Advancing Environmental Epidemiology to Assess the Beneficial Influence of the Natural Environment on Human Health and Well-Being

The effects of nature-based vs. indoor settings on the adaptability, performance and affect of calisthenics exercisers. A registered report

Comparisons of the beneficial effects of nature-based versus indoor physical activity have been extensively reported, but existing research addresses mainly aerobic activity (running, jogging), not resistance or mixed (aerobic and resistance) exercise. It is unclear if the psychological benefits extend to functionality, i.e., if participants perform their activities better in nature, and how movement is expressed in nature-based and indoor environments, during similar exercise. The present registered report was a randomized controlled trial investigating how engaging in similar resistance-based exercise (calisthenics) in nature-based and indoor settings differed in affective valence, perceived exertion, visual attention, movement adaptability, heart rate variability, and performance. Nature-based exercisers (N = 51) showed increased performance output than indoor exercisers (N = 53) (p < 0.001). There were no group differences in affective valence, perceived exertion, or visual attention. However, psychological states of nature-based exercisers showed stronger associations to performance output (r < 0.33) than those of indoor exercisers (r < 0.03). Nature-based exercisers' movement variability and structure, measured with non-linear and fractal techniques (Sample Entropy and Detrended Fluctuation Analysis), were more regular (p < 0.001) and more functionally adaptive (long-term Detrended Fluctuation Analysis, p = 0.022) to achieve better performance output. Heart rate variability measures were not different between groups. Distinct environments can influence movement adaptability in a calisthenics exercise routine, and ultimately contribute to better performance. These results show how action is specific to task environment, and how action implies not only the task, but also the characteristics of the environment. TRIAL REGISTRATION: NCT05090501 (Clinicaltrials.gov). Registered October 21, 2021.

Identify the significant landscape characteristics for the perceived restorativeness of 8 perceived sensory dimensions in urban green space

The restorative benefits of urban green spaces (UGSs) have been supported by many studies. Eight perceived sensory dimensions (PSDs) are regarded as a tool to classify green spaces based on perception. However, little attention has been given to the effects of landscape characteristics (LCs) on the perceived restorativeness (PR) of green spaces. Thus, this study aims to clarify this relationship using the eight PSDs. The research collected information, via video stimulus, from 30 participants on the restorative experiences of urban green parks, according to the eight kinds of PSDs. The skin conductance level obtained via biosensors was used to measure the PR. The subjective satisfaction evaluation of 10 LCs was further obtained using a 5-point Likert scale. The data were analyzed using correlation and regression analyses. The results show that the UGSs with dominant "serene," "open," and "sheltered" PSDs are rated highest for restoration. Furthermore, the findings identify the significant factors affecting the restoration of green spaces using different PSDs. In green spaces controlled by PSD, scene, vegetation, water features, and disturbances are more reliable predictors for restoration. The results indicate how different PSD spaces can be distributed in green urban planning and provide key points for designing each PSD for restoration. The use of physiological indexes rather than subjective feelings provides an alternative for demonstrating the restorative benefits of the environment. However, before it can officially be used by designers, more research is needed.

Exploring the effect of different typical plant community on human stress reduction: a field experiment

Research has demonstrated the positive effect of natural environment on human restoration and well-being. Time spent in nature can often alleviate both physiological and psychological stress. However, few studies have discussed the environmental health effects of the nature's components and characteristics. Sixty volunteers were recruited and one manufactured environment and five different natural environments were randomly assigned to them, including coniferous forests (pure coniferous forest-PC and mixed coniferous forest-MC), broad-leaved forests (pure broad-leaved forest-PB and mixed broad-leaved forest-MB), and mixed forest (mixed coniferous and broad-leaved forest-MCB). Each volunteer sat in a built or natural environment and looked around the environment for 15 min. Physiological (HR, HRV, BP, pulse rate and salivary cortisol) and psychological indicators (POMS and STAI) were used to evaluate the changes in their stress level. Results indicated a strong difference in HR, HRV, POMS and STAI between the built and natural environment, which showed that natural environment can lower the stress level. MC had the best effect on relieving physiological stress, whereas MCB is most successful in improving emotional state and reducing anxiety. Broad-leaved forest and mixed forest significantly affected the DBP and vigor level of the subjects, respectively. While coniferous forest did significantly increase the concentration of salivary cortisol in subjects. The study confirmed that compared to the built environment, the natural environment can relieve the human body's physical and psychological stress and negative emotions, while significantly increasing vitality. And different plant communities also have different effects on the physiological and psychological indicators of the subjects. These results will provide scientific basis for the construction and improvement of urban green space environment.

Dynamic greenspace exposure, individual mental health status and momentary stress level: A study using multiple greenspace measurements

Previous research on the relationship between greenspace exposure and mental health has largely taken a residence-based approach to exposure assessment, ignoring the dynamic nature of people's daily movements. Moreover, most studies evaluated greenspace from an overhead perspective, whereas an eye-level perspective could potentially offer a more comprehensive understanding of individuals' encounters with greenspaces. Based on our survey in two communities in Hong Kong (Sham Shui Po and Tin Shui Wai), we captured people's eye-level greenspace exposure based on their travel routes and visited places using GPS trajectories, streetscape images, and deep learning methods. We then compared the results with those obtained with an overhead greenness exposure measure (the normalized difference vegetation index [NDVI]). The results indicate that these two greenspace measurements are not associated with each other, implying that they encompass distinct facets of greenspace, which may have different effects on mental health. Further, we examined the associations between various greenspace exposure measures and mental health using GPS trajectories and ecological momentary assessment data. The results reveal a negative association between eye-level greenspace exposure and momentary stress, while no similar association was observed when using the top-down NDVI as an indicator of greenspace exposure. Moreover, compared to the total volume of greenspace exposure, the distance-weighted average of greenspace exposure based on dynamic mobility contexts has a stronger association with individual overall mental health. Lastly, the relationship between greenspace exposure and mental health varies between the two communities with different socio-economic attributes. The study indicates that policymakers should focus not only on residential neighborhoods and overhead greenspace but also consider the dynamic environments and socio-economic contexts that people are embedded in.

The relationship between nature exposure and depression among Chinese prisoners: a moderated mediation model

Aim

This study examined the association between self-reported nature exposure and depression among Chinese prisoners, as well as the mediating and moderating effects of meaning in life and callous-unemotional (CU) traits, respectively.

Background

Prisoners are more likely to experience depression than any other mental illness. Exposure to nature has been proposed as a highly cost-effective method of treating their depressive symptoms. However, the mechanism underlying the link between nature exposure and depression among prisoners needs further investigation, as the findings may provide new insights into how to address depression in incarcerated populations.

