Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England

Green space exposure and Chinese residents' physical activity participation: empirical evidence from a health geography perspective

Background

With continuous efforts made to promote the strategic goals of carbon neutrality and carbon peak, it is crucial to meet the growing and diversified needs of the public for fitness by practicing the concept of green development and promote the combination of national fitness and ecological civilization.

Methods

To achieve this purpose, an OLS regression model was applied to estimate the role of green space exposure in Chinese residents' participation in physical activity and its underlying mechanisms, using the microdata from the China General Social Survey (CGSS) data and the Provincial Vegetation Cover Index (NDVI) matched macrostatistical data.

Results

The empirical results show that green space exposure significantly increases the probability of residents' physical activity participation, and creating a green environment is conducive to creating a favorable physical activity environment for residents. Also, the core conclusions still hold after the year-by-year regression test is passed and the endogeneity problem is addressed. As revealed by mechanistic studies, green space exposure has indirect effects on the physical activity participation of residents through the independent mediating roles of reducing carbon emissions and promoting social interaction. According to heterogeneity results, males, those in marriage, and urban dweller groups are more inclined to perform physical activity in green spaces.

Conclusion

The results show that the exposure of green space can help increase the probability of residents' participation in physical exercise, and can that it achieved through two channels: reducing carbon emissions and enhancing social interaction. It is necessary to further strengthen the protection of the ecological lifestyle, give full play to the advantages of greenness and low-carbon, and create favorable conditions for the green development of a new model of national fitness.

Valuing the health benefits of nature-based recreational physical activity in England

Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease. Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose-response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers. In 2019, 22million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million). Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs.

Frequency of regular walking among Croatian adults

The aim of this study was to determine the share of Croatian adults who walk 210 min or more a week and to explore the relationship between regular walking and demographic factors, health-related behaviours, and chronic non-communicable diseases/conditions. To this end, we used the EHIS-PAQ questionnaire and collected self-reported data on minutes spent walking during a typical week from a total of 3,496 respondents. The data were additionally analysed by gender, age, education, residence (urban/rural), counties and regions, smoking, other types of physical activity, and diseases/chronic conditions. The results show that, overall, 40.9 % of the adult Croatian population walks 210 or more minutes a week, with the largest share found among those from the Lika-Senj County (76.8 %), those who spend 300 min or more weekly on health-enhancing (non-work-related) aerobic physical activity (57.6 %), those who reported having diabetes (49.3 %), and those aged 65-74 years (44.7 %). Despite its limitations, our study gives a valuable insight into the frequency and factors determining healthy walking habits in a representative sample of Croatian adults and provides grounds for further research.

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.

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.

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

Background

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

Objectives

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

Design

A retrospective, dynamic longitudinal panel study.

Setting

Wales, UK.

Participants

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

Main outcome measures

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

Data sources

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

Methods

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

Results and conclusions

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

Limitations

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

Future work

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

Funding

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

Association between housework and the risk of dementia among older Chinese adults: a prospective cohort study

OBJECTIVES

Physical activity (PA) is known to improve physical functioning and mental health and to reduce the incidence of dementia. However, studies of the effects of non-recreational PA on the incidence of dementia, especially in East Asian populations, remain limited. In this study, we evaluate the association of doing housework with the risk of dementia among participants in the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

The analysis was conducted with data from 7,237 CLHLS participants age over 65 obtained in 2008/2009, 2011/2012, 2014, and 2018. The frequency of housework performance was classified into four groups. A Cox proportional-hazards model was used to examine the association of the baseline housework frequency with the incidence of dementia, with adjustment for demographic and socioeconomic characteristics and lifestyle and health conditions.

RESULTS

The adjusted multivariate model showed that the incidence of dementia was lower among participants who did housework almost every day than among those who rarely or never did housework (hazard ratio = 0.49; 95% confidence interval, 0.39-0.61). The subgroup and sensitivity analyses yielded similar results.

CONCLUSION

A high frequency of housework performance was associated with a reduced incidence of dementia among older Chinese adults, especially those who did not exercise regularly. The encouragement of engagement in housework would be a cost-effective measure promoting healthy aging in the Chinese population.

Nature visits during the COVID-19 pandemic in Norway: Facilitators, motives, and associations with sociodemographic characteristics

Introduction

The COVID-19 pandemic has been linked to increased mental health issues and reduced well-being. Researchers also reports increased frequency of nature visits during the pandemic, proposing it may mitigate some of these negative consequences. Using the case of Norway, a country with ample access to nature and relatively low levels of pandemic-related restrictions, this study sought to (i) understand how the COVID-19 crisis impacted patterns of nature visits and specific nature-based activities, (ii) examine how these patterns varied among different population groups and levels of restrictions, and (iii) explore the motives and facilitators for increased frequency of nature visits.

Methods

The data were retrieved from a national cross-sectional survey conducted in June 2021, which was designed to assess participants (n = 1,005, age &gt; 15 years) habits in relation to nature visits and outdoor recreation since the beginning of the COVID-19 crisis, and associated factors.

Results

The results showed that 32 % of participants increased their frequency of nature visits during the crisis, while 11 % experienced a decrease. Multivariate logistic regression revealed significant positive associations between increased frequency of nature visits and longer duration of lockdown restrictions (OR [95% CI] = 2.35 [1.28–4.29] and 4.92 [2.77–8.74] for a few weeks and several months of lockdown, respectively). Increased frequency of nature visits was also more likely among women, younger respondents, and individuals from high-income households. A Cochran's Q test showed that the most common motive for increased frequency of nature visits was “To be physically active” (74%). The most commonly reported facilitators were the possibility of using natural environments as an alternative to gyms and organized sports alongside having more time available (58 and 49%, respectively).

Conclusion

These findings suggest that nature visits provided important opportunities for physical activity during the COVID-19 crisis, but also that the mental health benefits of nature visits during such times may be under-communicated. This highlights the importance of access to natural environments to promote physical activity and health, but also suggests that campaigns that specifically communicate the beneficial effects of nature visits during lockdowns or similar stressful situations might help people cope with the situation.

