Change in time spent visiting and experiences of green space following restrictions on movement during the COVID-19 pandemic: a nationally representative cross-sectional study of UK adults

Residential greenspace and COVID-19 Severity: A cohort study of 313,657 individuals in Greater Manchester, United Kingdom

BACKGROUND

Greenspaces contribute positively to mental and physical well-being, promote social cohesion, and alleviate environmental stressors, such as air pollution. Ecological studies suggest that greenspace may affect incidence and severity of Coronavirus Disease 2019 (COVID-19).

OBJECTIVE

This study examines the association between residential greenspace and COVID-19 related hospitalization and death.

METHOD

In this retrospective cohort based on patient records from the Greater Manchester Care Records, all first COVID-19 cases diagnosed between March 1, 2020, and May 31, 2022 were followed until COVID-19 related hospitalization or death within 28 days. Residential greenspace availability was assessed using the Normalized Difference Vegetation Index per lower super output area in Greater Manchester. The association of greenspace with COVID-19 hospitalization and mortality were estimated using multivariate logistic regression models after adjusting for potential individual, temporal, and spatial confounders. We explored potential effect modifications of the associations with greenspace and COVID-19 severity by age, sex, body mass index, smoking, deprivation, and certain comorbidities. Combined effects of greenspace and air pollution (NO2 and PM2.5) were investigated by mutually adjusting pairs with correlation coefficients ≤ 0·7.

RESULTS

Significant negative associations were observed between greenspace availability and COVID-19 hospitalization and mortality with odds ratios [OR] (95 % Confidence Intervals [CI]) of 0·96 (0·94-0·97) and 0·84 (0·80-0·88) (per interquartile range [IQR]), respectively. These were significantly modified by deprivation (P-value for interaction < 0.05), showing that those most deprived obtained largest benefits from greenspace. Inclusion of NO2 and PM2.5 diminished associations to null for COVID-19 hospitalization, but only reduced them slightly for mortality, where inverse associations remained.

CONCLUSION

In the Greater Manchester area, residential greenspace is associated with reduced risk of hospitalization or death in individuals with COVID-19, with deprived groups obtaining the greatest benefits. Associations were strongest for COVID-19 mortality, which were robust to inclusion of air pollutants in the models.

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.

Adults With IDD in Supported Accommodation During COVID-19 Lockdown: The Families' Perspective

The present study aims to understand and describe family caregivers' perceptions and experiences regarding contact and relationships with their adult relatives with intellectual and developmental disabilities (IDD) living in supported accommodation during the COVID-19 lockdown. A qualitative phenomenological approach was applied in which 19 Israeli family caregivers (parents and siblings) were interviewed. Inductive thematic analysis revealed themes at the microsystem level (the resident, the caregiver, and their relationship), and at the mesosystem level (the caregivers' interactions with service providers and other residents' families). The findings highlight the pivotal role of family caregivers in times of uncertainty and the need to develop explicit policies and mechanisms to facilitate family engagement in the residents' lives.

A systematic review of the relationship between natural environments and physiological and mental health during different stages of the COVID-19 pandemic

COVID-19 has altered how individuals interact with natural environments. Numerous studies have investigated the effects of such environments on health. However, how natural environments influenced individuals' physiological and mental health during various stages of the COVID-19 pandemic remains unclear. Therefore, we conducted this study to investigate the effects of natural environments on individuals' physiological and mental health during different stages of the pandemic; we also identified factors that mediated these effects. Overall, we evaluated the importance of natural environments during challenging times. This study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The pandemic period was divided into three stages on the basis of severity: pandemic (March 2020 - February 2022), easing (February 2022-September 2022), and post-acute COVID pandemic (September 2022 - present). An initial pool of 3018 studies was narrowed down to a final sample of 73 studies. During the pandemic stage, individuals frequenting public green spaces exhibited improved well-being, reduced stress levels, and a sense of nature deprivation. Private green spaces played crucial roles in maintaining health during the pandemic stage. Highquality window views were associated with improved well-being and reduced depression. During the easing stage, the environmental quality of public green spaces influenced individuals' perceived safety and sense of belonging. And coastal areas were the preferred natural destinations in this stage. During the post-acute COVID pandemic stage, individuals acknowledged the importance of natural environments in maintaining physiological and mental health as they gradually returned to prepandemic normalcy. In conclusion, the COVID-19 pandemic highlighted humanity's reliance on nature. Therefore, sufficient urban spaces should be dedicated to preservation of natural environments to mitigate negative emotions arising from prolonged indoor stays.

Urban green space visitation and mental health wellbeing during COVID-19 in Bangkok, Thailand

Urban green spaces offer numerous benefits, and their role in supporting mental health, particularly during global crises such as the COVID-19 pandemic, is of growing interest to researchers and policymakers. This study explored the relationship between urban green space visitation and mental health well-being during the COVID-19 pandemic in Bangkok, Thailand. This cross-sectional study, conducted in Bangkok during the COVID-19 lockdown, used a telephone survey of 579 respondents. A logistic regression model was employed to examine the association between urban green space visitation and the WHO-5 mental health well-being score, considering various factors such as socioeconomic variables, healthy behaviors, and COVID-19-related experiences. The findings revealed a significant association between urban green space visitation during the lockdown and higher mental health well-being. Socioeconomic variables and healthy behaviors of respondents were also notably linked to higher WHO-5 mental health well-being scores. These findings collectively indicate that urban greenspace visitation serves as a crucial determinant of mental health and well-being, especially during the COVID-19 pandemic.

Greenspace use during the COVID-19 pandemic: A longitudinal population mobility study in the United Kingdom

BACKGROUND

The coronavirus pandemic greatly disrupted the lives of people. Restrictions introduced worldwide to limit the spread of infection included stay-at-home orders, closure of venues, restrictions to travel and limits to social contacts. During this time, parks and outdoor greenspaces gained prominent attention as alternative location for respite. Population mobility data offers a unique opportunity to understand the impact of the pandemic on outdoor behaviour. We examine the role of the restrictions on park use throughout the full span of the pandemic while controlling for weather and region.

METHODS

This study provides a longitudinal population analysis of park visitation using Google COVID-19 Community Mobility Reports data in the UK. Daily park visitation was plotted and ANOVA analyses tested season and year effects in visitation. Then, regressions examined park visitation beyond weather (temperature and rain), according to COVID-19 restrictions, while controlling for region specificities through unit fixed effect models.

RESULTS

Time series and ANOVA analyses documented the significant decrease in park visitation in the spring of 2020, the seasonal pattern in visitation, and an overall sustained and elevated use over nearly three years. Regressions confirmed park visitation increased significantly when temperature was greater and when it rained less. More visitation was also seen when there were fewer COVID-19 cases and when the stringency level of restrictions was lower. Of special interest, a significant interaction effect was found between temperature and stringency, with stringency significantly supressing the effect of higher temperature on visitation.

CONCLUSIONS

COVID-19 restrictions negatively impacted park visitation on warm days. Given the general health, social, and wellbeing benefits of greenspace use, one should consider the collateral negative impact of restrictions on park visitation. When social distancing of contacts is required, the few remaining locations where it can safely occur should instead be promoted.

