Nature Contact and Human Health: A Research Agenda

'A healthy lifestyle is a journey': exploring health perceptions and self-defined facilitators to health through photo-elicitation

OBJECTIVE

The aim of this study was to explore health perceptions and self-defined facilitators to health in general population. An additional aim of the study was to assess if these perceptions were connected with the context of the Covid-19 pandemic.

DESIGN

We applied photo-elicitation method by gathering original photographs and narratives (captions) via social media and e-mails. Participants (N = 50) were asked to answer the question: 'What does it mean to be healthy?'. Data were collected online in Poland. We generated and interpreted the main themes associated with common perceptions of health and self-defined facilitators to health using polytextual thematic analysis.

RESULTS

The health perception themes were, health as: a 'long journey'; keeping balance; and self-acceptance. The main facilitators to health were: enjoyment of activities that are part of a healthy lifestyle; planning time for rest; contact with nature, and supportive relationships. Participants' perceptions of how Covid-19 impacted on their health differed.

CONCLUSIONS

The findings provide evidence for individual health perceptions and self-defined facilitators to health and can support the development of future health interventions.

Physical and Mental Health of Caregivers and Educators of Preschool-Aged Children: Identifying Benefits and Barriers to Outdoor Time, How Outdoor Time Can Make a Difference for Health Equity, and Why Income Matters

Outdoor time is positively associated with improved physical and mental health in adults. Little is known about the specific effects of outdoor time on health outcomes for parents and educators of preschool-aged children. Early childhood is a critical window for growth and development, as parental and educator stress negatively impacts young children; thus, it is of paramount importance to systematically support parents and educators during these developmental years. The objectives of this research were to use a cross-sectional natural experiment to (1) evaluate the association between outdoor time and physical and mental health in caregivers and educators who engage with preschool-aged children; (2) evaluate the association between income and physical and mental health in caregivers and educators who engage with preschool-aged children; and (3) identify benefits and barriers of outdoor time and the importance, availability, and accessibility of community resources for outdoor time. Participants were recruited from three stakeholder groups: preschool educators, parents of children attending an outdoor preschool, and parents of preschool-aged children in the local community. Participants completed a health needs assessment (n = 46) to assess demographics, mental and physical health outcomes, and benefits, barriers, and resources for outdoor time. Caregivers and educators in the higher income group (≥USD 70,000) were 41% (95% CI: 12%, 70%) more likely to report very good or excellent self-reported health. Mean anxiety, depression, and perceived stress were lower in the higher-income group. Caregivers and educators in the higher outdoor time group had lower body mass index (-5.5 kg/m2; 95% CI: -11.6, 0.7), and outdoor time appeared to be protective for general health independent of income. Thus, outdoor time may be a critical protective factor to enhance biological resilience for caregivers and educators, especially for those facing financial adversity.

Different exercise interventions on quality of sleep in breast cancer survivors-a network meta-analysis of randomized controlled trials

Introduction

Breast cancer is currently the most prevalent cancer globally; however, it generally has a favorable prognosis and is linked to a high survival rate. While effective treatments can extend survival and mitigate associated side effects, not all survivors are exempt from complications. Notably, a significant proportion of survivors experience sleep disorders following surgery, which can severely impact their quality of life. Exercise is frequently recommended as a non-pharmacological intervention to enhance sleep quality among breast cancer survivors and may also play a role in reducing recurrence rates. Recognizing that various forms of exercise may yield different outcomes in addressing sleep disorders in this population, we conducted a network review meta-analysis to assess the effectiveness of diverse exercise modalities for breast cancer survivors suffering from sleep disturbances.

Methods

We searched four electronic databases for randomized controlled trials of individuals diagnosed breast cancer with sleep disorders by different exercise therapy. The primary outcomes included Yoga, Pilates, Qigong, Tai Chi, Walking, Dance, Resistance training, Football, Virtual reality therapy, Activity change exercise, Software-guided exercises. The methodological quality of the included studies was assessed using the Cochrane Bias risk Assessment tool, and network meta-analysis was performed using Stata15 software. The review was pre-registered (PROSPERO ID: CRD42023442892).