Adventure Recreation in Blue Spaces and the Wellbeing of Young Polish Adults

The aim of this study was to assess the wellbeing of 248 young Polish adults between 18 and 26 years old (M = 22.35; SD = 2.20) involved in adventure blue space recreational activities. The adventure water recreational activities were measured by using a questionnaire specially designed for the purpose of this study. This questionnaire consisted of two subscales: adventure recreation associated with water risks and adventure recreation associated with weather risks. In turn, wellbeing was measured using six scales loaded in two factors: hedonic wellbeing and eudaimonic wellbeing. The regression analysis indicated that wellbeing (hedonic and eudaimonic) was positively predicted by adventure recreation associated with water risks. In turn, eudaimonic wellbeing was negatively predicted by adventure recreation associated with weather risks. Additionally, the cluster analysis revealed three distinct clusters of recreationists characterized by diverse results on the scales of adventure recreation dealing with water and weather risks: soft adventurers (low water risks/high weather risks), hard adventurers (high water risks/high water risks) and avoiders (low water risks/low weather risks). The hard adventurers had significantly higher means on hedonic wellbeing than that of the soft adventurers and the avoiders. Surprisingly, the soft adventurers had a significantly lower mean on eudaimonic wellbeing than that of the group of hard adventurers and the group avoiding risky activity in an aquatic environment.

Associations of greenness surrounding schools and self-reported depressive and anxiety symptoms in Chinese adolescents

BACKGROUND

The effect of school-based greenness exposure on mental health among adolescents remains unclear. The study aimed to estimate the associations between school-based greenness and depressive and anxiety symptoms among adolescents and explore potential modifier and mediator between the associations.

METHODS

A cross-sectional survey involving 15,559 adolescents was conducted in China. The Chinese version of the Center for Epidemiologic Studies Depression 9-Item Scale and the Generalized Anxiety Disorder 7-Item Scale were used to assess the depressive and anxiety symptoms among adolescents. The Normalized Difference Vegetation Index within a 400 m and 800 m zone surrounding schools was used to indicate the adolescents' exposure to greenness. We estimated daily concentrations of PM_1.0, PM_2.5, and NO₂ from the China High Air Pollutants dataset. Multiple logistic regression models were used.

RESULTS

Higher exposure to greenness surrounding schools was negatively associated with depressive (OR: 0.774, 95%CI: 0.685-0.875) and anxiety symptoms (0.740, 0.669-0.818). We observed stronger associations between greenness and depressive and anxiety symptoms among girls, lower age group (11-15 years), and adolescents born to parents with lower education levels. PM_1.0 (proportion mediated estimates: 14.3 %; 95 % CI: 4.2 %, 24.5 %) and PM_2.5 (10.5 %; 95 % CI: 3.0 %, 17.9 %) mediated the associations between greenness exposure and depressive symptoms. The number of days adolescents attended physical education classes per week mediated -22.8 % (95 % CI: -38.5 %, -7.1 %) and -9.7 % (95 % CI: -15.5 %, -3.8 %) of the effects of greenness on depressive and anxiety symptoms.

CONCLUSIONS

Increasing the greenness and improving the environment surrounding schools is effective in promoting the mental health of adolescents.

Restoration Skills Training in a Natural Setting Compared to Conventional Mindfulness Training: Sustained Advantages at a 6-Month Follow-Up

Restoration skills training (ReST) is a mindfulness-based course in which participants draw support from a natural practice setting while they learn to meditate. Well-established conventional mindfulness training (CMT) can improve psychological functioning but many perceive it as demanding and fail to sustain practice habits. Applying non-inferiority logic, previous research indicated that ReST overcomes compliance problems without compromising the benefits gained over 5 weeks’ training. This article applies similar logic in a 6-month follow-up. Of 97 contacted ReST and CMT course completers, 68 responded and 29 were included with multiple imputation data. The online survey included questions about their psychological functioning in three domains (dispositional mindfulness, cognitive lapses, and perceived stress) and the forms and frequencies with which they had continued to practice mindfulness after the course. Former ReST participants continued, on average, to show higher dispositional mindfulness and fewer cognitive lapses compared to pre-course ratings. Improved psychological functioning in one or more domains was demonstrated by 35%, as determined by a reliable change index. Again, analyses detected no indications of any substantive disadvantages compared to the more demanding, established CMT approach. Compared to the CMT group, more ReST participants had also continued to practice at least occasionally (92 vs. 67%). Continued practice was linked to sustained improvements for ReST but not clearly so for CMT. ReST participants thus continued to use the skills and sustained the improvements in psychological functioning that they had gained in the course, further supporting the utility of ReST as a health intervention.

Taking real steps in virtual nature: a randomized blinded trial

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: "Experience," "Physical engagement" and "Psychophysiological recovery." Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants' perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement.

Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being During COVID-19

Shifts in activity patterns during the COVID-19 pandemic might have impacted the benefits of outdoor activities for mental health. By leveraging an existing mobile application, we collected self-reported data on daily outdoor activities, emotional well-being, and the influence of COVID-19 on participant's outdoor activity levels during April-July 2020. Individuals reporting outdoor activities, in greenspaces or in their residence, had higher well-being scores and this effect increased with age. Self-reported impacts of COVID-19 on emotional well-being were associated with lower well-being scores. This work suggests that outdoor activities may have improved mental health during the COVID-19 pandemic.

Association between greenspace and blood pressure: A systematic review and meta-analysis

Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and meta-analysis to comprehensively evaluate the evidence concerning greenspaces with BP levels and prevalent hypertension. Systematic literature searches were performed in Web of Science, PubMed, and Embase up to 25 April 2021. Combined effect estimates were calculated using random-effect models for each greenspace exposure assessment method that had been examined in ≥3 studies. Sensitivity analysis, subgroup analysis, and publication bias were also conducted. Of 38 articles (including 52 analyses, 5.2 million participants in total) examining the effects of normalized difference vegetation index (NDVI) (n = 23), proportion of greenspace (n = 11), distance to greenspace (n = 9), and others (n = 9) were identified. Most studies (65%) reported beneficial associations between greenspaces and BP levels/hypertension. Our results of meta-analyses showed that higher NDVI_500m was significantly associated with lower levels of systolic blood pressure (SBP = -0.77 mmHg, 95%CI: -1.23 to -0.32) and diastolic blood pressure (DBP = -0.32 mmHg, 95%CI: -0.57 to -0.07). We also found that NDVI in different buffers and the proportion of greenspaces were significantly associated with lower odds (1-9%) of hypertension. However, no significant effect was found for distance to greenspaces. In summary, our results indicate the beneficial effects of greenspace exposure on BP and hypertension. However, future better-designed studies, preferably longitudinal, are needed to confirm and better quantify the observed benefits in BP and/or hypertension.

