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

Characteristics of natural environment use by occupational therapists working in mental health care: a scoping review

OBJECTIVE

The objective of this review was to identify and characterize the use of the natural environment/outdoor space by occupational therapists working in mental health care. This included consideration of the characteristics of the environment used, interventions, mental health conditions being treated, and the outcomes being used.

INTRODUCTION

Research has demonstrated the link between human health and the environment. The benefits appear to be particularly relevant to people with mental health conditions. Occupational therapists already consider the environment when assessing and developing interventions, and therefore are well placed to consider and use the natural environment in mental health practice. However, the use of the natural environment by occupational therapists working in mental health is unclear.

INCLUSION CRITERIA

The scoping review included any publication relating to the use of the natural environment/outdoor space in mental health occupational therapy practice. All forms of the natural environment or outdoor space were included, such as hospital gardens and local parks. There were no geographical, gender, or age restrictions. All mental health diagnoses were eligible for inclusion.

METHODS

Seven databases were searched: Embase (Ovid), Emcare (Ovid), MEDLINE (Ovid), PsycINFO (ProQuest), AMED (Ovid), Trip Database, and CINAHL (EBSCOhost). Gray literature was also searched using a selection of websites and digital repositories. Papers written in English were searched, with no time limit set on publication. Titles and abstracts were screened by 2 independent reviewers for assessment against the inclusion criteria, followed by a full-text review and data extraction. Data were extracted using the data extraction tool developed by the authors. Findings were presented in a tabular format, accompanied by a narrative summary describing how the results relate to the review objectives and question.

RESULTS

Of peer-reviewed publications, 7 papers used qualitative methods and 7 used mixed methodology. The remaining sources included conference abstracts, unpublished works, a book chapter, and a website article. The environments used included forests, beaches, gardens, and parks. A variety of interventions were delivered in these environments, including gardening and nature-based activities, physical activities, and animal-assisted interventions. Such activity-focused interventions are largely delivered in a group context, thus providing a social element. A diverse range of mental health conditions were treated. Several methods were used to consider the outcomes on the individual, including both qualitative measures and quantitative outcome measurement tools.

CONCLUSIONS

The review highlights many characteristics of how the natural environment is being used across mental health services by occupational therapists. A variety of conditions are targeted for such interventions, and several outcome measures have been used to understand impact. This review can support further development and implementation of nature-based approaches in mental health occupational therapy.

Access to land and nature as health determinants: a qualitative analysis exploring meaningful human-nature relationships among Indigenous youth in central Canada

BACKGROUND

Human relationships with and connections to nature and the "land" are a commonly accepted Social Determinant of Health. Greater knowledge about these relationships can inform public health policies and interventions focused on health equity among Indigenous populations. Two research questions were explored: (1) what are the experiences of meaningful human-nature relationships among Indigenous youth within central Canada; and (2) how do these relationships function as a determinant of health and wellness within their lives.

METHODS

Drawing from three community-based participatory research (CBPR) projects within two urban centers in Saskatchewan and Manitoba, the integrated qualitative findings presented here involved 92 interviews with 52 Indigenous youth that occurred over a period of nine years (2014-2023). Informed by "two-eyed seeing," this analysis combined Indigenous Methodologies and a Constructivist Grounded Theory approach.

RESULTS

Our integrative analysis revealed three cross-cutting themes about meaningful human-nature relationships: (1) promoting cultural belonging and positive identity; (2) connecting to community and family; and (3) supporting spiritual health and relationships. The experiences of young people also emphasized barriers to land and nature access within their local environments.

DISCUSSION

Policies, practices, and interventions aimed at strengthening urban Indigenous young peoples' relationships to and connections with nature and the land can have a positive impact on their health and wellness. Public Health systems and healthcare providers can learn about leveraging the health benefits of human-nature relationships at individual and community levels, and this is particularly vital for those working to advance health equity among Indigenous populations.

Contact with nature may be a remedy for loneliness: A nationally representative longitudinal cohort study

BACKGROUND

Nature prescribing - a written recommendation by a health professional for a person to spend more time in nature for health reasons - is being heralded by some as a potential solution to loneliness, defined as a felt deprivation of meaningful connection, companionship, and camaraderie. However, such recommendations currently lack evidence on how much time in natural environments is needed to tackle loneliness and over what timescale.

METHODS

General, emotional, and social loneliness were measured using De Jong Gierveld's 6-item scale in a nationally representative sample of 3043 Australian participants at baseline (October 2020), with 2421 and 2123 completing follow-ups at 4 months (February 2021) and 16 months (February 2022), respectively. Multilevel logistic regressions examined the odds of change in loneliness status between baseline and follow-up in relation to hours spent in nature in the 7 days prior to the baseline survey, adjusting for confounding factors that influence time spent in nature and the risk of feeling lonely.

FINDINGS

Relief from general loneliness in those experiencing it at baseline was 22.4% at month 4 and 29.4% at month 16. The equivalent findings for relief from social loneliness and emotional loneliness were 21.2% and 24.6%, and 34.2% and 41.2% at months 4 and 16, respectively. Incidence of loneliness at 4 months was 21.8% (general), 26.1% (social), and 11.8% (emotional), and at 16 months was 22.7% (general), 25.6% (social), and 12% (emotional). At each time point, the prevalence of loneliness was lower among participants with more time in nature. Just 1-2 h per week in nature (versus <1) was associated with relief from social loneliness at 4 months (Odds Ratio [OR] 1.69, 95%CI 1.10, 2.65) and at 16 months (OR 2.10, 95%CI 1.34, 3.30). Higher odds of relief from emotional loneliness were observed at 3-4 h spent in nature at 4 months (OR 1.84, 95%CI 1.11, 3.06) and at 16 months (OR 1.82, 95%CI 1.09, 3.07). Incidence of loneliness was not associated with nature contact.

INTERPRETATION

Increasing time in nature may an effective non-medical prescription for people who are lonely to find durable relief within a relatively short space of time. Findings from this longitudinal study can inform further investigation through randomised trials of co-designed nature prescriptions targeting relief from loneliness in vulnerable populations.

Which dimensions of nature contact in Urban Green Spaces most significantly contribute to mental wellbeing? A multidimensional analysis in Brazilian metropolitan cities

BACKGROUND

Urban environments pose challenges to mental health, an issue that Urban Green Spaces (UGS) can potentially mitigate. While the benefits of nature contact for mental wellbeing are recognized, a multidimensional analysis remains unexplored.

PURPOSE

This study aims to fill this gap by examining the association between nature contact within UGS and mental health. It underscores the importance of considering multiple dimensions of nature engagement-such as naturalness, intensity, duration, frequency, and infrastructure-in enhancing psychological wellbeing.

METHOD

A comprehensive analysis, including canonical correlation, multivariate analyses of variance, and Fisher discriminant analysis, was applied to survey data from several Brazilian metropolitan cities to assess how different aspects of nature contact influence mental health.

RESULTS AND CONCLUSIONS

Findings reveal association between these dimensions and mental wellbeing indicators, highlighting the importance of a multidimensional perspective.

PRACTICAL IMPLICATIONS

Results advocate for incorporating diverse aspects of nature contact in UGS design and policy-making to enhance urban dwellers' mental health.

FUTURE DIRECTIONS

Further research should focus on longitudinal studies and explore the mediating effects of socio-demographic factors. Additionally, expanding research to include other developing countries will provide valuable comparative insights.