Method

Data were collected through a survey conducted in four prisons in southern China from April to May 2022. The participants were 574 prisoners who anonymously completed four questionnaires about nature exposure, meaning in life, depression, and CU traits.

Results

The results show that: (1) meaning in life significantly mediates the association between nature exposure and depression, and (2) CU traits moderate the connection between nature exposure and meaning in life.

Conclusion

The current study uncovered that prisoners who contact more with the natural environment have a higher meaning in life and lower depression, and individuals with higher CU traits can benefit more from nature exposure.

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.

Obesogenic environments as major determinants of a disease: It is time to re-shape our cities

Obesity rates are increasing in almost all high- and low-income countries, and population-based approaches are necessary to reverse this trend. The current global efforts are focused on identifying the root causes of obesity and developing effective methods for early diagnosis, screening, treatment, and long-term management, both at an individual and health system level. However, there is a relative lack of effective options for early diagnosis, treatment, and long-term management, which means that population-based strategies are also needed. These strategies involve conceptual shifts towards community- and environment-focused approaches. This review aimed to provide evidence on how environmental factors contribute to the risk of obesity and how reshaping cities can help slow down obesity prevalence rates and improve long-term management.

Association of Redlining and Natural Environment with Depressive Symptoms in Women in the Sister Study

BACKGROUND

Improving mental health is recognized as an important factor for achieving global development goals. Despite strong evidence that neighborhood greenery promotes better mental health, there are environmental justice concerns over the distribution of neighborhood greenery. Underlying these concerns are present-day consequences of historical discriminatory financial investment practices, such as redlining which was established by the U.S. Federal Home Owners' Loan Corporation (HOLC) in the 1930s. The impacts of redlining on environmental and health disparities have been researched extensively. However, the influences of redlining on the associations between neighborhood environment and health outcomes have not been fully assessed.

OBJECTIVES

The aim of this study was to examine whether associations between residential tree cover and depressive symptoms vary across areas subject to HOLC practices.

METHODS

Depressive symptoms were defined by the 10-item Center for Epidemiologic Studies Depression Scale collected during the period 2008-2012 for 3,555 women in the Sister Study cohort residing in cities subject to HOLC practices across the United States. HOLC rating maps were obtained from the Mapping Inequality Project, University of Richmond, with neighborhoods graded as A (best for financial investment, green), B (still desirable, blue), C (declining, yellow), and D (hazardous, red-known as redlined). Tree cover within 500 m and 2,000 m from residences was estimated using 2011 U.S. Forest Service Percent Tree Canopy Cover. Mixed model using climate zone as the random effect was applied to evaluate the associations with adjustments for potential covariates. Analyses were stratified by HOLC grade.

RESULTS

Tree cover was significantly higher in neighborhoods with better HOLC grades. A 10% increase in tree cover was associated with reduced odds of depressive symptoms for the full study population, with adjusted odds ratios (AORs) of 0.93 [95% confidence interval (CI): 0.88, 0.99], and 0.91 (0.85, 0.97) for 500 -m and 2,000 -m buffer, respectively. Across HOLC grades, the strongest associations were observed in redlined neighborhoods, with respective AORs of 0.72 (95% CI: 0.52, 0.99) and 0.63 (95% CI: 0.45, 0.90) for 500 -m and 2,000 -m buffer.

DISCUSSION

Findings support a remediation strategy focused on neighborhood greenery that would address multiple public health priorities, including mental health and environmental justice. https://doi.org/10.1289/EHP12212.

Therapeutic Hospital Gardens: Literature Review and Working Definition

AIM

This review explores the role of purposefully designed and well-integrated therapeutic hospital gardens (THGs) for the benefits of patients, their families, and staff.

BACKGROUND

Significant benefits are realized when people are in contact with nature in the city. Although hospital gardens are prevalent and the beneficial effects of nature on health are widely acknowledged, the establishment of a consistent definition for hospital gardens that promote health is vital to attain reliable and quantifiable health outcomes.

METHODS

Twenty-eight peer-reviewed journals were critiqued for the period of 2016-2021 and updated with 12 articles from 2021 to 2023 to analyze and synthesize the latest thinking and development in this emergent field. Subsequently, current books and exemplar practice literature were synthesized with the results of the literature review to produce a working definition of THGs.

RESULTS

Three themes and 14 subthemes were established showing the interconnectedness of THG definition, user needs and experiences, and the benefits and values of THGs. Two original findings can be established-a need to have a consensus on terminology and to establish design processes. The working definition was produced as a foundational step to guide stakeholders in implementing THGs.

CONCLUSION

THGs can play a role in improving well-being when they are purposefully designed and well-integrated in hospital programs and health policy. Hospital CEOs, designers, and healthcare experts can use the findings and working definition to assist the establishment of such health promoting gardens.

Green Social Prescribing in Practice: A Case Study of Walsall, UK

This paper presents a case study of Green Social Prescribing (GSP) in Walsall, a medium-sized urban area located in the West Midlands, UK. GSP is a means of enabling health professionals to refer people to a range of local non-clinical nature-based activities, e.g., community gardening and conservation volunteering. As a new practice to address multiple challenges in health and sustainability, GSP has been promoted by the UK government and the NHS in the past few years. There is as yet limited evidence and knowledge about how this approach is implemented at a local level. This paper addresses this gap of knowledge, by exploring how GSP is implemented in Walsall as a case study. Based on extensive engagement and research activities with the local partners to collect data, this paper reveals the local contexts of GSP, the referral pathways, and people's lived experience, discussing the challenges, barriers, and opportunities in delivering GSP at the local level. This study suggests that a more collaborative and genuine place-based approach is essential, and alongside GSP, investment into infrastructure is needed to move the health paradigm further from 'prevention' to 'promotion' so that more people can benefit from what nature can offer.

Variation in leisure sport conflicts and coping strategies depending on participation type and proximity during the COVID-19 pandemic

Introduction

New conflict types have arisen in leisure sports activities due to social regulations designed to address COVID-19. We analyze the differences in conflict-inducing factors and coping strategies across various types of leisure sports and levels of spatial proximity.

Methods

Korean adults aged between 20 and 60 years, who had participated in leisure sports activities since the COVID-19 outbreak in January 2020, were surveyed, and 508 responses were collected for analysis. The differences in leisure sports conflicts and coping strategies across the types of leisure sports participation and spatial proximity were tested.

Results

The results show that conflict due to prejudice was higher in typical indoor sports activities, such as Pilates, yoga, and gym workouts, whereas conflict due to competition or not observing etiquette was higher in indoor golf. Second, conflict due to prior expectations and prejudice was high in outdoor sports activities, such as jogging and hiking. Finally, all participants showed avoidance behavior, but it was observed more frequently in outdoor sports than indoor sports.

