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Penedo FJ, Moreno PI, Pons M, Pinheiro PS, Antoni MH, Lopes G, Calfa C, Chalela P, Garcini L, Wang CP, Chen Y, Diaz A, Cole S, Ramirez AG. Avanzando Caminos (Leading Pathways): design and procedures of the Hispanic/Latino Cancer Survivorship Study. Am J Epidemiol 2024; 193:940-950. [PMID: 38576195 DOI: 10.1093/aje/kwae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Cohort Study aims to examine the influence of sociocultural, medical, stress-related, psychosocial, lifestyle, behavioral, and biological factors on symptom burden, health-related quality of life, and clinical outcomes among Hispanics/Latinos who have been previously treated for cancer. Avanzando Caminos is a prospective, cohort-based study of 3000 Hispanics/Latinos who completed primary cancer treatment within the past 5 years that is representative of the general Hispanic/Latino population in the United States. Participants will complete self-report measures at baseline (time [T] 1), 6 months (T2), 1 year (T3), 2 years (T4), 3 years (T5), 4 years (T6), and 5 years (T7). Blood samples drawn for assessment of leukocyte gene expression, cardiometabolic markers, and genetic admixture will be collected at baseline (T1), 1 year (T3), 3 years (T5), and 5 years (T7). Medical and cancer characteristics and clinical outcomes will be extracted from the electronic medical record and/or state cancer registry at each time point. Data analysis will include general latent variable modeling and latent growth modeling. Avanzando Caminos will fill critical gaps in knowledge in order to guide future secondary and tertiary prevention efforts to mitigate cancer disparities and optimize health-related quality of life among Hispanic/Latino cancer survivors.
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Affiliation(s)
- Frank J Penedo
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, United States
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, United States
| | - Patricia I Moreno
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, United States
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Magela Pons
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Paulo S Pinheiro
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Michael H Antoni
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, United States
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, United States
| | - Gilberto Lopes
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Carmen Calfa
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, United States
| | - Patricia Chalela
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX 78229, United States
- Department of Population Health Sciences, Long School of Medicine, UT Health San Antonio, San Antonio, TX 78229, United States
| | - Luz Garcini
- Department of Psychological Sciences, School of Social Sciences, Rice University, Houston, TX 77005, United States
| | - Chen-Pin Wang
- Department of Population Health Sciences, Long School of Medicine, UT Health San Antonio, San Antonio, TX 78229, United States
| | - Yidong Chen
- Department of Population Health Sciences, Long School of Medicine, UT Health San Antonio, San Antonio, TX 78229, United States
| | - Adolfo Diaz
- Department of Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, TX 78229, United States
| | - Steve Cole
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX 78229, United States
- Department of Population Health Sciences, Long School of Medicine, UT Health San Antonio, San Antonio, TX 78229, United States
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Singh N, Buczyłowska D, Baumbach C, Bratkowski J, Mysak Y, Wierzba-Łukaszyk M, Sitnik-Warchulska K, Skotak K, Lipowska M, Izydorczyk B, Szwed M, Dzhambov AM, Markevych I. Pathways linking greenspace to behavioural problems in Polish children. Heliyon 2024; 10:e31435. [PMID: 38818196 PMCID: PMC11137514 DOI: 10.1016/j.heliyon.2024.e31435] [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] [Received: 11/20/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Background Previous cross-sectional studies have found a beneficial relationship between greenspace and children's behaviour. Nevertheless, evidence on the mechanisms underlying this association remains scant. We examined whether the availability of greenspace was related to fewer behavioural problems in Polish children and investigated potential mechanisms. Methods Data were obtained from the case-control NeuroSmog study, in which children with and without attention deficit hyperactivity disorder (ADHD) were tested from October 2020 to September 2022. The analytic sample comprised 679 children aged 10-13 years. Parents reported internalizing, externalizing, and total behavioural problems using the Child Behaviour Check List (CBCL), as well as information about the presence of a domestic garden and potential mediators: greenspace perception, neighbourhood social cohesion, and physical activity. Tree and grass covers were extracted in 500 m and 1 km buffers around lifelong residences. Structural equation modelling (SEM) was used to examine the psychosocial pathways linking the greenspace metrics to behavioural problems. Results Greenspace was only indirectly related to fewer behavioural problems. Specifically, tree cover was related to greater levels of physical activity which, in turn, was related to fewer internalizing and total behavioural problems. Tree cover and presence of garden were related to greenspace perception which, in turn, was associated with higher neighbourhood social cohesion which, in turn, was linked to fewer behavioural problems. The patterns of associations in children without ADHD were very similar to those in the full sample except that the associations from garden to greenspace perception and from physical activity to total behavioural problems were no longer significant. The only association persisted among girls was from neighbourhood social cohesion to behavioural problems and among boys were from tree cover to physical activity and tree cover and garden to greenspace perception. Conclusion Trees and garden, but not grass, are linked to fewer behavioural problems through greenspace perception, neighbourhood social cohesion, and physical activity in Polish children.
