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Vilcins D, Sly PD, Scarth P, Mavoa S. Green space in health research: an overview of common indicators of greenness. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:221-231. [PMID: 36372560 DOI: 10.1515/reveh-2022-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
Human environments influence human health in both positive and negative ways. Green space is considered an environmental exposure that confers benefits to human health and has attracted a high level of interest from researchers, policy makers, and increasingly clinicians. Green space has been associated with a range of health benefits, such as improvements in physical, mental, and social wellbeing. There are different sources, metrics and indicators of green space used in research, all of which measure different aspects of the environment. It is important that readers of green space research understand the terminology used in this field, and what the green space indicators used in the studies represent in the real world. This paper provides an overview of the major definitions of green space and the indicators used to assess exposure for health practitioners, public health researchers, and health policy experts who may be interested in understanding this field more clearly, either in the provision of public health-promoting services or to undertake research.
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Affiliation(s)
- Dwan Vilcins
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
| | - Peter Scarth
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Suzanne Mavoa
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Moreira TCL, Polizel JL, Réquia WJ, Saldiva PHN, Silva Filho DFD, Saldiva SRDM, Mauad T. Effects of land cover and air pollution on the risk of preterm births. Rev Saude Publica 2024; 58:08. [PMID: 38477779 PMCID: PMC10926984 DOI: 10.11606/s1518-8787.2024058005504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/25/2024] [Accepted: 07/28/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level. METHODS The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations. RESULTS The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births. CONCLUSIONS The results of this study show that greener areas are less associated with preterm births when compared with less green areas.
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Affiliation(s)
- Tiana C L Moreira
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Patologia. São Paulo, SP, Brazil
| | - Jefferson L Polizel
- Escola Superior de Agricultura "Luiz de Queiroz". Departamento de Ciências Florestais. Piracicaba, SP, Brazil
| | - Weeberb J Réquia
- Fundação Getúlio Vargas. Escola de Políticas Públicas e Governo. Brasília, DF, Brazil
| | | | - Demostenes F da Silva Filho
- Escola Superior de Agricultura "Luiz de Queiroz". Departamento de Ciências Florestais. Piracicaba, SP, Brazil
| | | | - Thais Mauad
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Patologia. São Paulo, SP, Brazil
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Arodudu O, Foley R, Taghikhah F, Brennan M, Mills G, Ningal T. A health data led approach for assessing potential health benefits of green and blue spaces: Lessons from an Irish case study. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 345:118758. [PMID: 37690253 DOI: 10.1016/j.jenvman.2023.118758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023]
Abstract
Research producing evidence-based information on the health benefits of green and blue spaces often has within its design, the potential for inherent or implicit bias which can unconsciously orient the outcomes of such studies towards preconceived hypothesis. Many studies are situated in proximity to specific or generic green and blue spaces (hence, constituting a green or blue space led approach), others are conducted due to availability of green and blue space data (hence, applying a green or blue space data led approach), while other studies are shaped by particular interests in the association of particular health conditions with presence of, or engagements with green or blue spaces (hence, adopting a health or health status led approach). In order to tackle this bias and develop a more objective research design for studying associations between human health outcomes and green and blue spaces, this paper discussed the features of a methodological framework suitable for that purpose after an initial, year-long, exploratory Irish study. The innovative approach explored by this study (i.e., the health-data led approach) first identifies sample sites with good and poor health outcomes from available health data (using data clustering techniques) before examining the potential role of the presence of, or engagement with green and blue spaces in creating such health outcomes. By doing so, we argue that some of the bias associated with the other three listed methods can be reduced and even eliminated. Finally, we infer that the principles and paradigm adopted by the health data led approach can be applicable and effective in analyzing other sustainability problems beyond associations between human health outcomes and green and blue spaces (e.g., health, energy, food, income, environment and climate inequality and justice etc.). The possibility of this is also discussed within this paper.
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Affiliation(s)
- Oludunsin Arodudu
- Department of Sustainable Resources Management, State University of New York, College of Environmental Science and Forestry, Syracuse, NY, USA; Department of Geography, Rhetoric House, National University of Ireland Maynooth, Co. Kildare, Ireland.
| | - Ronan Foley
- Department of Geography, Rhetoric House, National University of Ireland Maynooth, Co. Kildare, Ireland.
| | - Firouzeh Taghikhah
- Dicipline of Business Analytics, The University of Sydney, Sydney, Australia.
| | - Michael Brennan
- Eastern and Midland Regional Assembly, 3rd Floor North, Ballymun Civic Centre, Main Street, Ballymun, Dublin 9, Ireland.
| | - Gerald Mills
- School of Geography, Newman Building, Belfield, University College Dublin, Ireland
| | - Tine Ningal
- School of Geography, Newman Building, Belfield, University College Dublin, Ireland.
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Geary RS, Thompson DA, Garrett JK, Mizen A, Rowney FM, Song J, White MP, Lovell R, Watkins A, Lyons RA, Williams S, Stratton G, Akbari A, Parker SC, Nieuwenhuijsen MJ, White J, Wheeler BW, Fry R, Tsimpida D, Rodgers SE. Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data. PUBLIC HEALTH RESEARCH 2023; 11:1-176. [PMID: 37929711 DOI: 10.3310/lqpt9410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited. Objectives To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use. Design A retrospective, dynamic longitudinal panel study. Setting Wales, UK. Participants An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces. Main outcome measures Common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale. Data sources Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank. Methods Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders. Results and conclusions Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower. Limitations Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets. Future work Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.
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Affiliation(s)
- Rebecca S Geary
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Joanne K Garrett
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Amy Mizen
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Francis M Rowney
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Jiao Song
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Alan Watkins
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Department of Health Data Science, Swansea University, Swansea, UK
| | | | | | - Ashley Akbari
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Sarah C Parker
- Department of Health Data Science, Swansea University, Swansea, UK
| | | | - James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, UK
| | - Richard Fry
- Department of Health Data Science, Swansea University, Swansea, UK
| | - Dialechti Tsimpida
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Sarah E Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Connolly R, Lipsitt J, Aboelata M, Yañez E, Bains J, Jerrett M. The association of green space, tree canopy and parks with life expectancy in neighborhoods of Los Angeles. ENVIRONMENT INTERNATIONAL 2023; 173:107785. [PMID: 36921560 DOI: 10.1016/j.envint.2023.107785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Substantial evidence suggests that access to urban green spaces and parks is associated with positive health outcomes, including decreased mortality. Few existing studies have investigated the association between green spaces and life expectancy (LE), and none have used small-area data in the U.S. Here we used the recently released U.S. Small-Area Life Expectancy Estimates Project data to quantify the relationship between LE and green space in Los Angeles County, a large diverse region with inequities in park access. We developed a model to quantify the association between green space and LE at the census tract level. We evaluated three green space metrics: normalized difference vegetation index (NDVI, 0.6-meter scale), percent tree canopy cover, and accessible park acres. We statistically adjusted for 15 other determinants of LE. We also developed conditional autoregressive models to account for spatial dependence. Tree canopy and NDVI were both significantly associated with higher LE. For an interquartile range (IQR) increase in each metric respectively, the spatial models demonstrated a 0.24 to 0.33-year increase in LE. Tree canopy and NDVI also modified the effect of park acreage on LE. ln areas with tree canopy levels below the county median, an IQR increase in park acreage was associated with an increase of 0.12 years. Although on an individual level these effects were modest, we predicted 155,300 years of LE gains across the population in LA County if all areas below median tree canopy were brought to the county median of park acres. If tree canopy or NDVI were brought to median levels, between 570,300 and 908,800 years of LE could be gained. The majority of potential gains are in areas with predominantly Hispanic/Latinx and Black populations. These findings suggest that equitable access to green spaces could result in substantial population health benefits.
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Affiliation(s)
- Rachel Connolly
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States
| | - Jonah Lipsitt
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States
| | - Manal Aboelata
- Prevention Institute, 4315 Leimert Blvd, Los Angeles, CA 90008, United States
| | - Elva Yañez
- Prevention Institute, 4315 Leimert Blvd, Los Angeles, CA 90008, United States
| | - Jasneet Bains
- Prevention Institute, 4315 Leimert Blvd, Los Angeles, CA 90008, United States
| | - Michael Jerrett
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States.
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Hu HY, Ma YH, Deng YT, Ou YN, Cheng W, Feng JF, Tan L, Yu JT. Residential greenness and risk of incident dementia: A prospective study of 375,342 participants. ENVIRONMENTAL RESEARCH 2023; 216:114703. [PMID: 36334822 DOI: 10.1016/j.envres.2022.114703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Incorporation of greenspace may be a novel environmental policy that might result in positive health effects; hence, this study aimed to investigate the association between residential greenness and dementia incidence. The effects of particulate air pollution on mediating dementia were also determined. METHODS A prospective cohort study involving 375,342 UK biobank participants was conducted, in which Cox regression models were used to determine the association of greenspace exposure with the risks of all-cause dementia (ACD), Alzheimer's disease (AD) and vascular dementia (VD). Sociodemographic variables, lifestyle or dietary characteristics and apolipoprotein E4 status were controlled using two levels of adjusted models. Mediation analyses were performed to determine the mediation effects of PMs. RESULTS The results indicated that there were 4929 ACD, 2132 AD, and 1184 VD incidents throughout the 8-year study. In the multi-adjusted model, each interquartile increment in greenspace (buffer 300m) conferred the lower risks of ACD (HR = 0.968, 95% confidence intervals [CI]: 0.938-1.000]) and VD (HR = 0.926, 95% CI: 0.867-0.989). The fourth greenspace quartile conferred also reduced risks of ACD (HR = 0.891, 95% CI: 0.804-0.989) and VD (HR = 0.778, 95% CI: 0.630-0.960) in reference to the first quartile. With regard to 1000m catchment, each interquartile increment conferred a 5.0% (95% CI: 1.8-8.1) lower risk of ACD, and the fourth greenspace quartile conferred a 10.9% (95% CI: 0.9-19.8) lower risk of ACD compared to the first quartile. The protective effect of greenness might be mediated based on the reduction of PM2.5 and PM10 (Pindirect effect<0.05). CONCLUSIONS Increasing greenness reduces the risk of dementia. This study suggests that greenspace is an environmental strategy that helps prevent dementia.
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Affiliation(s)
- He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Yue-Ting Deng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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Nejade RM, Grace D, Bowman LR. What is the impact of nature on human health? A scoping review of the literature. J Glob Health 2022; 12:04099. [PMID: 36520498 PMCID: PMC9754067 DOI: 10.7189/jogh.12.04099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The burden of non-communicable diseases (including poor mental health) is increasing, and some practitioners are turning to nature to provide the solution. Nature-based interventions (NBIs) could offer cost-effective solutions by reconnecting individuals with nature, but the success of these interventions depends partially on the way in which people engage with blue and green spaces. Methods We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Cochrane guidelines to establish the evidence base for treating poor mental and physical health with NBIs. We searched five databases and the grey literature. Exposure was the active engagement with natural environments. The primary outcome was mental health and the secondary outcome was physical health defined using established metrics. All data were extracted to a charting table and reported as a narrative synthesis. Results 952 studies were identified, of which 39 met the inclusion criteria. 92% demonstrated consistent improvements across any health outcome where individuals engaged with natural outdoor environments. Mental health outcomes improved across 98% of studies while physical and cognitive health outcomes showed improvement across 83% and 75% of studies respectively. Additionally, we identified 153 factors affecting engagement with nature, 78% of which facilitated engagement compared with 22% that reduced engagement. Aspects such as the sense of wilderness, accessibility, opportunities for physical activity and the absence of noise/ air pollution all increased engagement. Conclusions Further research (accompanied by a global improvement in study design) is needed to establish the magnitude and relative effect of nature-based interventions, and to quantify the compounding effect of factors that improve engagement with green and blue spaces. Nevertheless, this review has documented the increasing body of evidence in support of NBIs as effective tools to improve mental, physical, and cognitive health outcomes, and highlighted key factors that improve engagement with the natural world. Registration Open Science Framework: https://doi.org/10.17605/OSF.IO/8J5Q3.