Understanding the pathways between the use of urban green spaces and self-rated health: A case study in Mexico City

In recent decades, extensive research has demonstrated the positive impact of urban green spaces (UGS) on public health through several pathways. However, in the context of Latin America, particularly Mexico City, there remains a notable scarcity of evidence linking UGS use to health outcomes and an insufficient understanding of the pathways or factors underlying these associations. Therefore, this study employs Structural Equation Modeling (SEM) to investigate the intricate pathways between UGS use and residents' perceived health in Mexico City, a densely populated urban center. The SEM integrates three key mediators: sentiments towards UGS, UGS quality, and time spent within these spaces. Survey data was collected through an online survey distributed via social media in May 2020 (n = 1,707). The findings indicate a minor yet significant direct link between UGS use and self-reported health (0.0427, p < 0.1). Conversely, the indirect pathways through sentiments towards UGS, UGS quality, and time spent in UGS were highly significant (0.1950, p < 0.01), underscoring their substantial role as mediators in the UGS use-health association. While a comprehensive understanding of the mechanisms linking perceived health to UGS use in Mexico City requires further research, this study proposes that fostering positive sentiments towards UGS, enhancing UGS quality, and encouraging extended visits to green areas could potentially amplify the perceived health benefits associated with UGS use among residents. These insights offer valuable inputs for policymaking, emphasizing the importance of integrating public perspectives to optimize nature-based solutions and broaden their positive impact within Mexico City.

Outdoor recreation, tick borne encephalitis incidence and seasonality in Finland, Norway and Sweden during the COVID-19 pandemic (2020/2021)

During the pandemic outdoor activities were encouraged to mitigate transmission risk while providing safe spaces for social interactions. Human behaviour, which may favour or disfavour, contact rates between questing ticks and humans, is a key factor impacting tick-borne encephalitis (TBE) incidence. We analyzed annual and weekly TBE cases in Finland, Norway and Sweden from 2010 to 2021 to assess trend, seasonality, and discuss changes in human tick exposure imposed by COVID-19. We compared the pre-pandemic incidence (2010-2019) with the pandemic incidence (2020-2021) by fitting a generalized linear model (GLM) to incidence data. Pre-pandemic incidence was 1.0, 0.29 and 2.8 for Finland, Norway and Sweden, respectively, compared to incidence of 2.2, 1.0 and 3.9 during the pandemic years. However, there was an increasing trend for all countries across the whole study period. Therefore, we predicted the number of cases in 2020/2021 based on a model fitted to the annual cases in 2010-2019. The incidences during the pandemic were 1.3 times higher for Finland, 1.7 times higher for Norway and no difference for Sweden. When social restrictions were enforced to curb the spread of SARS-CoV-2 there were profound changes in outdoor recreational behavior. Future consideration of public health interventions that promote outdoor activities may increase exposure to vector-borne diseases.

Reduction in the use of green spaces during the COVID-19 pandemic and its impact on mental health

Our study examined the use of green spaces before and during the pandemic in a large cohort of Italian twins and evaluated its impact on measures of mental health (depressive, anxiety, stress symptoms). Twins were analysed as individuals and as pairs. A twin design approach was applied to minimize confounding by genetic and shared environmental factors. Questionnaires from 2,473 twins enrolled in the Italian Twin Registry were screened. Reduced green space use was associated with significantly higher levels of depression, anxiety and distress. Being a woman, residing in urban areas, and having a high perceived risk of the outbreak resulted in a higher likelihood to modify green space use, with a negative impact on mental health.

Green infrastructure inequality in the context of COVID-19: Taking parks and trails as examples

Inequality in access to urban green infrastructures has been a major concern among scholars and governments, especially since the COVID-19 outbreak. There is a lack of knowledge on how people respond to the pandemic regarding the usage of green infrastructure in cities. This paper explores the shifts in visitation to parks and trails, two popular green infrastructures in Salt Lake County, Utah, by analyzing the results of a survey conducted during the pandemic. Our conceptualization considers personal and neighborhood-level factors, including personal socioeconomic status, existing inequalities of green infrastructures, urban form, and neighborhood conditions. People who reside close to the city center tend to go to parks more often, while those living in urban edges use trails more. Visiting green infrastructures less often is more likely in areas with higher COVID-19 infection rates. The regression results confirm the importance of neighborhood-level factors and illustrate the intricate elements influencing people's decisions to visit different green infrastructures during the pandemic, which shows non-linear relationships. Richer, white, and younger people seem to enjoy green infrastructures more often, leading to the concern of amplified inequality. Higher COVID-19 cases result in higher demands for green infrastructures, which are not fulfilled during the pandemic, especially for vulnerable communities, leading to spatial exclusion. The results highlight the importance of smart growth, including compact development, public transit, and pocket parks, in promoting the urban resilience of park and trail visits, as they may provide more access opportunities and alternatives to green infrastructures even in the context of the pandemic.

Behavioral responses of terrestrial mammals to COVID-19 lockdowns

COVID-19 lockdowns in early 2020 reduced human mobility, providing an opportunity to disentangle its effects on animals from those of landscape modifications. Using GPS data, we compared movements and road avoidance of 2300 terrestrial mammals (43 species) during the lockdowns to the same period in 2019. Individual responses were variable with no change in average movements or road avoidance behavior, likely due to variable lockdown conditions. However, under strict lockdowns 10-day 95th percentile displacements increased by 73%, suggesting increased landscape permeability. Animals' 1-hour 95th percentile displacements declined by 12% and animals were 36% closer to roads in areas of high human footprint, indicating reduced avoidance during lockdowns. Overall, lockdowns rapidly altered some spatial behaviors, highlighting variable but substantial impacts of human mobility on wildlife worldwide.

Natural environments, psychosocial health, and health behaviors in a crisis - A scoping review of the literature in the COVID-19 context

The COVID-19 outbreak led to major restrictions globally, affecting people's psychosocial health and their health behaviors. Thus, the purpose of this scoping review was to summarize the available research regarding nature and health in the COVID-19 context. Keywords relating to natural environments and COVID-19 were combined to conduct a systematic online search in six major databases. Eligibility criteria were a) published since 2020 with data collected in the COVID-19 context b) peer-reviewed, c) original empirical data collected on human participants, d) investigated the association between natural environments and psychosocial health or health behaviors, and e) English, German, or Scandinavian languages. Out of 9126 articles being screened, we identified 188 relevant articles, representing 187 distinct studies. Most research focused on adults in the general population and was predominantly conducted in the USA, Europe, and China. Overall, the findings indicate that nature may mitigate the impact of COVID-19 on psychological health and physical activity. Through a systematic thematic analysis of the extracted data, three primary themes were identified: 1) type of nature assessed, 2) psychosocial health and health behaviors investigated, and 3) heterogeneity in the nature-health relationship. Research gaps in the COVID-19 context were identified regarding I) nature characteristics that promote psychosocial health and health behaviors, II) investigations of digital and virtual nature, III) psychological constructs relating to mental health promotion, IV) health-promoting behaviors other than physical activity, V) underlying mechanisms regarding heterogeneity in the nature-health relationship based on human, nature, and geographic characteristics, and VI) research focusing on vulnerable groups. Overall, natural environments demonstrate considerable potential in buffering the impact of stressful events on a population level on mental health. However, future research is warranted to fill the mentioned research gaps and to examine the long-term effects of nature exposure during COVID-19.

Designing "Tiny Forests" as a lesson for transdisciplinary urban ecology learning

The sustainability and livability of urban areas call for the next generation of scientists, practitioners and policy makers to understand the benefits, implementation and management of urban greenspaces. We harnessed the concept of "Tiny Forests©" - a restoration strategy for small wooded areas (~100-400 m2) - to create a transdisciplinary and experiential project for university forestry students that follows an ecology-with-cities framework. We worked with 16 students and a local municipality in the Munich, Germany metropolitan region to survey a community about its needs and desires and then used this information alongside urban environmental features and data collected by students (e.g., about soil conditions) to design a Tiny Forest. In this article, we describe the teaching concept, learning outcomes and activities, methodological approach, and instructor preparation and materials needed to adapt this project. Designing Tiny Forests provides benefits to students by having them approach authentic tasks in urban greening while experiencing the challenges and benefits of transdisciplinary communication and engagement with community members.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11252-023-01371-7.