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Affiliation(s)
- Nitika Singh
- Institute of Psychology, Jagiellonian University, Kraków, Poland
- Doctoral School of Social Sciences, Jagiellonian University, Kraków, Poland
| | | | - Clemens Baumbach
- Institute of Psychology, Jagiellonian University, Kraków, Poland
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jakub Bratkowski
- Institute of Environmental Protection-National Research Institute, Warsaw, Poland
| | - Yarema Mysak
- Institute of Psychology, Jagiellonian University, Kraków, Poland
| | | | | | - Krzysztof Skotak
- Institute of Environmental Protection-National Research Institute, Warsaw, Poland
| | - Małgorzata Lipowska
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- Institute of Psychology, University of Gdańsk, Gdańsk, Poland
| | | | - Marcin Szwed
- Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Angel M. Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
- Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
- Research Group “Health and Quality of Life in a Green and Sustainable Environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
- Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Kraków, Poland
- Research Group “Health and Quality of Life in a Green and Sustainable Environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
- Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria
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Chanvrier H, Rattaz V, Offredi V, Dupuis M, Horsch A. Swiss cohort on Traumatic Childbirth and Health (SwiTCH): protocol for a prospective, population-based cohort study on parents' mental health from pregnancy to one year postpartum. BMJ Open 2024; 14:e080557. [PMID: 38296274 PMCID: PMC10828876 DOI: 10.1136/bmjopen-2023-080557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Approximately 4%-5% of mothers develop childbirth-related post-traumatic stress disorder (CB-PTSD) and approximately 12.3% of mothers develop some CB-PTSD symptoms (CB-PTSS). To date, there is a dearth of studies on fathers and other coparents. Parental CB-PTSD and CB-PTSS may have a negative impact not only on the parents but also on the infant. Understanding risk and protective factors of CB-PTSD for both parents and its consequences on the family is key to detecting or anticipating it, to developing interventions aimed at reducing its detrimental effects and to supporting parents. METHODS AND ANALYSIS This study protocol describes an observational, population-based study, consisting of a longitudinal prospective cohort with online surveys at four time points. The population of interest consist of women, in the third trimester of pregnancy or at 6-12 weeks postpartum, and their partner/coparent, who will give birth or gave birth in the French-speaking part of Switzerland. The target sample size is 300-500 women and a proportional number of partners. The primary outcome of this study is the prevalence of CB-PTSD and CB-PTSS. The secondary outcomes focus on: (1) the impact of CB-PTSD and CB-PTSS on the marital and coparental relationships, the bonding with the infant, parental burnout and healthcare seeking behaviours, (2) the role of the childbirth experience in the development of CB-PTSD and CB-PTSS and (3) the social and economic determinants of CB-PTSD and CB-PTSS. ETHICS AND DISSEMINATION Ethical approval was granted by the human research ethics committee of the Canton de Vaud (study number 2022-00284). All study participants signed an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media. TRIAL REGISTRATION NUMBER NCT05865704.