Existential Well-Being in Nature: A Cross-Cultural and Descriptive Phenomenological Approach

Exploring the putative role of nature in human well-being has typically been operationalized and measured within a quantitative paradigm of research. However, such approaches are limited in the extent to which they can capture the full range of how natural experiences support well-being. The aim of the study was to explore personal experiences in nature and consider how they might be important to human health and well-being. Based on a descriptive phenomenological analysis of fifty descriptions of memorable moments in nature from England, Indonesia, and Norway, our findings illustrate a common structure presented under three themes: 1. serenity that gives rise to a growing awareness of how the body is stimulated by the senses; 2. admiration and appreciation for the sensation of beauty; 3. an emerging sense of togetherness and deep emotional bonding. The findings are discussed using the concepts of ecological time and the ecological body, which foreground being in nature as constituted as an interdependent and dynamic human process. We conclude by understanding well-being in terms of human responsiveness to their surroundings and thus as rooted in the human condition.

Body awareness and cognitive behavioral therapy for multisite musculoskeletal pain: patients` experiences with group rehabilitation

BACKGROUND

An extended group program called Mind and Body (MB), based on body awareness exercises and cognitive behavioral therapy (CBT), was offered to a subgroup of patients who had completed their traditional outpatient multidisciplinary rehabilitation and were motivated for further treatment.

PURPOSE

To explore how patients with multisite musculoskeletal pain experienced participation in the MB program with respect to usefulness, meaningfulness, behavioral changes, and transferability to daily life and work.

METHOD

The study is rooted in the phenomenological tradition. Individual, semi-structured interviews were performed with eight patients aged 29-56 years. The data were analyzed using systematic text condensation.

RESULTS

Two main themes emerged: 1) New knowledge provided increased body awareness, new ways of thinking, and acceptance of one's own situation. This theme reflected how new knowledge and MB coping strategies were useful in the process of changing problematic thoughts, increasing body awareness, and facilitating acceptance; and 2) Implementing new habits and strategies in daily life revealed how demanding it was to alter behavior, a process that unfolded over time.

CONCLUSION

A combination of body awareness exercises and cognitive coping strategies was described as helpful in further improving function and coping with pain and stress in daily life and work.

Associations of Park Use with Physical Activity in Renovated Parks Serving Low-Income Communities in New York City: Insights from the Community Parks Initiative

Parks have the potential to encourage physical activity among urban communities. However, existing research on the link between park use and physical activity has produced inconsistent results. Mixed findings in the past may be due in part to differences in park quality across studies. The aim of this study was to explore the association between park use and physical activity among New York City adults in low-income communities that recently received city-sponsored park renovation as part of the Community Parks Initiative (CPI). Using population-weighted survey data from eight neighborhoods with recent park renovation (n = 2,000), we measured associations between park use frequency (≥ once/week vs. < once/week) and self-reported physical activity (high vs. low-moderate based on the International Physical Activity Questionnaire). We adjusted models for age, sex, education, race/ethnicity, income, study site, and use of other (non-CPI) parks, and conducted stratified analysis for demographic variables with significant interactions with park use. After adjusting for covariates, we observed a positive association between park use and physical activity (prevalence ratio [PR] = 1.30, 95% CI = 1.16-1.46). Greater frequency of park use was more strongly associated with high physical activity among adults ≤ 50 y (PR = 1.39, 95% CI = 1.14-1.69), individuals with annual household income < $25,000 (PR = 1.54, 95% CI = 1.13-2.08), and Latinos (PR = 1.77, 95% CI = 1.44-2.18). Our findings suggest that high-quality parks might be particularly beneficial for promoting physical activity among those with a lower socioeconomic background and in younger and Latino adults, emphasizing the importance of continued investment in park revitalization among urban communities of color.

Quantifying physiological health efficiency and benefit threshold of greenspace exposure in typical urban landscapes

Although greenspace exposure has physiological health benefits, there is insufficient research on the threshold effect of health benefits in typical urban landscapes. Here we selected five typical urban landscapes (open greenspace, semi-closed greenspace, closed greenspace, bluespace, grey space) in 15 urban parks in Xiamen, China, and applied the physiological health threshold model to calculate the efficiency threshold and benefit threshold of greenspace exposure by continuously monitoring the changes of two physiological indicators-electroencephalography (EEG) and heart rate (HR). (1) The EEG threshold results show that compared with greenspace exposure, bluespace exposure can reach the physiological health efficiency threshold faster (4-5 min) but does not show an advantage in terms of benefit threshold. The more open the greenspace, the faster it can reach the efficiency threshold (5-6 min), but the higher the canopy density of the (closed) greenspace, the shorter the time to reach the efficiency threshold (8-9 min). (2) The HR threshold shows that bluespace and open greenspace are the fastest to reach the efficiency threshold (1 min), with the remaining greenspace reaching it after 6-7 min. The benefit threshold was reached faster in the bluespace (11 min) than in the greenspace (18-21 min), and the degree of openness of the greenspace has no significant effect on the speed of benefit thresholds. (3) Combining the results of EEG and HR thresholds, it can be seen that bluespace is better at reducing stress, while open greenspace can reach efficiency thresholds more quickly. This study confirms the physiological health threshold model, offering a reference for urban greenspace planning to enhance residents' stress management and health.

Can a nature walk change your brain? Investigating hippocampal brain plasticity after one hour in a forest

In cities, the incidence of mental disorders is higher, while visits to nature have been reported to benefit mental health and brain function. However, there is a lack of knowledge about how exposure to natural and urban environments affects brain structure. To explore the causal relationship between exposure to these environments and the hippocampal formation, 60 participants were sent on a one hour walk in either a natural (forest) or an urban environment (busy street), and high-resolution hippocampal imaging was performed before and after the walks. We found that the participants who walked in the forest had an increase in subiculum volume, a hippocampal subfield involved in stress response inhibition, while no change was observed after the urban walk. However, this result did not withstand Bonferroni correction for multiple comparisons. Furthermore, the increase in subiculum volume after the forest walk was associated with a decrease in self-reported rumination. These results indicate that visits to nature can lead to observable alterations in brain structure, with potential benefits for mental health and implications for public health and urban planning policies.

A Pre-Post Study Design Exploring the Potential Benefits of a Hiking Intervention for Active and Inactive Older Adults

INTRODUCTION

Physical activity (PA) is essential for healthy aging, yet PA levels are low in older adults. Group-based nature programming may be an ideal opportunity for engaging older adults in PA and improving health-related quality of life.

METHODS

Twenty-seven older adults, 55-75 years of age (n = 14 active and n = 13 previously inactive), enrolled in a biweekly 8-week hiking program. At baseline, participants completed online questionnaires on health-related quality of life, behavioral and psychological outcomes, and a one-mile walk test to assess cardiorespiratory fitness.

RESULTS

Average attendance was 81% in the previously inactive groups and 74% in the active group. There was a significant increase in the physical component of quality of life over time in the previously inactive group (p = .03, d = 0.71). Participants significantly improved their cardiorespiratory fitness (p = .003, d = 0.77) and competency (p = .005, d = 0.41) as assessed by the Basic Psychological Needs for Exercise Scale. The previously inactive group additionally increased their self-efficacy for exercise (p = .001, d = 1.43). Both active and previously inactive groups exercised at a similar relative intensity during the hikes based on heart rate; however, perceived exertion at the end of the hike on average was lower among active participants (p = .014).