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Affiliation(s)
- Rachel M Nejade
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Daniel Grace
- Abertawe Bro Morgannwg University Health Board, NHS Wales, Swansea, UK
| | - Leigh R Bowman
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Astell-Burt T, Hartig T, Putra IGNE, Walsan R, Dendup T, Feng X. Green space and loneliness: A systematic review with theoretical and methodological guidance for future research. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 847:157521. [PMID: 35878853 DOI: 10.1016/j.scitotenv.2022.157521] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Persistent loneliness troubles people across the life span, with prevalence as high as 61 % in some groups. Urban greening may help to reduce the population health impacts of loneliness and its concomitants, such as hopelessness and despair. However, the literature lacks both a critical appraisal of extant evidence and a conceptual model to explain how green space would work as a structural intervention. Both are needed to guide decision making and further research. We conducted a systematic review of quantitative studies testing associations between green space and loneliness, searching seven databases. Twenty two studies were identified by 25/01/2022. Most of the studies were conducted in high-income countries and fifteen (68 %) had cross-sectional designs. Green space was measured inconsistently using either objective or subjective indicators. Few studies examined specific green space types or qualities. The majority of studies measured general loneliness (e.g. using the UCLA loneliness scale). Different types of loneliness (social, emotional, existential) were not analysed. Of 132 associations, 88 (66.6 %) indicated potential protection from green space against loneliness, with 44 (33.3 %) reaching statistical significance (p < 0.05). We integrated these findings with evidence from qualitative studies to elaborate and extend the existing pathway domain model linking green space and health. These elaborations and extensions acknowledge the following: (a) different types of green space have implications for different types of loneliness; (b) multilevel circumstances influence the likelihood a person will benefit or suffer harm from green space; (c) personal, relational, and collective processes operate within different domains of pathways linking green space with loneliness and its concomitants; (d) loneliness and its concomitants are explicitly positioned as mediators within the broader causal system that links green space with health and wellbeing. This review and model provide guidance for decision making and further epidemiological research on green space and loneliness.
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Affiliation(s)
- Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, Australia.
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Sweden; Department of Psychology, Uppsala University, Sweden
| | - I Gusti Ngurah Edi Putra
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Ramya Walsan
- Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tashi Dendup
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; Save the Children, Bhutan Office, Thimphu, Bhutan
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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Hunter RF, Rodgers SE, Hilton J, Clarke M, Garcia L, Ward Thompson C, Geary R, Green MA, O'Neill C, Longo A, Lovell R, Nurse A, Wheeler BW, Clement S, Porroche-Escudero A, Mitchell R, Barr B, Barry J, Bell S, Bryan D, Buchan I, Butters O, Clemens T, Clewley N, Corcoran R, Elliott L, Ellis G, Guell C, Jurek-Loughrey A, Kee F, Maguire A, Maskell S, Murtagh B, Smith G, Taylor T, Jepson R. GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative. Wellcome Open Res 2022; 7:237. [PMID: 36865374 PMCID: PMC9971655 DOI: 10.12688/wellcomeopenres.18175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.
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Affiliation(s)
- Ruth F. Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK,
| | - Sarah E. Rodgers
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK,
| | - Jeremy Hilton
- School of Defence and Security, Cranfield University, Bedfordshire, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Rebecca Geary
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Mark A. Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alberto Longo
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Alex Nurse
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Benedict W. Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Sarah Clement
- Department of Geography and Planning, University of Western Australia, Perth, Australia
| | | | - Rich Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ben Barr
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - John Barry
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Sarah Bell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Dominic Bryan
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Iain Buchan
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Olly Butters
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Tom Clemens
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Natalie Clewley
- School of Defence and Security, Cranfield University, Bedfordshire, UK
| | - Rhiannon Corcoran
- Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Lewis Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Geraint Ellis
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Anna Jurek-Loughrey
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Simon Maskell
- Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Brendan Murtagh
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Grahame Smith
- Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Timothy Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), University of Edinburgh, Edinburgh, UK,
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10
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Bereziartua A, Chen J, de Hoogh K, Rodopoulou S, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Arthur Hvidtfeldt U, Verschuren WMM, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Hjertager Krog N, Brynedal B, Leander K, Liu S, Ljungman P, Faure E, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rizzuto D, Samoli E, van der Schouw YT, Schramm S, Severi G, Stafoggia M, Strak M, Sørensen M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G. Exposure to surrounding greenness and natural-cause and cause-specific mortality in the ELAPSE pooled cohort. ENVIRONMENT INTERNATIONAL 2022; 166:107341. [PMID: 35717714 DOI: 10.1016/j.envint.2022.107341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/28/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The majority of studies have shown higher greenness exposure associated with reduced mortality risks, but few controlled for spatially correlated air pollution and traffic noise exposures. We aim to address this research gap in the ELAPSE pooled cohort. METHODS Mean Normalized Difference Vegetation Index (NDVI) in a 300-m grid cell and 1-km radius were assigned to participants' baseline home addresses as a measure of surrounding greenness exposure. We used Cox proportional hazards models to estimate the association of NDVI exposure with natural-cause and cause-specific mortality, adjusting for a number of potential confounders including socioeconomic status and lifestyle factors at individual and area-levels. We further assessed the associations between greenness exposure and mortality after adjusting for fine particulate matter (PM2.5), nitrogen dioxide (NO2) and road traffic noise. RESULTS The pooled study population comprised 327,388 individuals who experienced 47,179 natural-cause deaths during 6,374,370 person-years of follow-up. The mean NDVI in the pooled cohort was 0.33 (SD 0.1) and 0.34 (SD 0.1) in the 300-m grid and 1-km buffer. In the main fully adjusted model, 0.1 unit increment of NDVI inside 300-m grid was associated with 5% lower risk of natural-cause mortality (Hazard Ratio (HR) 0.95 (95% CI: 0.94, 0.96)). The associations attenuated after adjustment for air pollution [HR (95% CI): 0.97 (0.96, 0.98) adjusted for PM2.5; 0.98 (0.96, 0.99) adjusted for NO2]. Additional adjustment for traffic noise hardly affected the associations. Consistent results were observed for NDVI within 1-km buffer. After adjustment for air pollution, NDVI was inversely associated with diabetes, respiratory and lung cancer mortality, yet with wider 95% confidence intervals. No association with cardiovascular mortality was found. CONCLUSIONS We found a significant inverse association between surrounding greenness and natural-cause mortality, which remained after adjusting for spatially correlated air pollution and traffic noise.
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Affiliation(s)
- Ainhoa Bereziartua
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Center for Climate Change, Aarhus University, Denmark.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
| | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Norun Hjertager Krog
- Section of Air Pollution and Noise, Norwegian Institute of Public Health, Norway.
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Diet, Genes and Environment (DGE), Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
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11
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Vidal C, Lyman C, Brown G, Hynson B. Reclaiming public spaces: The case for the built environment as a restorative tool in neighborhoods with high levels of community violence. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2399-2410. [PMID: 34990030 DOI: 10.1002/jcop.22783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Early-life exposure to neighborhood violence can negatively affect children's socioemotional development and long-term health outcomes. Community-level interventions that modify the built environment to facilitate social encounters can have a positive impact on health. An example of such interventions is the building of green spaces and playgrounds. This case study describes collaboration among residents, local organizations, and a university that aimed to increase the utilization of a vacant lot by converting it into a green space with a playground. Informal conversations at volunteer gatherings and neighborhood association meetings indicated a positive impact of this project in the community. We propose a model for future program implementation and research to improve health in disinvested and disordered communities. We conclude that more research is needed on community partnerships that modify the built environment to decrease community violence. Community-based participatory research may be successful in evaluating future projects with this goal.
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Affiliation(s)
- Carol Vidal
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Gwen Brown
- Baltimoreans United in Leadership Development (BUILD), Baltimore, Maryland, USA
| | - Briony Hynson
- Neighborhood Design Center (NDC), Baltimore, Maryland, USA
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12
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Chi D, Aerts R, Van Nieuwenhuyse A, Bauwelinck M, Demoury C, Plusquin M, Nawrot TS, Casas L, Somers B. Residential Exposure to Urban Trees and Medication Sales for Mood Disorders and Cardiovascular Disease in Brussels, Belgium: An Ecological Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:57003. [PMID: 35543508 PMCID: PMC9093162 DOI: 10.1289/ehp9924] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND The available evidence for positive associations between urban trees and human health is mixed, partly because the assessment of exposure to trees is often imprecise because of, for instance, exclusion of trees in private areas and the lack of three-dimensional (3D) exposure indicators (e.g., crown volume). OBJECTIVES We aimed to quantify all trees and relevant 3D structural traits in Brussels (Belgium) and to investigate associations between the number of trees, tree traits, and sales of medication commonly prescribed for mood disorders and cardiovascular disease. METHODS We developed a workflow to automatically isolate all individual trees from airborne light detection and ranging (LiDAR) data collected in 2012. Trait data were subsequently extracted for 309,757 trees in 604 census tracts. We used the average annual age-standardized rate of medication sales in Brussels for the period 2006 to 2014, calculated from reimbursement information on medication prescribed to adults (19-64 years of age). The medication sales data were provided by sex at the census tract level. Generalized log-linear models were used to investigate associations between the number of trees, the crown volume, tree structural variation, and medication sales. Models were run separately for mood disorder and cardiovascular medication and for men and women. All models were adjusted for indicators of area-level socioeconomic status. RESULTS Single-factor models showed that higher stem densities and higher crown volumes are both associated with lower medication sales, but opposing associations emerged in multifactor models. Higher crown volume [an increase by one interquartile range (IQR) of 1.4×104 m³/ha] was associated with 34% lower mood disorder medication sales [women, β=-0.341 (95% CI: -0.379, -0.303); men, β=-0.340 (95% CI: -0.378, -0.303)] and with 21-25% lower cardiovascular medication sales [women, β=-0.214 (95% CI: -0.246, -0.182); men, β=-0.252 (95% CI: -0.285, -0.219)]. Conversely, a higher stem density (an increase by one IQR of 21.8 trees/ha) was associated with 28-32% higher mood disorder medication sales [women, β=0.322 (95% CI: 0.284, 0.361); men, β=0.281 (95% CI: 0.243, 0.319)] and with 20-24% higher cardiovascular medication sales [women, β=0.202 (95% CI: 0.169, 0.236); men, β=0.240 (95% CI: 0.206, 0.273)]. DISCUSSION We found a trade-off between the number of trees and the crown volumes of those trees for human health benefits in an urban environment. Our results demonstrate that conserving large trees in urban environments may not only support conservation of biodiversity but also human health. https://doi.org/10.1289/EHP9924.
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Affiliation(s)
- Dengkai Chi
- Division of Forest, Nature and Landscape, University of Leuven (KU Leuven), Leuven, Belgium
- KU Leuven Plant Institute, KU Leuven, Leuven, Belgium
- KU Leuven Urban Studies Institute, KU Leuven, Leuven, Belgium
| | - Raf Aerts
- KU Leuven Plant Institute, KU Leuven, Leuven, Belgium
- Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Brussels, Belgium
- Division of Ecology, Evolution and Biodiversity Conservation, KU Leuven, Leuven, Belgium
- Center for Environmental Sciences, University of Hasselt, Hasselt, Belgium
| | - An Van Nieuwenhuyse
- Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Brussels, Belgium
- Center for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Claire Demoury
- Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Brussels, Belgium
| | - Michelle Plusquin
- Center for Environmental Sciences, University of Hasselt, Hasselt, Belgium
| | - Tim S. Nawrot
- Center for Environmental Sciences, University of Hasselt, Hasselt, Belgium
- Center for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Ben Somers
- Division of Forest, Nature and Landscape, University of Leuven (KU Leuven), Leuven, Belgium
- KU Leuven Plant Institute, KU Leuven, Leuven, Belgium
- KU Leuven Urban Studies Institute, KU Leuven, Leuven, Belgium
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13
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Jimenez MP, Elliott EG, DeVille NV, Laden F, Hart JE, Weuve J, Grodstein F, James P. Residential Green Space and Cognitive Function in a Large Cohort of Middle-Aged Women. JAMA Netw Open 2022; 5:e229306. [PMID: 35476063 PMCID: PMC9047638 DOI: 10.1001/jamanetworkopen.2022.9306] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/10/2022] [Indexed: 01/13/2023] Open
Abstract
Importance Green space can decelerate cognitive decline by supporting physical activity, psychological restoration, or reducing exposure to air pollution. However, existing studies on the association of green space with cognitive decline are limited. Objective To examine whether residential green space was associated with cognitive function in middle-aged women. Design, Setting, and Participants Starting in 1989, the Nurses' Health Study II enrolled 116 429 female nurses aged 25 to 42 years residing in the US. In 2014 to 2016, 40 082 women were invited to complete an online cognitive battery. This cohort study analyzed women who had data on both green space exposure and cognitive measures. Data analysis was conducted from June to October 2021. Exposures Residential exposure to green space was assessed using the Normalized Difference Vegetation Index, a satellite-derived indicator of the quantity of ground vegetation. Landsat satellite data at 270-m and 1230-m buffers around each participants' residential addresses in 2013 were used. Main Outcomes and Measures In 2014 to 2016, cognitive function was measured using a self-administered online battery, the Cogstate Brief Battery, consisting of 4 tasks measuring psychomotor speed, attention, learning, and working memory; 3 composite scores, averaging together all tasks, psychomotor speed/attention, and learning/working memory, were created. In addition, the study evaluated potential mediators, including air pollution, depression, and physical activity. Results The analytical sample included 13 594 women, of whom 13 293 (98%) were White. Mean (SD) age was 61.2 (4.6) years. In models adjusted for age at assessment, race, childhood, adulthood, and neighborhood socioeconomic status, green space was associated with higher scores on the global Cogstate composite (mean difference per IQR in green space, 0.05; 95% CI, 0.02 to 0.07), and psychomotor speed/attention (mean difference in score, 0.05 standard units; 95% CI, 0.02 to 0.08). This difference in scores is similar to the difference observed in women 1 year apart in age in the data. By contrast, there was no association between green space and learning/working memory (mean difference, 0.0300; 95% CI, -0.0003 to 0.0500). Conclusions and Relevance These findings suggest that increasing residential green space may be associated with modest benefits in cognition in middle-aged women.