Results

Data on 3083 breast cancer survivors with sleep disturbances from 34 eligible randomized controlled trials were analyzed, with 23 classified as medium risk and 2 as high risk. Network meta-analysis showed that walking exercise [Standard Median Different (SMD) =3.06, 95% Confidence Interval (95%CI)=(-5.89,-0.23)] significantly improved sleep disorder (Surface Under the Cumulative Ranking curve, SUCRA: 84.5%) and reduced Pittsburgh sleep quality index (PSQI) score.

Discussion

Based on the network ranking table, we can conclude that walking exercise offers greater benefits compared to other exercise interventions for improving sleep quality in breast cancer patients. This finding presents a novel perspective on exercise interventions for breast cancer survivors experiencing sleep disorders.

Systematic review registration

PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=442892, identifier CRD42023442892.

Virtual nature and well-being: Exploring the potential of 360° VR

This proof-of-concept study investigates the potential of immersive 360° VR nature videos to enhance emotional well-being and nature connectedness, focusing on their use as e-health interventions within social marketing initiatives. The research examined four key variables: (i) presence, or the extent to which participants felt immersed in the VR experience; (ii) emotional responses, measured by changes in participants' positive and negative affect; (iii) user experience, including enjoyment and engagement; and (iv) nature connectedness, reflecting participants' state of connection to the natural world. Using a mixed-method approach, participants (n = 63) engaged with four VR nature videos, with presence, emotional states and nature connectedness measured before and after the experience. Results showed high levels of presence, with participants reporting feelings of calmness, escape and connection to nature. Positive affect increased post-VR, although negative affect remained unchanged. Nature connectedness improved across all participants, highlighting the potential of VR nature experiences to support well-being. Individual differences, such as prior VR experience and gender, influenced perceptions, emphasising the need to tailor interventions. This study provides a foundation for using 360° VR nature videos in social marketing to promote emotional well-being, particularly for those with limited access to natural environments.

Nature's Touch: The Experience of Using Nature for Health Improvements in Patients with Mental Illness. A Qualitative Study

This study aims to describe staff experiences of nature as a tool for working with people with mental illnesses. A qualitative study consisting of nine interviews with staff working with nature as a tool was conducted. The data were analysed using qualitative content analysis. Two themes with six subthemes emerged. The first theme, making the invisible visible with subthemes, getting in touch with nature, getting in touch with feelings and acceptance of time and lack of demands, and the second theme, working with what we have with subthemes, nature becomes a tool for resiliency, the surrounding environment becomes a safe setting and important relationships for good treatment. The healthcare staffs' experiences of incorporating nature as a caring tool for patients with mental illness showed that nature could contribute to a patient's recovery. For psychiatric nursing, this study observed that having the knowledge and awareness of nature's effect on patients, and using it as complementary care and treatment-tool may inspire both staff, and their patients to further include nature-assisted care and therapy in their treatment of mental illnesses on the road to improved mental health.

Integrating Green Care Initiatives into Conventional Health Systems: Which Governance Dimensions Can Guide This Process?

Green Care initiatives (GCIs) encompass various interventions that support physical, mental, and social well-being through interaction with nature. Integrating GCIs into conventional healthcare systems is a complex task that requires multi-actor and multi-level governance efforts. This study examines, through a systematized literature review, the relevant governance dimensions to facilitate the inclusion of GCIs in traditional care pathways. From the analysis of the 36 selected studies, four key dimensions were identified: organizational structure, knowledge, legitimacy, and decentralization. The analysis highlights the need to strengthen the responsibility of Green Care actors as healthcare service providers, enhance local authorities' role in creating new integrated service delivery networks, combine different knowledge perspectives, and legitimize non-healthcare actors. Recommendations are made to address these governance aspects to facilitate the integration of GCIs and channel their benefits in prevention and health promotion. Adopting an adequate governance framework is fundamental for mainstreaming GCIs in current healthcare systems.

Association of urban green and blue space with accelerated ageing: A cohort Study in the UK Biobank

OBJECTIVE

We investigated the associations between urban green and blue spaces and the incidence of accelerated ageing, which have rarely been studied.

METHODS

Analyzed UK Biobank data (2006-2010) on 440,785 participants, focusing on urban green and blue space (UGBS). General linear models and logistics models assessed links between UGBS and accelerated ageing (Klemera-Doubal method, telomere length and frailty). Mediation analysis examined the role of pollution and other factors.