Discussion

The study reveals how much leisure conflict is induced by various types of leisure sports participation, particularly during outdoor activities, which usually feature a relatively low density of participants. It underscores the necessity of developing structural approaches to resolving leisure conflicts in dangerous spaces or requiring intensive management and creating new leisure sports activities.

Effects of exposure to immersive computer-generated virtual nature and control environments on affect and cognition

Previous research has shown that exposure to immersive virtual nature environments is able to induce positive affective and physiological effects. However, research on the effects on cognitive performance is scarce. Additionally, the effects of virtual nature exposure compared to a virtual control environment with a comparable amount of virtual objects have not been examined so far. Therefore, we conducted an experiment with 27 participants to study the psychological effects of such exposure. The virtual nature consisted of a 3D model of a typical forest environment, whereas the control environment was an abstract replication of the virtual forest environment. In both environments, a virtual wooden cart was used to transport the users from the start to the end of the virtual road. The typical background noise of moving such a cart was integrated into both environments as well. In addition, the virtual nature environment included typical forest sounds in the background, whereas the control condition did not have such background sounds. Both environments were compared with regard to their effects on cognitive performance (using trail making tests (TMTA, TMTB, and TMTB-A) as well as digit span forward and digit span backward tests), perceived restorativeness, mood, stress, sense of presence, and simulator sickness. The results showed that in comparison to the control environment, exposure to the virtual nature resulted in significantly higher cognitive performance, higher perceived restorativeness, higher positive affect, higher sense of presence, lower perceived stress, and lower simulator sickness.

Effects of Physical Exercise Program in Adults with Intellectual and Developmental Disabilities-A Study Protocol

We developed a physical exercise (PE) program for people with Intellectual and Developmental Disabilities (IDD), aiming to determine the effects on physical fitness, health, cognitive ability, and quality of life (QoL). Using experimental methodology, this intervention study recruited 21 adults (18 to 65 years old), institutionalized and with no other associated pathology, who will be allocated to one of the different groups: (i) gym/indoor intervention group (using weight machines), (ii) outdoor intervention group (using low-cost materials), or (iii) control group (without specific intervention, who continue with their normal daily activities). Both intervention groups will engage in 45 min of training per session, twice a week, for 24 weeks. Assessments will be conducted at baseline (initial assessment), 3 months (mid-term assessment), and 6 months (final assessment). Variables assessed include anthropometrics, body composition, functional capacity, muscle strength, general health, cognitive ability, and QoL. The results of this study will assist in the development of more effective strategies, recommendations, and interventions to ensure better and greater adherence to PE by institutionalized individuals with IDD, namely, recommendations for assessment, prescription, and implementation of PE for this population. Additionally, we intend to make available two PE programs, if they are adapted and promote positive effects.

The PAD-US-AR dataset: Measuring accessible and recreational parks in the contiguous United States

Most spatial epidemiological studies of nature-health relationships use generalized greenspace measures. For instance, coarse-resolution spatial data containing normalized difference vegetative index (NDVI) values are prominent despite criticisms, such as the inability to restrain exposure estimates to public and private land. Non-threatening natural landscapes can improve health by building capacities for health-promoting behaviors. Recreational and accessible parks may best activate such behaviors. We curated the Parks and Protected Areas Database of the U.S. (PAD-US) to identify parks that are accessible for outdoor recreation. Our title adds "AR" to "PAD-US" where A = Accessible and R = Recreational. We validated the PAD-US-AR by comparisons with greenspace datasets and sociodemographics, which demonstrated its uniqueness from other commonly employed metrics of nature exposure. The PAD-US-AR presents reliable estimates of parks in the contiguous U.S. that are accessible for outdoor recreation. It has strong associations with home prices, shares of female residents, and shares of older residents. This dataset can accompany other nature exposure metrics in environmental epidemiology and allied research fields.

Acknowledging geodiversity in safeguarding biodiversity and human health

Our existence on Earth is founded on a vital nature, which supports human physical and mental health. However, nature is often depicted only through biodiversity, whereas geodiversity-the diversity of non-living nature-has so far been neglected. Geodiversity consists of assemblages, structures, and systems of geological, geomorphological, soil, and hydrological components that fundamentally underlie biodiversity. Biodiversity can support overall human health only with the foundation of geodiversity. Landscape characteristics, such as varying topography or bodies of water, promote aesthetic and sensory experiences and are also a product of geodiversity. In this Personal View, we introduce the concept of geodiversity as a driver for planetary health, describe its functions and services, and outline the intricate relationships between geodiversity, biodiversity, and human health. We also propose an agenda for acknowledging the importance of geodiversity in health-related research and decision making. Geodiversity is an emerging topic with untapped potential for ensuring ecosystem functionality and good living conditions for people in a time of changing environments.

Urban Green Space and Subjective Well-Being of Older People: A Systematic Literature Review

A growing number of articles have identified and reported the benefits and importance of urban green spaces for improving human well-being, but there is a significant knowledge gap regarding the impact of urban green spaces on the subjective well-being of older adults. The literature search (August 2015-August 2022) was derived from two major scientific databases, Google Scholar, and Web of Science. As a result, 2558 articles were found, 1527 of which were retrieved from WOS and the rest from Google Scholar. Bibliometric methods and VOSviewer software were used to screen and organize the articles in the relevant fields. Finally, 65 articles met the review criteria. The included studies aim to capture the benefits of various features of urban green spaces in meeting or enhancing the subjective well-being needs of older adults. The results of our review further support the existence of a strong link between older adults' subjective well-being and various features of urban green spaces, providing new insights for future in-depth reexamination and policy development. Furthermore, the relationship between urban green spaces and older adults' subjective well-being depends not only on the urban green spaces themselves but also on the characteristics of the older adult population that uses them.

The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study

The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.

Benefits to Performance and Well-Being of Nature-Based Exercise: A Critical Systematic Review and Meta-Analysis

Prior reviews point to the superior benefits of exercising in nature vs in conventional indoor venues, particularly in terms of well-being. However, physical exercise performance, neither in terms of efficacy nor efficiency, has not been sufficiently addressed by past reviews of this topic. Therefore, we conducted both a systematic review and meta-analysis of the experimental literature that relates to differences in exercise performance and well-being between exercising in nature and in conventional indoor venues. Forty-nine relevant studies─the outcome data of which were used for the systematic review─were located within the Web of Science, PubMed, and Scopus databases. The meta-analyses, using data from twenty-four of the relevant studies, revealed no significant overall environmental effect on task performance efficacy outcomes (p = 0.100). For nature-based exercise, however, marginally positive cognitive performance outcomes (p = 0.059), lower ratings of perceived exhaustion (p = 0.001), and higher levels of vigor (p = 0.017) were observed, indicating higher performance efficiency. As for the effects of environment on well-being, positive affect was significantly higher for nature-based exercise (p = 0.000), while perceived stress was significantly higher for indoor exercise (p = 0.032). These results must, however, be interpreted with caution. High levels of bias and between-study heterogeneity were observed. Nonetheless, given several noticeable trends in the results, it may be that exercising in nature enhances the efficiency of exercise task performance to a greater extent than does indoor exercise.