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Affiliation(s)
- Hélène Chanvrier
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Valentine Rattaz
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Valentin Offredi
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- University Department of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marc Dupuis
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department of Woman Mother and Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Richardson L, Minh A, McCormack D, Laing A, Barbic S, Hayashi K, Milloy MJ, Huyser KR, Leahy K, Li J. Cohort Profile: The Assessing Economic Transitions (ASSET) Study-A Community-Based Mixed-Methods Study of Economic Engagement among Inner-City Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610456. [PMID: 36012091 PMCID: PMC9408769 DOI: 10.3390/ijerph191610456] [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: 06/28/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 05/07/2023]
Abstract
The Assessing Economic Transitions (ASSET) study was established to identify relationships between economic engagement, health and well-being in inner-city populations given that research in this area is currently underdeveloped. This paper describes the objectives, design, and characteristics of the ASSET study cohort, an open prospective cohort which aims to provide data on opportunities for addressing economic engagement in an inner-city drug-using population in Vancouver, Canada. Participants complete interviewer-administered surveys quarterly. A subset of participants complete nested semi-structured qualitative interviews semi-annually. Between April 2019 and May 2022, the study enrolled 257 participants ages 19 years or older (median age: 51; 40% Indigenous, 11.6% non-Indigenous people of colour; 39% cis-gender women, 3.9% transgender, genderqueer, or two-spirit) and 41 qualitative participants. At baseline, all participants reported past daily drug use, with 27% currently using opioids daily, and 20% currently using stimulants daily. In the three months prior to baseline, more participants undertook informal income generation (75%) than formal employment (50%). Employed participants largely had casual jobs (42%) or jobs with part-time/varied hours (35%). Nested qualitative studies will focus on how inner-city populations experience economic engagement. The resulting evidence will inform policy and programmatic initiatives to address socioeconomic drivers of health and well-being.
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Affiliation(s)
- Lindsey Richardson
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Correspondence:
| | - Anita Minh
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Deb McCormack
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - Allison Laing
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Providence Research, 1190 Hornby, Vancouver, BC V6Z 2K5, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Kathleen Leahy
- UBC Learning Exchange, University of British Columbia, 612 Main St., Vancouver, BC V6A 2V3, Canada
| | - Johanna Li
- EMBERS Eastside Works, 57 E Hastings St., Vancouver, BC V6A 0A7, Canada
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Gafter L, Tchetchik A, Shilo S. Urban resilience as a mitigating factor against economically driven out-migration during COVID-19: The case of Eilat, a tourism-based city. CITIES (LONDON, ENGLAND) 2022; 125:103636. [PMID: 36540057 PMCID: PMC9756421 DOI: 10.1016/j.cities.2022.103636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has created an ongoing global crisis. The unprecedented shock has been particularly devastating for tourism-based cities and has tested their resilience. This study addresses the mitigating role of urban resilience in the interplay between acute crises and the phenomenon of urban outmigration. Leveraging a unique dataset collected during the first national lockdown that followed the outbreak of COVID-19 in the city of Eilat (Israel)-a geographically isolated single economic sector-based city with no feasible options to commute-we offer here a new conceptual framework and an empirical framework for measuring perceived resilience. Using validated psychometric questionnaires and employing the nested hierarchical modeling approach, we estimate the impact of perceived resilience on the decision to migrate from the city. We find that even though Eilat has all the attributes to experience significant out-migration, its residents are not inclined towards migration due to its prior investment in resilience measures, which strengthened the local community and created a unique credo shared by its residents. These findings call for policymakers to focus on long-term resilience schemes directed at increasing the appeal that cities have for their residents and ensuring their endurance in times of extreme hardship.
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Affiliation(s)
- Lee Gafter
- The department of Geography and Environment, Bar-Ilan University, Ramat-Gan, Israel
| | - Anat Tchetchik
- The department of Geography and Environment, Bar-Ilan University, Ramat-Gan, Israel
| | - Shahar Shilo
- The department Tourism Studies, Ashkelon Academic College, Israel
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Tsai DH, Foster S, Gmel G, Mohler-Kuo M. Social cohesion, depression, and substance use severity among young men: Cross-sectional and longitudinal analyses from a Swiss cohort. Addict Behav 2020; 110:106510. [PMID: 32623236 DOI: 10.1016/j.addbeh.2020.106510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Social cohesion, depression, and problematic substance use are intertwined and poorly understood.This study aimed to examine cross-sectional and longitudinal associations between social cohesion, depression and problematic substance use amongyoung men, age 21-25. METHODS We used 2nd wave (t1, 2012-2014, N = 6020) and 3rd wave (t2, 2016-2018) data from the on-going Swiss CohortStudy on Substance Use Risk Factors (C-SURF), assessing social cohesion, depression, and severity of alcohol, nicotine and cannabis use during both waves. Structural Equation Models (SEMs) were employed to examine pathways in both waves under the framework of longitudinal analysis. RESULTS Social cohesion was directly associated with depression and problem nicotine and cannabis use and indirectly associated with problem alcohol, nicotine and cannabis use through depression at both t1 and t2. Social cohesion exerted direct effects on nicotine use and cannabis use severity, but not on alcohol use severity. Social cohesion had indirect effects on problem use of all three substances, mediated via depression. The predictive direction was from depression to substance use, rather than vice versa. CONCLUSIONS Higher social cohesion at an early age appears to protect young males from depression and problematic substance use later in life. However, once problematic substance use is established, the direct effect of social cohesion diminishes and is mediated through personal depression. Therefore, promoting a more cohesiveneighborhood in childhood or adolescenthood could play an important role preventing depression and more severe substance use behaviors.