Disparities in greenspace access during COVID-19 mobility restrictions

More than half of the human population lives in cities and therefore predominantly experience nature in urban greenspace, an important contributor to wellbeing. As the world faces a pandemic which threatens the physical and mental health of billions of people, it is crucial to understand that all have the possibility to access nature exposure to alleviate some of these challenges. Here, for the first time, we integrate data from Facebook, Twitter, and Google Search users to show that people looked for greenspace during COVID-19 mobility restrictions but may not have always managed to reach it. We used a longitudinal approach, replicated in three European cities, to assess whether people spent more time in locations with more greenspace, and whether this change in urban density remained for the whole pandemic, pre-vaccine, period. We coupled this human density study with a longitudinal study of web search patterns for Parks and online discussion about urban greenspace. People searched for Parks near them more during the pandemic, particularly when they were allowed to visit them. They discussed in positive terms greenspace particularly more at the start of the pandemic. People spent more time in areas with greenspace when they could and that depended on the level of multiple deprivation of their neighbourhood. Importantly, while people sought greenspace throughout the first 20 months of the pandemic, this preference intensified through the waves of lockdown. Living in an affluent area conferred a greenspace advantage in London and Paris but we find that in Berlin greenspace in more deprived neighbourhoods were used more. Overall, urban greenspace occupied a greater place in people's lives during the pandemic. Whether people could realise greenspace access depended on the deprivation level of the neighbourhood. Public greenspace access should be integrated in national indices of deprivation given its importance for wellbeing.

COVID-19 pandemic changes the recreational use of Moscow parks in space and time: Outcomes from crowd-sourcing and machine learning

The limited access to urban green spaces during the COVID-19 pandemic had a negative impact on the human-nature interaction in cities and human well-being. Number of visitors to green areas, initially declined due to imposed restrictions, was restored after they were lifted as established by several studies across the globe However, little is still known about changes in behavior and preferences of park visitors in the post-COVID time. In this study, we investigated spatial-temporal patterns of recreational activities in the three urban parks in Moscow (Russia) prior, during and after the COVID-19 lockdown (in 2019 and 2020). The selected parks represent two different types: a centrally located park with much infrastructure and open landscapes (Gorky Park) and parks located at the outskirts of the city center with a more forested landscape and little infrastructure (Timiryazevski and Sokolniki parks). Recreational activities were identified based on the analysis of social media photos using machine-learning algorithms. As expected, park closures during lockdown resulted in overall decrease in the number of taken photos. After the parks were re-opened, however, the number of photos did not grow immediately. The number of photos only restored after almost three months, and the visiting peak shifted to autumn. Differences between parks were related to the type of the park and its landscape structure. The lowest decrease in the number of photos was observed for the Timiryazevsky park - a semi-natural green area, while the centrally located Gorky Park was the most affected, likely due to the strictest control measures. In comparison to 2019, photos in 2020 were more evenly distributed across the area in all the three parks. Besides, 'natural' areas became the main attractors for the visitors - photos under 'nature observation' category became the most popular. Spatial distribution of the recreational activities in post-lockdown period was characterized by larger distances between photos, likely corresponding to the social distancing. COVID-19 pandemic highlighted the value of green areas for citizens, but also changed their recreational preferences and overall behavior in parks. The observed shift from high density of visitors around entertainments and attractions in 2019 to a more homogeneous and less dense distribution along the natural zones in 2020 reveals a new pattern in visitors behavior and preference, which shall be considered in spatial planning of the parks. Increasing availability of natural green areas and their integration in urban green infrastructures can become the most relevant policy to consider the crucial role of urban nature as a source of resilience in turbulent times.

Respite and connection: Autistic adults' reflections upon nature and well-being during the Covid-19 pandemic

LAY ABSTRACT

The Covid-19 pandemic and associated lockdowns provided opportunities to spend time in nature, with many people reporting that this benefitted their well-being. However, existing research from the pandemic period has focused on the way general populations experienced nature; less is known about how autistic people used nature to support their well-being during the pandemic. We created a survey that invited autistic adults living in the United Kingdom to reply to text box questions. A total of 127 people responded to our survey; we analysed their responses using a method called reflexive thematic analysis and developed themes based on patterns among all the responses. We developed two themes: respite in nature and connecting amid widespread disconnection. For some autistic adults during the pandemic, nature provided physical distance from others or from crowded homes, which helped them reduce their stress. In addition, some participants felt more psychologically connected to nature itself during the pandemic, while for others, nature served as a way of connecting with others during a potentially isolating time. These findings are important for autistic people and their families and carers who may want to seek out nature-based activities to support well-being in the wake of the pandemic.

Demographic and spatial variables associated with spending time in nature during COVID-19 lockdowns

To stop the spread of SARS-CoV-2 coronavirus (COVID-19) governments around the world implemented lockdowns restricting public travel. In the Australian state of Victoria, this included limiting permitted reasons for leaving home and restricting movements to within a 5 km radius of one's home. In 2020, we conducted a state-wide survey (N = 1024) of Victorians that coincided with a lockdown. We asked respondents where they had spent time in nature and how they perceived lockdowns affected the amount of time they spent in nature. We then considered demographic and spatial predictors of spending more or less time in nature. Women, younger people, and those living in areas with higher socio-economic status were likely to report spending more time in nature. Closer proximity of residents to parks and waterways and higher proportional area of native vegetation within a 1-km radius were also associated with more time in nature. Understanding how different groups were affected by restrictions on access to nature can help improve government management of crises like pandemics, including through urban planning for green space, supporting improved individual and societal resilience. We discuss the implications of our findings for improving access to nature during lockdowns as well as opportunities for a post-pandemic relationship with nature, particularly in urban settings.

The Impact of the Coronavirus Pandemic on the Contribution of Local Green Space and Nature Connection to Mental Health

BACKGROUND

Exposure to green space and feeling connected to the natural environment have independently been associated with improved mental health outcomes. During the coronavirus pandemic, people experienced restrictions on access to the outdoors, and health data indicated a decline in mental health in the UK general population.

METHODS

Data available from two independent surveys conducted prior to and during the pandemic enabled a naturally occurring comparison of mental health and its correlates prior to and during the pandemic.

RESULTS

Survey responses from 877 UK residents were included in the analyses. Independent t-tests revealed significant declines in mental health scores during the pandemic. After controlling for age and gender, greater nature connection significantly predicted lower depression and stress and improved well-being. Percentage of green space did not significantly predict any mental health outcomes. Further, time point (pre- or during COVID) and the interaction of time point with green space and nature connection did not significantly predict any of the outcome measures. The findings indicate that nature connection may play an important role in promoting mental health. Strategies to improve mental health and reduce mental illness should consider the role of nature connection and the use of interventions that involve direct interaction with natural environments.

How the COVID-19 pandemic changed patterns of green infrastructure use: A scoping review

The use of green infrastructure (GI) has been established as a way to alleviate stress and the COVID-19 pandemic has placed a new emphasis on the importance of GI as both a coping mechanism and a source of recreation. This scoping review seeks to address whether the COVID-19 pandemic affected the use of GI, specifically the ways in which the pandemic altered visitation patterns and the frequency of the use of GI. This review identifies studies that explore the relationship between the COVID-19 pandemic and GI use and assesses whether the pandemic has altered the use of GI, including whether GI use increased, decreased, or remained the same and examines potential changes in visitation structure as well as other effects studied. This review also discusses how future planning for GI can consider the lessons learned from the pandemic. Key findings suggest that GI use increased, as did visitors' appreciation for GI and its benefits. The use of local GI to one's home also increased in importance. Decreases in visitation were typically a result of COVID-19 lockdown restrictions and fear of viral transmission within GI.