A mixed-methods exploration of virtual reality as a tool to promote green exercise

The salutogenic effects of green exercise are widely recognised, yet many individuals do not engage in this health-related behaviour. Using a convergent mixed methods approach, this study explored the impact of experiencing nature through Virtual Reality (VR) on the decision-making process relating to green exercise. Three experimental trials were conducted (overall n = 136), in which healthy adults were exposed to different VR scenarios reproducing a virtual walk in an existing urban green area. Participants reported medium–high rating of intent to visit the location. Significant pre-to-post increments in future green exercise intention were observed after the VR exposure, though a significance difference was not achieved in comparison with a control condition. Qualitative analysis revealed the impact of the VR experience on behaviour regulation, and highlighted the pivotal role of anticipated emotional benefits. Despite scepticism, the VR experience was effective in arousing curiosity to explore natural environments, which was associated with environmental perceptions as well as nostalgic and socio-cultural perspectives.

Connectedness to Nature Does Not Explain the Variation in Physical Activity and Body Composition in Adults and Older People

Connectedness to nature (CN) is a significant predictor of pro-environmental behaviours, human health and well-being. However, research on how this connection to the natural world might promote a more active lifestyle and improve body mass composition according to gender is lacking. This study investigated the influence of CN on physical activity (PA) and body composition in adults and older people. We recruited a sample of 219 individuals (77 men and 142 women), and a self-administered questionnaire was used to measure CN and obtain demographic data. Body composition was assessed by bioimpedance, and PA was assessed by accelerometry. Correlations and stepwise multiple regressions were used in data analysis. CN's association with other variables was more pronounced in women than in men, and we only identified significant associations with steps/day and body composition. However, this variable would not be included in the regression models that we developed. Adiposity levels and muscle status were significant predictors of PA in women. In both genders, age, percentage of fat mass and fat-free mass were selected as regressors in the models developed for visceral fat area and muscle condition (R2 Adjusted ≥ 0.908).

Public Perception of Biodiversity: A Literature Review of Its Role in Urban Green Spaces

The significance of biodiversity in the survival of human beings and enhancing the urban quality of life is evident from the empirical measurements and qualitative studies carried out across the globe. Despite its importance and value, burgeoning population and growing urbanization are posing a serious threat to biodiversity leading to biodiversity homogenization and ecosystem fragmentation. Moreover, studies reveal that management practices of biodiversity hardly take into account perception, needs, and knowledge of urban residents regarding biodiversity. Urban green spaces have a major role to play in the conservation of urban biodiversity. However, the triangular relationship between biodiversity, urban green spaces, and public perception is still unexplored.

With this aim, the paper attempts to compile, analyze, and synthesize the empirical findings to understand the state-of-the-art knowledge regarding public perception of biodiversity in urban green spaces. The search strategy acquired for the selection of papers resulted in 43 papers from 22 different countries of the world. The paper focuses upon an inclusive definition of urban green spaces, thus encompasses a wide variety of urban and peri-urban green spaces, parks, gardens, and waterfront urban spaces. The analysis of literature pattern reveals a recent increase in studies related to biodiversity perception over the last 10 years. It indicates a strong geographic bias in publications as well. Studies of animals including birds, insects, and reptiles are found scarce compared to plant species. The study could identify potential variables affecting human biodiversity perception which include species literacy, visitation rate, preferences, recreational, health, and restorative benefits, vegetation characteristics, nature connectedness, and conservation support. The paper also proposes a framework for understanding biodiversity perception in urban green spaces that can assist in improving our understanding of the relationship between human interactions and natural environments and framing strategies for urban development, landscape planning, and community health promotions.

Redesigning walking brochures using behaviour change theory: implications for walking intentions in natural environments

Natural environments can be used to promote health through facilitating recreational walking. However, efforts to encourage this often neglect messages identified in psychological research that are effective at influencing intentions to walk. This is despite the National Institute for Health and Care Excellence stating that promotional efforts should utilize theoretical frameworks of behaviour change and be targeted towards less active adults. As an illustrative example, this experiment compared a prototypical recreational walking brochure with an "enhanced" version including such persuasive messages on people's intentions to walk for recreation in natural environments. The enhanced brochure heightened intentions for inexperienced recreational walkers through our hypothesized mechanisms, but appeared to dissuade already-experienced walkers. Optimal messaging strategies in recreational walking brochures require tailoring to more and less active readerships. Guidelines are provided for authors of recreational walking brochures, though the principles and techniques could easily be extended to other means of outdoor walking promotion.

Outdoor Recreation for Older Adults in Scotland: Qualitatively Exploring the Multiplicity of Constraints to Participation

Active ageing can lead to better health outcomes in older people. Examining constraints to outdoor recreation for older people, including outdoor physical activity, may therefore assist with developing strategies for active ageing. Findings are presented from a study seeking to understand the constraints to older peoples' access to outdoor recreation in Scotland, and this paper aimed to examine the multitude of constraints that discourage or prevent older people from accessing the outdoors and the ways in which these constraints are hierarchical (or not). This paper adopted a qualitative methodology using the hierarchical leisure constraints model (HLCM) as a lens to analyse the data, presenting the data in three vignettes. The paper identified multiple co-occurring constraints and considered these in relation to expectations based on the HLCM. Recognising that constraints to outdoor recreation for older people are multiple, co-occurring and mutually reinforcing may enable more effective solutions to be developed to overcome them.