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Affiliation(s)
- Marcia P. Jimenez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Now with Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Elise G. Elliott
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole V. DeVille
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francine Laden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jaime E. Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Francine Grodstein
- Department of Internal Medicine, Rush Medical College, Rush Alzheimer’s Disease Center, Chicago, Illinois
| | - Peter James
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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14
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Markevych I, Astell-Burt T, Altug H, Triebner K, Standl M, Flexeder C, Heinrich J, Schikowski T, Koletzko S, Herberth G, Bauer CP, von Berg A, Berdel D, Feng X. Residential green space and age at menarche in German and Australian adolescent girls: A longitudinal study. Int J Hyg Environ Health 2022; 240:113917. [PMID: 35007986 DOI: 10.1016/j.ijheh.2021.113917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A large multicentre European study reported later onset of menopause among women residing in greener areas. This influence on the timing of a reproductive event like menopause, raises the question whether similar associations can be observed with timing of menarche. We investigated whether exposure to residential green space was related to the age at menarche in German and Australian adolescent girls. METHODS The analytic samples comprised of 1706 German and 1474 Australian adolescent girls. Percentage of green space was calculated in 1000 m buffers around a residential address or its surrogate at the previous follow-up. Mixed effects Cox proportional hazard models were used to explore the associations. The survival object was the occurrence of menarche at the time of follow-up (15-year follow-up of the German cohorts and the study wave at 14-15 years in the Australian cohort) and number of years since baseline (10-year follow-up in the German cohort and the study wave at 10-11 years in the Australian cohort). Participants who did not reach menarche were included as censored observations. RESULTS A greener residence was not associated with the age at menarche. Null findings were consistent in the general population and in analyses stratified by socioeconomic status or urbanicity in both countries. Urban residents were more likely to have earlier menarche, and this association was consistent across Germany and Australia. CONCLUSION The results of our analysis do not support the hypothesis that residing in places with more green space can influence timing of menarche. However, given the limitations of our study, researchers should not be discouraged to further explore environmental risk factors of early menarche.
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Affiliation(s)
- Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Psychology, Jagiellonian University, Krakow, Poland; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Public Health, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia; National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Menzies Centre for Health Policy, University of Sydney, Sydney, Australia; School of Public Health, Peking Union Medical College and the Chinese Academy of Medical Sciences, Beijing, China
| | - Hicran Altug
- IUF, Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway; Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Flexeder
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tamara Schikowski
- IUF, Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Gunda Herberth
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Public Health, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia; National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Menzies Centre for Health Policy, University of Sydney, Sydney, Australia; School of Population Health, Faculty of Medicine, UNSW, Sydney, Australia
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15
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Is urban green space associated with lower mental healthcare expenditure? Soc Sci Med 2021; 292:114503. [PMID: 34772520 DOI: 10.1016/j.socscimed.2021.114503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/16/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION While the evidence of mental health benefits from investing in green space accumulates, claims of reduced healthcare expenditure are rarely supported by evidence from analyses of actual healthcare data. Additionally, the question of 'who pays?' has been ignored. We addressed these gaps using person-level data in three Australian cities. METHODS 55,339 participants with a mean follow-up time of 4.97 years in the Sax Institute's 45 and Up Study (wave 2, collected 2012-2015) were linked to fee-for-service records of antidepressant prescriptions and talking therapy subsidised by the Australian Government (including data on per unit fee, state subsidy, and individual co-payment). Total green space, tree canopy and open grass within 1.6 km road network distances were linked to each participant. Multilevel logistic, negative binomial, and generalised linear models with gamma distribution adjusted for demographic and socioeconomic confounders were used to assess association between each green space variable and prescribing/referral and costs of antidepressants and talking therapy. RESULTS Prescription of at least one course of antidepressants occurred for 20.01% (n = 11,071). Referral for at least one session of talking therapy occurred in 8.95% (n = 4954). 13,482 participants (24.4%) had either a prescription or a referral. A 10% increase in green space was associated with higher levels of antidepressant prescribing (e.g. incident rate ratio (IRR) = 1.06, 95%CI = 1.04-1.08). Tree canopy was not associated with antidepressant prescribing or referrals for talking therapy. Open grass was associated with higher odds (OR = 1.17, 95%CI = 1.13-1.20) and counts (IRR = 1.05, 95%CI = 1.02-1.08) of antidepressant prescriptions. Open grass was also associated with lower odds (OR = 0.87, 95%CI = 0.82-0.92) and counts (IRR = 0.93, 95%CI = 0.90-0.96) of talking therapy referrals. Open grass was associated with higher total and mean per-person levels of expenditure on antidepressant prescriptions. CONCLUSION Although green space supports mental health, these unexpected results provide pause for reflection on whether greening strategies will always result in purported reductions in mental healthcare expenditure.
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Sun Y, Wang X, Zhu J, Chen L, Jia Y, Lawrence JM, Jiang LH, Xie X, Wu J. Using machine learning to examine street green space types at a high spatial resolution: Application in Los Angeles County on socioeconomic disparities in exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 787. [PMID: 36118158 PMCID: PMC9472772 DOI: 10.1016/j.scitotenv.2021.147653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Compared to commonly-used green space indicators from downward-facing satellite imagery, street view-based green space may capture different types of green space and represent how environments are perceived and experienced by people on the ground, which is important to elucidate the underlying mechanisms linking green space and health. OBJECTIVES This study aimed to evaluate machine learning models that can classify the type of vegetation (i.e., tree, low-lying vegetation, grass) from street view images; and to investigate the associations between street green space and socioeconomic (SES) factors, in Los Angeles County, California. METHODS SES variables were obtained from the CalEnviroScreen3.0 dataset. Microsoft Bing Maps images in conjunction with deep learning were used to measure total and types of street view green space, which were compared to normalized difference vegetation index (NDVI) as commonly-used satellite-based green space measure. Generalized linear mixed model was used to examine associations between green space and census tract SES, adjusting for population density and rural/urban status. RESULTS The accuracy of the deep learning model was high with 92.5% mean intersection over union. NDVI were moderately correlated with total street view-based green space and tree, and weakly correlated with low-lying vegetation and grass. Total and three types of green space showed significant negative associations with neighborhood SES. The percentage of total green space decreased by 2.62 [95% confidence interval (CI): -3.02, -2.21, p < 0.001] with each interquartile range increase in CalEnviroScreen3.0 score. Disadvantaged communities contained approximately 5% less average street green space than other communities. CONCLUSION Street view imagery coupled with deep learning approach can accurately and efficiently measure eye-level street green space and distinguish vegetation types. In Los Angeles County, disadvantaged communities had substantively less street green space. Governments and urban planners need to consider the type and visibility of street green space from pedestrian's perspective.
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Affiliation(s)
- Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Xingzhi Wang
- School of Computer Science, Beijing Institute of Technology, Beijing, China
| | - Jiayin Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Liangjian Chen
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Yuhang Jia
- Testin AI Data, Beijing Yunce Information Technology Co., Ltd, China
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Luo-Hua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Xiaohui Xie
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
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Sun Y, Wang X, Zhu J, Chen L, Jia Y, Lawrence JM, Jiang LH, Xie X, Wu J. Using machine learning to examine street green space types at a high spatial resolution: Application in Los Angeles County on socioeconomic disparities in exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:142734. [PMID: 36118158 DOI: 10.1016/j.scitotenv.2020.142734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Compared to commonly-used green space indicators from downward-facing satellite imagery, street view-based green space may capture different types of green space and represent how environments are perceived and experienced by people on the ground, which is important to elucidate the underlying mechanisms linking green space and health. OBJECTIVES This study aimed to evaluate machine learning models that can classify the type of vegetation (i.e., tree, low-lying vegetation, grass) from street view images; and to investigate the associations between street green space and socioeconomic (SES) factors, in Los Angeles County, California. METHODS SES variables were obtained from the CalEnviroScreen3.0 dataset. Microsoft Bing Maps images in conjunction with deep learning were used to measure total and types of street view green space, which were compared to normalized difference vegetation index (NDVI) as commonly-used satellite-based green space measure. Generalized linear mixed model was used to examine associations between green space and census tract SES, adjusting for population density and rural/urban status. RESULTS The accuracy of the deep learning model was high with 92.5% mean intersection over union. NDVI were moderately correlated with total street view-based green space and tree, and weakly correlated with low-lying vegetation and grass. Total and three types of green space showed significant negative associations with neighborhood SES. The percentage of total green space decreased by 2.62 [95% confidence interval (CI): -3.02, -2.21, p < 0.001] with each interquartile range increase in CalEnviroScreen3.0 score. Disadvantaged communities contained approximately 5% less average street green space than other communities. CONCLUSION Street view imagery coupled with deep learning approach can accurately and efficiently measure eye-level street green space and distinguish vegetation types. In Los Angeles County, disadvantaged communities had substantively less street green space. Governments and urban planners need to consider the type and visibility of street green space from pedestrian's perspective.
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Affiliation(s)
- Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Xingzhi Wang
- School of Computer Science, Beijing Institute of Technology, Beijing, China
| | - Jiayin Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Liangjian Chen
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Yuhang Jia
- Testin AI Data, Beijing Yunce Information Technology Co., Ltd, China
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Luo-Hua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Xiaohui Xie
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
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Aliyas Z. Physical, mental, and physiological health benefits of green and blue outdoor spaces among elderly people. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:703-714. [PMID: 31625761 DOI: 10.1080/09603123.2019.1681379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
This study investigated the influence of designed natural outdoor spaces and space type on the physical, mental, and physiological health status of elderlies. A total of 978 questionnaires were distributed among a population-based randomized sample of elderlies residing in Bandar Abbas city, Iran. Blue space users reported better health status. Park access was associated with physical and physiological health. Those participants who had cardiovascular diseases were more likely to visit the parks more often, while the people with hypertension visited the parks less often. Length of park stay positively was associated with all aspects of health status. In addition, the level of physical activity positively was associated with physical and mental health. The park organizations should work on establishing parks in shorter distances and consider the opportunity for elderlies to participate in social programs to encourage them to frequently visit the parks and increase their length of park stay.
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Affiliation(s)
- Zeinab Aliyas
- Department of Architecture, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
- Young Researchers and Elite Club, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
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Which Green Space Metric Best Predicts a Lowered Odds of Type 2 Diabetes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084088. [PMID: 33924462 PMCID: PMC8068830 DOI: 10.3390/ijerph18084088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
The choice of a green space metric may affect what relationship is found with health outcomes. In this research, we investigated the relationship between percent green space area, a novel metric developed by us (based on the average contiguous green space area a spatial buffer has contact with), in three different types of buffers and type 2 diabetes (T2D). We obtained information about diagnosed T2D and relevant covariates at the individual level from the large and representative 45 and Up Study. Average contiguous green space and the percentage of green space within 500 m, 1 km, and 2 km of circular buffer, line-based road network (LBRN) buffers, and polygon-based road network (PBRN) buffers around participants' residences were used as proxies for geographic access to green space. Generalized estimating equation regression models were used to determine associations between access to green space and T2D status of individuals. It was found that 30%-40% green space within 500 m LBRN or PBRN buffers, and 2 km PBRN buffers, but not within circular buffers, significantly reduced the risk of T2D. The novel average green space area metric did not appear to be particularly effective at measuring reductions in T2D. This study complements an existing research body on optimal buffers for green space measurement.