Impact of a social prescribing intervention in North East England on adults with type 2 diabetes: the SPRING_NE multimethod study

Background

Link worker social prescribing enables health-care professionals to address patients’ non-medical needs by linking patients into various services. Evidence for its effectiveness and how it is experienced by link workers and clients is lacking.

Objectives

To evaluate the impact and costs of a link worker social prescribing intervention on health and health-care costs and utilisation and to observe link worker delivery and patient engagement.

Data sources

Quality Outcomes Framework and Secondary Services Use data.

Design

Multimethods comprising (1) quasi-experimental evaluation of effects of social prescribing on health and health-care use, (2) cost-effectiveness analysis, (3) ethnographic methods to explore intervention delivery and receipt, and (4) a supplementary interview study examining intervention impact during the first UK COVID-19 lockdown (April–July 2020).

Study population and setting

Community-dwelling adults aged 40–74 years with type 2 diabetes and link workers in a socioeconomically deprived locality of North East England, UK.

Intervention

Link worker social prescribing to improve health and well-being-related outcomes among people with long-term conditions.

Participants

(1) Health outcomes study, approximately n = 8400 patients; EuroQol-5 Dimensions, five-level version (EQ-5D-5L), study, n = 694 (baseline) and n = 474 (follow-up); (2) ethnography, n = 20 link workers and n = 19 clients; and COVID-19 interviews, n = 14 staff and n = 44 clients.

Main outcome measures

The main outcome measures were glycated haemoglobin level (HbA1c; primary outcome), body mass index, blood pressure, cholesterol level, smoking status, health-care costs and utilisation, and EQ-5D-5L score.

Results

Intention-to-treat analysis of approximately 8400 patients in 13 intervention and 11 control general practices demonstrated a statistically significant, although not clinically significant, difference in HbA1c level (–1.11 mmol/mol) and a non-statistically significant 1.5-percentage-point reduction in the probability of having high blood pressure, but no statistically significant effects on other outcomes. Health-care cost estimates ranged from £18.22 (individuals with one extra comorbidity) to –£50.35 (individuals with no extra comorbidity). A statistically non-significant shift from unplanned (non-elective and accident and emergency admissions) to planned care (elective and outpatient care) was observed. Subgroup analysis showed more benefit for individuals living in more deprived areas, for the ethnically white and those with fewer comorbidities. The mean cost of the intervention itself was £1345 per participant; the incremental mean health gain was 0.004 quality-adjusted life-years (95% confidence interval –0.022 to 0.029 quality-adjusted life-years); and the incremental cost-effectiveness ratio was £327,250 per quality-adjusted life-year gained. Ethnographic data showed that successfully embedded, holistic social prescribing providing supported linking to navigate social determinants of health was challenging to deliver, but could offer opportunities for improving health and well-being. However, the intervention was heterogeneous and was shaped in unanticipated ways by the delivery context. Pressures to generate referrals and meet targets detracted from face-to-face contact and capacity to address setbacks among those with complex health and social problems.

Limitations

The limitations of the study include (1) a reduced sample size because of non-participation of seven general practices; (2) incompleteness and unreliability of some of the Quality and Outcomes Framework data; (3) unavailability of accurate data on intervention intensity and patient comorbidity; (4) reliance on an exploratory analysis with significant sensitivity analysis; and (5) limited perspectives from voluntary, community and social enterprise.

Conclusions

This social prescribing model resulted in a small improvement in glycaemic control. Outcome effects varied across different groups and the experience of social prescribing differed depending on client circumstances.

Future work

To examine how the NHS Primary Care Network social prescribing is being operationalised; its impact on health outcomes, service use and costs; and its tailoring to different contexts.

Trial registration

This trial is registered as ISRCTN13880272.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme, Community Groups and Health Promotion (grant no. 16/122/33) and will be published in full in Public Health Research; Vol. 11, No. 2. See the NIHR Journals Library website for further project information.

Visiting Urban Green Space and Orientation to Nature Is Associated with Better Wellbeing during COVID-19

The COVID-19 pandemic has severely challenged mental health and wellbeing. However, research has consistently reinforced the value of spending time in green space for better health and wellbeing outcomes. Factors such as an individual's nature orientation, used to describe one's affinity to nature, may influence an individual's green space visitation behaviour, and thus influence the wellbeing benefits gained. An online survey in Brisbane and Sydney, Australia (n = 2084), deployed during the COVID-19 pandemic (April 2021), explores if nature experiences and nature orientation are positively associated with personal wellbeing and if increased amounts of nature experiences are associated with improvement in wellbeing in the first year of the COVID-19 pandemic. We found that both yard and public green space visitation, as well as nature orientation scores, were correlated with high personal wellbeing scores, and individuals who spent more time in green space compared to the previous year also experienced a positive change in their health and wellbeing. Consistently, people with stronger nature orientations are also more likely to experience positive change. We also found that age was positively correlated to a perceived improvement in wellbeing over the year, and income was negatively correlated with a decreased change in wellbeing over the year, supporting other COVID-19 research that has shown that the effects of COVID-19 lifestyle changes were structurally unequal, with financially more established individuals experiencing better wellbeing. Such results highlight that spending time in nature and having high nature orientation are important for gaining those important health and wellbeing benefits and may provide a buffer for wellbeing during stressful periods of life that go beyond sociodemographic factors.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

Neighborhood Greenspace and Changes in Pediatric Obesity During COVID-19

INTRODUCTION

Pediatric obesity rates increased during the COVID-19 pandemic. This study examined the associations of neighborhood greenspace with changes in pediatric obesity during the pandemic.

METHODS

Electronic health record data from a large pediatric primary care network were extracted to create a retrospective cohort of patients aged 2-17 years with a visit in each of 2 periods: June 2019-December 2019 (before pandemic) and June 2020-December 2020 (pandemic). Multivariable longitudinal generalized estimating equations Poisson regression estimated the associations of census tract‒level Normalized Difference Vegetation Index with (1) changes in obesity risk during the pandemic and (2) risk of new-onset obesity among children who were not obese prepandemic. Analyses were conducted between November 2021 and May 2022.

RESULTS

Among 81,418 children (mean age: 8.4 years, 18% Black), the percentage of children who were obese increased by 3.2% during the pandemic. Children in Normalized Difference Vegetation Index Quartiles 2-4 had smaller increases in obesity risk during the pandemic than those in Quartile 1 (risk ratio=0.96, 95% CI=0.93, 0.99; Quartile 3 risk ratio=0.95; 95% CI=0.91, 0.98; Quartile 4 risk ratio=0.95, 95% CI=0.92, 0.99). Among the subset who were not obese before the pandemic, children in Normalized Difference Vegetation Index quartiles 3-4 had a lower risk of new-onset obesity during the pandemic (Quartile 3 risk ratio=0.82, 95% CI=0.71, 0.95; Quartile 4 risk ratio=0.73, 95% CI=0.62, 0.85). Higher Normalized Difference Vegetation Index was associated with smaller increases in obesity risk and lower risk of new-onset obesity among children in urban and suburban areas, but results were in the opposite direction for children in rural areas.