RESULTS

After controlling for random effects and various types of covariates, we found that 1) populations with higher levels of UGBS exposure are associated with accelerated ageing and slowing down; 2) UGBS has the greatest impact on accelerated ageing within a 1000-m street network buffer distance; 3) Participants living in heavily polluted areas should pay more attention to UGBS; 4) Intermediary analysis found that UGBS mainly accelerates aging by reducing harm, rather than affecting the population's ability to recover and build.

CONCLUSIONS

UGBS with a composite weighted score showed a better correlation with accelerated ageing than green spaces. Other factors such as gender, race and lifestyle also influence the impact of the environment on accelerated ageing.

Outdoor health intervention for refugees, migrants, and asylum-seekers: A mixed-methods pilot study

Despite the multifaceted and diverse challenges that refugees, migrants, and asylum-seekers experience when entering a new country, they remain notably underrepresented in the evaluation and understanding of the health and wellbeing impacts of outdoor health interventions. We addressed this knowledge gap by a mixed-methods evaluation (questionnaires, focus groups and photo elicitation activity) facilitated by a community researcher. Qualitative data (focus groups and photo elicitation activity) revealed that the participants saw the social component of outdoor activities as a critical factor in improving their wellbeing, an insight not captured by established quantitative wellbeing scales. Given the diverse backgrounds of refugee, migrant, and asylum-seeker populations, we underline the importance of a transdisciplinary, collaborative, and mixed-methods research approach.

The influence of freshwater blue spaces on human health and well-being:A systematic review based on assessment method

An increasing number of studies have explored the positive effects of blue spaces on human health, much of which involves the impacts of various blue space exposures on human health indicators, recognizing that the diversity in assessment methods may influence the final results. However, there are currently few systematic reviews that comprehensively synthesize this evidence. Additionally, current reviews in this field predominantly focus on coastal environments, while Freshwater Blue Spaces(FBS)receive less attention. Given that more than 50% of the global population lives within 3 km of freshwater bodies, it is crucial to understand the health impacts of these unique environments. Therefore, this study aims to systematically review the existing literature on the effects of FBS on human health and identify knowledge gaps. We systematically reviewed 34 articles following the PRISMA protocol. The results showed six main FBS exposure assessment methods and ten related health indicators. Additionally, we identified 74 health indicators and their relation to FBS exposure assessments. Our findings revealed: (i) FBS exposure assessment methods are becoming more diverse and refined, but challenges and limitations persist in their application; (ii) the studies employed a range of health indicators to explore different dimensions of human health, yet significant differences exist in their focus and methodologies; (iii) The results on the association between FBS and health exhibit heterogeneity, which not only depends on the health focus and indicators of each study but is also related to the exposure assessment methods used, the characteristics of FBS, sample differences, and the rigor of bias evaluation and control of confounding factors. Based on our findings, we propose a series of recommendations to further investigate the intrinsic connections between FBS and human health, providing opportunities to enhance human health and well-being.

Do Green Spaces Mitigate Mental Health Disorders in Tehran? Evidence from 358 Neighborhoods

BACKGROUND

With a prevalence of mental disorders affecting 18 out of every 100 Iranians and a rising urban population, it is crucial to examine the impact of built environments on people's well-being.

OBJECTIVE

While some studies have conducted individual-level surveys in Iran, this research aims to investigate the potential impact of green spaces on mental health at the neighborhood level in Tehran.

METHOD

Using secondary data from 358 neighborhoods in Tehran in 2011, a linear regression analysis was conducted to investigate the correlation between four green space indicators and three mental health metrics.

RESULTS

The results indicate that green space indicators have the potential to mitigate mental disorders in Tehran, with accessibility to green spaces emerging as the most impactful factor among those studied on mental disorders and anxiety. However, no significant association was found with depression when considering intervening variables. The study also found that other green space indicators, such as the ratio of green space in neighborhoods and satisfaction with green spaces, did not show significant effects, underscoring the importance of accessibility over size or quantity of green spaces per person. Additionally, our findings suggest that higher levels of unemployment in neighborhoods have a more pronounced impact on mental disorders among sociodemographic factors.