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Suyin Chalmin-Pui L, Roe J, Griffiths A, Smyth N, Heaton T, Clayden A, Cameron R. "It made me feel brighter in myself"- The health and well-being impacts of a residential front garden horticultural intervention. LANDSCAPE AND URBAN PLANNING 2021; 205:103958. [PMID: 33012932 PMCID: PMC7525452 DOI: 10.1016/j.landurbplan.2020.103958] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 05/23/2023]
Abstract
Residential gardens make up 30% of urban space in the UK, yet unlike many other green space typologies, their role in the health and well-being agenda has largely been overlooked. A horticultural intervention introduced ornamental plants to 38 previously bare front gardens (≈ 10 m2) within an economically deprived region of North England, UK. Measures of perceived stress and diurnal cortisol profiles (as an indicator of health status) were taken pre- and post-intervention (over 3 months). Residents reported significant decreases in perceived stress post-intervention. This finding was aligned with a higher proportion of 'healthy' diurnal cortisol patterns post-intervention, suggesting better health status in those individuals. All residents derived one or more reported socio-cultural benefits as a result of the front garden plantings, although overall scores for subjective well-being did not increase to a significant level. Further qualitative data suggested that the gardens were valued for enhancing relaxation, increasing positive emotions, motivation, and pride of place. The results indicate that adding even small quantities of ornamental plants to front gardens within deprived urban communities had a positive effect on an individual's stress regulation and some, but not all, aspects of subjective well-being. The research highlights the importance of residential front gardens to human health and well-being, and thus their contribution to the wider debates around city densification, natural capital and urban planning.
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Affiliation(s)
- Lauriane Suyin Chalmin-Pui
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
| | - Jenny Roe
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
| | - Alistair Griffiths
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
| | - Nina Smyth
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
| | - Timothy Heaton
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
| | - Andy Clayden
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
| | - Ross Cameron
- Department of Landscape Architecture, University of Sheffield, UK
- Center for Design and Health, University of Virginia, USA
- Science Team, Royal Horticultural Society, UK
- School of Social Sciences, Psychology, University of Westminster, UK
- School of Mathematics and Statistics, University of Sheffield, UK
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21
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Relationship between Long-Term Residential Green Exposure and Individuals' Mental Health: Moderated by Income Differences and Residential Location in Urban China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238955. [PMID: 33271997 PMCID: PMC7730860 DOI: 10.3390/ijerph17238955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023]
Abstract
Environmental health effects during urbanization have attracted much attention. However, knowledge is lacking on the relationship between long-term cumulative residential environment and health effects on individuals during rapid transformations in urban physical and social space. Taking Guangzhou, China, as a case example, this study analyzed the relationship between long-term exposure to green environments and residents’ mental health under urban spatial restructuring. Based on a household survey in 2016, 820 residents who have lived in Guangzhou for more than 15 years were used as the sample. High-resolution remote sensing images were used to assess the long-term green exposure of residents. The results indicate that long-term green exposure in residential areas had a negative correlation with residents’ mental health (p < 0.05), and the correlation was strongest for the cumulative green environment in the last five years. However, this significant effect was moderated by income and residential location. Green exposure had a positive relationship with mental health for low income groups, and a negative relationship for middle and high income groups. In addition, residents living farther away from the city center were likely to have fewer green environmental health benefits. Residential relocation in a rapidly urbanizing and transforming China has led to the continuous differentiation of residential green environments among different income groups, which has also caused different mental health effects from green exposure. It provides empirical evidence and theoretical support for policymakers to improve the urban environment and reduce environmental health disparities by considering social differences and residential location.
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Sia A, Tam WWS, Fogel A, Kua EH, Khoo K, Ho RCM. Nature-based activities improve the well-being of older adults. Sci Rep 2020; 10:18178. [PMID: 33097785 PMCID: PMC7585438 DOI: 10.1038/s41598-020-74828-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/05/2020] [Indexed: 01/09/2023] Open
Abstract
Current literature shows that interaction with urban greenery can have a wide range of positive health outcomes. Targeted nature-based programs, such as therapeutic horticulture, have been shown to result in multiple health benefits for older adults residing in temperate environments, but much less research has been carried out on populations with different phenotypes, such as older Asian adults in the tropics. The current study investigated the effects of a 24-session therapeutic horticulture program on 47 older participants in Singapore, with an experimental pretest posttest design. We found that participants maintained healthy sleep patterns and psychological health, as well as showed reduced anxiety and improved cognitive functioning (p < 0.05). In addition, they reported an increase in mean happiness score after each session. This study provides new evidence using a comprehensive set of indicators across the affective, cognitive, functional, psychosocial and physical domains, supporting current literature on the benefits of nature programs, with a novel focus on tropical environments. It provides evidence that the nature-based intervention has the potential to be translated to programs to benefit older adults in the tropics.
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Affiliation(s)
- Angelia Sia
- Centre for Urban Greenery and Ecology Research, National Parks Board, Singapore, 259569, Singapore. .,Department of Psychological Medicine, National University of Singapore, Singapore, 119228, Singapore.
| | - Wilson W S Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 1175974, Singapore
| | - Anna Fogel
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Sciences, 30 Medical Drive, Singapore, 117609, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Kenneth Khoo
- Centre for Urban Greenery and Ecology Research, National Parks Board, Singapore, 259569, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, 119228, Singapore
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23
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Carreño A, Gascon M, Vert C, Lloret J. The Beneficial Effects of Short-Term Exposure to Scuba Diving on Human Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197238. [PMID: 33022983 PMCID: PMC7579011 DOI: 10.3390/ijerph17197238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022]
Abstract
Exposure to outdoor blue spaces can help improve human health by reducing stress, promoting social relationships, and physical activity. While most studies have focused on the adverse health effects of scuba diving, very few have assessed its health benefits. Moreover, when scuba diving is done in large groups with no diving instructor or pre-dive briefing, negative environmental impacts are generated and negative impacts on human health may also occur due to overcrowding, which may create stress. This is the first study to evaluate the effects of scuba diving on divers' mental health using their diving practices to estimate the impacts on the ecosystem. In the marine-protected area of Cap de Creus and adjacent areas, we assessed the mental health of 176 divers and 70 beach users (control group) by employing a 29-item version of Profile of Mood State (POMS) questionnaires. According to the parameters associated with reduced environmental impacts, two scuba diving experiences were established. Poisson regression models were performed to assess both the contribution of the activity and diving experiences to POMS scores. Both groups (scuba divers and beach goers) reduced their POMS scores after carrying out the activities. Although no significant differences were found between beach and scuba diving activities, nor between the two different scuba diving experiences, our results showed that subjects with regular medication intake due to a chronic or psychiatric illness had a POMS reduction score significantly higher than other subjects. We conclude that both beach and scuba diving activities have positive effects for human mental health, particularly among subjects with regular medication intake.
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Affiliation(s)
- Arnau Carreño
- Oceans & Human Health Chair, Institute of Aquatic Ecology, University of Girona, 17003 Girona, Spain;
- Correspondence: or
| | - Mireia Gascon
- ISGlobal (Global Health Institute Barcelona), Campus Mar, 08003 Barcelona, Spain; (M.G.); (C.V.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Cristina Vert
- ISGlobal (Global Health Institute Barcelona), Campus Mar, 08003 Barcelona, Spain; (M.G.); (C.V.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Josep Lloret
- Oceans & Human Health Chair, Institute of Aquatic Ecology, University of Girona, 17003 Girona, Spain;
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Sun Y, Sheridan P, Laurent O, Li J, Sacks DA, Fischer H, Qiu Y, Jiang Y, Yim IS, Jiang LH, Molitor J, Chen JC, Benmarhnia T, Lawrence JM, Wu J. Associations between green space and preterm birth: Windows of susceptibility and interaction with air pollution. ENVIRONMENT INTERNATIONAL 2020; 142:105804. [PMID: 32505016 PMCID: PMC7340571 DOI: 10.1016/j.envint.2020.105804] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Recent studies have reported inconsistent associations between maternal residential green space and preterm birth (PTB, born < 37 completed gestational weeks). In addition, windows of susceptibility during pregnancy have not been explored and potential interactions of green space with air pollution exposures during pregnancy are still unclear. OBJECTIVES To evaluate the relationships between green space and PTB, identify windows of susceptibility, and explore potential interactions between green space and air pollution. METHODS Birth certificate records for all births in California (2001-2008) were obtained. The Normalized Difference Vegetation Index (NDVI) was used to characterized green space exposure. Gestational age was treated as a time-to-event outcome; Cox proportional hazard models were applied to estimate the association between green space exposure and PTB, moderately PTB (MPTB, gestational age < 35 weeks), and very PTB (VPTB, gestational age < 30 weeks), after controlling for maternal age, race/ethnicity, education, and median household income. Month-specific green space exposure was used to identify potential windows of susceptibility. Potential interactions between green space and air pollution [fine particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3)] were examined on both additive and multiplicative scales. RESULTS In total, 3,753,799 eligible births were identified, including 341,123 (9.09%) PTBs, 124,631 (3.32%) MPTBs, and 22,313 (0.59%) VPTBs. A reduced risk of PTB was associated with increases in residential NDVI exposure in 250 m, 500 m, 1000 m, and 2000 m buffers. In the 2000 m buffer, the association was strongest for VPTB [adjusted hazard ratio (HR) per interquartile range increase in NDVI: 0.959, 95% confidence interval (CI): 0.942-0.976)], followed by MPTB (HR = 0.970, 95% CI: 0.962-0.978) and overall PTB (HR = 0.972, 95% CI: 0.966-0.978). For PTB, green space during the 3rd - 5th gestational months had stronger associations than those in the other time periods, especially during the 4th gestational month (NDVI 2000 m: HR = 0.970, 95% CI: 0.965-0.975). We identified consistent positive additive and multiplicative interactions between decreasing green space and higher air pollution. CONCLUSION This large study found that maternal exposure to residential green space was associated with decreased risk of PTB, MPTB, and VPTB, especially in the second trimester. There is a synergistic effect between low green space and high air pollution levels on PTB, indicating that increasing exposure to green space may be more beneficial for women with higher air pollution exposures during pregnancy.
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Affiliation(s)
- Yi Sun
- Program in Environmental Health Sciences, University of California, Irvine, CA 92697-3957, USA
| | - Paige Sheridan
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, 9500 Gilman Drive #0725, CA La Jolla 92093, USA
| | - Olivier Laurent
- Program in Public Health, 653 East Peltason Drive, University of California, Irvine CA 92697-3957, USA
| | - Jia Li
- Program in Public Health, 653 East Peltason Drive, University of California, Irvine CA 92697-3957, USA
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Heidi Fischer
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yang Qiu
- Department of Environmental Science and Engineering, College of Architecture and Environment, Sichuan University, #24 First Ring Road South Section One, Chengdu, Sichuan, China
| | - Yu Jiang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, CA 92697-7085, USA
| | - Luo-Hua Jiang
- Department of Epidemiology, University of California, Irvine, CA, USA
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, 9500 Gilman Drive #0725, CA La Jolla 92093, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jun Wu
- Program in Environmental Health Sciences, University of California, Irvine, CA 92697-3957, USA; Program in Public Health, 653 East Peltason Drive, University of California, Irvine CA 92697-3957, USA.
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25
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Jimenez MP, Oken E, Gold DR, Luttmann-Gibson H, Requia WJ, Rifas-Shiman SL, Gingras V, Hivert MF, Rimm EB, James P. Early life exposure to green space and insulin resistance: An assessment from infancy to early adolescence. ENVIRONMENT INTERNATIONAL 2020; 142:105849. [PMID: 32593049 PMCID: PMC7784302 DOI: 10.1016/j.envint.2020.105849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Recent studies suggest that greater exposure to natural vegetation, or "green space" is associated with lower diabetes risk, possibly through increasing physical activity. However, there is limited research on green space and insulin resistance in youth. We hypothesized greater green space at early-life sensitive time periods would be associated with lower insulin resistance in youth. METHODS We used data from Project Viva (N = 460), a pre-birth cohort study that recruited pregnant women in eastern Massachusetts, 1999-2002, and followed offspring into adolescence. We defined residential green space exposure at infancy (median age - 1.1 years), early childhood (3.2 years), mid-childhood (7.7 years), and early adolescence (12.8 years), using 30 m resolution Landsat satellite imagery to estimate the Normalized Difference Vegetation Index [NDVI]. Our main outcome was early adolescence estimated insulin resistance (HOMA-IR). We used multiple imputation to account for missing data and multiple linear regression models adjusted for age, sex, race/ethnicity, parental education, household income, and neighborhood median household income. RESULTS The highest green space tertile had the highest percentage of white participants (85%), college-educated mothers (87%) and fathers (85%), and households with income higher than US$70,000 (86%). Unadjusted models showed that participants living in the highest green space tertile at infancy had a 0.15 unit lower HOMA-IR (95% CI: -0.23, -0.06) in early adolescence, than those living in the lowest tertile. However, in adjusted models, we did not observe evidence of associations between green space from infancy to early adolescence and HOMA-IR in early adolescence, although some point estimates were in the hypothesized direction. For example, participants in the highest green space tertile in infancy had 0.03 units lower HOMA-IR (95%CI: -0.14, 0.08) than those living in the lowest tertile. CONCLUSIONS Exposure to green space at early life sensitive time periods was not associated with HOMA-IR in youth. Early-life longitudinal studies across diverse populations are needed to confirm or refute our results.