CONCLUSIONS

Children living in greener neighborhoods experienced smaller increases in obesity during the pandemic than children in less green neighborhoods, although findings differed by urbanicity.

Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemic

The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.

Green spaces for mental disorders

PURPOSE OF REVIEW

Mental illness is a global challenge, exacerbated by the coronavirus pandemic. Research suggests access to local green spaces is associated with better mental health, yet access is not always equitable. Evaluation of how nature-based interventions protect and support mental health is therefore required.

RECENT FINDINGS

Accessible local green spaces are associated with better mental health. They encourage active behaviours and social interaction, reduce loneliness and stress. Green views from the home are associated with increased self-esteem, life satisfaction and happiness and reduced depression, anxiety and loneliness. Nature-based interventions and green social prescriptions effectively target vulnerable groups, resulting in significant reductions in depression, anxiety and anger alongside positive mental health outcomes.

SUMMARY

Although existing evidence is encouraging, robust, high-quality research that strengthens the evidence base and informs future clinical practice and policy decision making is needed. Evidence of the long-term effectiveness in individuals with diagnosed mental illness is also required to ascertain the potential social and wider returns on investment. Barriers to use of green social prescriptions like mental health symptoms and geographical accessibility need to be overcome to increase accessibility and uptake of green social prescriptions for the prevention and treatment of mental illness.

Perceived COVID-19-related stress drives home gardening intentions and improves human health in Taiwan

The COVID-19 pandemic has added a layer of mental health problems and perceived stress. Home gardening is considered a good method to reduce perceived stress. The current research evidence is insufficient to understand the relationship and influencing factors between the intentions, behaviors, and benefits of home gardening during short-term COVID-19 events. Although the duration from the onset to stabilization of the outbreak lasted for only 1.5 months from May to June 2021 throughout Taiwan, the significant pandemic changes might have affected the perceived stress along with the intentions, behaviors, and benefits of home gardening. This study explored the relationship between pandemic stress and home gardening through online snowball sampling because of the strict social distancing regulations. A total of 1455 non-follow-up and internet questionnaires throughout Taiwan were collected during the wave onset, peak, easing, and stabilization stages. The questionnaire included questions on personal information, perceived pandemic stress, gardening intentions, gardening behaviors, and gardening benefits. This study showed that perceived stress increased from the pandemic onset to its peak, and decreased from the peak to stabilization stages. Home gardening intentions and behaviors also revealed similar trends. Higher pandemic-perceived stress directly increased home-gardening intentions and indirectly promoted home-gardening behaviors and benefits. Our findings indicated that home gardening is a positive element in reducing perceived stress. Lower gardening intentions and behaviors were observed when the high perceived stress was removed. This study suggests that home gardening was a valuable strategy for staying close to nature and obtaining multiple benefits during the peak pandemic period. Providing small-scale gardening activities and spaces is appropriate for obtaining gardening benefits and avoiding space abandonment after the pandemic. Providing seeds, seedlings, tools, knowledge, online home gardening programs, and small residential and food gardens is a valuable strategy for obtaining multiple benefits during the peak of the pandemic.

Trends and inequalities in distance to and use of nearest natural space in the context of the 20-min neighbourhood: A 4-wave national repeat cross-sectional study, 2013 to 2019

The 20-min neighbourhood is a policy priority for governments worldwide; a key feature of this policy is providing access to natural space (NS) within 800 m of home. The study aims were to (1) examine the association between distance to nearest NS and frequent use over time and (2) examine whether frequent use and changes in use were patterned by income and housing tenure over time. Bi-annual Scottish Household Survey data were obtained for 2013 to 2019 (n:42128 aged 16+). Adults were asked the walking distance to their nearest NS, the frequency of visits to this space and their housing tenure, as well as age, sex and income. We examined the association between distance from home of nearest NS, housing tenure, and the likelihood of frequent NS use (visited once a week or more). Two-way interaction terms were further applied to explore variation in the association between tenure and frequent NS use over time. We found that 87% of respondents lived within 10 min walk of a NS, meeting the policy specification for a 20-min neighbourhood. Greater proximity to NS was associated with increased use; individuals living a 6-10 min walk and over 10 min walk were respectively 53% and 78% less likely to report frequent NS use than those living within a 5 min walk. Housing tenure was an important predictor of frequent NS use; private renters and homeowners were more likely to report frequent NS use than social renters. Our findings provide evidence that proximity to NS is a strong predictor of frequent use. Our study provides important evidence that time-based access measures alone do not consider deep-rooted socioeconomic variation in use of NS. Policy makers should ensure a nuanced lens is applied to operationalising and monitoring the 20-min neighbourhood to safeguard against exacerbating existing inequalities.

Nature's contributions in coping with a pandemic in the 21st century: A narrative review of evidence during COVID-19

While COVID-19 lockdowns have slowed coronavirus transmission, such structural measures also have unintended consequences on mental and physical health. Growing evidence shows that exposure to the natural environment (e.g., blue-green spaces) can improve human health and wellbeing. In this narrative review, we synthesized the evidence about nature's contributions to health and wellbeing during the first two years of the COVID-19 pandemic. We found that during the pandemic, people experienced multiple types of nature, including both outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public parks) depended on lockdown severity and socio-cultural contexts. Other forms of nature exposure, such as spending time in private gardens and viewing outdoor greenery from windows, may have increased. The majority of the evidence suggests nature exposure during COVID-19 pandemic was associated with less depression, anxiety, stress, and more happiness and life satisfaction. Additionally, nature exposure was correlated with less physical inactivity and fewer sleep disturbances. Evidence was mixed regarding associations between nature exposure and COVID-related health outcomes, while nature visits might be associated with greater rates of COVID-19 transmission and mortality when proper social distancing measures were not maintained. Findings on whether nature exposure during lockdowns helped ameliorate health inequities by impacting the health of lower-socioeconomic populations more than their higher-socioeconomic counterparts for example were mixed. Based on these findings, we argue that nature exposure may have buffered the negative mental and behavioral impacts of lockdowns during the COVID-19 pandemic. Recovery and resilience during the current crises and future public health crises might be improved with nature-based infrastructure, interventions, designs, and governance.

Human Flow Dataset Reveals Changes in Citizens’ Outing Behaviors including Greenspace Visits before and during the First Wave of the COVID-19 Pandemic in Kanazawa, Japan

Greenspaces, including parks, provide various socio-ecological benefits such as for aesthetics, temperature remediation, biodiversity conservation, and outdoor recreation. The health benefits of urban greenspaces have received particular attention since the onset of the COVID-19 pandemic, which has triggered various movement restrictions and lifestyle changes, including regarding the frequency of people’s visits to greenspaces. Using mobile-tracking GPS data of Kanazawa citizens, we explored how citizens’ behaviors with respect to outings changed before and during Japan’s declaration of a COVID-19 state of emergency (April–May 2020). We also examined citizens’ greenspace visits in relation to their travel distance from home. We found that Kanazawa citizens avoided going out during the pandemic, with a decrease in the number, time, and distance of outings. As for the means of transportation, the percentage of outings by foot increased on both weekdays and holidays. While citizens refrained from going out, the percentage change of the percentage in large greenspace visits increased very slightly in 2020. As for greenspace visitation in 2020 compared to 2019, we found that citizens generally visited greenspaces closer to their homes, actually increasing visitation of nearby (within 1000 m) greenspaces. This study of how outing behaviors and greenspace use by Kanazawa citizens have changed underscores the value of nearby greenspaces for physical and mental health during movement restrictions under the pandemic.