CONCLUSION

Urban planners and designers should prioritize equitable access to green spaces within neighborhoods, rather than focusing solely on size or per capita availability. Additionally, policymakers should recognize that addressing both environmental and socioeconomic factors-rather than just one-can effectively alleviate residents' mental health issues.

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

OBJECTIVE

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

INTRODUCTION

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

INCLUSION CRITERIA

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The indoors microbiome and human health

Indoor environments serve as habitat for humans and are replete with various reservoirs and niches for microorganisms. Microorganisms enter indoor spaces with their human and non-human hosts, as well as via exchange with outdoor sources, such as ventilation and plumbing. Once inside, many microorganisms do not survive, especially on dry, barren surfaces. Even reduced, this microbial biomass has critical implications for the health of human occupants. As urbanization escalates, exploring the intersection of the indoor environment with the human microbiome and health is increasingly vital. The indoor microbiome, a complex ecosystem of microorganisms influenced by human activities and environmental factors, plays a pivotal role in modulating infectious diseases and fostering healthy immune development. Recent advancements in microbiome research shed light on this unique ecological system, highlighting the need for innovative approaches in creating health-promoting living spaces. In this Review, we explore the microbial ecology of built environments - places where humans spend most of their lives - and its implications for immune, endocrine and neurological health. We further propose strategies to harness the indoor microbiome for better health outcomes.

Reassessing green exercise research: unveiling methodological gaps and pathways for progress

The present review critically assesses the nexus between physical activity, nature exposure and health benefits by analysing environmental measures in green exercise research. A Cochrane-inspired review of systematic studies exposes methodological gaps, emphasising the scarcity of long-term research and the lack of rigorous designed studies. It calls for more robust, varied research designs and improved environmental metrics. The findings advocate for longitudinal research to better comprehend the mental and physical health benefits of exposure to nature. Embracing an ecological-dynamic perspective is recommended to advance our understanding of the intricate connections between activity, environment, and well-being.

The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action

Despite the initial hope inspired by the 2015 Paris Agreement, the world is now dangerously close to breaching its target of limiting global multiyear mean heating to 1·5°C. Annual mean surface temperature reached a record high of 1·45°C above the pre-industrial baseline in 2023, and new temperature highs were recorded throughout 2024. The resulting climatic extremes are increasingly claiming lives and livelihoods worldwide.

The Lancet Countdown: tracking progress on health and climate change was established the same year the Paris Agreement entered into force, to monitor the health impacts and opportunities of the world’s response to this landmark agreement. Supported through strategic core funding from Wellcome, the collaboration brings together over 300 multidisciplinary researchers and health professionals from around the world to take stock annually of the evolving links between health and climate change at global, regional, and national levels.

The 2024 report of the Lancet Countdown, building on the expertise of 122 leading researchers from UN agencies and academic institutions worldwide, reveals the most concerning findings yet in the collaboration’s 8 years of monitoring.

The influence of a walk in nature on human resting brain activity: a randomized controlled trial

Behavioral studies suggest that immersion in nature improves affect and executive attention. However, the neural mechanisms underlying these benefits remain unclear. This randomized controlled trial (N = 92) explored differences in self-reported affect and in frontal midline theta (FMθ), a neural oscillation linked to executive attention, between a 40-min, low-intensity nature walk and an urban walk of comparable time and distance-controlling for ambient temperature, humidity, elevation change, walking pace, heart rate, calories burned, and moving time between the two groups. While affect improved for both groups, the nature walkers showed a significantly greater boost in positive affect than the urban walkers. Electroencephalography (EEG) data revealed significantly greater FMθ activity following the urban walk compared to the nature walk, suggesting that the urban walk placed higher demands on executive attention. In contrast, the nature walk allowed executive attention to rest, as indicated by the lower FMθ activity observed after the walk. This study suggests that changes in FMθ may be a potential neural mechanism underlying the attentional strain of urban environments in contrast to the attentional rest in nature.