CONCLUSION

Group-based hiking for previously inactive older adults significantly improved physical health-related quality of life over an 8-week biweekly intervention. Hiking at an individualized pace may allow for hiking to be an appropriate PA program in previously inactive older adults.

Mind the gap: Development and validation of an evolutionary mismatched lifestyle scale and its impact on health and wellbeing

Identifying an integrative framework that could appropriately delineate underlying mechanisms and individual risk/protective factors for human health has remained elusive. Evolutionary mismatch theory provides a comprehensive, integrative model for understanding the underlying causes and mechanisms of a wide range of modern health and well-being problems, ranging from obesity to depression. Despite growing interest regarding its importance though, no psychometrically-sound measure of evolutionary mismatch yet exists to facilitate research and intervention. To construct such a scale, aimed at gauging individual differences in the extent to which people's modern lifestyles are mismatched with ancestral conditions, we conducted four studies (a pilot study, followed by 3 main studies, with a final sample of 1901 participants across the main studies). Results from exploratory and confirmatory factor analyses have produced a 36-item evolutionary mismatched lifestyle scale (EMLS) with 7 subdomains of mismatched behaviours (e.g., diet, physical activity, relationships, social media use) that is psychometrically sound. Further, the EMLS is associated with physical, mental and subjective health. We explore the potential of the EMLS as a tool for examining interpersonal and cultural variations in health and wellbeing, while also discussing the limitations of the scale and future directions in relation to further psychometric examinations.

What Do Your Neighbors Think About You? How Perceived Neighbor Attitudes Toward Latinos Influence Mental Health Among a Pregnant Latina Cohort

Latina women living in the USA experience disproportionately higher rates of psychological distress compared to their non-Latina White counterparts. Poor maternal mental health during pregnancy can contribute to intergenerational mental health disparities. Through this pathway, mothers' experiences, environments, and exposures (henceforth "exposures") during pregnancy become biologically embodied and can negatively affect the fetus and life-long developmental trajectories of her child. One of the exposures that can affect mother-offspring dyads is the neighborhood. With the goal of integrating anthropological and sociological theories to explain mental health disparities among pregnant Latina women, we explored how perceptions of neighbor attitudes may influence mental health during pregnancy. We analyzed self-reported responses from 239 pregnant Latina women in Southern California (131 foreign-born, 108 US-born) on their mental health and perceived attitudes of their neighbors using multiple linear regression models. Among foreign-born Latina women, living in neighborhoods with more favorable views of Latinos was associated with lower depression scores (pooled β =  - .70, SE = .29, p = .019) and lower pregnancy-related anxiety scores (pooled β =  - .11, SE = .05, p = .021), but greater state anxiety scores (pooled β = .09, SE = .04, p = .021). Among US-born women, there were no associations between neighbor attitudes and mental health. Overall, results suggest that social environments are correlated with mental health and that foreign-born and US-born Latinas have varied mental health experiences in the USA. Our findings highlight the importance of improving aspects of neighborhood cohesion as part of maternal-fetal care management.

Unraveling the longitudinal relationships between connectedness to nature, depressive symptoms, and learning burnout in adolescents

INTRODUCTION

Following the conservation of resource theory and natural stress reduction theory, the current study investigated mediated pathways, reverse mediated pathways, and reciprocal pathways between connectedness to nature, depressive symptoms, and adolescent learning burnout via a half-longitudinal analysis, and discussed gender differences in the three models.

METHODS

Two waves of data were collected in December 2022 (T1) and June 2023 (T2) for this study. The sample consisted of 1092 Chinese adolescents (52.20% girls, Mage = 13.03, SD = 1.43). Semi-longitudinal analyses were conducted to examine the relationship between connectedness to nature, depressive symptoms, and adolescent academic burnout.

RESULTS

The results indicated that connectedness to nature can serve as a positive resource to alleviate the levels of depressive symptoms among adolescents and thereby decrease learning burnout. However, the protective effect of connectedness to nature was smaller, and the decreasing effect of learning burnout on connectedness to nature was stronger than the alleviating effect of connectedness to nature on learning burnout. Additionally, the study found that depressive symptoms and academic burnout have a mutually reinforcing effect over time and that the effects of this interaction are more pronounced in females.

CONCLUSIONS

The present study emphasizes the protective role of nature connectedness and the detrimental effects of learning burnout in adolescents.

Encouraging online consumers into making better food choices: The power of nature exposure on healthy food choices

BACKGROUND

online environments can influence food desire and choices. We tested if online calming nature and stressful street environments can affect desire for healthy and unhealthy foods.

METHOD

we asked 238 participants (40 ± 14 yrs) to rate their desire (100 mm VAS) for 7 low calorie nutrient rich foods (Healthy) and 7 high calorie nutrient poor foods (Unhealthy), and perceived stress (state anxiety in STAI), before and after imagining themselves in a control, nature park, or busy street condition.

RESULTS

participants who imagined themselves being in a nature park had a significant higher desire for Healthy foods, than participants in the busy street condition (p < 0.05). Participants in the busy street condition decreased their desire for Healthy foods after they imagined themselves in a busy street (p < 0.05)). However, perceived stress did not impact the association between condition and desire for low calorie foods nor high calorie foods.

CONCLUSION

this study suggests that online environments can have an impact on healthy food desires, which could be of importance for the increased number of food choices which are made in online environments.

Associations of nature contact with emotional ill-being and well-being: the role of emotion regulation

Nature contact has associations with emotional ill-being and well-being. However, the mechanisms underlying these associations are not fully understood. We hypothesised that increased adaptive and decreased maladaptive emotion regulation strategies would be a pathway linking nature contact to ill-being and well-being. Using data from a survey of 600 U.S.-based adults administered online in 2022, we conducted structural equation modelling to test our hypotheses. We found that (1) frequency of nature contact was significantly associated with lesser emotional ill-being and greater emotional well-being, (2) effective emotion regulation was significantly associated with lesser emotional ill-being and greater emotional well-being, and (3) the associations of higher frequency of nature contact with these benefits were partly explained via emotion regulation. Moreover, we found a nonlinear relationship for the associations of duration of nature contact with some outcomes, with a rise in benefits up to certain amounts of time, and a levelling off after these points. These findings support and extend previous work that demonstrates that the associations of nature contact with emotional ill-being and well-being may be partly explained by changes in emotion regulation.

Where and how to invest in greenspace for optimal health benefits: a systematic review of greenspace morphology and human health relationships

Research on the relationship between greenspace morphology and health is a growing field that informs the spatial design of greenspace to enhance health outcomes. This study reviews the current progress, methodologies, and knowledge gaps in this area. From a database search of 272 940 English articles and 39 053 Chinese articles up to April 18, 2024, we identified 22 and 7 studies on the topic for further evaluation. Predominantly cross-sectional and neighbourhood-scale analyses were conducted using land cover maps ranging from 0·25 to 100 meters in resolution. Six primary characteristics of greenspace morphology have been studied, including size, shape, fragmentation, connectedness, aggregation, and diversity. While associations between greenspace morphology and health outcomes have been observed, both their reliability and generalisability remain suggestive due to ecological study designs and heterogeneity among studies. Future research should prioritise individual-level prospective cohorts and intervention studies. Exploring mechanisms linking greenspace morphology and health, determining optimal map resolution, and distinguishing it from greenness magnitude in statistical analysis is essential. This evidence is crucial for health-promoting greenspace planning and should be routinely integrated into urban epidemiological research.