Exploring Biodiversity and Disturbances in the of Peri-Urban Forests of Thessaloniki, Greece

Forests host important plant biodiversity. Nevertheless, due to climate change and human disturbances, the floristic quality of forest ecosystems is degraded. Greek peri-urban forests biodiversity is threatened by anthropogenic activities such as forest fragmentation, pollution, garbage, etc. Measurement of biodiversity status and the floristic quality assessment can be used to estimate the degree of forest degradation caused by anthropogenic disturbances. In this study, we compared and evaluated six forest ecosystem types in the peri-urban forests of Thessaloniki, northern Greece, by using Shannon’s biodiversity index as well as and α and β diversity Sørensen indices. Furthermore, we recorded the prevailing anthropogenic disturbances and compared the plant families and the ruderal species appearing in each forest ecosystem. Finally, the average conservatism value (C value) of the plant species found in each ecosystem was determined in order to calculate the ecosystem floristic quality index. Analysis of the results showed that the floristic and ecological parameters tested greatly vary among ecosystems. Broadleaf forests of higher altitude hosted the greatest biodiversity, and the higher floristic quality index and plant conservation value. On the contrary, most disturbances and most ruderal species were recorded in ecosystems of lower altitude, adjacent to the city (Pinus brutia forest and Maqui vegetation), the least disturbed ecosystems were found in the steep slopes (Castanea sativa forest). Most ruderal species found belonged to the Asteraceae and Rosaceae families. Accessibility and attractiveness of stands were positively correlated with disturbances. Insufficient management, lack of protection measures, and littering removal contribute to the increase in the level of disturbance.

A correlational analysis of COVID-19 incidence and mortality and urban determinants of vitamin D status across the London boroughs

One of the biggest challenges of the COVID-19 pandemic is the heterogeneity in disease severity exhibited amongst patients. Among multiple factors, latest studies suggest vitamin D deficiency and pre-existing health conditions to be major contributors to death from COVID-19. It is known that certain urban form attributes can impact sun exposure and vitamin D synthesis. Also, long-term exposure to air pollution can play an independent role in vitamin D deficiency. We conducted a correlational analysis of urban form and air quality in relation to the demographics and COVID-19 incidence and mortality across 32 London boroughs between March 2020 and January 2021. We found total population, number of residents of Asian ethnicity, 4-year average PM₁₀ levels and road length to be positively correlated with COVID-19 cases and deaths. We also found percentage of households with access to total open space to be negatively correlated with COVID-19 deaths. Our findings link COVID-19 incidence and mortality across London with environmental variables linked to vitamin D status. Our study is entirely based on publicly available data and provides a reference framework for further research as more data are gathered and the syndemic dimension of COVID-19 becomes increasingly relevant in connection to health inequalities within large urban areas.

Has the Pandemic Altered Public Perception of How Local Green Spaces Affect Quality of Life in the United Kingdom?

Green spaces unquestionably improve both physical and mental health, but there is little information on how they affect quality of life. This study investigates whether the public perception of how local green spaces and their impact on quality of life have altered as a result of restrictions imposed by the U.K.’s SARS-CoV-2 pandemic containment strategy. Qualitative data were collected using an online questionnaire distributed via social media platforms and postal flyers. The results clearly demonstrate that 90% of participants believe that green spaces improved their quality of life during the pandemic, with over 85% thinking that green spaces will continue to have a positive impact on their quality of life once the pandemic is over. Whether this is a permanent change in public thinking or a short-term adaptation to the stresses of the pandemic can be assessed in future research studies. More detailed research is required to understand more clearly the aspects and types of green spaces that are the most valuable for improving quality of life so that future ones can be designed to provide maximum benefits.

Perceived Qualities, Visitation and Felt Benefits of Preferred Nature Spaces during the COVID-19 Pandemic in Australia: A Nationally-Representative Cross-Sectional Study of 2940 Adults

We investigated how the perceived quality of natural spaces influenced levels of visitation and felt benefits during the COVID-19 pandemic in Australia via a nationally representative online and telephone survey conducted on 12–26 October (Social Research Centre’s Life in AustraliaTM panel aged > 18 years, 78.8% response, n = 3043). Our sample was restricted to those with complete information (n = 2940). Likert scale responses to 18 statements regarding the quality of local natural spaces that participants preferred to visit were classified into eight quality domains: access; aesthetics; amenities; facilities; incivilities; potential usage; safety; and social. These domains were then summed into an overall nature quality score (mean = 5.8, range = 0–16). Associations between these quality variables and a range of nature visitation and felt benefits were tested using weighted multilevel models, adjusted for demographic and socioeconomic confounders. Compared with participants in the lowest perceived nature quality quintile, those in the highest quality quintile had higher odds of spending at least 2 h in their preferred local nature space in the past week (Odds Ratio [OR] = 3.40; 95% Confidence Interval [95%CI] = 2.38–4.86), of visiting their preferred nature space almost every day in the past four weeks (OR = 3.90; 2.77–5.47), and of reporting increased levels of nature visitation in comparison with before the COVID-19 pandemic (OR = 3.90; 2.54–6.00). Participants in the highest versus lowest perceived nature quality quintile also reported higher odds of feeling their visits to nature enabled them to take solace and respite during the pandemic (OR = 9.49; 6.73–13.39), to keep connected with their communities (OR = 5.30; 3.46–8.11), and to exercise more often than they did before the pandemic (OR = 3.88; 2.57–5.86). Further analyses of each quality domain indicated time in and frequency of visiting nature spaces were most affected by potential usage and safety (time in nature was also influenced by the level of amenity). Feelings of connection and solace were most affected by potential usage and social domains. Exercise was most influenced by potential usage, social and access domains. In conclusion, evidence reported in this study indicates that visits to nature and various health-related benefits associated with it during the COVID-19 pandemic were highly contingent upon numerous qualities of green and blue spaces.

Living with the aftermaths of a stroke in the era of the COVID-19 pandemic; the significance of home and close surroundings

Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61–91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities–strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.

Outdoor Activities Associated with Lower Odds of SARS-CoV-2 Acquisition: A Case-Control Study

Access to recreational physical activities, particularly in outdoor spaces, has been a crucial outlet for physical and mental health during the COVID-19 pandemic. There is a need to understand how conducting these activities modulates the risk of SARS-CoV-2 infection. In this case–control study of unvaccinated individuals conducted in San Francisco, California, the odds of testing positive to SARS-CoV-2 were lower for those who conducted physical activity in outdoor locations (adjusted odds ratio [aOR]: 0.16, 95% confidence interval [CI]: 0.05, 0.40) in the two weeks prior to testing than for those who conducted no activity or indoor physical activity only. Individuals who visited outdoor parks, beaches, or playgrounds also had lower odds of testing positive to SARS-CoV-2 (aOR: 0.28, 95% CI: 0.11, 0.68) as compared with those who did not visit outdoor parks, beaches, or playgrounds. These findings, albeit in an unvaccinated population, offer observational data to support pre-existing ecological studies that suggest that activity in outdoor spaces lowers COVID-19 risk.

Do we have enough recreational spaces during pandemics? An answer based on the analysis of individual mobility patterns in Switzerland

Densification of cities threatens the provision of public open space for people living in and around cities. The increasing evidence of the many benefits of recreational walking for physical and mental health during the COVID-19 pandemic has highlighted an urgent need for fostering the availability of public open space. In this context, urban planners need information to anticipate recreational needs and propose long-term, resilient solutions that consider the growing demand driven by increasing urban population and intensified in times of crisis such as the recent pandemic. In this paper, we harness the unique large MOBIS:COVID-19 GPS travel diary data on mobility behaviour collected during a normal baseline period and during the first wave of the Covid-19 pandemic in the Canton of Zurich Switzerland. We estimate a sufficiency rate that allows to geolocate locations where the demand for public open space is higher than the available offer. In a second step, we explore if preference patterns for recreational areas have changed during the pandemic. Results indicate that the main cities and important towns in the case study area are saturated by current demand, and that the pandemic has amplified the problem. In particular, urban dwellers look for tranquil areas to recreate. Such information is crucial to guide decision-making processes for planning the cities of the future.