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Affiliation(s)
- Marcia P Jimenez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heike Luttmann-Gibson
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Weeberb J Requia
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Veronique Gingras
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Esmene DS, Leyshon PC, Leyshon DM. Beyond adherence to social prescriptions: How places, social acquaintances and stories help walking group members to thrive. Health Place 2020; 64:102394. [PMID: 32791463 DOI: 10.1016/j.healthplace.2020.102394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/05/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022]
Abstract
Social prescribing (SP) is an increasingly popular means of enabling medical professionals to refer people to social activities. However, how individuals accommodate activity groups into their routines has been neglected by studies exploring SP. This paper uses qualitative approaches to explore how place and sociability influence the experiences of individuals with type-2 diabetes in a social prescription walking group. Using in-situ conversations and in-depth interviews, we demonstrate how place and sociability extends beyond a group via storytelling, and allows individuals to become part of a group. Understanding place, sociability and storytelling is critical in characterising the benefits of social prescription.
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Affiliation(s)
- Dr Shukru Esmene
- University of Exeter, Centre for Geography and Environmental Science, College of Life and Environmental Sciences, Peter Lanyon Building, Penryn Campus, Treliever Road, Penryn, Cornwall, TR10 9FE, UK.
| | - Prof Catherine Leyshon
- University of Exeter, Centre for Geography and Environmental Science, College of Life and Environmental Sciences, Peter Lanyon Building, Penryn Campus, Treliever Road, Penryn, Cornwall, TR10 9FE, UK
| | - Dr Michael Leyshon
- University of Exeter, Centre for Geography and Environmental Science, College of Life and Environmental Sciences, Peter Lanyon Building, Penryn Campus, Treliever Road, Penryn, Cornwall, TR10 9FE, UK
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Impact of Residential Green Space on Sleep Quality and Sufficiency in Children and Adolescents Residing in Australia and Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134894. [PMID: 32645895 PMCID: PMC7369701 DOI: 10.3390/ijerph17134894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/23/2023]
Abstract
Increasing evidence suggests adults living in greener areas tend to have more favourable sleep-related outcomes, but children and adolescents are under-researched. We hypothesised that children and adolescents living in greener areas would have better quality and more sufficient levels of sleep on average, especially within the context of high traffic noise exposure. These hypotheses were tested using multilevel logistic regressions fitted on samples from the nationally representative Longitudinal Study of Australian Children (10–11 years old, n = 3469, and 14–15 years old, n = 2814) and the GINIplus and LISA cohorts (10 years old, n = 1461, and 15 years old, n = 4172) from the Munich, Wesel, and Leipzig areas of Germany. Questionnaire-based binary indicators of sleep sufficiency and sleep quality in each cohort were assessed with respect to objectively measured green space exposures adjusting for age, sex, and maternal education. Models were augmented with proxy measures of traffic noise and two-way interaction terms to test for effect modification. Cross-tabulations illustrated little convincing evidence of association between green space and insufficient sleep or poor sleep quality in either sample, except for insufficient sleep among 10 year old participants in Germany. These null findings were replicated in adjusted models. The proxy for traffic noise was associated with poor quality sleep in 15 year old participants in Germany, but no convincing evidence of modified association with green space was observed.
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Dennis M, Cook PA, James P, Wheater CP, Lindley SJ. Relationships between health outcomes in older populations and urban green infrastructure size, quality and proximity. BMC Public Health 2020; 20:626. [PMID: 32375720 PMCID: PMC7201616 DOI: 10.1186/s12889-020-08762-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/22/2020] [Indexed: 01/03/2023] Open
Abstract
Background There is a growing body of literature supporting positive associations between natural environments and better health. The type, quality and quantity of green and blue space (‘green-space’) in proximity to the home might be particularly important for less mobile populations, such as for some older people. However, considerations of measurement and definition of green-space, beyond single aggregated metrics, are rare. This constitutes a major source of uncertainty in current understanding of public health benefits derived from natural environments. We aimed to improve our understanding of how such benefits are conferred to different demographic groups through a comprehensive evaluation of the physical and spatial characteristics of urban green infrastructure. Methods We employed a green infrastructure (GI) approach combining a high-resolution spatial dataset of land-cover and function with area-level demographic and socio-economic data. This allowed for a comprehensive characterization of a densely populated, polycentric city-region. We produced multiple GI attributes including, for example, urban vegetation health. We used a series of step-wise multi-level regression analyses to test associations between population chronic morbidity and the functional, physical and spatial components of GI across an urban socio-demographic gradient. Results GI attributes demonstrated associations with health in all socio-demographic contexts even where associations between health and overall green cover were non-significant. Associations varied by urban socio-demographic group. For areas characterised by having higher proportions of older people (‘older neighbourhoods’), associations with better health were exhibited by land-cover diversity, informal greenery and patch size in high income areas and by proximity to public parks and recreation land in low income areas. Quality of GI was a significant predictor of good health in areas of low income and low GI cover. Proximity of publicly accessible GI was also significant. Conclusions The influence of urban GI on population health is mediated by green-space form, quantity, accessibility, and vegetation health. People in urban neighbourhoods that are characterised by lower income and older age populations are disproportionately healthy if their neighbourhoods contain accessible, good quality public green-space. This has implications for strategies to decrease health inequalities and inform international initiatives, such as the World Health Organisation’s Age-Friendly Cities programme.
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Affiliation(s)
- Matthew Dennis
- Department of Geography, School of Environment Education and Development, University of Manchester, Arthur Lewis Building, Manchester, M13 9PL, UK.
| | - Penny A Cook
- School of Health and Society, University of Salford, The Crescent, Allerton Building, Salford, M5 4WT, UK
| | - Philip James
- School of Science, Engineering and Environment, University of Salford, The Crescent, Peel Building, Salford, M5 4WT, UK
| | - C Philip Wheater
- School of Science and the Environment, Manchester Metropolitan University, Chester Street, John Dalton Building, Manchester, M1 5GD, UK
| | - Sarah J Lindley
- Department of Geography, School of Environment Education and Development, University of Manchester, Arthur Lewis Building, Manchester, M13 9PL, UK
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Parmes E, Pesce G, Sabel CE, Baldacci S, Bono R, Brescianini S, D'Ippolito C, Hanke W, Horvat M, Liedes H, Maio S, Marchetti P, Marcon A, Medda E, Molinier M, Panunzi S, Pärkkä J, Polańska K, Prud'homme J, Ricci P, Snoj Tratnik J, Squillacioti G, Stazi MA, Maesano CN, Annesi-Maesano I. Influence of residential land cover on childhood allergic and respiratory symptoms and diseases: Evidence from 9 European cohorts. ENVIRONMENTAL RESEARCH 2020; 183:108953. [PMID: 31818476 DOI: 10.1016/j.envres.2019.108953] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/02/2019] [Accepted: 11/20/2019] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Recent research focused on the interaction between land cover and the development of allergic and respiratory disease has provided conflicting results and the underlying mechanisms are not fully understood. In particular, green space, which confers an overall positive impact on general health, may be significantly contributing to adverse respiratory health outcomes. This study evaluates associations between surrounding residential land cover (green, grey, agricultural and blue space), including type of forest cover (deciduous, coniferous and mixed), and childhood allergic and respiratory diseases. METHODS Data from 8063 children, aged 3-14 years, were obtained from nine European population-based studies participating in the HEALS project. Land-cover exposures within a 500 m buffer centred on each child's residential address were computed using data from the Coordination of Information on the Environment (CORINE) program. The associations of allergic and respiratory symptoms (wheeze, asthma, allergic rhinitis and eczema) with land coverage were estimated for each study using logistic regression models, adjusted for sex, age, body mass index, maternal education, parental smoking, and parental history of allergy. Finally, the pooled effects across studies were estimated using meta-analyses. RESULTS In the pooled analyses, a 10% increase in green space coverage was significantly associated with a 5.9%-13.0% increase in the odds of wheezing, asthma, and allergic rhinitis, but not eczema. A trend of an inverse relationship between agricultural space and respiratory symptoms was observed, but did not reach statistical significance. In secondary analyses, children living in areas with surrounding coniferous forests had significantly greater odds of reporting wheezing, asthma and allergic rhinitis. CONCLUSION Our results provide further evidence that exposure to green space is associated with increased respiratory disease in children. Additionally, our findings suggest that coniferous forests might be associated with wheezing, asthma and allergic rhinitis. Additional studies evaluating both the type of green space and its use in relation to respiratory conditions should be conducted in order to clarify the underlying mechanisms behind associated adverse impacts.
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Affiliation(s)
- Eija Parmes
- VTT Technical Research Centre of Finland Ltd, 02150 Espoo, Finland.
| | - Giancarlo Pesce
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Department, Institut Pierre Louis D'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Clive E Sabel
- BERTHA, The Danish Big Data Centre for Environment and Health, Department of Environmental Science, Aarhus University, 4000, Roskilde, Denmark
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste No. 41, 56126, Pisa, Italy
| | - Roberto Bono
- Department of Public Health and Paediatrics, University of Turin, Italy. Via Santena 5 Bis Turin, Italy
| | - Sonia Brescianini
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Cristina D'Ippolito
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Milena Horvat
- Jožef Stefan Institute, Department of Environmental Sciences, Jamova Cesta 39, Ljubljana, Slovenia
| | - Hilkka Liedes
- VTT Technical Research Centre of Finland Ltd, 02150 Espoo, Finland
| | - Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste No. 41, 56126, Pisa, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Emanuela Medda
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Silvia Panunzi
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Juha Pärkkä
- VTT Technical Research Centre of Finland Ltd, 02150 Espoo, Finland
| | - Kinga Polańska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Julie Prud'homme
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Department, Institut Pierre Louis D'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Paolo Ricci
- Unità Operativa Complessa Osservatorio Epidemiologico, Agenzia Tutela Salute Della Val Padana, Mantova, Italy
| | - Janja Snoj Tratnik
- Jožef Stefan Institute, Department of Environmental Sciences, Jamova Cesta 39, Ljubljana, Slovenia
| | - Giulia Squillacioti
- Department of Public Health and Paediatrics, University of Turin, Italy. Via Santena 5 Bis Turin, Italy
| | - Maria Antonietta Stazi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Cara Nichole Maesano
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Department, Institut Pierre Louis D'Épidémiologie et de Santé Publique, F75012, Paris, France
| | - Isabella Annesi-Maesano
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Department, Institut Pierre Louis D'Épidémiologie et de Santé Publique, F75012, Paris, France
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Kumar P, Druckman A, Gallagher J, Gatersleben B, Allison S, Eisenman TS, Hoang U, Hama S, Tiwari A, Sharma A, Abhijith KV, Adlakha D, McNabola A, Astell-Burt T, Feng X, Skeldon AC, de Lusignan S, Morawska L. The nexus between air pollution, green infrastructure and human health. ENVIRONMENT INTERNATIONAL 2019; 133:105181. [PMID: 31675531 DOI: 10.1016/j.envint.2019.105181] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/03/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Cities are constantly evolving and so are the living conditions within and between them. Rapid urbanization and the ever-growing need for housing have turned large areas of many cities into concrete landscapes that lack greenery. Green infrastructure can support human health, provide socio-economic and environmental benefits, and bring color to an otherwise grey urban landscape. Sometimes, benefits come with downsides in relation to its impact on air quality and human health, requiring suitable data and guidelines to implement effective greening strategies. Air pollution and human health, as well as green infrastructure and human health, are often studied together. Linking green infrastructure with air quality and human health together is a unique aspect of this article. A holistic understanding of these links is key to enabling policymakers and urban planners to make informed decisions. By critically evaluating the link between green infrastructure and human health via air pollution mitigation, we also discuss if our existing understanding of such interventions is sufficient to inform their uptake in practice. Natural science and epidemiology approach the topic of green infrastructure and human health very differently. The pathways linking health benefits to pollution reduction by urban vegetation remain unclear and the mode of green infrastructure deployment is critical to avoid unintended consequences. Strategic deployment of green infrastructure may reduce downwind pollution exposure. However, the development of bespoke design guidelines is vital to promote and optimize greening benefits, and measuring green infrastructure's socio-economic and health benefits are key for their uptake. Greening cities to mitigate pollution effects is on the rise and these need to be matched by scientific evidence and appropriate guidelines. We conclude that urban vegetation can facilitate broad health benefits, but there is little empirical evidence linking these benefits to air pollution reduction by urban vegetation, and appreciable efforts are needed to establish the underlying policies, design and engineering guidelines governing its deployment.