Physical Activity Levels and Perceived Changes in the Context of Intra-EEA Migration: A Study on Italian Immigrants in Norway

As mobility within the European Economic Area (EEA) is on the rise, it is important to understand migrants' health-related behaviors (such as physical activity [PA]) within this context. This study investigated i) the extent to which Italian immigrants in Norway perceive that moving had a negative or positive impact on their PA; ii) possible differences between the PA of the Italian immigrants compared with the Norwegian population; and iii) possible associations of the Italian immigrants' PA with key sociodemographic characteristics (gender, age, region of residence, and educational level). The data were retrieved from the Mens Sana in Corpore Sano study. In order to enhance the sample's representativeness, the original dataset (n = 321) was oversampled in accordance with the proportion of key sociodemographic characteristics of the reference population using the ADASYN method (resampled n = 531). The results indicate that a large majority of Italian immigrants perceived that they were as or even more physically active in Norway than they would have been if they continued living in Italy, while 20% of the Italians perceived instead a negative impact. No significant differences were found in the PA levels of the Italians in comparison with the Norwegian population, though some differences were found in relation to specific modes of PA. After controlling for multiple sociodemographic characteristics, men, those with lower educational levels and, to a certain extent, older adults tended to perceive a more negative impact and be less physically active than their respective counterparts. Compared with those living in the most urbanized regions, a larger proportion of those living in less urbanized regions perceived a negative impact, though no differences were observed in terms of PA levels. The findings are discussed in light of acculturation, gender, and social gradient. The knowledge generated by this study sheds light on an important health-related behavior among Italians in Norway, which can inform initiatives that aim at promoting PA in this specific group as well as other similar contexts of intra-EEA migration.

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.

Neighbourhood green and blue spaces and allergic sensitization in children: A longitudinal study based on repeated measures from the Generation XXI cohort

Evidence on the effect of natural environments on atopy in children is limited and inconsistent, disregarding the time-varying and cumulative exposures throughout the life course. To assess critical periods of exposure as well as the effect of longitudinal trajectories of exposure to green and blue spaces on the development of allergic sensitization in children at the age of 10 years. A longitudinal study was conducted involving 730 children enrolled in Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). Food and aeroallergens sensitization were evaluated at 10 years of age using Phadiatop Infant, Phadiatop fx1 and fx22 ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden). Residential Normalized Difference Vegetation Index (NDVI) and distance to the nearest blue space (sea, river) were assessed using a Geographic Information System. Latent class linear mixed models were fitted to determine longitudinal trajectories of exposure. Associations were estimated using Cox proportional hazards regression models and expressed using hazard ratios (HR) and 95% confidence intervals (95% CI). Residing in neighbourhoods surrounded by more vegetation at 10 years, as well as lifetime exposure to a trajectory of higher levels of NDVI, were associated with a lower risk of allergic sensitization [HR (95% CI) = 0.095 (0.011, 0.823) and HR (95% CI) = 0.539 (0.301, 0.965), respectively]. Our findings support a role for both longitudinal, but particularly late-childhood, exposure to green spaces, in the prevention of allergic sensitization in children.

Unhealthy Neighbourhood “Syndrome”: A Useful Label for Analysing and Providing Advice on Urban Design Decision-Making?

Even before the COVID-19 pandemic, there was growing interest in designing healthier neighbourhoods. Adopting this perspective brings attention to how conditions in neighbourhoods (directly and indirectly) affect their inhabitants’ physical health and mental wellbeing. However, considerably less attention has been paid to how to alleviate such conditions through integrated interventions designed to operate specifically at the neighbourhood scale. To address this gap, this paper introduces the term “unhealthy neighbourhood syndrome” (UNS). The conceptual clarity and practical utility offered by using this term are critically examined. The paper contains a rigorous review and critical analysis of academic and grey literature on what are held to be the relationships between key features of the built environment and people’s health and wellbeing. It also examines literature offering advice on how urban designers should make neighbourhoods healthier. It illustrates the complexity of the range of issues involved and the complicated web of top down, bottom up and middling out actors that need to be involved in making decisions about them. Despite having inherent weaknesses, the term “unhealthy neighbourhood syndrome” is judged to be useful. It illustrates how seemingly separate issues operate in urban design, promoted for tackling specific symptoms of ill health, need to be addressed jointly through an integrated programme of parallel work streams operating at the neighbourhood scale. The paper is innovative in identifying the wide cluster of symptoms used to describe unhealthy neighbourhoods in the literature as being a “syndrome”. Its significance lies in its injunction that this syndrome needs to be tackled through integrated streams of remedial action drawing on experience and expertise that lie beyond those offered by the traditional membership of urban design teams.

The value of blue-space recreation and perceived water quality across Europe: A contingent behaviour study

This study estimates the value of recreational visits to blue-space sites across 14 EU Member States, representing 78% of the Union's population. Across all countries surveyed, respondents made an average of 47 blue-space visits per person per year. Employing travel cost and contingent behaviour methods, the value of a visit is estimated at €41.32 which adds up to a recreational value of €631bn per year for the total adult population surveyed. Using the Bathing Water Directive's water quality designation, the analysis shows that a one-level improvement in water quality leads to 3.13 more visits (+6.67%), whereas a one-level deterioration leads to 9.77 fewer annual visits (-20.83%). This study provides valuations of benefits of recreation and changes of recreational values due to changes in surface water quality, which can be compared to the implementation and monitoring costs of efforts under the EU's Bathing Water, Water Framework and Marine Strategy Framework Directives.

Nature relatedness as a potential factor to promote physical activity and reduce sedentary behavior in Ecuadorian children

Background

Nature relatedness can be associated with health-related outcomes. This study aims to evaluate the associations of nature relatedness with physical activity and sedentary behavior.

Methods

A cross-sectional study involving 9–12 year old children living in Cuenca, Ecuador, was conducted between October 2018 and March 2019. Questionnaires were used to evaluate physical activity (PAQ-C), out-of-school sedentary behavior, nature relatedness and wellbeing. Associations of nature relatedness with physical activity, and sedentary behavior were evaluated using linear regression models or tobit regressions adjusted by age, sex, school type, wellbeing, and body mass index z-score.