Barriers Affecting Women’s Access to Urban Green Spaces during the COVID-19 Pandemic

During the COVID-19 pandemic, urban green spaces (UGS) have gained relevance as a resilience tool that can sustain or increase well-being and public health in cities. However, several cities in Latin America have seen a decrease in their UGS use rates during the health emergency, particularly among vulnerable groups such as women. Using Mexico City as a case study, this research examines the main barriers affecting women’s access to UGS during the COVID-19 pandemic in Latin America. We applied a sequential mixed-methods approach in which the results of a survey distributed via social media in June 2020 to women aged 18 and older were used to develop semi-structured interviews with 12 women during October 2020. One year later, in November 2021, the continuity of the themes was evaluated through focus groups with the same group of women who participated in the interviews. Our results suggest that (1) prohibiting access to some UGS during the first months of the pandemic negatively impacted UGS access for women in marginalized neighborhoods; (2) for women, the concept of UGS quality and safety are intertwined, including the security level of the surrounding streets; and (3) women who live in socially cohesive neighborhoods indicated using UGS to a greater extent. Our findings highlight that while design interventions can affect women’s willingness to use UGS by improving their perceived safety and comfort, they remain insufficient to fully achieve equity in access to UGS.

Green Space Visits and Barriers to Visiting during the COVID-19 Pandemic: A Three-Wave Nationally Representative Cross-Sectional Study of UK Adults

Green spaces have been found to promote physical activity, social contact, and mental wellbeing, however, there are inequalities in the use and experience of green spaces. The United Kingdom’s (UK) response to the COVID-19 pandemic imposed very substantial changes on its citizens’ lives which could plausibly affect their willingness to visit green spaces. These sudden lifestyle changes severely affected the population’s mental health, leading to a greater dependency on the positive influence of nature in reducing stress and improving mood. Whilst early cross-sectional evidence suggested an increased orientation to nature and visits to green spaces as a response to COVID-19 ‘lockdowns’, there is little longitudinal evidence about how sustained and equal these changes may have been. This study explored green space visits, barriers to visiting, and the inequalities of both of those over an entire year of the pandemic in the UK. Three waves of nationally representative cross-sectional surveys were administered by YouGov in April 2020, November 2020, and April 2021 (N = 6713). Data included reported visits to green spaces and, for those with no or infrequent visiting, perceived barriers including those plausibly related to the risk of COVID-19. Green space visits increased over the year as lockdown restrictions were relaxed; 68% of respondents reported green space visits in April 2021, compared with 49% in April 2020. However, the socio-economic inequalities in use were sustained and increased. COVID-19 related barriers fell over time, but there were indications of increased interest in green spaces among younger people. Further action is required to ensure that the positive impacts of green spaces are experienced equally, and that good quality green space is accessible to all.

Understanding the Role of Nature Engagement in Supporting Health and Wellbeing during COVID-19

The importance of natural environments in supporting health and wellbeing has been well evidenced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications.

Park Characteristics and Changes in Park Visitation before, during, and after COVID-19 Shelter-in-Place Order

The COVID-19 pandemic has limited people’s visitation to public places because of social distancing and shelter-in-place orders. According to Google’s community mobility reports, some countries showed a decrease in park visitation during the pandemic, while others showed an increase. Although government responses played a significant role in this variation, little is known about park visitation changes and the park attributes that are associated with these changes. Therefore, we aimed to examine the associations between park characteristics and percent changes in park visitation in Harris County, TX, for three time periods: before, during, and after the shelter-in-place order of Harris County. We utilized SafeGraph’s point-of-interest data to extract weekly park visitation counts for the Harris County area. This dataset included the size of each park and its weekly number of visits from 2 March to 31 May 2020. In addition, we measured park characteristics, including greenness density, using the normalized difference vegetation index; park type (mini, neighborhood, community, regional/metropolitan); presence of sidewalks and bikeways; sidewalk and bikeway quantity; and bikeway quality. Results showed that park visitation decreased after issuing the shelter-in-place order and increased after this order was lifted. Results from linear regression models indicated that the higher the greenness density of the park, the smaller the decrease in park visitation during the shelter-in-place period compared to before the shelter-in-place order. This relationship also appeared after the shelter-in-place order. The presence of more sidewalks was related to less visitation increase after the shelter-in-place order. These findings can guide planners and designers to implement parks that promote public visitation during pandemics and potentially benefit people’s physical and mental health.

Changes in Green Space Use During a COVID-19 Lockdown Are Associated With Both Individual and Green Space Characteristics

Mobility restrictions imposed during the COVID-19 pandemic present a useful study system for understanding the temporal and spatial patterns of green space use. Here, we examine green space characteristics and sociodemographic factors associated with change in frequency of green space use before and during a COVID-19 lockdown in Brisbane, Australia drawing on a survey of 372 individuals. Applying regression analysis, we found that individuals who visited a different green space during lockdown than before tended to decrease their frequency of visits. In contrast, individuals who continued visiting their usual green space during lockdown were more inclined to increase their number of visits. Changes in frequency of green space use were also associated with particular characteristics of their usually visited green space. The presence of blue spaces and accessibility (carparks/public transport) were associated with increased frequency of use while foliage height diversity was associated with reduced frequency of use. We found that females were more likely to change their green space visitation frequency during COVID-19 compared to men and they also reported greater importance of green spaces for social and family interactions and spiritual reasons during COVID-19 compared to before. Males showed greater increases than females in the importance of green space for nature interactions and mental health benefits during the COVID-19 lockdown compared to before. Our results provide key insights for future resilient urban planning and policy that can fulfil a wide range of physical and psychological needs during a time of crisis and beyond.

From Childhood Residential Green space to Adult Mental Wellbeing: A Pathway Analysis among Chinese Adults

Residential green spaces, arguably the most accessible type of urban green space, may have lasting impacts on children and even change their lives later in adulthood. However, the potential pathways from childhood residential green space to adulthood mental wellbeing are not well understood. Therefore, we conducted a questionnaire survey among Chinese adults (N = 770) in September 2021 to capture data on subjective measures of residential green space and nature contact during childhood, and nature connectedness, nature contact, and mental wellbeing during adulthood. Structural equation modeling (SEM) was employed to examine theoretical pathways between childhood residential green space and adult mental wellbeing. The results suggest that childhood residential green space positively predicts childhood nature contact and also has direct and indirect positive impacts on nature contact, nature connectedness, and mental wellbeing during adulthood. These findings advance understanding of the long-term impacts of childhood residential green space. Policymakers are advised to prioritize residential greening as well as other recreational facilities for children when planning health-promoting environments in urban spaces. Due to limitations in our study design, we also advise future studies to re-examine and extend the framework documented here.