Influences of Outdoor Experiences During Childhood on Time Spent in Nature as an Adult

Introduction

Time spent in nature provides myriad physical and mental health benefits for both adults and children. Despite these benefits, most people spend too little time in nature to realize the maximal effect. Different types of childhood experiences may have differential influence on adult time in nature. This study assessed the influences of different kinds of childhood outdoor experiences on time spent in nature as an adult. The first aim was to utilize 20 childhood nature experience items to construct summative scales. The second aim was to examine the influence of each scale and other factors on adult time in nature.

Methods

A 2-factor scale measuring wild and domesticated childhood nature experiences was developed using principal and confirmatory factor analyses. An online study of 2,109 American adults was conducted. Multiple linear regression examined the influences of the 2 childhood nature experiences scales, attitude and self-efficacy scales, and sex and age covariates on adult time spent in nature.

Results

Significant predictors of adult time in nature were wild childhood nature experiences (β=0.279, p<0.001), positive attitudes about nature (β=0.12, p<0.05), negative attitudes about nature (β= -0.23, p<0.001), and self-efficacy (β=0.71, p<0.001).

Conclusions

Wild childhood nature experiences (e.g., camping, hiking, and fishing) that include skill building, that are immersive and engaging, and that involve opportunity for social interaction may translate better into adult nature activities. Programs that introduce and support wild experiences may increase lifelong time spent in nature.

Is Having Urban Green Space in the Neighborhood Enough to Make a Difference? Insights for Healthier City Design

Background: Prior research indicates that engagement with nature is associated with mental well-being; however, the impact of accessibility to urban green spaces (UGS) with suitable infrastructure for visitation and physical activities, like leisure or recreation, remains underexplored, particularly in developing countries. Purpose: This study delves into whether merely having green space in the neighborhood is sufficient to impact residents' mental health in Brazilian metropolitan regions. Method: Utilizing a cross-sectional survey, data were collected from 2136 participants. The analyzed variables included the intensity, duration, and frequency of nature engagement, suitability of UGS for visitation and physical activities, and mental well-being indicators measured by the DASS-21 scale. Multivariate statistical analyses and multiple regression models were employed to verify hypothetical relationships. Results and conclusions: Higher intensity, duration, and frequency of nature engagement in UGS were significantly associated with lower depression, anxiety, and stress scores. Notably, having urban UGS in the neighborhood alone was not enough to reduce mental health issues. Practical implications: The findings point out the need for urban planning policies that prioritize the development of high-quality, accessible green spaces to maximize mental well-being benefits. These insights could inform city designs that foster healthier urban environments. Future directions: Longitudinal studies are needed to establish causality between nature engagement and mental health improvements. Further research should incorporate objective measures of nature engagement and explore more aspects of green space quality, such as biodiversity and amenities.

What Does It Mean to "Age Well" Among British and Javanese Older Adults? A Cross-Cultural Qualitative Study

OBJECTIVES

This study aimed to investigate perceptions of what it means to "age well" and to explore similarities and differences between a Western and non-Western culture (Britain and Java).

METHODS

Qualitative interviews explored how Javanese and British older adults defined aging well, establishing the similarities and differences between cultures. Javanese (n = 14) and British (n = 15) adults aged 61-80 (mean age = 68) participated. The data were analyzed using reflexive thematic analysis and organized with NVivo.

RESULTS

Four themes were identified that captured what it means to age well across cultures: (a) good health is a springboard for aging well; (b) holding a positive outlook is a decisive factor in aging well; (c) "having enough" and "feeling safe" provide peace of mind; and (d) spirituality and religiosity provide tranquility. Although both cultures mentioned similar factors, there were variations in the interpretations and emphasis within themes. For example, Javanese participants emphasized the importance of the social environment whereas British participants highlighted the physical environment.

DISCUSSION

Differences between cultures are important for understanding how best to support people as they age. For example, in Java, aging well may be best supported by providing a vibrant social environment. For people in Britain, having a safe and secure physical environment may be more important.

Biogenic volatile organic compounds in forest therapy base: A source of air pollutants or a healthcare function?

Air pollution poses a significant threat to public health, while biogenic volatile organic compounds (BVOCs) play a crucial role in both aspects. However, the unclear relationship between BVOCs and air pollutants in the under-canopy space limits the accuracy of air pollution control and the exploitation of forest healthcare functions. To clarify the variation of BVOCs in forest therapy bases, and their impacts on ozone (O3) and fine particulate matter (PM2.5) at nose height, total VOCs (TVOCs) in the forest were collected during typical sunny days, while air pollutants and meteorological factors were observed simultaneously. The results showed that the branch-level emissions of P. tabuliformis were dominated by healthcare-effective monoterpenoids, with only α-pinene having relative air concentrations of over 5 % in forest air samples. The correlation between concentrations of under-canopy TVOCs and emission rates of BVOCs from P. tabuliformis was weak (p > 0.09) in all seasons. However, the correlation between concentrations of TVOCs and the concentrations of O3 and PM2.5 showed clear seasonal differences. In spring, TVOCs only showed a significant negative correlation with PM2.5 in the forest (p < 0.01). In summer and autumn, TVOCs were significantly negatively correlated with both O3 (p < 0.001) and PM2.5 (p < 0.01). Specifically, the negative linear relationships were more pronounced for O3 and oxygenated VOCs in autumn (R2 = 0.40, p < 0.001) than for other relationships. The relationship between air pollutant concentrations inside and outside the forest also showed significant seasonal differences, generally characterized by a weaker correlation between them during seasons of strong emissions. Therefore, BVOCs in coniferous forests are health functions as they can provide healthcare effects and mitigate the concentration of air pollutants in the forest, and the establishment of forest therapy bases in rural areas with low NOx can be a sensible approach to promote good health, well-being, and sustainable development.

Nature Prescriptions and Indigenous Peoples: A Qualitative Inquiry in the Northwest Territories, Canada

Nature prescription programs have become more common within healthcare settings. Despite the health benefits of being in nature, nature prescriptions within the context of Indigenous Peoples have received little attention. We therefore sought to answer the following question: What are circumpolar-based physicians' and Indigenous Elders' views on nature prescribing in the Northwest Territories, Canada? We carried out thirteen semi-structured interviews with physicians between May 2022 and March 2023, and one sharing circle with Indigenous Elders in February 2023. Separate reflexive thematic analysis was carried out to generate key themes through inductive coding of the data. The main themes identified from the physician interviews included the importance of cultural context; barriers with nature prescriptions in the region; and the potential for nature prescriptions in the North. Reflections shared by the Elders included the need for things to be done in the right way; the sentiment that the Land is not just an experience but a way of life; and the importance of traditional food as a connection with Nature. With expanding nature prescription programs, key considerations are needed when serving Indigenous communities. Further investigation is warranted to ensure that nature prescriptions are appropriate within a given context, are inclusive of supporting Land-based approaches to health and wellbeing, and are considered within the context of Indigenous self-determination.

Innovative health tracker that provides advanced functionalities to support and guide users in modifying their lifestyle: a Straussian ground theory approach

Objective

Health can be described as the state of homeostasis and optimal functioning across various bio-psycho-social dimensions and processes, allowing an individual to adapt and respond effectively to extrinsic and intrinsic challenges. Our thoughts, choices, behaviors, experiences, and feelings shape our existence. By transitioning from unconscious reactions to conscious responses, we can establish novel habits and behaviors, actively embracing positive shifts in our lifestyle.