Scoping review of the use of virtual reality in intensive care units

BACKGROUND

A wide range of reviews have demonstrated the effectiveness and tolerability of Virtual Reality (VR) in a range of clinical areas and subpopulations. However, no previous review has explored the current maturity, acceptability, tolerability, and effectiveness of VR with intensive care patients.

AIMS

To identify the range of uses of VR for intensive care patients, classify their current phase of development, effectiveness, acceptability, and tolerability.

METHODS

A scoping review was conducted. A multi-database search was undertaken (inception to January 2021). Any type of study which examined the use of VR with the target application population of intensive care patients were included. Screening, data extraction, and assessment of quality were undertaken by a single reviewer. A meta-analysis and a descriptive synthesis were undertaken.

RESULTS

Six hundred and forty-seven records were identified, after duplicate removal and screening 21 studies were included (weak quality). The majority of studies for relaxation, delirium, and Post Traumatic Stress Disorder (PTSD) were at the early stages of assessing acceptability, tolerability, and initial clinical efficacy. Virtual Reality for relaxation and delirium were well-tolerated with completion rates of target treatment of 73.6%, (95% CI:51.1%-96%, I²  = 98.52%) 52.7% (95% CI:52.7%-100%, I²  = 96.8%). The majority of reasons for non-completion were due to external clinical factors. There were some potential benefits demonstrated for the use of VR for relaxation, delirium, and sleep.

CONCLUSION

Virtual Reality for intensive care is a new domain of research with the majority of areas of application being in the early stages of development. There is great potential for the use of VR in this clinical environment. Further robust assessment of effectiveness is required before any clinical recommendations can be made.

Estimating multiple greenspace exposure types and their associations with neighbourhood premature mortality: A socioecological study

BACKGROUND

Greenspace exposures are often measured using single exposure metrics, which can lead to conflicting results. Existing methodologies are limited in their ability to estimate greenspace exposure comprehensively. We demonstrate new methods for estimating single and combined greenspace exposure metrics, representing multiple exposure types that combine impacts at various scales. We also investigate the association between those greenspace exposure types and premature mortality.

METHODS

We used geospatial data and spatial analytics to model and map greenspace availability, accessibility and eye-level visibility exposure metrics. These were harmonised and standardised to create a novel composite greenspace exposure index (CGEI). Using these metrics, we investigated associations between greenspace exposures and years of potential life lost (YPLL) for 1673 neighbourhoods applying spatial autoregressive models. We also investigated the variations in these associations in conjunction with levels of socioeconomic deprivation based on the index of multiple deprivations.

RESULTS

Our new CGEI metric provides the opportunity to estimate spatially explicit total greenspace exposure. We found that a 1-unit increase in neighbourhood CGEI was associated with approximately a 10-year reduction in YPLL. Meaning a 0.1 increment or 10% increase in the CGEI is associated with an approximately one year lower premature mortality value. A single 1-unit increase in greenspace availability was associated with a YPLL reduction of 9.8 years, whereas greenness visibility related to a reduction of 6.14 years. We found no significant association between greenspace accessibility and YPLL. Our results further identified divergent trends in the relations between greenspace exposure types (e.g. availability vs. accessibility) and levels of socioeconomic deprivation (e.g. least vs. most).

CONCLUSION

Our methods and metrics provide a novel approach to the assessment of multiple greenspace exposure types, and can be linked to the broader exposome framework. Our results showed that a higher composite greenspace exposure is associated with lower premature mortality.

Students' Intention of Visiting Urban Green Spaces after the COVID-19 Lockdown in China

This study addresses students' perceptions of using urban green spaces (UGSs) after the easing of COVID-19 lockdown in China. We questioned whether they are still mindful of the risks from the outdoor gathering, or conversely, starting to learn the restoration benefits from the green spaces. Online self-reported surveys were distributed to the Chinese students aging from 14 to 30 who study in Hunan and Jiangsu Provinces, China. We finally obtained 608 complete and valid questionnaire forms from all participants. Their intentions of visiting UGSs were investigated based on the extended theory of planned behavior model. Structural equation modeling was employed to test the hypothesized psychological model. The results have shown good estimation performance on risk perception and perceived knowledge to explain the variances in their attitudes, social norms, and perceived behavior control. Among these three endogenous variables, the perceived behavior control owns the greatest and positive influence on the behavioral intention, inferring that controllability is crucial for students to make decisions of visiting green spaces in a post-pandemic context.

Types and spatial contexts of neighborhood greenery matter in associations with weight status in women across 28 U.S. communities

Excess body weight is a risk factor for many chronic diseases. Studies have identified neighborhood greenery as supportive of healthy weight. However, few have considered plausible effect pathways for ecosystem services (e.g., heat mitigation, landscape aesthetics, and venues for physical activities) or potential variations by climate. This study examined associations between weight status and neighborhood greenery that capture ecosystem services most relevant to weight status across 28 U.S. communities. Weight status was defined by body mass index (BMI) reported for 6591 women from the U.S. Sister Study cohort. Measures of greenery within street and circular areas at 500 m and 2000 m buffer distances from homes were derived for each participant using 1 m land cover data. Street area was defined as a 25 m-wide zone on both sides of street centerlines multiplied by the buffer distances, and circular area was the area of the circle centered on a home within each of the buffer distances. Measures of street greenery characterized the pedestrian environment to capture physically and visually accessible greenery for shade and aesthetics. Circular greenery was generated for comparison. Greenery types of tree and herbaceous cover were quantified separately, and a combined measure of tree and herbaceous cover (i.e., aggregate greenery) was also included. Mixed models accounting for the clustering at the community level were applied to evaluate the associations between neighborhood greenery and the odds of being overweight or obese (BMI > 25) with adjustment for covariates selected using gradient boosted regression trees. Analyses were stratified by climate zone (arid, continental, and temperate). Tree cover was consistently associated with decreased odds of being overweight or obese. For example, the adjusted odds ratio [AOR] was 0.92, 95% Confidence Interval [CI]: 0.88-0.96, given a 10% increase in street tree cover at the 2000 m buffer across the 28 U.S. communities. These associations held across climate zones, with the lowest AOR in the arid climate (AOR: 0.74, 95% CI: 0.54-1.01). In contrast, associations with herbaceous cover varied by climate zone. For the arid climate, a 10% increase in street herbaceous cover at the 2000 m buffer was associated with lower odds of being overweight or obese (AOR: 0.75, 95% CI: 0.55-1.03), whereas the association was reversed for the temperate climate, the odds increased (AOR: 1.19, 95% CI: 1.05-1.35). Associations between greenery and overweight/obesity varied by type and spatial context of greenery, and climate. Our findings add to a growing body of evidence that greenery design in urban planning can support public health. These findings also justify further defining the mechanism that underlies the observed associations.