Exploring the equitable inclusion of diverse voices in urban green design, planning and policy development: a scoping review protocol

INTRODUCTION

Despite the increasingly evidenced positive impacts of green space on human physical and mental health, green spaces remain inequitably distributed across different socioeconomic groups. Urban planning and design should prioritise the development and maintenance of urban green spaces, especially for vulnerable and marginalised populations while thinking about protecting them from the effects of green gentrification. This scoping review will explore how the concepts of equity, diversity and inclusion are integrated into the design, the planning and policy development of urban green spaces. Also, we will explore what are the efforts made to incorporate equity, diversity, and inclusion concepts into the planning, design and policy development of urban green spaces to make them equitable for vulnerable and marginalised populations.

METHODS AND ANALYSIS

This protocol is based on the methodology developed by Arksey and O'Malley and improved by Levac et al. The search will be done in conjunction with a professional librarian, to include studies in all languages. The review will include multidisciplinary databases: Ovid MEDLINE, Ovid EMBASE, CINAHL, Web of Science and GeoBase. The search will be done from each database's inception to February 2024. We will present our results narratively and will conduct a thematic analysis using the urban green equity framework. This framework will guide our understanding of the interplay between the spatial distribution of urban green spaces and the recognition of diverse voices in urban greening decision-making.

ETHICS AND DISSEMINATION

This scoping review will not require ethical approval since it will be collected from publicly available documents. The results of this scoping review will be presented as a scientific article, social media and public health or environmental conferences organised by environmental organisations or academic institutions.

Effect of Relaxation-Based Virtual Reality on Psychological and Physiological Stress of Substance Abusers Under Detoxification: A Randomized Controlled Trial

INTRODUCTION

Substance abuse is a widespread problem, with high rates of treatment dropout. Stress plays a crucial role in this problem, so innovative interventions with stressed patients can assist them in completing treatment.

METHODS

This study is a randomized controlled trial with 60 participants who have substance abuse disorder undergoing detoxification at a residency facility in Tehran, Iran. Participants were randomly assigned to one of three groups: watching a 360° video of nature, a 360° video of a city environment, or no virtual experience. The intervention was performed only for one session. Psychological stress was measured using the Positive and Negative Affect Schedule and Perceived Stress Scale before and after the intervention. Physiological stress was assessed through respiratory rate, skin conductance, and heart rate recordings during the virtual reality (VR) experience. Data analysis was performed using R software (version 4.2).

RESULTS

Paired t-test results indicated significant psychological differences before and after virtual nature experiences, but not in the control and city groups. The repeated measure ANOVA showed a significant reduction in skin conductance (p < 0.01) and respiratory rate (p < 0.01) scores in the nature group.

CONCLUSION

The findings suggest that VR relaxation could be a potentially beneficial intervention for reducing stress in patients during detoxification.

Socioeconomic deprivation modifies green space and mental health associations: A within person study

Living in an area with good availability and accessibility of residential green spaces such as parks, woodlands, and residential gardens can improve mental health and reduce the global disease burden. Unlike for physical health, it is not well understood if mental health and green space associations might be modified by local area deprivation. Existing evidence for this association comes from cross-sectional studies, widely considered vulnerable to confounding and bias. Individual time-invariant mental health status, personality, and other factors may result in positive effect modification on green space and mental health associations in more deprived areas. We use fixed-effects models that remove time-invariant confounding by calculating differences within-persons to eliminate this bias and add to the existing evidence. We modelled changes in mental health status, green space, and deprivation (relative to the within-person mean) within 54,666 individuals with a combined total of 300,710 mental health scores from one of the world's largest panel surveys: "Understanding Society" in the UK. We found a positive effect of increasing residential green space on mental health and this was positively modified and intensified by area deprivation before and after adjusting for confounding. Our results support providing green space to protect against the negative impact of socioeconomic deprivation on health, particularly for those moving from a less deprived to a more deprived area.