Subjects and methods

The presented examination focuses on the smartwatch (SW), analyzing the incorporation of potentially progressive attributes that could enrich our lifestyle pursuits. The objective is not the health disorders themselves but the employment of wearable devices to create a strong sense of coherence in the Straussian grounded theory approach. The study had no subjects.

Results

The potential of the SW has been partially explored in lifestyle intervention, modification, research, and practice.

Conclusion

Based on our examination, creating an innovative SW capable of aiding individuals in better comprehending their behaviors and motivating them toward comprehensive changes in their lifestyle is a challenging yet attainable endeavor. Our ambition is to bring into existence SW capable of comprehensively measuring and evaluating interoception, circadian rhythm (CR), selected lifestyle pillars, and their associated components, and seamlessly integrating them into current SW features. It focuses on boosting motivation, maintenance, and amelioration regarding one's lifestyle. The novel approach strives to boost both immediate and underlying factors that actively contribute to improving one's metacognition.

Nature-based experience in Venetian lagoon: Effects on craving and wellbeing in addict residential inpatients

Introduction

It is known that exposure to the natural environment may positively modulate mental processes and behaviors; in particular, it can reduce stress, anxiety, and depressive symptoms. This suggests a potential integration of "nature experience" into the treatment for substance use disorder (SUD) since various types of addiction are associated with anxiety and depression. Considering that only one study has been reported to date in patients with alcohol use disorder, the effect of nature experience in SUD patients' needs to be further investigated. This study aimed to test the effects of exposure to a natural lagoon environment on craving and measures of wellbeing in SUD patients in comparison to exposure to an urban environment.

Methods

Twenty-four SUD patients were divided into three groups of eight participants and exposed to two walking sessions (interspersed with a 1-week wash-out period) in a natural environment typical of the Venetian lagoon, an Urban walk, or staying at the residential center based on a Latin-square design. Before and after each session, drug craving, mood, wellbeing, agency, openness to the future, and restorativeness were assessed.

Results

The Nature walk significantly decreased craving in participants compared to their pre-walk values, and compared to craving after the Urban walk, with the latter significantly increased vs. pre-walk values. The Nature walk significantly decreased negative mood and increased wellbeing and agency. Openness to the future and restorativeness measures showed significant improvement after the Nature walk compared to the Urban walk. On the other hand, craving scores after the Urban Walk positively correlated with negative mood and a Sense of Negative Agency values and negatively correlated with wellbeing scores.

Discussion

Our results confirm that "nature experience" may improve mood, wellbeing, attention, stress relief, openness, and sense of being active in SUD patients. Moreover, we also showed a specific effect on drug craving-a key symptom of SUD.

Challenges for monitoring artificial turf expansion with satellite remote sensing

Urban green spaces are central components of urban ecosystems, providing refuge for wildlife while helping 'future proof' cities against climate change. Conversion of urban green spaces to artificial turf has become increasingly popular in various developed countries, such as the UK, leading to reduced urban ecosystem services delivery. To date, there is no established satellite remote sensing method for reliably detecting and mapping artificial turf expansion at scale. We here assess the combined use of very high-resolution multispectral satellite imagery and classical, open source, supervised classification approaches to map artificial lawns in a typical British city. Both object-based and pixel-based classifications struggled to reliably detect artificial turf, with large patches of artificial turf not being any more reliably identified than small patches of artificial turf. As urban ecosystems are increasingly recognised for their key contributions to human wellbeing and health, the poor performance of these standard methods highlights the urgency of developing and applying new, easily accessible approaches for the monitoring of these important ecosystems.

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

On proposing relational environmental metaphors to stimulate engagement and foster well-being in the midst of climate change

Messages regarding climate change that are intended to stimulate responsible engagement can impact our mental health in both positive and negative ways, which in turn can increase or limit the potential engagement being sought through those very messages. Increasingly alarmist environmental metaphors are being brought into question due to their possibly detrimental impact on mental health and well-being, and in their place, relational environmental metaphors are proffered to instill hopeful and constructive individual and collective engagement for responsible climate action. This article discusses how both alarmist and relational environmental metaphors interact with eco-emotions. It proposes, in light of concepts arising from Porges' Polyvagal Theory - on the psychophysiology of autonomic states created in contexts of threatening cues and feelings of safety and connection -, that relational environmental metaphors are preferable for stimulating responsible collective engagement and fostering global well-being in the midst of climate change.

Synergies of affordances and place-based relationality in Forest School practice: implications for socio-emotional well-being

Research shows that the human-nature relationship positively impacts human well-being. Forest School (FS) practice offers young children a structured program of nature connection through activities, aiming to enhance their self-esteem and social skills. FS is now adapted in countries such as Australia, Canada and New Zealand where a unique cultural interface occurs between European settlers and Indigenous peoples. Responding to socio-cultural diversities, geographical contexts, and the traditional ecological knowledges, FS needs to go beyond play pedagogy and incorporate theoretical perspectives that promote human-nature relationship in local context-specific environments. We argue that the synergies between Western perspectives on affordances perceived in person-environment relationship and Indigenous place-based relationality perspective provide a more suitable approach for developing reciprocal relationships between FS participants and land/place/nature. We propose that the synergies between affordances perceived in FS and place-based relationality cultivated in participants will enhance social and emotional well-being. We call for specific research investigating such synergies supporting participant well-being. Future research on FS practice should be directed toward initiating and exploring co-designed studies by Indigenous and non-Indigenous researchers incorporating methodologies that study participant experience as well as evaluating the impact of FS programs embedding affordances and place-based relationality perspectives.

Quantifying time spent outdoors: A versatile method using any type of global positioning system (GPS) and accelerometer devices

Spending time outdoors is associated with increased time spent in physical activity, lower chronic disease risk, and wellbeing. Many studies rely on self-reported measures, which are prone to recall bias. Other methods rely on features and functions only available in some GPS devices. Thus, a reliable and versatile method to objectively quantify time spent outdoors is needed. This study sought to develop a versatile method to classify indoor and outdoor (I/O) GPS data that can be widely applied using most types of GPS and accelerometer devices. To develop and test the method, five university students wore an accelerometer (ActiGraph wGT3X-BT) and a GPS device (Canmore GT-730FL-S) on an elastic belt at the right hip for two hours in June 2022 and logged their activity mode, setting, and start time via activity diaries. GPS trackers were set to collect data every 5 seconds. A rule-based point cluster-based method was developed to identify indoor, outdoor, and in-vehicle time. Point clusters were detected using an application called GPSAS_Destinations and classification were done in R using accelerometer lux, building footprint, and park location data. Classification results were compared with the submitted activity diaries for validation. A total of 7,006 points for all participants were used for I/O classification analyses. The overall I/O GPS classification accuracy rate was 89.58% (Kappa = 0.78), indicating good classification accuracy. This method provides reliable I/O clarification results and can be widely applied using most types of GPS and accelerometer devices.

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.

Kokedama and essential oils had a relaxing psychophysiological effect on Taiwanese women during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, we designed an indoor nature activity program for citizens with a relaxing effect similar to forest bathing to promote their physical and mental health. We integrated an indoor horticultural activity (Kokedama) with the breathing of Pseudotsuga menziesii (P. menziesii) and Lavandula angustifolia (L. angustifolia) essential oils (EOs) with the goal of creating a nature-inspired environment in an indoor setting where participants would feel as if immersed in a forest atmosphere.

