved Gaussian-based two-step floating catchment area (2SFCA) method to evaluate PGS accessibility in Ningbo (China) and its matching with different levels of residential areas. We present a case study in Ningbo, and discuss its implications for PGS management. This study contains two elements: (a) Compare the current and initial PGS accessibility of each community to accurately identify the communities with PGS vacancies. (b) Analyze and discuss the association between community accessibility and residential house prices. Compare the PGS coverage ratios of communities at different levels to determine the equity of PGS planning in Ningbo. We found that the level of PGS allocation in the central area of Ningbo is high. Obviously, high-value clusters are formed in Sanjiangkou, Zhenhai New Town, Southern and Eastern Yinzhou. The accessibility level in the middle area of Yinzhou is low, and there are super high accessibility residential communities in the outer city area. There is an exact period of green space vacancy in the middle and the outer area. The residential areas with ultra-high accessibility did not configure PGS services at the beginning of their construction. There is no noticeable difference in PGS accessibility of residential communities of different levels at present, but 149 low- and middle-income residential communities lack green space service when the construction was completed. High-end residential communities have priority on enjoying park green space services. Our study suggests that PGS accessibility should be studied temporally and spatially for each residential community. The Ningbo government should strengthen the balanced construction of green space in parks and guarantee green space services for low-end residential communities to improve green space equity.

Exercise Spaces in Parks for Older Adults: A Qualitative Investigation

In response to demographic changes in recent years, an increasing number of parks have established exercise spaces for older adults. However, limited research has been conducted to investigate how older adults utilize, experience, and perceive these spaces. This study aims to explore their experiences of using these spaces and their perspectives on these spaces by using a qualitative descriptive research design. In-depth interviews were conducted with 32 users in three Hong Kong parks with low, medium, and high area-based socioeconomic statuses. The findings highlight that exercise spaces in parks can cultivate a positive environment allowing older adults with varying physical abilities and health statuses to remain active together as well as to support each other socially and emotionally in a natural outdoor setting. The participants' perspectives on the exercise space discussed in this study suggest that future plans for constructing such spaces in parks might benefit from a co-design approach.

Planning for Supportive Green Spaces in the Winter City of China: Linking Exercise of Elderly Residents and Exercise Prescription for Cardiovascular Health

The elderly population have a high incidence of cardiovascular disease and are the main users of green spaces, such as city parks. Creating supportive green spaces for exercise for the elderly is of great significance to promote their cardiovascular health. The winter cities have a severely cold climate and high incidence of cardiovascular disease, while the elderly, especially those with cardiovascular disease, face more challenges when participating in exercise in the green spaces. In the context of the winter cities, the kinds of exercise the elderly participate in are more conducive to their cardiovascular health, and determining the factors of the green spaces that are supportive for exercise for cardiovascular health in the winter are of particular interest. Taking Harbin, a typical winter city in China, as an example, this study aims to identify the exercise characteristics of elderly residents in the green spaces in winter, to link them with the principles and contents of exercise prescription for cardiovascular health, to identify the deficient factors of the green spaces in supporting exercise for cardiovascular health, and to put forward optimization design implications. Mixed qualitative methods including interviews, a questionnaire, and field observation were used to identify special behavioral characteristics and spatial factors involving winter exercise in the green spaces among the elderly. The results showed that: (1) about 42.4% of the participants had a gap with the principles of exercise prescription for cardiovascular health. Their exercise items were generally consistent with the principle of low-intensity exercise, but some of them had the problems regarding early exercise time and insufficient exercise duration and frequency. (2) Insufficient supportive factors of the green spaces mainly included facilities allocation, comfort, safety, accessibility, and air quality. Facilities allocation involved walking paths, rehabilitation facilities, auxiliary facilities, and guidance facilities; comfort involved sunlight conditions of the exercise areas; safety involved slippery roads and sites with ice and snow and medical accidents; accessibility involved the proximity, the safety of connecting roads, and the movement of the elderly; air quality involved the planting of evergreen trees. Accordingly, the design implications were given in order to bridge the supportive gap of the green spaces for exercise for cardiovascular health in the elderly population.

A qualitative study of social connectedness and its relationship to community health programs in rural Chiapas, Mexico

Background

Social connectedness is an important predictor of health outcomes and plays a large role in the physical and mental health of an individual and a community. The presence of a functioning health clinic with a community health worker program may indirectly improve health outcomes by increasing the social connectedness of the community in addition to providing direct patient care. This study examines the social connectedness of the inhabitants of three Mexican towns within the catchment area of a healthcare Non-Government Organization (NGO) through a qualitative analysis.

Methods

Willing participants were videotaped answering open-ended questions about their community and use of healthcare resources. Interviews were then coded for relevant themes and analyzed for content relating to social connectedness, social isolation, and health.

Results

Respondents reported that having a functioning community clinic had improved their lives significantly through direct provision of care and by reducing the financial burden of travel to seek medical care elsewhere. Respondents from each town differed slightly in their primary means of social support. One town relied more heavily on organized groups (i.e., religious groups) for their support system. Social isolation was reported most frequently by housewives who felt isolated in the home and by respondents that had to deal with personal illness. Respondents that self-identified as Community Health Workers (CHWs) in their respective communities acknowledged that their roles bestowed physical and psychological health benefits upon themselves and their families.

Conclusions

Overall, a long-term health intervention may directly impact the relative social isolation and social connectedness of a community’s inhabitants. The social connectedness of the community is an important quality that must be considered when evaluating and planning health interventions.