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Affiliation(s)
- Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom; Department of Civil, Structural & Environmental Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.
| | - Angela Druckman
- Centre for Environment & Sustainability, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - John Gallagher
- Department of Civil, Structural & Environmental Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Birgitta Gatersleben
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Sarah Allison
- School of Bioscience and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Theodore S Eisenman
- Department of Landscape Architecture and Regional Planning, University of Massachusetts, Amherst, USA
| | - Uy Hoang
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, United Kingdom; Royal College of General Practitioners (RCGP), Research & Surveillance Centre (RSC), Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, United Kingdom
| | - Sarkawt Hama
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Arvind Tiwari
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Ashish Sharma
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - K V Abhijith
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Deepti Adlakha
- School of Natural and Built Environment, Queen's University Belfast, Belfast, United Kingdom
| | - Aonghus McNabola
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom; Department of Civil, Structural & Environmental Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Anne C Skeldon
- Department of Mathematics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Simon de Lusignan
- School of Bioscience and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom; Department of Landscape Architecture and Regional Planning, University of Massachusetts, Amherst, USA
| | - Lidia Morawska
- International Laboratory for Air Quality & Health, Queensland University of Technology, Brisbane, QLD, Australia
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Wang R, Helbich M, Yao Y, Zhang J, Liu P, Yuan Y, Liu Y. Urban greenery and mental wellbeing in adults: Cross-sectional mediation analyses on multiple pathways across different greenery measures. ENVIRONMENTAL RESEARCH 2019; 176:108535. [PMID: 31260914 DOI: 10.1016/j.envres.2019.108535] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Multiple mechanisms have been proposed to explain how greenery in the vicinity of people's homes enhances their mental health and wellbeing. Mediation studies, however, focus on a limited number of mechanisms and rely on remotely sensed greenery measures, which do not accurately capture how neighborhood greenery is perceived on the ground. OBJECTIVE To examine: 1) how streetscape and remote sensing-based greenery affect people's mental wellbeing; 2) whether and, if so, to what extent the associations are mediated by physical activity, stress, air quality and noise, and social cohesion; and 3) whether differences in the mediation across the streetscape greenery and NDVI exposure metrics occurred. METHODS We used a population sample of 1029 adult residents of the metropolis of Guangzhou, China, from 2016. Mental wellbeing was quantified by the World Health Organization Well-Being Index (WHO-5). Two objective greenery measures were extracted at the neighborhood level: 1) streetscape greenery from street view data via a convolutional neural network, and 2) the normalized difference vegetation index (NDVI) from Landsat 8 remote sensing images. Single and multiple mediation analyses with multilevel regressions were conducted. RESULTS Streetscape and NDVI greenery were weakly and positively, but not significantly, correlated. Our regression results revealed that streetscape greenery and NDVI were, individually and jointly, positively associated with mental wellbeing. Significant partial mediators for the streetscape greenery were physical activity, stress, air quality and noise, and social cohesion; together, they explained 62% of the association. For NDVI, only physical activity and social cohesion were significant partial mediators, accounting for 22% of the association. CONCLUSIONS Mental health and wellbeing and both streetscape and satellite-derived greenery seem to be both directly correlated and indirectly mediated. Our findings signify that both greenery measures capture different aspects of natural environments and may contribute to people's wellbeing by means of different mechanisms.
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Affiliation(s)
- Ruoyu Wang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-sen University, Guangzhou, China
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, the Netherlands.
| | - Yao Yao
- School of Information Engineering, China University of Geosciences, Wuhan, China.
| | - Jinbao Zhang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-sen University, Guangzhou, China.
| | - Penghua Liu
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-sen University, Guangzhou, China.
| | - Yuan Yuan
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-sen University, Guangzhou, China.
| | - Ye Liu
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-sen University, Guangzhou, China.
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Asta F, Michelozzi P, Cesaroni G, De Sario M, Badaloni C, Davoli M, Schifano P. The Modifying Role of Socioeconomic Position and Greenness on the Short-Term Effect of Heat and Air Pollution on Preterm Births in Rome, 2001-2013. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142497. [PMID: 31336970 PMCID: PMC6678295 DOI: 10.3390/ijerph16142497] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/04/2023]
Abstract
Urban green spaces have been associated with health benefits, but few studies have evaluated the role of greenness on pregnancy outcomes. We examined how the association between short-term exposure to heat and air pollution on the probability of preterm delivery is affected by the spatial variation of socioeconomic position (SEP) and greenness. We analyzed a cohort of newborns in Rome, from April to October of 2001–2013, defining preterm as births between the 22nd and the 36th week of gestation. We used a time series approach, with maximum apparent temperature (MAT), PM10, NO2, and O3 as exposure variables. As greenness indicators, we considered maternal residential proximity to green spaces and the Normalized Difference Vegetation Index (NDVI) within a 100 m buffer around each woman’s residential address. We enrolled 56,576 newborns (5.1% preterm). The effect of a 1 °C increase in temperature on the daily number of preterm births was higher in women with low SEP (+2.49% (90% CI: 1.29–3.71)) and among those living within 100 m from green spaces (+3.33% (90% CI: 1.82–4.87)). No effect modification was observed for NDVI or PM10. SEP was an important effect modifier of the heat-preterm birth relationship. The role of greenness in modifying this association between heat and preterm delivery should be further investigated.
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Affiliation(s)
- Federica Asta
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy.
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy
| | - Manuela De Sario
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy
| | - Chiara Badaloni
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy
| | - Patrizia Schifano
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Rome, Italy
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Liveable for whom? Prospects of urban liveability to address health inequities. Soc Sci Med 2019; 232:94-105. [DOI: 10.1016/j.socscimed.2019.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/13/2019] [Accepted: 05/01/2019] [Indexed: 12/31/2022]
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Bratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, Folke C, Frumkin H, Gross JJ, Hartig T, Kahn PH, Kuo M, Lawler JJ, Levin PS, Lindahl T, Meyer-Lindenberg A, Mitchell R, Ouyang Z, Roe J, Scarlett L, Smith JR, van den Bosch M, Wheeler BW, White MP, Zheng H, Daily GC. Nature and mental health: An ecosystem service perspective. SCIENCE ADVANCES 2019; 5:eaax0903. [PMID: 31355340 PMCID: PMC6656547 DOI: 10.1126/sciadv.aax0903] [Citation(s) in RCA: 439] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/20/2019] [Indexed: 05/17/2023]
Abstract
A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.
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Affiliation(s)
- Gregory N. Bratman
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, USA
- Center for Creative Conservation, University of Washington, Seattle, WA 98195, USA
- Center for Conservation Biology, Stanford University, Stanford, CA 94305, USA
- The Natural Capital Project, Stanford, CA 94305, USA
- Corresponding author. (G.N.B.); (G.C.D.)
| | - Christopher B. Anderson
- Center for Conservation Biology, Stanford University, Stanford, CA 94305, USA
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Marc G. Berman
- Department of Psychology, University of Chicago, Chicago, IL 60637, USA
- Grossman Institute for Neuroscience, Quantitative Biology, and Human Behavior, University of Chicago, Chicago, IL 60637, USA
| | | | - Sjerp de Vries
- Wageningen Environmental Research, Wageningen University and Research, Wageningen, Netherlands
| | - Jon Flanders
- School of Biological Sciences, University of Bristol, Bristol, UK
- Bat Conservation International, Austin, TX 78746, USA
| | - Carl Folke
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Beijer Institute, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Howard Frumkin
- Wellcome Trust, London, UK
- School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Peter H. Kahn
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, USA
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Ming Kuo
- Landscape and Human Health Laboratory, Department of Natural Resources and Environmental Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Joshua J. Lawler
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, USA
- Center for Creative Conservation, University of Washington, Seattle, WA 98195, USA
| | - Phillip S. Levin
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, USA
- Center for Creative Conservation, University of Washington, Seattle, WA 98195, USA
- The Nature Conservancy, Seattle, WA 98121, USA
| | - Therese Lindahl
- Beijer Institute, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Richard Mitchell
- Centre for Research on Environment, Society and Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Zhiyun Ouyang
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Jenny Roe
- Center for Design and Health, University of Virginia, Charlottesville, VA 22904, USA
| | | | - Jeffrey R. Smith
- Center for Conservation Biology, Stanford University, Stanford, CA 94305, USA
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Matilda van den Bosch
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Forest and Conservation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benedict W. Wheeler
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Mathew P. White
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Hua Zheng
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Gretchen C. Daily
- Center for Conservation Biology, Stanford University, Stanford, CA 94305, USA
- The Natural Capital Project, Stanford, CA 94305, USA
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- Stanford Woods Institute, Stanford University, Stanford, CA 94305, USA
- Corresponding author. (G.N.B.); (G.C.D.)
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Helbich M, Yao Y, Liu Y, Zhang J, Liu P, Wang R. Using deep learning to examine street view green and blue spaces and their associations with geriatric depression in Beijing, China. ENVIRONMENT INTERNATIONAL 2019; 126:107-117. [PMID: 30797100 PMCID: PMC6437315 DOI: 10.1016/j.envint.2019.02.013] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 04/14/2023]
Abstract
BACKGROUND Residential green and blue spaces may be therapeutic for the mental health. However, solid evidence on the linkage between exposure to green and blue spaces and mental health among the elderly in non-Western countries is scarce and limited to exposure metrics based on remote sensing images (i.e., land cover and vegetation indices). Such overhead-view measures may fail to capture how people perceive the environment on the site. OBJECTIVE This study aimed to compare streetscape metrics derived from street view images with satellite-derived ones for the assessment of green and blue space; and to examine associations between exposure to green and blue spaces as well as geriatric depression in Beijing, China. METHODS Questionnaire data on 1190 participants aged 60 or above were analyzed cross-sectionally. Depressive symptoms were assessed through the shortened Geriatric Depression Scale (GDS-15). Streetscape green and blue spaces were extracted from Tencent Street View data by a fully convolutional neural network. Indicators derived from street view images were compared with a satellite-based normalized difference vegetation index (NDVI), a normalized difference water index (NDWI), and those derived from GlobeLand30 land cover data on a neighborhood level. Multilevel regressions with neighborhood-level random effects were fitted to assess correlations between GDS-15 scores and these green and blue spaces exposure metrics. RESULTS The average cumulative GDS-15 score was 3.4 (i.e., no depressive symptoms). Metrics of green and blue space derived from street view images were not correlated with satellite-based ones. While NDVI was highly correlated with GlobeLand30 green space, NDWI was moderately correlated with GlobeLand30 blue space. Multilevel regressions showed that both street view green and blue spaces were inversely associated with GDS-15 scores and achieved the highest model goodness-of-fit. No significant associations were found with NDVI, NDWI, and GlobeLand30 green and blue space. Our results passed robustness tests. CONCLUSION Our findings provide support that street view green and blue spaces are protective against depression for the elderly in China, yet longitudinal confirmation to infer causality is necessary. Street view and satellite-derived green and blue space measures represent different aspects of natural environments. Both street view data and deep learning are valuable tools for automated environmental exposure assessments for health-related studies.
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Affiliation(s)
- Marco Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands.
| | - Yao Yao
- School of Information Engineering, China University of Geosciences, Wuhan, China.
| | - Ye Liu
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Guangzhou, China
| | - Jinbao Zhang
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Guangzhou, China
| | - Penghua Liu
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Guangzhou, China
| | - Ruoyu Wang
- School of Information Engineering, China University of Geosciences, Wuhan, China; School of Geography and Planning, Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Guangzhou, China.
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Availability of Public Toilets in Parks and Recreational Sites in Selected US Cities. J Wound Ostomy Continence Nurs 2019; 46:235-239. [PMID: 31022127 DOI: 10.1097/won.0000000000000522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The principal aim of this study was to map and describe the availability of parkland public toilets in major US cities per population and area. DESIGN Observational and descriptive. SUBJECTS AND SETTING Data were collected from the following cities: Austin, Texas; Minneapolis-St Paul (MSP), Minnesota; Nashville, Tennessee; New York City (NYC), New York; Philadelphia, Pennsylvania; San Francisco, California (SFC); Seattle, Washington; and Tampa, Florida. These cities are located throughout the United States. METHODS Data from the US Census and cities' parks/recreation departments about publicly owned and operated permanent toilet facilities were analyzed and then mapped using geographic information systems. Toilet density by population and residential area (mi) was calculated, and toilet distribution was visualized. RESULTS When calculated per 100,000 residents, MSP had the most parkland public toilets with 24; Tampa, Seattle, and Philadelphia had 17 to 22; and Nashville, NYC, and SFC had the fewest, around 7 toilets. Parkland public toilet density per residential area was highest in NYC and Philadelphia (>2/mi), followed by MSP, Seattle, and SFC (1/mi), then Tampa, Austin, and Nashville (<1/mi). The proportion of Census tracts containing parkland public toilets was more than 0.4 in MSP, Seattle, Tampa, and Philadelphia, more than 0.20 in Nashville and Austin, and less than 0.20 in the other cities. Toilet mapping showed fairly even distribution across Census tracts in MSP, Seattle, Tampa, and Philadelphia. CONCLUSIONS Availability of parkland public toilets was highest in MSP and lowest in SFC. Findings inform WOC nurses for counseling incontinent patients about self-management strategies. Urban planning that provides an adequate number and distribution of parkland public toilets may improve quality of life.