METHODS

Taiwanese women participated in the experiment, using two Saturday mornings, one Saturday in a university classroom in the city center; and the other Saturday in a workshop in a Suburban Park. Intra-group comparisons were used to assess the Physiological responses to urban and suburban environmental stimuli and measured self-reported psychological responses. We recorded parameters associated with heart-rate variability and brainwaves. We also administered the State-Trait Anxiety Inventory-State (STAI-S) questionnaire before and after the participants had completed the entire program.

RESULTS

After the participants had breathed the P. menziesii and L. angustifolia EOs, the levels of some physiological parameters increased (standard deviation of normal-to-normal intervals, normalized high frequency, and high alpha wave) and those of others decreased (normalized low frequency, low- to high-frequency ratio power, high beta wave, and gamma wave). These findings were corroborated by the data from the STAI-S questionnaires.

CONCLUSIONS

The psychophysiological data from this study provide significant scientific evidence for the health benefits of an indoor nature activity program in women.

Environmental attitude and affective-motivational beliefs towards sustainability of secondary school children in Germany and their associations with gender, age, school type, socio-economic status and time spent in nature

There are warnings that human actions will lead to irreversible environmental damage if they continue at their current pace and scale. With regard to individual aspects, a pro-environmental attitude and positive affective-motivational beliefs towards sustainability represent fundamentals for a more sustainable future. However, there is little data regarding these constructs and relevant explanatory factors, especially with regard to young people. We examined environmental attitude (two-dimensional: utilization and preservation) and affective-motivational beliefs towards sustainability with regard to gender, age, socio-economic status, school type and time spent in nature in 484 adolescents (11-14 years) living in German cities by means of univariate and multiple regression analyses. Mean values were high in preservation and affective-motivational beliefs towards sustainability, and relatively low in utilization. Female adolescents had higher values compared to male students in affective-motivational beliefs towards sustainability. Age did not play a substantial role. Although being strongly correlated with each other, school type and socio-economic status each exhibited positive associations to environmental attitude and affective-motivational beliefs towards sustainability. Furthermore, multiple regression analyses identified time spent in nature as a significant predictor of incremental value, suggesting a tentative recommendation to spend at least half an hour per week in nature in order to promote positive attitudes towards the environment and sustainability. In sum, special needs for topic-related education seem to exist for male students, students with lower formal level of education, students with a lower socio-economic status and students who spend little time in nature.

Chronic exercise and neuropsychological function in healthy young adults: a randomised controlled trial investigating a running intervention

Despite the well-known physical and mental health benefits of regular exercise, many of the world's population, including healthy young adults, grossly undershoot recommended physical activity levels. Chronic exercise has potential to improve cognitive performance and affect in most age groups. However, there is currently a poverty of relevant research in young adults, especially randomised controlled trials. To address this, the current research investigated the effects of a running intervention on neuropsychological function (cognition and affect) in young adults. We predicted that following a running intervention, neuropsychological performance would improve alongside increases in aerobic fitness. Thirty-two healthy young adult university students were randomised (using a 3:1 ratio) into an intervention or control group, with the intervention group (n = 24) asked to run for 30 min three times a week over a 6-week period and the control group (n = 8) asked to maintain their current level of exercise over a 6-week period. We assessed fitness, cognitive performance, affect and running enjoyment at baseline and follow-up, and runners recorded the environmental conditions of their runs. Repeated measures ANCOVAs failed to find any significant effects of the running intervention on fitness or the neuropsychological measures. Anecdotal evidence supported running environment and enjoyment as potentially relevant factors. The failure to find any fitness improvements, which likely underpins the lack of neuropsychological improvements, highlights the importance of monitoring exercise sessions. Coupled with other insights gained from this trial, this article may prove useful towards future endeavours to develop exercise interventions beneficial to young adults.TRN: ACTRN12621000242820, Date of registration: 08/03/2021.

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

Trait emotional intelligence and ecological outcomes: the role of connectedness to nature

BACKGROUND

Global climate change is recognized as a major and irreversible challenge for humanity, requiring people's responsible and sustainable behaviors toward the environment. So far, the literature has widely investigated the role of cognitive determinants of ecological outcomes (e.g., pro-environmental behaviors and climate change perception), while less attention has been devoted to emotional processes, such as trait emotional intelligence (TEI). The current double study investigates whether TEI is directly and indirectly associated with climate change perception (CCP, Study 1) and pro-environmental behaviors (PEBs, Study 2) among young adults. Furthermore, the mediating role of connectedness to nature (CN), both as cognitive and emotional factors, was also analyzed. We hypothesized that CN (i.e., cognitive mediator) would positively mediate the relationship between TEI and CCP (H1), and Love and Care for Nature (LCN, i.e., emotional mediator) would positively mediate the relationship between TEI and PEBs (H2).

METHODS

The study involved 342 young adults (F = 60.7%; age 19-40; Mage=22.99; SD = 2.66) in Study 1 and 365 young adults (F = 71.2%; age 17-35; Mage=22.2; SD = 3.98) in Study 2. Data were collected through an online tool shared by the snowball method. We administered the following self-reports: Trait Emotional Intelligence Questionnaire- Short Form (TEIQue- SF), Global Climate Change (GCC), and Connectedness to Nature Scale (CNS) (Study 1); Trait Emotional Intelligence Questionnaire- Short Form (TEIQue-SF), General Environmental Behaviors Scale (GEB), and Love and Care for Nature (LCN) (Study 2).

RESULTS

Findings from Study 1 showed that higher TEI levels enhance CN (i.e., cognitive mediator), positively influencing CCP (estimate = 0.14; 95% CI = 0.07 to 0.23). Findings from Study 2 showed that higher TEI levels are associated with higher LCN levels (i.e., emotional mediator), influencing people's engagement in PEBs (estimate = 0.7; 95% CI = 0.03 to 0.11).

CONCLUSION

It is crucial to design environmental education programs that promote greater emotional intelligence ability and encourage individuals' involvement in ecological outcomes.

Public nature and health for homeless populations: Professionals' perceptions of contingent human benefits and harms

This article investigates relationships between public nature and health for unsheltered homeless populations. It examines perceptions of health benefits and harms for people living in public natural areas including local, state, and national forests and parks in the Seattle metropolitan area (USA). Interviews with environmental, social service, and law enforcement professionals who regularly interact with this vulnerable population were conducted and thematically analyzed to understand perceptions of physical and mental health outcomes. Results show professionals' perspectives on the health benefits and detriments of time spent in natural environments and the contextual factors perceived to influence health. Interviewees' observations about the variability of personal circumstances and biophysical, social, and weather conditions encourage the nuanced consideration of how contingent therapeutic landscapes provide deeply needed benefits, but for a population with a diminished capacity to adapt when conditions change. We conclude with insights for future research that directly assesses homeless populations' exposures and health outcomes of living in public natural areas.

Mothering occupations: A review identifying mothering occupations

INTRODUCTION

This review aimed to retrieve and collate a list of culturally relevant mothering occupations in the New Zealand context with mothers positioned as experts of their experience. Mothering occupations influence wellbeing and this study aimed to better inform on the daily occupations mothers participate in that contribute to feelings of maternal confidence.

METHODS

Two main sources were used to identify mothering occupations: A systematic search of mothering literature, and participant additions. The first step involved mothering literature being searched, collated and condensed. The second step involved presenting the compiled list of mothering occupations to a panel of mothers for review and to invite additions. Mothers were asked to consider the occupations they participate in that evoke feelings of confidence and mastery in their mothering. Fifteen mothers with infants 12 to 18 months old were recruited, eight contributed to the mothering occupations list.