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Dzhambov AM, Browning MHEM, Markevych I, Hartig T, Lercher P. Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature. ENVIRONMENTAL RESEARCH 2020; 186:109613. [PMID: 32668553 DOI: 10.1016/j.envres.2020.109613] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Inadequate translation from theoretical to statistical models of the greenspace - health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses. METHODS We conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics. RESULTS We found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing. CONCLUSIONS We found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Matthew H E M Browning
- Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, USA
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
| | - Peter Lercher
- Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
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Preston S, Moffat S, Smith L. Active Bucks: engaging and retaining inactive residents in self-sustaining activities. Perspect Public Health 2019; 139:173-174. [PMID: 31251130 DOI: 10.1177/1757913919850780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah Preston
- Public Health Principal, Buckinghamshire County Council, Aylesbury, UK
| | - Stephanie Moffat
- Public Health Practitioner, Buckinghamshire County Council, Aylesbury, UK
| | - Lucie Smith
- Public Health Principal, Buckinghamshire County Council, Aylesbury, UK
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Residential green and blue space associated with better mental health: a pilot follow-up study in university students. Arh Hig Rada Toksikol 2019; 69:340-349. [DOI: 10.2478/aiht-2018-69-3166] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/01/2018] [Indexed: 12/27/2022] Open
Abstract
Abstract
Previous research has suggested that natural urban environment (green space and blue space) benefit mental health, but only a few longitudinal studies have explored the underlying mechanisms. In this pilot study we aimed to examine mechanisms/variables mediating associations between residential green/blue space and symptoms of anxiety/depression in 109 Bulgarian students from Plovdiv university. The students were followed from the beginning to the end of the school year (October 2017 to May 2018). Residential green space was defined as the mean of the normalised difference vegetation index (NDVI) in circular buffers of 100, 300, and 500 m around their residences. Blue space was assessed based on its presence in the same buffers. Levels of anxiety/depression were assessed using the 12-item General Health Questionnaire. The investigated mediator variables included residential noise (LAeq) and air pollution (NO2), environmental annoyance, perceived restorative quality of the neighbourhood, neighbourhood social cohesion, physical activity, and sleep disturbance. Cross-sectional data (obtained at baseline) showed that higher NDVI correlated with better mental health only indirectly through higher physical activity and restorative quality. Longitudinal (follow-up) data showed improved mental health but no significant effect of mediator variables. Similarly, blue space correlated with better mental health in all models, but physical activity and restorative quality were significant mediator variables only in the cross-sectional analysis. Our findings support that green space and blue space are psychologically restorative features in urban environment. Future research should replicate these findings in the general population and employ longitudinal modelling tailored to the specific mechanisms under study.