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Mizen A, Song J, Fry R, Akbari A, Berridge D, Parker SC, Johnson R, Lovell R, Lyons RA, Nieuwenhuijsen M, Stratton G, Wheeler BW, White J, White M, Rodgers SE. Longitudinal access and exposure to green-blue spaces and individual-level mental health and well-being: protocol for a longitudinal, population-wide record-linked natural experiment. BMJ Open 2019; 9:e027289. [PMID: 31005938 PMCID: PMC6528002 DOI: 10.1136/bmjopen-2018-027289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Studies suggest that access and exposure to green-blue spaces (GBS) have beneficial impacts on mental health. However, the evidence base is limited with respect to longitudinal studies. The main aim of this longitudinal, population-wide, record-linked natural experiment, is to model the daily lived experience by linking GBS accessibility indices, residential GBS exposure and health data; to enable quantification of the impact of GBS on well-being and common mental health disorders, for a national population. METHODS AND ANALYSIS This research will estimate the impact of neighbourhood GBS access, GBS exposure and visits to GBS on the risk of common mental health conditions and the opportunity for promoting subjective well-being (SWB); both key priorities for public health. We will use a Geographic Information System (GIS) to create quarterly household GBS accessibility indices and GBS exposure using digital map and satellite data for 1.4 million homes in Wales, UK (2008-2018). We will link the GBS accessibility indices and GBS exposures to individual-level mental health outcomes for 1.7 million people with general practitioner (GP) data and data from the National Survey for Wales (n=~12 000) on well-being in the Secure Anonymised Information Linkage (SAIL) Databank. We will examine if these associations are modified by multiple sociophysical variables, migration and socioeconomic disadvantage. Subgroup analyses will examine associations by different types of GBS. This longitudinal study will be augmented by cross-sectional research using survey data on self-reported visits to GBS and SWB. ETHICS AND DISSEMINATION All data will be anonymised and linked within the privacy protecting SAIL Databank. We will be using anonymised data and therefore we are exempt from National Research Ethics Committee (NREC). An Information Governance Review Panel (IGRP) application (Project ID: 0562) to link these data has been approved.The research programme will be undertaken in close collaboration with public/patient involvement groups. A multistrategy programme of dissemination is planned with the academic community, policy-makers, practitioners and the public.
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Affiliation(s)
- Amy Mizen
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Jiao Song
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Richard Fry
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ashley Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Damon Berridge
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Sarah C Parker
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rhodri Johnson
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
| | - Ronan A Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Mark Nieuwenhuijsen
- Instituto de Salud Global de Barcelona.c/ Rosselló, 132, 5º 2ª, Barcelona, Spain
| | - Gareth Stratton
- Research Centre in Applied Sports, Technology Exercise and Medicine, College of Engineering, Swansea University, Swansea, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
| | - James White
- DECIPHer, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mathew White
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
| | - Sarah E Rodgers
- Swansea University Medical School, Swansea University, Swansea, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Abstract
Urban residential greening provides opportunities for social integration and physical exercise. These activities are beneficial to promoting citizens’ mental health, relieving stress, and reducing obesity and violent crimes. However, how to measure the distribution and spatial difference of green resources in urban residential areas have been controversial. This study takes the greening of urban residential units in Shenzhen City as its research object, measures the various greening index values of each residential unit, and analyses the spatial distribution characteristics of residential greening, regional differences, and influencing factors. A large sample of street view pictures, urban land use and high-resolution remote sensing image data are employed to establish an urban residential greening database containing 14,196 residential units. This study proposes three greening indicators, namely, green coverage index, green view index, and accessible public green land index, for measuring the green coverage of residential units, the visible greening of surrounding street space and the public green land around, respectively. Results show that (1) the greening level of residential units in Shenzhen City is generally high, with the three indicators averaging 32.7%, 30.5%, and 15.1%, respectively; (2) the types of residential greening differ per area; and (3) the level of residential greening is affected by development intensity, location, elevation and residential type. Such findings can serve as a reference for improving the greening level of residential units. This study argues that one indicator alone cannot measure the greenness of a residential community. It proposes an accessible public green land index as a measure for the spatial relationship between residential units and green lands. It suggests that future green space planning should pay more attention to the spatial distribution of green land, and introduce quantitative indicators to ensure sufficient green lands around the walking range of residential areas.
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Associations between Urban Green Spaces and Health are Dependent on the Analytical Scale and How Urban Green Spaces are Measured. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040578. [PMID: 30781534 PMCID: PMC6406785 DOI: 10.3390/ijerph16040578] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 01/21/2023]
Abstract
Although the benefits from exposure to urban green spaces (UGS) are increasingly reported, there are important knowledge gaps in the nature of UGS-health relationships. One such unknown area is the dependence of UGS-health associations on the types of UGS studied, the way they are quantified, and the spatial scale used in the analysis. These knowledge gaps have important ramifications on our ability to develop generalizations to promote implementation and facilitate comparative studies across different socio-cultural and socio-economic contexts. We conducted a study in Singapore to examine the dependence of UGS-health associations on the metrics for quantifying UGS (vegetation cover, canopy cover and park area) in different types of buffer area (circular, nested and network) at different spatial scales. A population-based household survey (n = 1000) was used to collect information on self-reported health and perception and usage pattern of UGS. The results showed that although all three UGS metrics were positively related to mental health at certain scales, overall, canopy cover showed the strongest associations with mental health at most scales. There also appears to be minimum and maximum threshold levels of spatial scale at which UGS and health have significant associations, with the strongest associations consistently shown between 400 m to 1600 m in different buffer types. We discuss the significance of these results for UGS-health studies and applications in UGS planning for improved health of urban dwellers.
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Orioli R, Antonucci C, Scortichini M, Cerza F, Marando F, Ancona C, Manes F, Davoli M, Michelozzi P, Forastiere F, Cesaroni G. Exposure to Residential Greenness as a Predictor of Cause-Specific Mortality and Stroke Incidence in the Rome Longitudinal Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:27002. [PMID: 30775931 PMCID: PMC6752936 DOI: 10.1289/ehp2854] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Living in areas with higher levels of surrounding greenness and access to urban green areas have been associated with beneficial health outcomes. Some studies suggested a beneficial influence on mortality, but the evidence is still controversial. OBJECTIVES We used longitudinal data from a large cohort to estimate associations of two measures of residential greenness exposure with cause-specific mortality and stroke incidence. METHODS We studied a population-based cohort of 1,263,721 residents in Rome aged [Formula: see text], followed from 2001 to 2013. As greenness exposure, we utilized the leaf area index (LAI), which expresses the tree canopy as the leaf area per unit ground surface area, and the normalized difference vegetation index (NDVI) within 300- and [Formula: see text] buffers around home addresses. We estimated the association between the two measures of residential greenness and the outcomes using Cox models, after controlling for relevant individual covariates and contextual characteristics, and explored potential mediation by air pollution [fine particulate matter with aerodynamic diameter [Formula: see text] [Formula: see text] and [Formula: see text]] and road traffic noise. RESULTS We observed 198,704 deaths from nonaccidental causes, 81,269 from cardiovascular diseases [CVDs; 29,654 from ischemic heart disease (IHD)], 18,090 from cerebrovascular diseases, and 29,033 incident cases of stroke. Residential greenness, expressed as interquartile range (IQR) increase in LAI within [Formula: see text], was inversely associated with stroke incidence {hazard ratio (HR) 0.977 [95% confidence interval (CI): 0.961, 0.994]} and mortality for nonaccidental [HR 0.988 (95% CI: 0.981, 0.994)], cardiovascular [HR 0.984 (95% CI: 0.974, 0.994)] and cerebrovascular diseases [HR 0.964 (95% CI: 0.943, 0.985)]. Similar results were obtained using NDVI with 300- or [Formula: see text] buffers. CONCLUSIONS Living in greener areas was associated with better health outcomes in our study, which could be partly due to reduced exposure to environmental hazards. Further research is required to understand the underlying mechanisms. https://doi.org/10.1289/EHP2854.
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Affiliation(s)
- Riccardo Orioli
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
- Hygiene and Public Health Service, Local Health Authority, Merano, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara Antonucci
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Matteo Scortichini
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Francesco Cerza
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Federica Marando
- Department of Environmental Biology, Sapienza University of Rome, Rome, Italy
| | - Carla Ancona
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Fausto Manes
- Department of Environmental Biology, Sapienza University of Rome, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
| | | | - Giulia Cesaroni
- Department of Epidemiology-Regional Health Service, ASL Roma 1, Rome, Italy
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Ward Thompson C, Silveirinha de Oliveira E, Tilley S, Elizalde A, Botha W, Briggs A, Cummins S, Leyland AH, Roe JJ, Aspinall P, Brookfield K, Mitchell R. Health impacts of environmental and social interventions designed to increase deprived communities’ access to urban woodlands: a mixed-methods study. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundContact with natural environments can bring health benefits, but research is lacking on how changes in access to natural environments might improve health, especially for deprived populations.ObjectiveTo evaluate the health impacts of woodland environment interventions intended to increase communities’ engagement with these woodlands.DesignA prospective study of Forestry Commission Scotland’s Woods In and Around Towns (WIAT) programme in deprived communities to enhance public access to natural environments. The study investigated the impact that WIAT had on community-level mental health over time.SettingThree intervention and three control woodland sites, and associated communities within 1.5 km of the woodlands, located in central Scotland and eligible for WIAT support.ParticipantsA core community survey was administered at each site in three waves, at baseline and after each phase of intervention (n = 5460, panel A). The completed survey contained a nested longitudinal cohort (n = 609, panel B). Community members also undertook 6-monthly environmental audits at all sites (n = 256) and participated in post-intervention focus groups (n = 34).InterventionsPhase 1 involved physical changes to the woodlands, including footpaths, entrances and vegetation. Phase 2 involved community engagement events promoting woodland use.Main outcome measuresThe primary outcome was the Perceived Stress Scale (PSS). Other health measures included health-related quality of life (HRQoL) EuroQol-5 Dimensions (EQ-5D), physical activity (PA) [International Physical Activity Questionnaire (IPAQ)], connectedness to nature [Inclusion of Nature in Self (INS) scale] and social cohesion.ResultsThe PSS scores significantly increased in the intervention group and marginally decreased in the control group. Multilevel regression models showed a differential impact between the intervention and the control at survey wave 3 in panel A [B(unstandardised coefficient) 3.58, 95% confidence interval (CI) 2.85 to 4.31;p < 0.001] and in panel B [B3.03, 95% CI 1.54 to 4.52;p < 0.001]. Using the same analytical approach, no significant change in HRQoL was associated with the intervention. Economic assessment included an illustrative cost–utility analysis and a cost–consequences analysis. The differential in stress between the intervention group and the control group was lower or non-significant in those who visited ‘nature’ in the previous year [panel A,B1.9, 95% CI 0.8 to 3.0;p < 0.001; panel B,B0.64, 95% CI –1.60 to 2.88;p = 0.57]. The IPAQ score showed a positive association with the intervention for moderate levels of PA [panel B,B559.3, 95% CI 211.3 to 907.2;p = 0.002] and overall PA [panel B,B861.5, 95% CI 106.5 to 1616.4;p = 0.025]. The intervention was also associated with increased nature connectedness and social cohesion by wave 3 – significant for panel A only. Qualitative and quantitative evidence showed that interventions increased the perceived quality of the woodland environment and enhanced its enjoyment for different activities, but the increase in use of natural environments post intervention was only 6% (panel B).LimitationsThis study was limited to three intervention sites. External factors may be the primary influence on health outcomes.ConclusionsThe WIAT interventions did not improve community-level health within 6 months of completion, and hence there was no basis for demonstrating cost-effectiveness. However, the WIAT interventions are low cost (average £11.80 per person in the eligible population) and have potential for cost-effectiveness, if health benefits were found in the longer term.Future workUsing routinely collected data to consider a whole-programme evaluation is recommended.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
| | | | - Sara Tilley
- OPENspace Research Centre, Edinburgh College of Art, University of Edinburgh, Edinburgh, UK
| | - Aldo Elizalde
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Willings Botha
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Alastair H Leyland
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jenny J Roe
- School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh, UK
- Stockholm Environment Institute, University of York, York, UK
- Center for Design and Health, University of Virginia, Charlottesville, VA, USA
| | - Peter Aspinall
- School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh, UK
| | - Katherine Brookfield
- OPENspace Research Centre, Edinburgh College of Art, University of Edinburgh, Edinburgh, UK
| | - Richard Mitchell
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Agay-Shay K, Michael Y, Basagaña X, Martínez-Solanas È, Broday D, Lensky IM, Rudolf M, Rubin L, Kent R, Levy N, Haklai Z, Grotto I. Mean and variance of greenness and pregnancy outcomes in Tel Aviv during 2000–14: longitudinal and cross-sectional approaches. Int J Epidemiol 2018; 48:1054-1072. [DOI: 10.1093/ije/dyy249] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 01/02/2023] Open
Abstract
Abstract
Background
Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel.