Results

A total of 1028 children were surveyed (average age:10.4±1.22 years, 52% female.). Nature relatedness was positively associated with physical activity (β = 0.07; CI 95%: 0.05–0.09; p < 0.001) and non-screen-related sedentary leisure (β = 3.77 minutes; CI 95%: 0.76–6.68; p < 0.05); it was negatively associated with screen time (β = -5.59 minutes; CI 95%: -10.53–0.65; p < 0.05).

Conclusions

Findings suggest that nature relatedness is associated with physical activity and some sedentary behaviors among Ecuadorian school-age children. The promotion of nature relatedness has the potential to improve health.

Reviewing the reliability of Land Use and Land Cover data in studies relating human health to the environment

BACKGROUND

In recent years, research has been increasingly devoted to understanding the complex human health-environment relationship. Nevertheless, many different measurements have been applied to characterize the environment. Among them, the application of Land Use and Land Cover (LULC) data is becoming more noticeable over time.

AIMS

This research aims to analyse the reliability of Land Use and Land Cover data (LULC) data as a suitable describer of the environment in studies relating human health to the environment. With a specific focus on the methodologies using LULC data, we also examine the study designs and analytical methods that have been commonly performed so far.

MATERIALS AND METHODS

We gathered studies relating human health outcomes to Land Use and Land Cover (LULC) data. A Boolean search limited to reviews was conducted in February 2019 using Web of Science Core Collection search engines. Five reviews were selected as our preliminary starting set of literature and from those, two backward snowballing searches were conducted. The first backward snowballing search used the reference lists of the first 5 reviews and revealed 17 articles. From these, the second search gathered 24 new articles also fulfilling the inclusion criteria established. In total, 41 articles were examined.

RESULTS

Our main results reported that Land Use and Land Cover (LULC) data national level data was preferred over LULC international level data. However, this tendency seems to be strongly related to the specific aims of the articles. They essentially defined the living environment either through buffer zones, using the administrative boundaries wherein the individuals reside, or using the specific location of the individuals assessed. As for the characterization of the environment, authors performed 4 principal methodologies: extracting the percentage of green space, computing the "Land Use mix", recording the type of land cover, and using the percentage of tree canopy. Besides, all the articles included measurements in urban contexts and most of them evaluated the accessibility of individuals to their surroundings. Furthermore, it was clearly stated that the complexity of the topic and the challenging data leads authors to carry out advanced statistical methods and mostly cross-sectional designs with no causal relations.

DISCUSSION AND CONCLUSIONS

Land Use and Land Cover (LULC) data has been demonstrated to be a versatile tool supporting both local-focused studies with few individuals involved and broad territorial-scoped studies with huge populations. Promising synergy has been highlighted between Electronic Health Records (EHR) and LULC data in studies dealing with massive information and broader scopes with regards to the assessment of territorial realities. As this emerging topic matures, investigators should (1) elucidate subjects of ongoing debate such as the measurement of the living environment and its characterization; (2) explore the whole potential of LULC data, using methodologies that encompass both their biophysical and socioeconomic information; (3) perform innovative designs that are able to establish causal relationships among the studied variables (for example, Cellular Automata models), and (4) expand the current set of studied health outcomes leveraging comprehensive and trustworthy health data sources such as EHR.

Family Orchards and Health-Related Quality of Life in the Elderly. A Protocol for a Study in Las Hurdes (Spain) Based on an Ethnographic Approach

Demographic evolution is resulting on an aged population increment in Spain. This growth has been more relevant in rural areas, where the population has traditionally lived under hard socio-economic conditions and leveraging the natural resources such as food from family orchards to survive. Studies that have investigated the possibilities and uses of these traditional family orchards today in relation to health-related quality of life in the elderly are scarce. Based on a previous ethnography, this mixed research aims to describe a protocol that will evaluate the effects of the use of traditional family orchards as a daily resource on fitness and quality of life of the elderly population in Las Hurdes (Spain). Body composition, fitness, mental health, health-related quality of life, and activity-related behaviors of participants will be assessed. The outcomes of this study might enable us to design further tailored physical exercise-based interventions using family orchards as an adequate resource to improve the health-related quality of life and fitness of the elderly in rural areas. In addition, the study detailed here might also be applied to other similar rural areas in Spain and worldwide.

Understanding multifunctional Bay of Fundy dykelands and tidal wetlands using ecosystem services—a baseline

We review what is known about ecosystem service (ES) delivery from agricultural dykelands and tidal wetlands around the dynamic Bay of Fundy in the face of climate change and sea-level rise, at the outset of the national NSERC ResNet project. Agricultural dykelands are areas of drained tidal wetland that have been converted to agricultural lands and protected using dykes and aboiteaux (one-way drains or sluices), first introduced by early French settlers (Acadians). Today, Nova Scotia’s 242 km system of dykes protect 17,364 ha of increasingly diverse land uses—including residential, industrial, and commercial uses as well as significant tourism, recreational, and cultural amenities—and is undergoing system modernization and adaptation. Different ES are provided by drained and undrained landscapes such as agriculture from dykelands and regulating services from wetlands, but more complex dynamics exist when beneficiaries are differentiated. This review reveals many knowledge gaps about ES delivery and dynamics, including around net greenhouse gas implications, storm protection, water quality, fish stocks, pollination processes, sense of place, and aesthetics, some of which may reveal shared ES or synergies instead of trade-offs. We emphasize the need to be open to adapting ES concepts and categorizations to fully understand Indigenous implications of these land use decisions.

Urban Blue Acupuncture: An Experiment on Preferences for Design Options Using Virtual Models

Within the BlueHealth project, funded under the Horizon 2020 European Union research framework, a number of targeted experimental design interventions created in virtual reality (VR) were used to test the effect and impact of planning and design on encouraging people to use various blue spaces. A set of designs in three different coastal landscape types—a cliff/steep slope; a sandy beach and an area of reed beds—located in Tallinn, Estonia, were used as the sites for nine different intervention designs. The designs were based on a combination of the site features and inspirations from solutions found in different locations internationally. Using 3D modelling and a Virtual Reality system, a set of nine videos, one to depict each intervention, was created and shown to a quota sample of 252 Estonian residents. Respondents were asked a set of questions associated with each option. The results were analysed statistically and qualitatively. The results uncovered key preferences for designs and revealed differences among age groups and the levels of personal interconnection with nature. However, there were problems associated with the interpretation and understanding of some of the options by some of the people due to the degree of realism of the VR representations, which may have affected the results. The project shows that VR could be a useful tool for testing design ideas as part of public participation approaches but that care is needed in ensuring that viewers understand what they are assessing.

Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income

BACKGROUND

Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched.

METHODS

We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status.

RESULTS

After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (OR_adj) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% OR_adj = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample.

CONCLUSION

Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.

Mental health rescue effects of women's outdoor tourism: A role in COVID-19 recovery

Mental and social health outcomes from a portfolio of women's outdoor tourism products, with ~100,000 clients, are analysed using a catalysed netnography of >1000 social media posts. Entirely novel outcomes include: psychological rescue; recognition of a previously missing life component, and flow-on effects to family members. Outcomes reported previously for extreme sports, but not previously for hiking in nature, include psychological transformation. Outcomes also identified previously include: happiness, gratitude, relaxation, clarity and insights, nature appreciation, challenge and capability, and companionship and community effects. Commercial outdoor tourism enterprises can contribute powerfully to the wellbeing of women and families. This will be especially valuable for mental health recovery, following deterioration during COVID-19 coronavirus lockdowns worldwide.

Ecological momentary assessment of mood and physical activity in people with depression

BACKGROUND

This study aimed to examine temporal associations between physical activity and subsequent mood in people with moderate to severe depression.

METHODS

The study used ecological momentary assessment to associate mood, measured via text messaging twice daily for five days, using a 10-point Likert scale, with objectively measured physical activity (accelerometer data) in people with moderate-to-severe depression. Multilevel regression models were used to explore the relationship between physical activity undertaken at different intensities over the previous one and three hours, and subsequent affect score. A total of 388 paired data points were collected from 43 participants.

RESULTS

There was no association between minutes of moderate-vigorous physical activity in the previous hour and subsequent affect score (which we had hypothesised). However, exploratory analyses found a significant relationship between affect and combined physical activity in the previous hour (β₁ coefficient = 0.023, p = 0.037).

LIMITATIONS

Periods of moderate-vigorous activity were infrequent, reducing the statistical power for analysing associations with this intensity of activity. Only one dimension of mood was sampled.

CONCLUSIONS

The data suggest that, in people with moderate-to-severe depression, time spent engaging in any intensity of physical activity was significantly associated with subsequent mood. Further research is needed to more clearly define the dynamics of the relationship between physical activity and low mood. This will aid identification of optimal prescription criteria for physical activity in people with depression.

A Systematic Review Exploring the Economic Valuation of Accessing and Using Green and Blue Spaces to Improve Public Health

Contact with the natural environment in green and blue spaces can have a valuable influence on population physical and mental health and wellbeing. The aim of this study is to explore the economic evidence associated with the public's value for accessing, using and improving local environments to undertake recreational activity and consuming the associated health benefits of green and blue spaces. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Peer-reviewed articles were sought using electronic databases, scrutiny of reference lists, experts and grey literature. All relevant papers meeting the criteria were critically appraised for methodological quality using the Drummond checklist. The review search concluded with 12 papers applying the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach to assess the quality with a narrative analysis conducted under the themes. Results suggest the public value access to green and blue spaces to undertake recreational activities and avoid delay or losing the recreational experience and associated health benefits. The public are willing to pay between £5.72 and £15.64 in 2019 value estimates for not postponing or losing an outdoor experience and for walking in local environments under current and improved environmental conditions, respectively. Valuation estimates indicate the public value green and blue spaces and are willing to pay to improve local environments to gain the health benefits of undertaking leisure activities in green and blue spaces.

Urban Blue Acupuncture: A Protocol for Evaluating a Complex Landscape Design Intervention to Improve Health and Wellbeing in a Coastal Community

Within the BlueHealth project, funded under the Horizon 2020 European Union research framework, a number of targeted experimental design interventions were used to test the effect and impact of planning and design on encouraging people to use various blue spaces. Complex interventions were implemented and evaluations before and after each were made using a set of tools which triangulate with each other—a site assessment tool, a behaviour observation tool, a questionnaire survey (including an economic evaluation) and qualitative interviews. The theoretical basis for the research is that of affordances, and the projects each involved modest changes to the landscape using the approach of “urban acupuncture” where a small intervention can potentially have an effect out of all proportion to the investment. This paper is a protocol paper and describes the research strategy and methodology in detail for one of the intervention sites, located in Plymouth in the UK. The aim is to present the methodology as a whole so as to act as (a) a reference framework for the results of all the projects which will be reported separately in a series of research articles once all the results are in and analysed and (b) a useful reference for other researchers wishing to carry out such complex projects and where a comprehensive presentation of the strategy and methodology is unavailable. We offer this protocol for reference, for critique and for inspiration to those following us.

General health and residential proximity to the coast in Belgium: Results from a cross-sectional health survey

The health risks of coastal areas have long been researched, but the potential benefits for health are only recently being explored. The present study compared the general health of Belgian citizens a) according to the EU's definition of coastal (<50 km) vs. inland (>50 km), and b) between eight more refined categories of residential proximity to the coast (<5 km to >250 km). Data was drawn from the Belgian Health Interview Survey (n = 60,939) and investigated using linear regression models and mediation analyses on several hypothesized mechanisms. Results indicated that populations living <5 km of the coast reported better general health than populations living at >50-100 km. Four commonly hypothesized mechanisms were considered but no indirect associations were found: scores for mental health, physical activity levels and social contacts were not higher at 0-5 km from the coast, and air pollution (PM₁₀ concentrations) was lower at 0-5 km from the coast but not statistically associated with better health. Results are controlled for typical variables such as age, sex, income, neighbourhood levels of green and freshwater blue space, etc. The spatial urban-rural-nature mosaic at the Belgian coast and alternative explanations are discussed. The positive associations between the ocean and human health observed in this study encourage policy makers to manage coastal areas sustainably to maintain associated public health benefits into the future.