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Dzhambov AM, Markevych I, Hartig T, Tilov B, Arabadzhiev Z, Stoyanov D, Gatseva P, Dimitrova DD. Multiple pathways link urban green- and bluespace to mental health in young adults. ENVIRONMENTAL RESEARCH 2018; 166:223-233. [PMID: 29890427 DOI: 10.1016/j.envres.2018.06.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND A growing body of scientific literature indicates that urban green- and bluespace support mental health; however, little research has attempted to address the complexities in likely interrelations among the pathways through which benefits plausibly are realized. OBJECTIVES The present study examines how different plausible pathways between green/bluespace and mental health can work together. Both objective and perceived measures of green- and bluespace are used in these models. METHODS We sampled 720 students from the city of Plovdiv, Bulgaria. Residential greenspace was measured in terms of the Normalized Difference Vegetation Index (NDVI), tree cover density, percentage of green areas, and Euclidean distance to the nearest green space. Bluespace was measured in terms of its presence in the neighborhood and the Euclidean distance to the nearest bluespace. Mental health was measured with the 12-item form of the General Health Questionnaire (GHQ-12). The following mediators were considered: perceived neighborhood green/bluespace, restorative quality of the neighborhood, social cohesion, physical activity, noise and air pollution, and environmental annoyance. Structural equation modelling techniques were used to analyze the data. RESULTS Higher NDVI within a 300 m buffer around the residence was associated with better mental health through higher perceived greenspace; through higher perceived greenspace, leading to increased restorative quality, and subsequently to increased physical activity (i.e., serial mediation); through lower noise exposure, which in turn was associated with lower annoyance; and through higher perceived greenspace, which was associated with lower annoyance. Presence of bluespace within a 300 m buffer did not have a straightforward association with mental health owing to competitive indirect paths: one supporting mental health through higher perceived bluespace, restorative quality, and physical activity; and another engendering mental ill-health through higher noise exposure and annoyance. CONCLUSIONS We found evidence that having more greenspace near the residence supported mental health through several indirect pathways with serial components. Conversely, bluespace was not clearly associated with mental health.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
| | - Boris Tilov
- Medical College, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Management, Faculty of Economics and Management, University of Agribusiness and Rural Development, Plovdiv, Bulgaria
| | - Zlatoslav Arabadzhiev
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Drozdstoj Stoyanov
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Penka Gatseva
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Donka D Dimitrova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
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Dzhambov AM, Markevych I, Tilov B, Arabadzhiev Z, Stoyanov D, Gatseva P, Dimitrova DD. Pathways linking residential noise and air pollution to mental ill-health in young adults. ENVIRONMENTAL RESEARCH 2018; 166:458-465. [PMID: 29940479 DOI: 10.1016/j.envres.2018.06.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Recent years have seen growing, but still tentative, evidence of the potential associations of environmental noise and air pollution with mental disorders. In the present study, we aimed to examine the associations between residential noise and air pollution exposures and general mental health in young adults with a focus on underlying processes METHODS: We sampled 720 students (18-35 years) from one university in the city of Plovdiv, Bulgaria. Residential noise (LAeq; day equivalent noise level) and air pollution (NO2) were assessed at participant's residential address by land use regression models. General mental health was measured with a short form of the General Health Questionnaire (GHQ). The following putative mediators were considered: annoyance from environmental pollution, sleep disturbance, restorative quality of the neighborhood, neighborhood social cohesion, and commuting/leisure time physical activity. Structural equation modeling was used to analyze the theoretically-indicated interplay between exposures, mediators, and GHQ. RESULTS We observed an association between higher LAeq and GHQ, in which environmental annoyance and neighborhood restorative quality emerged as key mediators. First, LAeq was associated with higher annoyance, and through it with lower restorative quality, and then in turn with lower physical activity, and thus with higher GHQ. Simultaneously, higher annoyance was associated with higher sleep disturbance, and thereby with higher GHQ. NO2 had no overall association with GHQ, but it was indirectly associated with it through higher annoyance, lower restorative quality, and lower physical activity working in serial. CONCLUSION We found evidence that increased residential noise was related to mental ill-health through several indirect pathways. Air pollution was associated with mental health only indirectly.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria.