An ecosystem service perspective on urban nature, physical activity, and health

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

Classification of typical hot springs and their relationship with health in Guizhou, China

Aim to classify typical hot springs in Guizhou, China and their relevance to health. Assessing geochemical characters of typical hot springs of Guizhou and classifying through hierarchical cluster analysis, an epidemiologic study was conducted to analyze the correlation between hot spring types and health, which showed typical hot springs in Guizhou can be divided into two types, A and B. Type A is rich in fluorine, metasilicic acid, radon components and a large number of essential elements, such as Na, that the human body needs, with trace elements, such as Cr and V, that are essential or possibly essential. Type B is rich in fluorine, metasilicate, strontium components and a large number of essential elements, Ca, Mg, and S, with trace elements, Cu, Mn, Mo, Co, and Ni, that are essential or possibly essential. These hot springs' effects on the health of those bathing in them showed both types were associated with bone and joint diseases. Having bathed in hot springs during the past year was associated with skin symptoms and bone and joint symptoms, and having bathed within the past two weeks was linked to sleep quality and levels of appetite and energy. However, differences do exist between the correlation between the two types and some chronic diseases, with Type A hot springs significantly related to cardiovascular and cerebrovascular diseases and diabetes and Type B to hypertension. This classification of Guizhou's hot springs can guide the future development and use of hot spring physiotherapy.

Effects of exposure to immersive videos and photo slideshows of forest and urban environments

A large number of studies have demonstrated the benefits of natural environments on people's health and well-being. For people who have limited access to nature (e.g., elderly in nursing homes, hospital patients, or jail inmates), virtual representations may provide an alternative to benefit from the illusion of a natural environment. For this purpose and in most previous studies, conventional photos of nature have been used. Immersive virtual reality (VR) environments, however, can induce a higher sense of presence compared to conventional photos. Whether this higher sense of presence leads to increased positive impacts of virtual nature exposure is the main research question of this study. Therefore, we compared exposure to a forest and an urban virtual environment in terms of their respective impact on mood, stress, physiological reactions, and cognition. The environments were presented via a head-mounted display as (1) conventional photo slideshows or (2) 360[Formula: see text] videos. The results show that the forest environment had a positive effect on cognition and the urban environment disturbed mood regardless of the mode of presentation. In addition, photos of either urban or forest environment were both more effective in reducing physiological arousal compared to immersive 360[Formula: see text] videos.

Modelling and mapping eye-level greenness visibility exposure using multi-source data at high spatial resolutions

The visibility of natural greenness is associated with several health benefits along multiple pathways, including stress recovery and attention restoration mechanisms. However, existing methodologies are inadequate for capturing eye-level greenness visibility exposure at high spatial resolutions for observers located on the ground. As a response, we developed an innovative methodological approach to model and map eye-level greenness visibility exposure for 5 m interval locations within a large study area. We used multi-source spatial data and applied viewshed analysis in conjunction with a distance decay model to compute a novel Viewshed Greenness Visibility Index (VGVI) at more than 86 million observer locations. We compared our eye-level visibility exposure map with traditional top-down greenness exposure metrics such as Normalised Differential Vegetation Index (NDVI) and a Street view based Green View Index (SGVI). Furthermore, we compared greenness visibility at street-only locations with total neighbourhood greenness visibility. We found strong to moderate correlations (r = 0.65-0.42, p < 0.05) between greenness visibility and mean NDVI, with a decreasing trend in correlation strength at increasing buffer distances from observer locations. Our findings suggest that top-down and eye-level measurements of greenness are two distinct metrics for assessing greenness exposure. Additionally, VGVI showed a strong correlation (r = 0.481, p < 0.01) with SGVI. Although the new VGVI has good agreement with existing street view based measures, we found that street-only greenness visibility values are not wholly representative of total neighbourhood visibility due to the under-representation of visible greenness in locations such as backyards and community parks. Our new methodology overcomes such underestimations, is easily transferable, and offers a computationally efficient approach to assessing eye-level greenness exposure.

The Impact of the Closure and Reopening of Golf Courses in the United Kingdom on Wellbeing During the COVID-19 Pandemic: A Multi-Study Approach

The purpose of this multi-study was to assess what impact the closure and reopening of golf courses had on: personal competence; sense of belonging; enjoyment; self-esteem; self-confidence; resilience; social connections; wellbeing and life satisfaction (hereafter referred to collectively as "key variables of interest") during the COVID-19 pandemic. Golfers (Study 1: n = 298, Study 2: n = 124) ≥16 years old residing in the UK participated in this study which collected data using online surveys. Study 1 was conducted during a period of quarantine restrictions (4-12th May 2020), whilst study 2 took place following the easing of the COVID-19 quarantine restrictions (6-14th July 2020). Within study 1 and study 2, key variables of interest levels were also collected to investigate the association with golf related activities. The findings of study 1 highlighted that negligible and non-significant correlations were observed between golf physical and sedentary activities and key variables of interest (r < 0.3, p > 0.05) except sense of belonging and sedentary golf activities (r = 0.178, p = 0.003). Study 2 highlighted that sense of belonging, enjoyment and wellbeing were significantly associated with outdoor golf course activity (r = 0.186-0.252, p ≤ 0.05). Furthermore, when comparing study 1 and study 2, sense of belonging and life satisfaction significantly improved (p < 0.05, d = 0.2). Based on these findings, playing golf on outdoor golf courses appears to be positively related to sense of belonging, enjoyment and wellbeing. Also, with the reopening of golf courses life satisfaction improved which, together, highlights the beneficial impact that outdoor golf can impart.