Methods
Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to ‘outdoor gyms’ located in parks.
Results
Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to ‘outdoor gyms’ and variance of greenness had the largest estimates of mediation.
Conclusion
This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations.
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Affiliation(s)
- Keren Agay-Shay
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Yaron Michael
- Department of Geography and Environment, Bar Ilan University, Ramat-Gan, Israel
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Èrica Martínez-Solanas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Broday
- Department of Environmental, Water, and Agricultural Engineering, Faculty of Civil and Environmental Engineering, Technion—Israel Institute of Technology, Haifa, Israel
| | - Itamar M Lensky
- Department of Geography and Environment, Bar Ilan University, Ramat-Gan, Israel
| | - Mary Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lisa Rubin
- Department of Maternal and Child Health, Public Health Services, Ministry of Health, Jerusalem, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Rafi Kent
- Department of Geography and Environment, Bar Ilan University, Ramat-Gan, Israel
| | - Nadav Levy
- Public Transport Unit, Tel Aviv Municipality, Tel Aviv, Israel
| | - Ziona Haklai
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | - Itamar Grotto
- Ministry of Health, Jerusalem, Israel
- School of Public Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Le Texier M, Schiel K, Caruso G. The provision of urban green space and its accessibility: Spatial data effects in Brussels. PLoS One 2018; 13:e0204684. [PMID: 30332449 PMCID: PMC6192568 DOI: 10.1371/journal.pone.0204684] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
Urban green space (UGS) has many environmental and social benefits. UGS provision and access are increasingly considered in urban policies and must rely on data and indicators that can capture variations in the distribution of UGS within cities. There is no consensus about how UGS, and their provision and access, must be defined from different land use data types. Here we identify four spatial dimensions of UGS and critically examine how different data sources affect these dimensions and our understanding of their variation within a city region (Brussels). We compare UGS indicators measured from an imagery source (NDVI from Landsat), an official cadastre-based map, and the voluntary geographical information provided by OpenStreetMap (OSM). We compare aggregate values of provision and access to UGS as well as their spatial distribution along a centrality gradient and at neighbourhood scale. We find that there are strong differences in the value of indicators when using the different datasets, especially due to their ability to capture private and public green space. However we find that the interpretation of intra-urban spatial variations is not affected by changes in data source. Centrality in particular is a strong determinant of the relative values of UGS availability, fragmentation and accessibility, irrespective of datasets.
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Affiliation(s)
- Marion Le Texier
- UMR CNRS 6266 IDEES, Mont-Saint-Aignan, France
- University Rouen Normandie, Department of Geography, Mont-Saint-Aignan, France
- * E-mail:
| | - Kerry Schiel
- Institute of Geography and Spatial Planning, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Geoffrey Caruso
- Institute of Geography and Spatial Planning, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
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Protected Natural Areas: In Sickness and in Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102182. [PMID: 30301212 PMCID: PMC6211000 DOI: 10.3390/ijerph15102182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022]
Abstract
Numerous studies show the benefits that contact with the natural environment have for human health, but there are few studies on the role of Protected Natural Areas (PNAs), either from the preventive point of view or on their potential benefits, on individuals with health problems. A study was made of the relationship between the visitation of Montseny Natural Park and Biosphere Reserve and health, from the perspective of a population group with different diseases. A total of 250 patients resident in the areas near the park were surveyed, recording their beliefs about the benefits of nature, as well as the reasons for visiting and the activities associated with health that they carried out in the park. The pure air is the most valued benefit (27.2%), particularly for those with allergies. The majority (57%) visit the park for health reasons. High levels (82%) of exercise are recorded, especially by patients with heart diseases (85%), and 65% exercised in the park. More physical activity is mentioned among those that visit the park most often, particularly among those that carried it out for health reasons. Plants were collected for medicinal use by 39.6%. The study confirmed the significant role of the Montseny Natural Park and Biosphere Reserve as a health resource for individuals with diseases that live near it. It also corroborates the beneficial effects that the PNA provide in human health.
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Chaparro MP, Benzeval M, Richardson E, Mitchell R. Neighborhood deprivation and biomarkers of health in Britain: the mediating role of the physical environment. BMC Public Health 2018; 18:801. [PMID: 29945580 PMCID: PMC6020450 DOI: 10.1186/s12889-018-5667-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain. METHODS We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010-2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV1%; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO2], particulate matter [PM10], nitrogen dioxide [NO2], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income. RESULTS Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO2 exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP. CONCLUSION Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain.
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Affiliation(s)
- M. Pia Chaparro
- Institute for Social and Economic Research (ISER), University of Essex. Wivenhoe Park, Colchester, Essex, CO4 3SQ UK
- Present Address : Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., suite 2200-16, New Orleans, LA 70112 USA
| | - Michaela Benzeval
- Institute for Social and Economic Research (ISER), University of Essex. Wivenhoe Park, Colchester, Essex, CO4 3SQ UK
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Elizabeth Richardson
- NHS Health Scotland, Gyle Square, 1 S Gyle Cres, Edinburgh, EH12 9EB UK
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP UK
| | - Richard Mitchell
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB UK
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Abstract
There is increasing evidence that exposure to plants and green space, and particularly to gardening, is beneficial to mental and physical health, and so could reduce the pressure on NHS services. Health professionals should therefore encourage their patients to make use of green space and to work in gardens, and should pressure local authorities to increase open spaces and the number of trees, thus also helping to counteract air pollution and climate change.
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Zhang L, Tan PY, Diehl JA. A conceptual framework for studying urban green spaces effects on health. JOURNAL OF URBAN ECOLOGY 2017. [DOI: 10.1093/jue/jux015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vienneau D, de Hoogh K, Faeh D, Kaufmann M, Wunderli JM, Röösli M. More than clean air and tranquillity: Residential green is independently associated with decreasing mortality. ENVIRONMENT INTERNATIONAL 2017; 108:176-184. [PMID: 28863390 DOI: 10.1016/j.envint.2017.08.012] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/31/2017] [Accepted: 08/20/2017] [Indexed: 05/17/2023]
Abstract
Green space may improve health by enabling physical activity and recovery from stress or by decreased pollution levels. We investigated the association between residential green (greenness or green space) and mortality in adults using the Swiss National Cohort (SNC) by mutually considering air pollution and transportation noise exposure. To reflect residential green at the address level, two different metrics were derived: normalised difference vegetation index (NDVI) for greenness, and high resolution land use classification data to identify green spaces (LU-green). We used stratified Cox proportional hazard models (stratified by sex) to study the association between exposure and all natural cause mortality, respiratory and cardiovascular disease (CVD), including ischemic heart disease, stroke and hypertension related mortality. Models were adjusted for civil status, job position, education, neighbourhood socio-economic position (SEP), geographic region, area type, altitude, air pollution (PM10), and transportation noise. From the nation-wide SNC, 4.2 million adults were included providing 7.8years of follow-up and respectively 363,553, 85,314 and 232,322 natural cause, respiratory and CVD deaths. Hazard ratios (and 95%-confidence intervals) for NDVI [and LU-green] per interquartile range within 500m of residence were highly comparable: 0.94 (0.93-0.95) [0.94 (0.93-0.95)] for natural causes; 0.92 (0.91-0.94) [0.92 (0.90-0.95)] for respiratory; and 0.95 (0.94-0.96) [0.96 (0.95-0.98)] for CVD mortality. Protective effects were stronger in younger individuals and in women and, for most outcomes, in urban (vs. rural) and in the highest (vs. lowest) SEP quartile. Estimates remained virtually unchanged after incremental adjustment for air pollution and transportation noise, and mediation by these environmental factors was found to be small. We found consistent evidence that residential green reduced the risk of mortality independently from other environmental exposures. This suggests the protective effect goes beyond the absence of pollution sources. Environmental public health measures should not only aim at reducing pollutant exposure, but additionally maintain existing and increase residential green in areas where lacking.
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Affiliation(s)
- Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - David Faeh
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| | - Jean Marc Wunderli
- Empa, Laboratory for Acoustics/Noise Control, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
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Triguero-Mas M, Donaire-Gonzalez D, Seto E, Valentín A, Martínez D, Smith G, Hurst G, Carrasco-Turigas G, Masterson D, van den Berg M, Ambròs A, Martínez-Íñiguez T, Dedele A, Ellis N, Grazulevicius T, Voorsmit M, Cirach M, Cirac-Claveras J, Swart W, Clasquin E, Ruijsbroek A, Maas J, Jerret M, Gražulevičienė R, Kruize H, Gidlow CJ, Nieuwenhuijsen MJ. Natural outdoor environments and mental health: Stress as a possible mechanism. ENVIRONMENTAL RESEARCH 2017; 159:629-638. [PMID: 28938204 DOI: 10.1016/j.envres.2017.08.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Better mental health has been associated with exposure to natural outdoor environments (NOE). However, comprehensive studies including several indicators of exposure and outcomes, potential effect modifiers and mediators are scarce. OBJECTIVES We used novel, objective measures to explore the relationships between exposure to NOE (i.e. residential availability and contact) and different indicators of mental health, and possible modifiers and mediators. METHODS A nested cross-sectional study was conducted in: Barcelona, Spain; Stoke-on-Trent, United Kingdom; Doetinchem, Netherlands; Kaunas, Lithuania. Participants' exposure to NOE (including both surrounding greenness and green and/or blue spaces) was measured in terms of (a) amount in their residential environment (using Geographical Information Systems) and (b) their contact with NOE (using smartphone data collected over seven days). Self-reported information was collected for mental health (psychological wellbeing, sleep quality, vitality, and somatisation), and potential effect modifiers (gender, age, education level, and city) and mediators (perceived stress and social contacts), with additional objective NOE physical activity (potential mediator) derived from smartphone accelerometers. RESULTS Analysis of data from 406 participants showed no statistically significant associations linking mental health and residential NOE exposure. However, NOE contact, especially surrounding greenness, was statistically significantly tied to better mental health. There were indications that these relationships were stronger for males, younger people, low-medium educated, and Doetinchem residents. Perceived stress was a mediator of most associations, and physical activity and social contacts were not. CONCLUSIONS Our findings indicate that contact with NOE benefits mental health. Our results also suggest that having contact with NOE that can facilitate stress reduction could be particularly beneficial.
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Affiliation(s)
- Margarita Triguero-Mas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - David Donaire-Gonzalez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Physical Activity and Sports Sciences Department, Fundació Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain.
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, USA.
| | - Antònia Valentín
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - David Martínez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Graham Smith
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Gemma Hurst
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Glòria Carrasco-Turigas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Daniel Masterson
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Magdalena van den Berg
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Albert Ambròs
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Tania Martínez-Íñiguez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Audrius Dedele
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.
| | - Naomi Ellis
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Tomas Grazulevicius
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.
| | - Martin Voorsmit
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Marta Cirach
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Judith Cirac-Claveras
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Wim Swart
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Eddy Clasquin
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Annemarie Ruijsbroek
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jolanda Maas
- Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands.
| | - Michael Jerret
- Department of Environmental Health Sciences and Center for Occupational and Environmental Health, University of California, Los Angeles, USA.
| | - Regina Gražulevičienė
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.
| | - Hanneke Kruize
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Christopher J Gidlow
- Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom; Centre for Health and Development, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Helbich M, Blüml V, de Jong T, Plener PL, Kwan MP, Kapusta ND. Urban-rural inequalities in suicide mortality: a comparison of urbanicity indicators. Int J Health Geogr 2017; 16:39. [PMID: 29084555 PMCID: PMC5663034 DOI: 10.1186/s12942-017-0112-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Urban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators. Methods Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors. Results Urban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported. Conclusions The strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised. Electronic supplementary material The online version of this article (10.1186/s12942-017-0112-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, The Netherlands.
| | - V Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090, Vienna, Austria
| | - T de Jong
- Department of Logistics, University of Stellenbosch, Van der Sterrbuilding 3017, Bosmanstreet, Matieland, Stellenbosch, South Africa
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, 89075, Ulm, Germany
| | - M-P Kwan
- Department of Human Geography and Spatial Planning, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, The Netherlands.,Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - N D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090, Vienna, Austria
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