Greenspace and park use associated with less emotional distress among college students in the United States during the COVID-19 pandemic

The COVID-19 pandemic has negatively affected many people's psychological health. Impacts may be particularly severe among socially vulnerable populations such as college students, a group predisposed to mental health problems. Outdoor recreation and visits to greenspaces such as parks offer promising pathways for addressing the mental health challenges associated with COVID-19. During the early stages of the pandemic (March-May 2020), we surveyed 1280 college students at four large public universities across the United States (U.S.) to assess how, and why, outdoor recreation and park use changed since the emergence of COVID-19. We also measured students' self-reported levels of emotional distress (a proxy for psychological health) and assessed potential demographic and contextual correlates of distress, including county-level per capita park area and greenness, using generalized linear models. We found that 67% of students reported limiting outdoor activities and 54% reported reducing park use during the pandemic. Students who reduced their use of outdoor spaces cited structural reasons (e.g., lockdowns), concerns about viral transmission, and negative emotions that obstructed active lifestyles. Students who maintained pre-pandemic park use levels expressed a desire to be outdoors in nature, often with the explicit goal of improving mental and physical health. Emotional distress among students was widespread. Models showed higher levels of emotional distress were associated with reducing park use during the pandemic and residing in counties with a smaller area of parks per capita. This study of U.S. college students supports the value of park-based recreation as a health promotion strategy for diverse populations of young adults during a time of crisis.

Travel changes and equitable access to urban parks in the post COVID-19 pandemic period: Evidence from Wuhan, China

COVID-19 has spread worldwide, leading to a significant impact on daily life. Numerous studies have confirmed that people have changed their travel to urban green spaces during the COVID-19 pandemic. However, in China, where COVID-19 has been effectively controlled, how the travel behavior of visitors to urban parks has changed under different risk levels (RLs) of COVID-19 is unclear. Faced with these gaps, we took a highly developed city, Wuhan, as a case study and a questionnaire survey was conducted with 3276 respondents to analyze the changes in park visitors' travel behaviors under different COVID-19 RLs. Using a stated preference (SP) survey method, four RLs were assigned: new cases in other provinces (RL1), Hubei province (RL2), Wuhan (RL3), and in the district of the park (RL4). The results indicated that visitors reduced their willingness to visit urban parks, with 78.39%, 37.97%, and 13.34% of visitors remaining under RL2, RL3, and RL4, respectively. Furthermore, the service radius of urban parks also shrank from 4230 m under no new cases of COVID-19 to approximately 3000 m under RL3. A higher impact was found for visitors using public transport, those with a higher income and higher education, and female visitors. Based on the modified travel behaviors, the Gaussian-based two-step floating catchment area (2SFCA) method was used to evaluate the accessibility and the Gini coefficient was calculated to represent the equality of the urban parks. A higher RL led to lower accessibility and greater inequitable access. The results should help the government guide residents' travel behaviors after COVID-19.

Osteoarthritis year in review 2021: epidemiology & therapy

This "Year in review" presents a selection of research themes and individual studies from the clinical osteoarthritis (OA) field (epidemiology and therapy) and includes noteworthy descriptive, analytical-observational, and intervention studies. The electronic database search for the review was conducted in Medline, Embase and medRxiv (15th April 2020 to 1st April 2021). Following study screening, the following OA-related themes emerged: COVID-19; disease burden; occupational risk; prediction models; cartilage loss and pain; stem cell treatments; novel pharmacotherapy trials; therapy for less well researched OA phenotypes; benefits and challenges of Individual Participant Data (IPD) meta-analyses; patient choice-balancing benefits and harms; OA and comorbidity; and inequalities in OA. Headline study findings included: a longitudinal cohort study demonstrating no evidence for a harmful effect of non-steroidal anti-inflammatory drugs (NSAIDs) in terms of COVID-19 related deaths; a Global Burden of Disease study reporting a 102% increase in crude incidence rate of OA in 2017 compared to 1990; a longitudinal study reporting cartilage thickness loss was associated with only a very small degree of worsening in pain over 2 years; an exploratory analysis of a non-OA randomised controlled trial (RCT) finding reduced risk of total joint replacement with an Interleukin -1β inhibitor (canakinumab); a significant relationship between cumulative disadvantage and clinical outcomes of pain and depression mediated by perceived discrimination in a secondary analysis from a RCT; worsening socioeconomic circumstances were associated with future arthritis diagnosis in an innovative natural experiment (with implications for unique research possibilities arising from the COVID-19 pandemic context).

Spatial statistical analysis of the relationship between self-reported mental health during the COVID-19 lockdown and closeness to green infrastructure

The COVID-19 pandemic has produced alterations in the behaviour and psychological health of people, who have had to learn living under uncertain circumstances escaping their control. This situation has been aggravated in those countries applying strict home confinement rules to try bending their epidemic curve. This is the case of Spain, where the stringent lockdown period was extended over three months. This study aimed at proving a research hypothesis whereby living close to Green Infrastructure (GI) during the confinement period was beneficial for mental health. To this end, La Palma (Canary Islands) and Zaragoza (Peninsular Spain) were taken as case studies, since both locations distributed a questionnaire to address citizenry's self-reported mental health under strict lockdown conditions. A spatial statistical analysis of the responses collected by these questionnaires revealed that variables such as stress, anger, medication use, alcohol consumption or visits to the doctor significantly decreased if citizens were close to GI, whereas people having very high expectations of enjoying the city after the confinement were positively correlated to proximity of green areas. Although these outcomes are limited by the inferential capacity of correlation analysis, they point out to a sense of relief derived from having visual contact with vegetated landscapes and feeling stimulated about using them for recreation, aesthetical or sporting purposes. The joint consideration of these psychological gains with the social and environmental benefits provided by GI emphasizes the importance of approaching urban regeneration through the design and implementation of interconnected green spaces.

A process approach to the open green space system planning

Open green spaces have significant contributions to the city, urban residents and ecosystem. However, these contributions could not be fully reflected on the urban space due to rapid urbanization. Furthermore, studies on this reflection have focused only on a specific function of open green spaces without a holistic approach. Also, there is no common framework for the definition, classification and standardization of open green spaces or a comprehensive analysis of these domains. The present study aimed to propose a guideline that included five criteria to serve as a baseline to plan open green space systems. In the study, open green spaces and the city were considered as a subsystem of the landscape. Thus, open green space objectives and strategies were proposed based on the landscape functions, urban character and urbanization level (urban density). Furthermore, the study reconsidered the definition and classification of open green spaces and recommended standards. These standards were categorized in two groups based on recreational standards and natural disasters. Thus, the open green spaces were analyzed based on qualitative, quantitative, connectivity and location selection criteria with a holistic approach and a multi-dimensional framework was developed based on ecological, recreational and disaster criteria.

COVID-19 Changed Human-Nature Interactions across Green Space Types: Evidence of Change in Multiple Types of Activities from the West Bank, Palestine

COVID-19 stay-at-home orders impacted the way humans interacted with built and natural environments. Previous research on the human use of green spaces during the pandemic, largely conducted in a Western context, has found increased use of home gardens and urban green spaces, and decreased visitation to conservation areas. We explored changes in residents’ outdoor nature-associated activities during the pandemic in the West Bank, Palestine. We used a web-based survey to ask residents about their passive, interactive, and extractive outdoor activities that take place in home gardens, urban parks, and natural areas. Overall, our 1278 respondents spent less time with family and friends and more time alone. We found differences in respondent’s participation in activities both between green space types and between activity types. Participation in passive appreciation of nature activities increased for home gardens but decreased in urban parks and natural areas. Interactive activities, including cultivation, increased for all areas, while extractive activities stayed the same or decreased. Only in natural areas did respondents’ demographics explain changes in activity participation rates after the pandemic. Residents’ increased time alone raises concerns about mental health. The differences we observed in activity participation across green space types highlights the importance of looking across different types of natural spaces and different activities in the same setting, as well as examining non-Western settings.