Light absorption enhancement of particulate matters and their source apportionment over the Asian continental outflow site and South Yellow Sea

Light absorption enhancement of black carbon due to the aerosol mixing states is an important parameterization for climate modeling, while emission source contributions to the enhancement factor are unclear. An intensive campaign was conducted simultaneously at a China coastal site (Qingdao city) and maritime sites (South Yellow Sea, SYS) in August and Nov to Dec 2018. The absorption enhancement (E_MAC) of the black carbon was calculated using a two-step solvent dissolution protocol and found 1.96 ± 0.68, 1.64 ± 0.38, and 2.40 ± 0.76 for Qingdao summer (QS), Qingdao autumn (QA), and SYS, respectively. Positive matrix factorization (PMF) model identified six sources of PM_2.5 and E_MAC, which were secondary aerosol (with contribution 27.9% and 29.2%), coal combustion (24.9% and 20.2%), industrial emissions (15.2% and 25.4%), sea salt (6.9% and 9.6%), vehicle emissions (12.1% and 10.9%), and soil dust (13.0% and 4.7%), respectively. These sources increased the absorption of black carbon by a factor of 1.25 ± 0.11 (secondary aerosol), 1.21 ± 0.20 (industrial emissions), 1.17 ± 0.08 (coal combustion), 1.09 ± 0.07 (vehicle emissions), 1.08 ± 0.17 (sea salt), and 1.04 ± 0.10 (soil dust). Based on the correlation between PM and E_MAC source contributions, we estimated that secondary aerosols, industrial emissions, and coal combustion contributed to 74.8% of absorption enhancement at a regional scale in China. The source apportionment for E_MAC offers a new diagnosis for each source regarding aerosol forcing simulation which inputs from the individual emission sector.

Comparative Study of the Restorative Effects of Forest and Urban Videos during COVID-19 Lockdown: Intrinsic and Benchmark Values

The prolonged lockdown imposed to contain the COrona VIrus Disease 19 COVID-19 pandemic prevented many people from direct contact with nature and greenspaces, raising alarms for a possible worsening of mental health. This study investigated the effectiveness of a simple and affordable remedy for improving psychological well-being, based on audio-visual stimuli brought by a short computer video showing forest environments, with an urban video as a control. Randomly selected participants were assigned the forest or urban video, to look at and listen to early in the morning, and questionnaires to fill out. In particular, the State-Trait Anxiety Inventory (STAI) Form Y collected in baseline condition and at the end of the study and the Part II of the Sheehan Patient Rated Anxiety Scale (SPRAS) collected every day immediately before and after watching the video. The virtual exposure to forest environments showed effective to reduce perceived anxiety levels in people forced by lockdown in limited spaces and environmental deprivation. Although significant, the effects were observed only in the short term, highlighting the limitation of the virtual experiences. The reported effects might also represent a benchmark to disentangle the determinants of health effects due to real forest experiences, for example, the inhalation of biogenic volatile organic compounds (BVOC).

Mapping ecological space quality changes for ecological management: A case study in the Pearl River Delta urban agglomeration, China

Compiling information concerning changes in ecological space quality (ESQ) is imperative for urban management and restoration, as proper management promotes sustainable development. Most previous studies have lacked a comprehensive model for evaluating ESQ and are thus unable to provide effective support for decision-makers. Based on the purpose of policy and needs of the public, this paper constructs a comprehensive adaptive evaluation model for mapping ESQ using the Pearl River Delta (PRD) urban agglomeration as an example, and the analysis uncovers the driving forces of urbanization indicators of ESQ change. From 2000 to 2017, the overall ESQ was considered as good, but the overall value decreased slightly, from 52.8 to 51.5. ESQ in the central PRD exhibited a notable downward trend, while coastal cities exhibited an upward trend. There was an approximate negative correlation between ESQ and the urbanization indexes, except for education level and the proportion of primary industry. In the PRD, rural population density, the proportion of primary industry, and education level were the important drivers of magnitude and direction in most cities, but their impacts differed across cities. The ecological management lacked control of in areas good and moderate ESQ, and this was the main factor resulting in the decline of regional ESQ. By quantifying ESQ and the spatially explicit urbanization drivers, the potential for ecological management in the urban agglomeration is also discussed.

How do natural features in the residential environment influence women's self-reported general health? Results from cross-sectional analyses of a U.S. national cohort

BACKGROUND

The relationship between health and human interaction with nature is complex. Here we conduct analyses to provide insights into potential health benefits related to residential proximity to nature.

OBJECTIVES

We aimed to examine associations between measures of residential nature and self-reported general health (SRGH), and to explore mediation roles of behavioral, social, and air quality factors, and variations in these relationships by urbanicity and regional climate.

METHODS

Using residential addresses for 41,127 women from the Sister Study, a U.S.-based national cohort, we derived two nature exposure metrics, canopy and non-gray cover, using Percent Tree Canopy and Percent Developed Imperviousness from the National Land Cover Database. Residential circular buffers of 250 m and 1250 m were considered. Gradient boosted regression trees were used to model the effects of nature exposure on the odds of reporting better SRGH (Excellent/Very Good versus the referent, Good/Fair/Poor). Analyses stratified by urbanicity and regional climate (arid, continental, temperate) and mediation by physical activity, social support, and air quality were conducted.

RESULTS

A 10% increase in canopy and non-gray cover within 1250 m buffer was associated with 1.02 (95% CI: 1.00-1.03) and 1.03 (95% CI: 1.01-1.04) times the odds of reporting better SRGH, respectively. Stronger associations were observed for the urban group and for continental climate relative to other strata. Social support and physical activity played a more significant mediation role than air quality for the full study population.

DISCUSSION

Findings from this study identified a small but important beneficial association between residential nature and general health. These findings could inform community planning and investments in neighborhood nature for targeted health improvements and potential societal and environmental co-benefits.

Using structural equation modeling to examine pathways between perceived residential green space and mental health among internal migrants in China

BACKGROUND

Emerging evidence suggests that exposure to residential green space is beneficial for people's mental health along multiple pathways. It remains unknown, however, whether the complex pathways found for the general population also apply to internal migrants in China.

AIM

To examine the mediators of green space-mental health associations among migrants in the metropolis of Shenzhen, China.

METHODS

We conducted a cross-sectional survey among 591 migrants aged between 18 and 68 years in January-April 2017 in Shenzhen, a city facing a considerable inflow of rural-urban migration. Migrants' mental health was assessed using the 12-item General Health Questionnaire. Data on migrant's green space perception, migration characteristics, environmental disturbances, social cohesion, physical health, etc. were obtained through a questionnaire. Structural equation modeling was used to analyze the mechanisms underlying the green space-mental health association.

RESULTS

No direct effect of perceived green space on migrants' mental health was found. We did find, however, that perceived green space is significantly and indirectly related to mental health through reducing perceived environmental disturbance and enhancing social cohesion. Migrants' residential mobility presented a significant potential risk to migrants' physical health and might influence their mental health indirectly. A similar but only weakly significant health-threatening effect was found for migration frequency. Male and female respondents showed different patterns regarding their physical and mental health status. Migrants with higher personal incomes seemed to face a lower mental health risk.

CONCLUSIONS

Our findings suggest distinctive pathways through which residential green space could affect the mental health of internal migrants in China. Further studies in rapidly urbanizing areas are advised to evaluate green space-mental health relationships for specific population groups/subgroups with distinctive socioeconomic backgrounds.