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Boris Tilov
- Medical College, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Management, Faculty of Economics and Management, University of Agribusiness and Rural Development, Plovdiv, Bulgaria
| | - Zlatoslav Arabadzhiev
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Drozdstoj Stoyanov
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Penka Gatseva
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria
| | - Donka D Dimitrova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
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Dzhambov A, Hartig T, Markevych I, Tilov B, Dimitrova D. Urban residential greenspace and mental health in youth: Different approaches to testing multiple pathways yield different conclusions. ENVIRONMENTAL RESEARCH 2018; 160:47-59. [PMID: 28961469 DOI: 10.1016/j.envres.2017.09.015] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Urban greenspace can benefit mental health through multiple mechanisms. They may work together, but previous studies have treated them as independent. OBJECTIVES We aimed to compare single and parallel mediation models, which estimate the independent contributions of different paths, to several models that posit serial mediation components in the pathway from greenspace to mental health. METHODS We collected cross-sectional survey data from 399 participants (15-25 years of age) in the city of Plovdiv, Bulgaria. Objective "exposure" to urban residential greenspace was defined by the Normalized Difference Vegetation Index (NDVI), Soil Adjusted Vegetation Index, tree cover density within the 500-m buffer, and Euclidean distance to the nearest urban greenspace. Self-reported measures of availability, access, quality, and usage of greenspace were also used. Mental health was measured with the General Health Questionnaire. The following potential mediators were considered in single and parallel mediation models: restorative quality of the neighborhood, neighborhood social cohesion, commuting and leisure time physical activity, road traffic noise annoyance, and perceived air pollution. Four models were tested with the following serial mediation components: (1) restorative quality → social cohesion; (2) restorative quality → physical activity; (3) perceived traffic pollution → restorative quality; (4) and noise annoyance → physical activity. RESULTS There was no direct association between objectively-measured greenspace and mental health. For the 500-m buffer, the tests of the single mediator models suggested that restorative quality mediated the relationship between NDVI and mental health. Tests of parallel mediation models did not find any significant indirect effects. In line with theory, tests of the serial mediation models showed that higher restorative quality was associated with more physical activity and more social cohesion, and in turn with better mental health. As for self-reported greenspace measures, single mediation through restorative quality was significant only for time in greenspace, and there was no mediation though restorative quality in the parallel mediation models; however, serial mediation through restorative quality and social cohesion/physical activity was indicated for all self-reported measures except for greenspace quality. CONCLUSIONS Statistical models should adequately address the theoretically indicated interdependencies between mechanisms underlying association between greenspace and mental health. If such causal relationships hold, testing mediators alone or in parallel may lead to incorrect inferences about the relative contribution of specific paths, and thus to inappropriate intervention strategies.
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Affiliation(s)
- Angel Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Terry Hartig
- Institute for Housing and Urban Research and Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Boris Tilov
- Medical College, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Management, Faculty of Economics and Management, University of Agribusiness and Rural Development, Plovdiv, Bulgaria
| | - Donka Dimitrova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
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Dzhambov A, Tilov B, Markevych I, Dimitrova D. Residential road traffic noise and general mental health in youth: The role of noise annoyance, neighborhood restorative quality, physical activity, and social cohesion as potential mediators. ENVIRONMENT INTERNATIONAL 2017; 109:1-9. [PMID: 28917129 DOI: 10.1016/j.envint.2017.09.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/26/2017] [Accepted: 09/09/2017] [Indexed: 05/24/2023]
Abstract
Given the ubiquitous nature of both noise pollution and mental disorders, their alleged association has not escaped the spotlight of public health research. The effect of traffic noise on mental health is probably mediated by other factors, which have not been elucidated sufficiently. Herein, we aimed to disentangle the pathways linking road traffic noise to general mental health in Bulgarian youth, with a focus on several candidate mediators - noise annoyance, perceived restorative quality of the living environment, physical activity, and neighborhood social cohesion. A cross-sectional sample was collected in October - December 2016 in the city of Plovdiv, Bulgaria. It consisted of 399 students aged 15-25years, recruited from two high schools and three universities. Road traffic noise exposure (Lden) was derived from the strategic noise map of Plovdiv. Mental health was measured with the 12-item form of the General Health Questionnaire (GHQ-12). Noise annoyance, perceived restorative quality of the living environment, commuting and leisure time physical activity, and neighborhood social cohesion were assessed using validated questionnaires. Analyses were based on linear regression mediation models and a structural equation modeling (SEM) to account for the hypothesized interdependencies between candidate mediators. Results showed that higher noise exposure was associated with worse mental health only indirectly. More specifically, tests of the single and parallel mediation models indicated independent indirect paths through noise annoyance, social cohesion, and physical activity. In addition, the SEM revealed that more noise annoyance was associated with less social cohesion, and in turn with worse mental health; noise annoyance was also associated with lower neighborhood restorative quality, thereby with less social cohesion and physical activity, and in turn with worse mental health. However, causality could not be established. Further research is warranted to expand our still limited understanding of these person-environment interactions.
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Affiliation(s)
- Angel Dzhambov
- Department of Hygiene and Ecomedicine, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Boris Tilov
- Medical College, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Management, Faculty of Economics and Management, University of Agribusiness and Rural Development, Plovdiv, Bulgaria
| | - Iana Markevych
- Institute for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany; Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Donka Dimitrova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
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