RESULTS

A list of 203 items was collated then condensed based on the inclusion criteria for the participant group, and was tracked in a table. The list was reduced to 36 items. Eight participants added to the mothering occupations list, bringing the total number of items to 47. Mothers indicated through their contributions to the list that some types of mothering occupations are more relevant to them when considering feelings of maternal confidence and mastery. The mothers of this study indicated that connecting with their infant, their culture and nature are of high value to them.

CONCLUSION

Developing a list of culturally relevant and relatable mothering occupations is a significant undertaking, highlighting the subjective experiences of mothers. Mothering occupations are vast and influenced by context. Mothers valuing some types of occupation more in relation to maternal confidence indicates a role for occupational therapy with this population to support with engagement and participation in occupations that promote wellbeing.

A ticket to where? Dwindling snow cover impacts the winter tourism sector as a consequence of climate change

Climate change affects human activities, including tourism across various sectors and time frames. The winter tourism industry, dependent on low temperatures, faces significant impacts. This paper reviews the implications of climate change on winter tourism, emphasising challenges for activities like skiing and snowboarding, which rely on consistent snowfall and low temperatures. As the climate changes, these once taken-for-granted conditions are no longer as commonplace. Through a comprehensive review supported by up-to-date satellite imagery, this paper presents evidence suggesting that the reliability of winter snow is decreasing, with findings revealing a progressive reduction in snow levels associated with temperature and precipitation changes in some regions. The analysis underscores the need for concerted efforts by stakeholders who must recognize the reality of diminishing snow availability and work towards understanding the specific changes in snow patterns. This should involve multi-risk and multi-instrument assessments, including ongoing satellite data monitoring to track snow cover changes. The practical implications for sports activities and the tourism industry reliant on snow involve addressing challenges by diversifying offerings. This includes developing alternative winter tourism activities less dependent on snow, such as winter hiking, nature walks, or cultural experiences.

Effectiveness of Virtual Reality-Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review

BACKGROUND

Adolescents can be especially vulnerable to various stressors as they are still in their formative years and transitioning into adulthood. Hence, it is important for them to have effective stress management strategies.

OBJECTIVE

This systematic review investigates current well-being interventions that are aimed at reducing stress among young adults. In particular, interventions using the medium of virtual reality (VR) are explored.

METHODS

This mixed methods systematic review follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, and papers were gathered from databases such as PsycINFO, PubMed, Science Direct, Web of Science, OpenGrey, and Edutopia. Predetermined criteria and specific keywords were used to search for the papers. Search results were screened and extracted with all article screening or extraction delegated among all authors. Any disagreements after reconciliation were settled by a third author. The quality and risk of bias of included studies were assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Tool for Quantitative Studies. Studies were analyzed qualitatively.

RESULTS

In total, 20 studies were included, and qualitative analysis was performed to evaluate the effectiveness of VR-based interventions in 3 domains: nature, stress, and academics.

CONCLUSIONS

Studies using VR interventions, overall, promoted a reduction in stress and an increase in well-being. The findings suggest that VR may serve as an accessible and affordable medium of stress reduction for students and young adults. Larger sample sizes, and a greater number of included studies, may be required in future directions.

Assessing nature exposure: a study on the reliability and validity of a Portuguese version of the nature exposure scale

Introduction

Engaging with nature has been widely acknowledged for its positive impact on well-being. Traditionally, assessments of nature exposure focus on estimating green space exposure and outdoor time. However, the Nature Exposure Scale (NES) offers a unique approach by evaluating the quality of nature experiences, encompassing both deliberate and spontaneous encounters.

Methods

This study aimed to assess the validity and reliability of the NES in the context of Portugal. Exploratory Factor Analysis (PCA) and Confirmatory Factor Analysis (CFA) were employed to examine the underlying structure of the scale. Additionally, reliability assessments, along with tests of convergent and divergent validity, were conducted. Data were collected from a sample of 558 adults and 241 adolescents between 2016 and 2018.

Results

The findings revealed strong internal consistency of the NES, supported by acceptable correlation values and robust factor loadings within a unidimensional model. The scale effectively predicted variations in nature exposure across diverse professional activities.

Discussion

In summary, the 4-item NES emerged as a reliable tool for assessing nature exposure in various settings, effectively bridging a gap in the Portuguese context. The scale demonstrated potential for cross-cultural research and was particularly adept at predicting nature exposure in different professional contexts. The results suggest that the NES can enhance our understanding of the impact of nature on well-being in diverse cultural settings.

Conclusion

The study underscores the reliability of the NES in assessing nature exposure in Portugal, paving the way for further exploration in Portuguese-speaking regions. The scale holds promise for advancing research on the relationship between nature and well-being, contributing valuable insights across different cultural contexts.

Exposure to urban green spaces and mental health during the COVID-19 pandemic: evidence from two low and lower-middle-income countries

Introduction

The COVID-19 pandemic has had a significant impact on mental health globally, with limited access to mental health care affecting low- and middle-income countries (LMICs) the most. In response, alternative strategies to support mental health have been necessary, with access to green spaces being a potential solution. While studies have highlighted the role of green spaces in promoting mental health during pandemic lockdowns, few studies have focused on the role of green spaces in mental health recovery after lockdowns. This study investigated changes in green space access and associations with mental health recovery in Bangladesh and Egypt across the pandemic.

Methods

An online survey was conducted between January and April 2021 after the first lockdown was lifted in Bangladesh (n = 556) and Egypt (n = 660). We evaluated indoor and outdoor greenery, including the number of household plants, window views, and duration of outdoor visits. The quantity of greenness was estimated using the normalized difference vegetation index (NDVI). This index was estimated using satellite images with a resolution of 10x10m during the survey period (January-April 2021) with Sentinel-2 satellite in the Google Earth Engine platform. We calculated averages within 250m, 300m, 500m and 1000m buffers of the survey check-in locations using ArcGIS 10.3. Multiple linear regression models were used to evaluate relationships between changes in natural exposure and changes in mental health.

Results

The results showed that mental health improved in both countries after the lockdown period. People in both countries increased their time spent outdoors in green spaces after the lockdown period, and these increases in time outdoors were associated with improved mental health. Unexpectedly, changes in the number of indoor plants after the lockdown period were associated with contrasting mental health outcomes; more plants translated to increased anxiety and decreased depression. Refocusing lives after the pandemic on areas other than maintaining indoor plants may assist with worrying and feeling panicked. Still, indoor plants may assist with depressive symptoms for people remaining isolated.

Conclusion

These findings have important implications for policymakers and urban planners in LMICs, highlighting the need to increase access to natural environments in urban areas to improve mental health and well-being in public health emergencies.

Creative therapy in health and disease: Inner vision

Can we better understand the unique mechanisms of de novo abilities in light of our current knowledge of the psychological and neuroscientific literature on creativity? This review outlines the state-of-the-art in the neuroscience of creativity and points out crucial aspects that still demand further exploration, such as brain plasticity. The progressive development of current neuroscience research on creativity presents a multitude of prospects and potentials for furnishing efficacious therapy in the context of health and illness. Therefore, we discuss directions for future studies, identifying a focus on pinpointing the neglected beneficial practices for creative therapy. We emphasize the neglected neuroscience perspective of creativity on health and disease and how creative therapy could offer limitless possibilities to improve our well-being and give hope to patients with neurodegenerative diseases to compensate for their brain injuries and cognitive impairments by expressing their hidden creativity.