Can Simulated Nature Support Mental Health? Comparing Short, Single-Doses of 360-Degree Nature Videos in Virtual Reality With the Outdoors

Nature exposure in virtual reality (VR) can provide emotional well-being benefits for people who cannot access the outdoors. Little is known about how these simulated experiences compare with real outdoor experiences. We conduct an experiment with healthy undergraduate students that tests the effects of 6 min of outdoor nature exposure with 6 min of exposure to a 360-degree VR nature video, which is recorded at the outdoor nature exposure location. Skin conductivity, restorativeness, and mood before and after exposure are measured. We find that both types of nature exposure increase physiological arousal, benefit positive mood levels, and are restorative compared to an indoor setting without nature; however, for outdoor exposure, positive mood levels increase and for virtual nature, they stay the same. The nature-based experience shows benefits above and beyond the variance explained by participants' preferences, nature and VR experiences, and demographic characteristics. Settings where people have limited access to nature might consider using VR nature experiences to promote mental health.

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

BACKGROUND

There is an increasing volume of literature investigating the links between urban environments and human health, much of which involves spatial conceptualisations and research designs involving various aspects of geographical information science. Despite intensifying research interest, there has been little systematic investigation of pragmatic methodological concerns, such as how studies are realised in terms of the types of data that are gathered and the analytical techniques that are applied, both of which have the potential to impact results. The aim of this systematic review is, therefore, to understand how spatial scale, datasets, methods, and analytics are currently applied in studies investigating the relationship between green and blue spaces and human health in urban areas.

METHOD

We systematically reviewed 93 articles following PRISMA protocol, extracted information regarding different spatial dimensions, and synthesised them in relation to various health indicators.

RESULTS AND DISCUSSION

We found a preponderance of the use of neighbourhood-scale in these studies, and a majority of the studies utilised land-use and vegetation indices gleaned from moderate resolution satellite imagery. We also observed the frequent adoption of fixed spatial units for measuring exposure to green and blue spaces based on physical proximity, typically ranging between 30 and 5000 m. The conceptual frameworks of the studies (e.g., the focus on physical vs. mental health or the definition of exposure to green space) were found to have an influence on the strength of association between exposure and health outcomes. Additionally, the strength and significance of associations also varied by study design, something which has not been considered systematically.

CONCLUSION

On the basis of our findings, we propose a set of recommendations for standardised protocols and methods for the evaluation of the impact of green-blue spaces on health. Our analysis suggests that future studies should consider conducting analyses at finer spatial scales and employing multiple exposure assessment methods to achieve a comprehensive and comparable evaluation of the association between greenspace and health along multiple pathways.

Sustainability

This review on Sustainability covers selected 2018 publications on the focus of sustainability. It is divided into the following sections: (a) Water quantity; (b) Water quality; (c) Climate change and resilience; (d) Planning and ecosystem evaluation; (e) Life cycle assessment (LCA) applications; (f) Sustainable management; (g) Sustainability and asset management; (h) Sustainability in wastewater treatment; (i) Sustainable water and wastewater utilities; (j) Sustainable water resource management.

Structural Characteristics of Tree Cover and the Association with Cardiovascular and Respiratory Health in Tampa, FL

Urban tree cover can provide several ecological and public health benefits. Secondary datasets for Tampa, FL, including sociodemographic variables (e.g., race/ethnicity), health data, and interpolated values for features of tree cover (e.g., percent canopy and leaf area index) were analyzed using correlation and regression. Percent canopy cover and leaf area index were inversely correlated to respiratory and cardiovascular outcomes, yet only leaf area index displayed a significant association with respiratory conditions in the logistic regression model. Percent racial/ethnic minority residents at the block group level was significantly negatively correlated with median income and tree density. Leaf area index was also significantly lower in block groups with more African-American residents. The percentage of African Americans (p = 0.101) and Hispanics (p < 0.001) were positively associated with respiratory outcomes while population density (p < 0.001), percent canopy (p < 0.01), and leaf area index (p < 0.01) were negatively associated. In multivariate models, higher tree density, leaf area index, and median income were significantly negatively associated with respiratory cases. Block groups with a higher proportion of African Americans had a higher odds of displaying respiratory admissions above the median rate. Tree density and median income were also negatively associated with cardiovascular cases. Home ownership and tree condition were significantly positively associated with cardiovascular cases.

Urban greenery and mental wellbeing in adults: Cross-sectional mediation analyses on multiple pathways across different greenery measures

BACKGROUND

Multiple mechanisms have been proposed to explain how greenery in the vicinity of people's homes enhances their mental health and wellbeing. Mediation studies, however, focus on a limited number of mechanisms and rely on remotely sensed greenery measures, which do not accurately capture how neighborhood greenery is perceived on the ground.

OBJECTIVE

To examine: 1) how streetscape and remote sensing-based greenery affect people's mental wellbeing; 2) whether and, if so, to what extent the associations are mediated by physical activity, stress, air quality and noise, and social cohesion; and 3) whether differences in the mediation across the streetscape greenery and NDVI exposure metrics occurred.

METHODS

We used a population sample of 1029 adult residents of the metropolis of Guangzhou, China, from 2016. Mental wellbeing was quantified by the World Health Organization Well-Being Index (WHO-5). Two objective greenery measures were extracted at the neighborhood level: 1) streetscape greenery from street view data via a convolutional neural network, and 2) the normalized difference vegetation index (NDVI) from Landsat 8 remote sensing images. Single and multiple mediation analyses with multilevel regressions were conducted.

RESULTS

Streetscape and NDVI greenery were weakly and positively, but not significantly, correlated. Our regression results revealed that streetscape greenery and NDVI were, individually and jointly, positively associated with mental wellbeing. Significant partial mediators for the streetscape greenery were physical activity, stress, air quality and noise, and social cohesion; together, they explained 62% of the association. For NDVI, only physical activity and social cohesion were significant partial mediators, accounting for 22% of the association.

CONCLUSIONS

Mental health and wellbeing and both streetscape and satellite-derived greenery seem to be both directly correlated and indirectly mediated. Our findings signify that both greenery measures capture different aspects of natural environments and may contribute to people's wellbeing by means of different mechanisms.

Dynamic Urban Environmental Exposures on Depression and Suicide (NEEDS) in the Netherlands: a protocol for a cross-sectional smartphone tracking study and a longitudinal population register study

INTRODUCTION

Environmental exposures are intertwined with mental health outcomes. People are exposed to the environments in which they currently live, and to a multitude of environments along their daily movements and through their residential relocations. However, most research assumes that people are immobile, disregarding that such dynamic exposures also serve as stressors or buffers potentially associated with depression and suicide risk. The aim of the Dynamic Urban Environmental Exposures on Depression and Suicide (NEEDS) study is to examine how dynamic environmental exposures along people's daily movements and over their residential histories affect depression and suicide mortality in the Netherlands.