E. M. Browning M, Rigolon A. Noncommunicable Diseases, Park Prescriptions, and Urban Green Space Use Patterns in a Global South Context: The Case of Dhaka, Bangladesh

Urban green space use is often associated with improved physical and mental health and lower noncommunicable disease (NCDs) burdens. Factors that influence green space visits have been documented in cities of the Global North, but evidence of urban green space use patterns for cities in the Global South is scarce. The aim of this study is to investigate factors influencing urban green space use patterns in Dhaka, Bangladesh, a megacity of the Global South, with a particular focus on how poor health condition and healthcare professionals' prescriptions to exercise outdoors (park prescriptions-ParkRx) impact the green space use of middle-aged adults. We collected green space characteristics and use factors (i.e., availability, accessibility, attractiveness, and attachment), health condition, ParkRx, and urban green space use intensity (i.e., frequency and duration) via a self-reported questionnaire from 169 middle-aged residents of Dhaka. We used multivariate modeling to estimate the association of green space characteristics, health condition, and ParkRx with use intensity. We further applied a mediation analysis to determine the influence of ParkRx on the relationship between residents' poor health conditions and use intensity. We found that green space availability and accessibility did not significantly influence use intensity, but attractiveness was negatively associated with use intensity. Green space use intensity was significantly and positively associated with attachment to the green space, poor health condition (i.e., having noncommunicable diseases), and ParkRx. ParkRx significantly mediated the relationship between health condition and use intensity. We observed limited supply, poor access, and low attractiveness when studying the urban green spaces in Dhaka, but these qualities did not affect use intensity, as found in many case studies in the Global North. In contrast, urban green space use intensity in our case study is mostly dependent on poor health condition and park prescriptions.

The Relationship Between Green Space and Prosocial Behaviour Among Children and Adolescents: A Systematic Review

The plausible role of nearby green space in influencing prosocial behaviour among children and adolescents has been studied recently. However, no review has been conducted of the evidence testing the association between green space and prosocial behaviour. This systematic review addresses this gap among children and adolescents. Within this review, we propose a conceptual framework describing potential pathways linking green space to prosocial behaviour, discuss the direction, magnitude, moderators, and mediators of the association, and develop a narrative synthesis of future study directions. Out of 63 extracted associations from 15 studies, 44 were in the positive or expected direction, of which 18 were reported to be statistically significant (p < 0.05). Overall, the current evidence shows that exposure to green space may potentially increase prosocial behaviour among children and adolescents, with some contingencies (e.g., child's sex and ethnic background). However, the volume and quality of this evidence is not yet sufficient to draw conclusions on causality. Further, heterogeneity in the indicators of green space exposure could lead to mixed findings. In addition, none of the included studies investigated potential mediators. Nevertheless, this review provides preliminary evidence and a basis for further investigation with rigorous study methodology capable of drawing causal inferences and testing potential effect modifiers, linking pathways, and relevant green space measures.

Too Old for Recreation? How Friendly Are Urban Parks for Elderly People?

Urbanization and ageing are the two main processes currently shaping the social environment worldwide. In this context, creating senior friendly cities should be an important target, especially in developed countries, which have the highest rates of population over 60 years old. Our study focuses on the use of urban parks and aims to analyze how friendly their planning, design, and use are for elderly people. We used field observation carried out in four case study parks in Bucharest (Romania) to assess the spatial planning and design of urban parks, and to identify the environmental problems. We applied a total of 5752 questionnaires (16% to elderly people) in the majority of Bucharest’s parks in order to analyze the behavior and perception of seniors in contrast with that of the general population. The analysis highlighted the lack of endowments especially planned or designed for seniors and the multiple problems deriving from their interaction with other visitor groups which make them feel disrespected or unsafe. Our study highlights the need for including the needs, demands, and desires of elderly people in decision making processes, with the aim of creating inclusive and senior friendly parks.

The nexus between air pollution, green infrastructure and human health

Cities are constantly evolving and so are the living conditions within and between them. Rapid urbanization and the ever-growing need for housing have turned large areas of many cities into concrete landscapes that lack greenery. Green infrastructure can support human health, provide socio-economic and environmental benefits, and bring color to an otherwise grey urban landscape. Sometimes, benefits come with downsides in relation to its impact on air quality and human health, requiring suitable data and guidelines to implement effective greening strategies. Air pollution and human health, as well as green infrastructure and human health, are often studied together. Linking green infrastructure with air quality and human health together is a unique aspect of this article. A holistic understanding of these links is key to enabling policymakers and urban planners to make informed decisions. By critically evaluating the link between green infrastructure and human health via air pollution mitigation, we also discuss if our existing understanding of such interventions is sufficient to inform their uptake in practice. Natural science and epidemiology approach the topic of green infrastructure and human health very differently. The pathways linking health benefits to pollution reduction by urban vegetation remain unclear and the mode of green infrastructure deployment is critical to avoid unintended consequences. Strategic deployment of green infrastructure may reduce downwind pollution exposure. However, the development of bespoke design guidelines is vital to promote and optimize greening benefits, and measuring green infrastructure's socio-economic and health benefits are key for their uptake. Greening cities to mitigate pollution effects is on the rise and these need to be matched by scientific evidence and appropriate guidelines. We conclude that urban vegetation can facilitate broad health benefits, but there is little empirical evidence linking these benefits to air pollution reduction by urban vegetation, and appreciable efforts are needed to establish the underlying policies, design and engineering guidelines governing its deployment.