Providing Access to Urban Green Spaces: A Participatory Benefit-Cost Analysis in Spain

The opening up of green spaces could provide significant benefits to society. This study develops a framework to assess the economic benefits and costs of public interventions providing citizen access to urban green spaces. The Thinking Fadura project in Getxo (Spain) was used as a case study. A method for participatory benefit-cost analysis is developed, where a stakeholder-participatory evaluation is combined with a standard cost-benefit analysis. The participatory evaluation followed a bottom-up approach in a sequential evaluation including three main focal points: key stakeholders and experts, visitors and the general public. The assessment demonstrates that the Thinking Fadura project's benefits outweigh the costs. The results suggest that projects designed with the purpose of improving green space accessibility to the general public can be beneficial from a societal perspective. The highest economic benefits were an increase in the amenity and recreational value and an increase in people's physical activity. The participatory evaluation indicates that giving access to people of lower socio-economic status and vulnerable groups and improving recreational use were perceived as the most beneficial. An increase in noise, dirt, and risk of criminal activities as well as potential conflicts between green space users were perceived as the most negative impacts of opening a previously restricted area to the general public. The economic assessment of Thinking Fadura project could serve as a model in the decision-making process in locations where the use of greenspaces is restricted.

Analysis of Environmental Activities for Developing Public Health Investments and Policies: A Comparative Study with Structure Equation and Interval Type 2 Fuzzy Hybrid Models

The design of elements which exert pivotal effects on leisurely physical activity (LPA) in open space is an important part of urban development. However, little research has been done about the influence and discrepancies of those elements in different types of open space. To research these issues and to guide the design of urban open space, a survey from 8 open spaces (2 curtilage, 2 neighborhood squares (NS), 2 parks, and 2 campus) is conducted and a questionnaire is administered. Simultaneous analysis of several groups (SASG) of Structure equation model (SEM) is used, and the effects and discrepancies are acquired. In addition to this situation, interval type 2 (IT2) fuzzy hybrid decision making model is proposed in the second analysis. In this framework, IT2 fuzzy decision-making trial, evaluation laboratory (DEMATEL), and IT2 fuzzy technique for order preference by similarity to ideal solution (TOPSIS) methods are used. The results show that the influence relationships between elements and LPA did exist in four groups. Another important conclusion is that there were discrepancies of influence among different space groups. Physical environment (PE) has the greatest influence on LPA in the curtilage, whereas facilities exert the most effect in NS group. Additionally, amenities only have significant impact in parks and facilities only exercise remarkable influence on duration on campus. In addition to them, it is also identified that key design elements are presented for different types of space and that design strategy is provided through 4 specific examples.

MacIntyre T, Calogiuri G. Enable, Reconnect and Augment: A New ERA of Virtual Nature Research and Application

Being exposed to natural environments is associated with improved health and well-being, as these environments are believed to promote feelings of “being away” from everyday struggles, positive emotional reactions and stress reduction. Despite these positive effects, humanity is becoming increasingly more distanced from nature due to societal changes, such as increased urbanization and the reduced accessibility of natural environments. Technology is also partly to blame, as research suggests that people replace nature contact with increased screen time. In this cross-section between nature and technology, we find technological nature which is progressing towards a point where we may be capable of simulating exposure to real nature. Concerns have been raised regarding this technology, as it is feared it will replace real nature. However, research suggests that virtual nature may have a more positive impact on society than a mere replacement of real nature, and this review propose several areas where virtual nature may be a beneficial addition to actual nature (Enable), help people reconnect with the real natural world (Reconnect) and “boost” human-nature interactions (Augment). Based on the current research and theoretical framework, this review proposes guidelines for future research within these areas, with the aim of advancing the field by producing high quality research.

Insomnia, excessive daytime sleepiness, anxiety, depression and socioeconomic status among customer service employees in Canada

OBJECTIVE

It is the first study investigating deeply symptoms of neuropsychiatric diseases among a large population of customer service employees (n=1238, 640 females and 598 males). The study's goals were document presence of sleep disorders, anxiety and depression among customer service advisors and determine the influence of the socioeconomic status (pSES), duration in position and full-time or part-time shift on the diseases above.

METHODS

Linear regressions and ANOVA with a Tukey multiple comparisons of means was performed to analyze correlation and differences between citizens, international students and immigrants in their pSES and neuropsychiatric diseases.

RESULTS

Customer service employees (578 Canadians, 264 immigrants and 358 international students) are in majority undergraduate students (286 men and 289 females) with a high school degree (280 men and 308 women). They work full-time (560 men and 548 women) and are single (420 men and 560 women). Among customer service advisors, the time spent as an advisor was an excellent predictor of insomnia, sleepiness and anxiety (respectively with R2=91,83%, R2=81,23% and R2=87,46%) but a moderate predictor of depression (R2=69,14%). The pSES was a moderate predictor of sleep disorders (respectively R2=62,04% for insomnia and R2=53,62% for sleepiness) and strongly associated with anxiety and depression (R2=82,95% for anxiety and R2=89,77% for depression).

DISCUSSION

Insomnia, sleepiness and anxiety are more prevalent for full-time employees (higher for immigrants and international students compared to Canadians) compared with part-time employees, while depression was similarly higher for Canadian and immigrants compared to international students. Regarding full-time employees, symptoms of insomnia, anxiety and depression were higher for men compared to women. Regarding part-time employees, symptoms of insomnia and sleepiness were higher for women compared to men. Employees working full-time with rotating shifts are more exposed to insomnia, sleepiness and anxiety than employees working part-time. More research is needed to understand mental health of customer service employees regardless of their area and it is worthy of interest to study the link between sleep disorders and mood disorders with work conditions. Here some practical suggestions are made to reduce neuropsychiatric disorders for customer service employees or to at least mitigate the work burden on their brains.