Nature and Mental Health in Urban Texas: A NatureScore-Based Study

In this cross-sectional study, we examined the impact of access to nature on mental health utilization in urban neighborhoods using Texas outpatient encounters data merged with NatureScoreTM (0-100; low to high nature levels) and US census data (household income, education, employment, poverty, and insurance coverage) at the zipcode level. Our sample size included 61 million outpatient encounters across 1169 zipcodes, with 63% women and 30% elderly. A total of 369,344 mental health encounters were identified, with anxiety/stress and depression encounters representing 68.3% and 23.6%, respectively. We found that neighborhoods with a NatureScore of 60+ had lower overall mental health utilization than those below 40 (RR 0.51, 95%CI 0.38-0.69). This relationship persisted for depression, bipolar disorder, and anxiety/stress and in neighborhoods with a NatureScore above 80 (p < 0.001). Compared to neighborhoods with a NatureScore below 40, those above 80 had significantly lower depression (aRR 0.68, 95%CI 0.49-0.95) and bipolar (aRR 0.59, 95%CI 0.36-0.99) health encounters after adjusting for demographic and socioeconomic factors. This novel approach, utilizing NatureScore as a proxy for urban greenness, demonstrates the correlation between a higher NatureScore and reduced mental health utilization. Our findings highlight the importance of integrating nature into our healthcare strategies to promote well-being and mental health.

How human health and well-being depends on healthy marine habitats in the Mediterranean: A review

Human health and well-being, and how they are affected by terrestrial and freshwater ecosystems have been the subject of numerous studies. In contrast, there are very few such studies relating to marine ecosystems. Here, in the context of the Mediterranean Sea, we assess evidence of the broad interplay of relationships between marine habitats and human health and well-being. Our review shows that the major Mediterranean marine habitats provide various provisioning, cultural and regulating services that improve physical and mental health in a number of different ways. These include: (i) the provision of seafood rich in omega-3 fatty acids, which help to reduce the risk of developing certain types of illnesses; and also, species that produce bioactive compounds that are potential sources of new drugs; (ii) the provision of blue spaces - areas of water suitable for leisure and recreational activities able to inspire, educate, and appeal to the aesthetic senses - that not only increase physical and psychological health, but also foster an individual and collective sense of place and identity and contribute to improving social relations; and (iii) the regulation of climate change, and of water quality and pollution, for example via sequestration of carbon and heavy metals, thus reducing the associated health risks. Our results show that Mediterranean marine habitats are valuable for health and well-being, thus highlighting the need to conserve as much of these habitats as possible (particularly through marine protected areas) and to carry out new studies to determine the specific causal pathways by which certain characteristics of marine habitats - including biotic (e.g. marine biodiversity) and abiotic (e.g. water quality) factors - affect human health and well-being.

Nature-Based Interventions Targeting Elderly People's Health and Well-Being: An Evidence Map

BACKGROUND

Healthy aging encompasses more than the absence of disease, emphasizing the preservation of functional abilities for enhanced well-being and quality of life. Nature-based interventions are scientifically proven contributors to healthy aging.

OBJECTIVE

To develop an evidence map showcasing nature-based interventions targeting older individuals' health and well-being.

METHODS

The evidence map was developed through critical analysis of systematic reviews and clinical trials utilizing the tools AMSTAR2 and CONSORT. A systematic search spanning the past decade was conducted across databases: Cochrane, SCOPUS, PubMed, Web of Science, Embase, and LILACS.

RESULTS

Twelve articles met the eligibility criteria. Nature-based interventions such as forest bathing, hiking, therapeutic gardens, virtual reality, and forest sounds were identified. Outcomes were categorized into physical aspects (cardiovascular and pulmonary; neuro-immuno-endocrinological) and mental/behavioral aspects. The final map integrated interventions, outcomes, and quality assessments.

CONCLUSIONS

The survey highlights the positive impact of nature-based interventions on the health of the elderly. This study provides insights across various domains, fostering the development of programs and policies in management to promote healthy aging. Regarding healthcare, it encourages discourse among professionals regarding the integration of nature-based practices for equitable care in both individual and group settings. Furthermore, it underscores the need for research in the Southern Hemisphere, particularly in Brazil, where the study was conducted.

Supporting Wellness, Resilience, and Community With Forest Therapy

Background

Physician burnout has reached epidemic proportions. Although burnout is rooted in systems, practices for physician wellbeing and community can address exhaustion, burnout, and isolation. Inspired by the Japanese practice shinrin-yoku, forest therapy/bathing (FT) is a nature immersion practice that improves wellbeing in a group setting.

Objective

This program offered guided FT experiences to frontline faculty physicians in the Department of Medicine and evaluated potential for impact on burnout, resilience, and community.

Methods

Faculty physicians were recruited via email invitations to a free Forest Therapy group experience in the Arnold Arboretum in Boston, MA. Participants completed pre-and post-course surveys and evaluated its value as a community experience. Surveys measured burnout, resilience, and qualitative feedback on the experience.

Results

Twenty-seven faculty completed the baseline survey, twenty-three faculty participated, with 19 survey respondents. At baseline, 85% reported feeling burned out at least once a month. 46% reported feeling burned out more than a few times a month. 83% of participants responded that forest therapy could help them with the feeling of being burned out from work. Post-intervention, 100% of participants rated the experience as very or extremely valuable. 96% of participants reported they were interested in more frequent forest therapy sessions. 100% of participants would recommend this practice to other faculty. 70% of respondents reported the program could help them with burnout. Despite high baseline resilience, 94% of participants reported that forest therapy could help with stressful events and setbacks. Post-intervention, participants reported feeling relaxed, at peace, and calm.

Conclusion

This pilot demonstrates feasibility and acceptability for physicians of FT. Participants would consider recommending FT to their colleagues, and agreed that FT can help with wellbeing, and expressed enthusiasm for the community experience. This program may also be successfully incorporated into programs for leadership, teambuilding, and support after adverse events.

Nature as Medicine and Classroom: Evaluating an Innovative, Outdoor Course for Medical and Dental Students

Background

There is a growing, global awareness and recognition of the important, interdependent relationships between our natural world and human health. Several contemporary health organizations have placed calls to action and emphasize an urgent need for collaboration and interdisciplinary research, education, and clinical work to address the increasing degradation of our planetary and human health. With more research dedicated to nature's health impacts, health professions schools would benefit by including such training in their programs while also cultivating a comprehensive mind-body health perspective to support both the health of student practitioners and their future patients.

Objective

The present program evaluation investigates a five-day outdoor mini-course covering nature-based health techniques at a medical and dental school in the American Northeast. This unique outdoor course combines nature, creativity, and reflection within the context of modern medicine.

Methods

A concurrent mixed-method design using descriptive statistics, quantitative and qualitative data from students' anonymous final course evaluations and final reflection projects are evaluated.

Results

Data suggests that students benefitted from their experience during this five-day course. Students provided feedback reinforcing the enjoyment and transformative outcomes gleaned from the course experiences. Students entered the course describing feeling stressed, overwhelmed, and overextended, not uncommon for learners in medical and dental school, and completed the course describing the acquisition of applicable skills, increased attention and mindfulness, creativity, and connection to the natural world.

Conclusions

Students described a positive experience of the course. Several areas of personal and professional development were also described, such as improvements within cognitive domains, enhanced connection with nature, others, and themselves, increased mindfulness, and overall improved well-being. Findings have implications for medical and dental programs on how such innovative training may lean into the work of nature-based care to provide for the whole person.

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

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