METHODS AND ANALYSIS

The research design comprises two studies emphasising the temporality of exposures. First, a cross-sectional study is assessing how daily exposures correlate with depression. A nationally representative survey was administered to participants recruited through stratified random sampling of the population aged 18-65 years. Survey data were enriched with smartphone-based data (eg, Global Positioning System tracking, Bluetooth sensing, social media usage, communication patterns) and environmental exposures (eg, green and blue spaces, noise, air pollution). Second, a longitudinal population register study is addressing the extent to which past environmental exposures over people's residential history affect suicide risk later in life. Statistical and machine learning-based models are being developed to quantify environment-health relations.

ETHICS AND DISSEMINATION

Ethical approval (FETC17-060) was granted by the Ethics Review Board of Utrecht University, The Netherlands. Project-related findings will be disseminated at conferences and in peer-reviewed journal papers. Other project outcomes will be made available through the project's web page, http://www.needs.sites.uu.nl.

A Community EcoHealth Index from EnviroAtlas Ecosystem Services Metrics

Human health is inextricably tied to ecosystem services (ES), including those associated with greenspace in urban communities. EnviroAtlas provides close to 100 maps of ES metrics based on high-resolution land cover data in featured communities across the contiguous United States. Using selected EnviroAtlas ES metrics, a Community EcoHealth Index (CEHI) was created based on an ecohealth framework including health promotion and hazard buffering domains. Aggregation of eight selected ES metrics in these domains entailed a weighted distance measure, where objective, data-driven weights were generated. CEHI was calculated by Census Block Group (CBG) at both the local level and the national level for 22 EnviroAtlas communities. Results were mapped to show one- to five-star CBGs or neighborhoods within and across all 22 featured communities. At the national level, CEHI favors communities in forested ecoregions. The local version of CEHI is more appropriate to inform social, economic, and environmental decision-making for improving community ES associated with human health.

Impact of Frequency of Visits and Time Spent in Urban Green Space on Subjective Well-Being

Exposure to green spaces can reduce the negative effects of stress. This study examines how frequency of visits and time spent in urban green spaces (UGS) affect urban dwellers’ subjective well-being. We also investigated the numbers of respondents visiting UGS, their primary motivation, and constraints on their ability to visit. Using quota sampling, an online survey was conducted of 400 residents of Daejeon City, South Korea. ANOVA results indicated no significant interactions between visit frequency and time spent in UGS. Respondents who had visited UGS within the past two weeks expressed higher positive and lower negative emotions than did non-visitors, regardless of visit frequency, and regular visitors showed higher general life satisfaction levels. These positive effects were confirmed by estimated structural equation models. However, the time spent in UGS did not affect emotions or life satisfaction in general. Heavy users mostly visited UGS to walk, and light/non-users cited the lack of urban green spaces near their home as the major constraint on visiting UGS. The estimated structural equation models clearly show positive effects from motivation and negative effects of constraints and access time to UGS on visit frequency. To improve urban dwellers’ subjective well-being, UGS should prioritize good walking environments and accessibility.

A biodiversity hypothesis

Biodiversity hypothesis states that contact with natural environments enriches the human microbiome, promotes immune balance and protects from allergy and inflammatory disorders. We are protected by two nested layers of biodiversity, microbiota of the outer layer (soil, natural waters, plants, animals) and inner layer (gut, skin, airways). The latter inhabits our body and is colonized from the outer layer. Explosion of human populations along with cultural evolution is profoundly changing our environment and lifestyle. Adaptive immunoregulatory circuits and dynamic homeostasis are at stake in the newly emerged urban surroundings. In allergy, and chronic inflammatory disorders in general, exploring the determinants of immunotolerance is the key for prevention and more effective treatment. Loss of immunoprotective factors, derived from nature, is a new kind of health risk poorly acknowledged until recently. The paradigm change has been implemented in the Finnish allergy programme (2008-2018), which emphasized tolerance instead of avoidance. The first results are promising, as allergy burden has started to reduce. The rapidly urbanizing world is facing serious biodiversity loss with global warming, which are interconnected. Biodiversity hypothesis of health and disease has societal impact, for example, on city planning, food and energy production and nature conservation. It has also a message for individuals for health and well-being: take nature close, to touch, eat, breathe, experience and enjoy. Biodiverse natural environments are dependent on planetary health, which should be a priority also among health professionals.

Using deep learning to examine street view green and blue spaces and their associations with geriatric depression in Beijing, China

BACKGROUND

Residential green and blue spaces may be therapeutic for the mental health. However, solid evidence on the linkage between exposure to green and blue spaces and mental health among the elderly in non-Western countries is scarce and limited to exposure metrics based on remote sensing images (i.e., land cover and vegetation indices). Such overhead-view measures may fail to capture how people perceive the environment on the site.

OBJECTIVE

This study aimed to compare streetscape metrics derived from street view images with satellite-derived ones for the assessment of green and blue space; and to examine associations between exposure to green and blue spaces as well as geriatric depression in Beijing, China.

METHODS

Questionnaire data on 1190 participants aged 60 or above were analyzed cross-sectionally. Depressive symptoms were assessed through the shortened Geriatric Depression Scale (GDS-15). Streetscape green and blue spaces were extracted from Tencent Street View data by a fully convolutional neural network. Indicators derived from street view images were compared with a satellite-based normalized difference vegetation index (NDVI), a normalized difference water index (NDWI), and those derived from GlobeLand30 land cover data on a neighborhood level. Multilevel regressions with neighborhood-level random effects were fitted to assess correlations between GDS-15 scores and these green and blue spaces exposure metrics.

RESULTS

The average cumulative GDS-15 score was 3.4 (i.e., no depressive symptoms). Metrics of green and blue space derived from street view images were not correlated with satellite-based ones. While NDVI was highly correlated with GlobeLand30 green space, NDWI was moderately correlated with GlobeLand30 blue space. Multilevel regressions showed that both street view green and blue spaces were inversely associated with GDS-15 scores and achieved the highest model goodness-of-fit. No significant associations were found with NDVI, NDWI, and GlobeLand30 green and blue space. Our results passed robustness tests.

CONCLUSION

Our findings provide support that street view green and blue spaces are protective against depression for the elderly in China, yet longitudinal confirmation to infer causality is necessary. Street view and satellite-derived green and blue space measures represent different aspects of natural environments. Both street view data and deep learning are valuable tools for automated environmental exposure assessments for health-related studies.