Designing Urban Green Blue Infrastructure for Mental Health and Elderly Wellbeing

The main objective of this essay is to illustrate the state-of-the-art on ‘mental health-sensitive’ open space design in the built environment. Urban Green Blue Infrastructure can contribute to urbanites’ mental health and wellbeing as well as healthy aging, while providing co-benefits balancing the negative impacts of climate change, through the provision of integrated ecosystem services. There are a number of ways that exposure to and affiliation with Nature have shown to support mental health, but we are still missing the necessary evidence of the actual benefits achieved, as well as the key performance indicators and metrics to monitor and adapt our open space to the growing urban challenges. After introducing the key concepts of degenerative mental disorders as they are growing in the urban environment, and the emerging green blue infrastructure design approach, the authors present international case studies describing how evidence-based design and Nature-based Solutions have been found to be beneficial, especially to those diagnosed with mental disorders. Subsequently, in a comparative critical analysis, the authors look closer at a number of design solutions capable, at different scales, to support healthy aging through exposure to, and affiliation with, biodiversity.

Economic value of protected areas via visitor mental health

We evaluate methods to calculate the economic value of protected areas derived from the improved mental health of visitors. A conservative global estimate using quality-adjusted life years, a standard measure in health economics, is US$6 trillion p.a. This is an order of magnitude greater than the global value of protected area tourism, and two to three orders greater than global aggregate protected area management agency budgets. Future research should: refine this estimate using more precise methods; consider interactions between health and conservation policies and budgets at national scales; and examine links between personalities and protected area experiences at individual scale.

Urban Green Space: Creating a Triple Win for Environmental Sustainability, Health, and Health Equity through Behavior Change

Urbanization, costs of green space maintenance, and diminishing connection between people and nature all exert pressures on urban green space. This is regrettable as green space has the potential to create wins for environmental sustainability, health, and health equity. This paper explores this potential triple win and investigates how to increase the use of urban green space through behavior change. A narrative literature review was conducted and was supplemented with literature suggested by experts. Results show that creating well-designed green spaces and stimulating people to use them can indeed deliver this triple win. Providing accessible, attractive, well-maintained green space with room for socialization, and where people feel safe, may increase the opportunity and motivation of people to use it more often. Informing and educating people and organizing activities may increase capability (and motivation) to use green space. Since the use of green space depends on life stage, lifestyle factors and individual values, it is important to involve potential users in its design. We recommend a specific focus on those groups who may benefit most from the use of green space. More evaluation is needed to inform effective green space interventions and to assess related economic, social, and environmental benefits.

Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis

BACKGROUND

As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity.

OBJECTIVES

To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions.

DATA SOURCES

Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS.

STUDY APPRAISAL AND SYNTHESIS METHODS

Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research.

RESULTS

Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised.

The Mental Health Benefits of Purposeful Activities in Public Green Spaces in Urban and Semi-Urban Neighbourhoods: A Mixed-Methods Pilot and Proof of Concept Study

Access and exposure to public green space might be critical to health promotion and prevention of mental ill health. However, it is uncertain if differential health and mental health benefits are associated with undertaking different activities in public green space. We evaluated the health and wellbeing benefits of different activities in different locations of public green spaces in urban and semi-urban areas. We used a mixed-methods before-and-after design. Volunteers at three conservation sites were recruited and took part in group guided walks, practical conservation tasks or citizen science. Repeated measures one-way ANOVAs with Bonferroni correction assessed the relationship between location and activity type on change in acute subjective mood from pre- to post-activity, measured with the UWIST Mood Adjective Checklist (UWIST-MACL). Qualitative semi-structured interviews were undertaken and analysed thematically to explore participants’ perceptions about the health and wellbeing benefits of activities in public green space. Forty-five participants were recruited, leading to 65 independent observations. Walking, conservation and citizen science in public green space were associated with improved mood. Across all participants acute subjective mood improved across all domains of the UWIST-MACL. There was a significant association between reduction in stress and location (p = 0.009). Qualitatively participants reported that conservation and citizen science conferred co-benefits to the environment and individual health and well-being and were perceived as purposeful. Undertaking purposeful activity in public green space has the potential to promote health and prevent mental ill health.

Spending at least 120 minutes a week in nature is associated with good health and wellbeing

Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15-2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120-179 mins: ORs [95%CIs]: Health = 1.59 [1.31-1.92]; Well-being = 1.23 [1.08-1.40]). Positive associations peaked between 200-300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly nature exposure guidelines comparable to those for physical activity.

Advancing Well-Being and Health of Elderly with Integrative Nursing Principles

There is a need for holistic care for the survival of the elderly, to increase their independence in their daily life activities, to improve their health and their well-being in order to ensure a healthy aging. Integrative nursing principles are a field of application of holistic philosophy and may be a guide to health professionals in improving the health of individuals, families and communities. These principles were first announced in 2014, and have been described as a health approach that takes the individual, family and society as a whole together with their environment and relationships and adopts the principle of using all the healing methods in health care. Integrative nursing principles can be used as a guide to holistic assessment and improvement of the health of the elderly. Interventions who take care of them with the environment they live in (home visits), support their existing healing process (focusing to patient during nursing care), benefit from the healing effect of the nature (spending time in nature), strengthen the relationship (mobilization of the social environment) and use all evidence-based healing methods (yoga, tai chi) should be included in the care of elderly individuals. Health professionals should learn integrative nursing principles and care for these principles in order to improve the health and well-being of the elderly. Giving care according to integrative nursing principles can increase the quality of life of the elderly and reduce health spending.

What Motivates Participants to Adhere to Green Exercise?

There is a lack of research into green exercise which investigates and compares motivational drivers between the different types of outdoor activities. The current paper addressed this gap by classifying and comparing three types of green exercise: (i) Recreational physical activity, (ii) competitive sport, and (iii) outdoor adventure sport. Using a mixed methodological approach, the present study investigated the motivations for adhering to green exercise and directly compared the differences between these three forms of green exercise. Online questionnaires and face-to-face interviews were used to collect data. The results demonstrated that within all types of green exercise, enjoyment was the greatest motivator. Based on analysis of the qualitative materials, extrinsic motivators such as the environment, family, and friends were highlighted as key factors in beginning and continuing their activity. However, intrinsic motivators were also emphasised as more important in adherence to green exercise. Furthermore, as seen in other research, numerous psychological benefits were reported over time. The results of the study may act as a starting point in understanding how we may increase public engagement in green exercise by prompting participants to select a form of green exercise that best suits them based on their motivational profile.