A short simulated nature experience as an effective way to promote restoration from work-related stress

Spending time in nature, and even watching images or videos of nature, has positive effects on one's mental state. However, cognitively stressful work is often performed indoors, in offices that lack easy access to nature during breaks. In this study, we investigated whether watching a 5-min audiovisual video that describes a first-person perspective walk on a forest path could help to restore one's mental state after cognitive stress. Participants were asked to perform cognitive stressor tasks, after which they were shown either a nature walk video or a control video. Subjective restoration was measured using self-reports before and after the videos, while electrodermal activity (EDA) and electroencephalography (EEG) were measured during the video-watching session. The results showed that experiencing the nature walk video enhanced subjective restoration more than watching the control video. Arousal of the autonomic nervous system, measured using EDA, decreased more during the nature walk video than during the control video. Additionally, activity in the EEG's upper theta band (6-8 Hz) and lower alpha band (8-10 Hz) increased during the nature walk video, suggesting that it induced a relaxed state of mind. Interestingly, the participants' connection with nature moderated the effects of the nature video. The subjective and physiological measures both suggest that watching a short, simulated nature walk may be beneficial in relaxing the mind and restoring one's mental state after cognitive stress.

Different types of greenspace within urban parks and depressive symptoms among older U.S. adults living in urban areas

Access to greenspace in the form of urban parks is frequently used to study the mental health benefits of nature and may alleviate depression. However, there is a lack of research that considers the different types of vegetated and non-vegetated spaces that parks can provide. Our aim was to investigate whether different types of accessible park area, grassy; tree covered; and non-vegetated, were associated with depressive symptoms among older (≥50 years) urban US adults. We used interviews from the Health and Retirement Study spanning 2010 through 2016 as our primary data source. We calculated total grassy, tree covered, and non-vegetated park space accessible to participants using a comprehensive national database of US parks and a high resolution (10 m) landcover dataset. To measure depressive symptoms, we used the CESD-8 analyzed as a continuous scale. We used Poisson regression to estimate the percent difference in CESD-8 scores comparing quartiles of accessible park space. To control for confounding, we adjusted for sociodemographic characteristics, geography, and climate. Aggregated accessible park area was not substantively associated with depressive symptoms. However, having grassy park area near the home was associated with as much as 27 % fewer depressive symptoms. In contrast, non-vegetated park area was associated with up to 54 % more depressive symptoms. Our findings were robust to adjustment for air pollution, environmental noise, and artificial light at night. Different types of accessible park space may have disparate effects on mental health among older urban US adults.

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

Correlation of unobserved factors of old town street walkability using SEM: Case study of old southern area, Nanjing

Contemporary research on the walking environment focuses closely on the construction logic and internal correlation. Walkability is one of the vital characteristics of the old town street space. To understand how to improve the old town street space effectively, the investigation of the correlation mechanism of street walkability is essential. This study utilizes structural equation model (SEM) to construct a street walkability measurement model composed of four unobserved factors. Then, take Old Southern Area in Nanjing as an example, integrate Depthmap, ArcGIS and Python to obtain multi-source data, and establish a database of observed factors on street space. Finally, the matrix of the observed factors is set by SEM to calculate the correlation of the unobserved factors. This paper provides a novel technical approach for the correlation study of spatial construction logic as well as a reference for strengthening the spatial quality of the contemporary built environment.

Examining the audiovisual therapy effects on hospital groups of varying linear canopy landscapes and those with hydrodynamic forces

Recent research has highlighted the beneficial effects of urban green spaces on physical and mental health. This study focused on the hospital population and innovatively subdivided the population into four groups: doctors, caregivers, patients and nurses. A total of 96 volunteers participated in this virtual reality experiment to assess the restoration of a linear canopy landscape and a landscape with different levels of hydrodynamics through interactive audiovisual immersion. We utilized pre-research method, brainwave monitoring technique, psychological scales, observation and interviews in this experiment. The research identified five key findings. First, both linear canopy landscapes and those with low to medium hydrodynamic forces significantly enhance physiological and psychological restoration for all groups, with the most substantial physiological benefits observed in doctors and patients, and the greatest psychological relief noted in caregivers. Second, landscapes with medium hydrodynamic forces yield higher restorative effects than those with low forces in hospital settings. Third, green landscapes with medium and low-density canopies prove more conducive to patient recovery compared to those with high-density canopies. Fourth, the inclusion of bird songs does not markedly affect physiological restoration across the hospital groups. Finally, landscapes that incorporate elements of water dynamics, open skies, and lightly foliated canopies draw significant interest from all groups involved. This study advocates for the integration of natural blue and green elements into hospital environments as complementary therapeutic interventions, aiming to alleviate stress and promote health recovery among hospital communities.

Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis

Prior reviews have highlighted that nature exposure was a valuable coping strategy enhancing mental health during the COVID-19 pandemic. However, no existing reviews have determined the quality of evidence and risk of bias of the empirical studies supporting this claim. To address this gap, we employed a Navigation Guide systematic review and meta-analysis approach to investigate associations between nature exposure and mental health during the pandemic. Searches in PubMed, Web of Science, Scopus, CINAHL, and PsycInfo retrieved relevant articles published between January 1, 2020, and March 4, 2024. We used the Navigation Guide methodology to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessments to evaluate the overall quality of evidence. Our search retrieved 113 studies that met the inclusion criteria and reported diverse types of exposure, including nature availability, nature visit frequency, green space accessibility, and green space type, alongside associations with 12 mental health outcomes. Meta-analyses found access to gardens was associated with lower odds of depression [(Pooled odds ratio [OR] = 0.71, 95%CI = 0.61, 0.82), I2 = 0%, n = 3] and anxiety [(Pooled OR = 0.73, 95%CI = 0.63, 0.84), I2 = 0%, n = 3]. Increased time in green spaces was associated with lower level of stress [(Pooled Corr = -0.11, 95%CI = -0.17, -0.05), I2 = 0%, n = 2]. Higher frequency of visits to nature was associated with improved mental well-being [(Pooled standardized beta = 0.10, 95%CI = 0.07, 0.14), I2 = 0%, n = 2] and general mental health [(Pooled standardized beta = 0.11, 95%CI = 0.03-0.38), I2 = 82%, n = 2]. However, the number of pooled studies was small and the overall quality of evidence was "very low" for all outcomes, and high levels of bias were observed (26% of studies had high, 71% probably high). Nonetheless, given the trends in the results, nature-based solutions emphasizing exposure to gardens and green spaces near the home may have promoted psychological resilience during this public health crisis.

Embodied earth kinship: interoceptive awareness and relational attachment personal factors predict nature connectedness in a structural model of nature connection

Previous research has found that nature connectedness, an experiential close connection to nature with cognitive, affective and physical benefits, profoundly impacts individual wellbeing and subsequently increases pro-environmental behaviors. However, little is known about the personal and contextual factors that predict nature connectedness. Testing theory derived from a qualitative interpretative phenomenological analysis study, this research addresses the lacuna in the literature. A structural equation model analysis finds that interoceptive awareness significantly predicts nature connection, that secure attachment to nature significantly explains this relationship, and that these inter-related constructs predict both pro-environmental behavior and wellbeing. This revised model of nature connection indicates important antecedents for the human-nature bond, illuminating in particular that the interpersonal relational processes foundational for close bonding with humans also occur in bonding with nature. Structural equation modeling indicates that emotional awareness is the dimension of interoceptive awareness that most significantly predicts nature connection, suggesting that the more aware a person is of the connection between inner bodily sensations and emotions, the more likely they can bond with nature. Given that interoceptive awareness indicates a coherent relationship with the self, including effective communication between body, mind and feelings, this process is therefore implicated in the capacity for humans to bond with nature. In sum, this present research points to the efficacy of an embodied, secure attachment with nature to help close both the human-nature disconnection chasm, and the environmental value-action gap. Theoretical and methodological implications for research and policy are discussed.

Mental health, subjective experiences and environmental change

This article responds to Coope's call for the medical humanities to address the climate crisis as a health issue. Coope proposes three areas for progress towards ecological thinking in healthcare, with a focus on ecological mental health. The article emphasises the need to understand the cultural dimensions of mental health and proposes an interdisciplinary approach that integrates insights from the arts and humanities. It examines the impact of climate change on mental health, drawing on The Rockefeller Foundation - Lancet Commission on Planetary Health and recent studies. The discussion focuses on the intersection of mental health, subjective experience and environmental change. Focusing on emotional experiences as constructed from biological and cultural elements, the article proposes a holistic approach to mental health. It proposes two converging lines of research, in constant interaction: first, a historical and cultural research of those concepts, practices and symbols related to the environment, emphasising a cultural history of nature; and second, a synchronous research, drawing on anthropology, sociology and participatory art-based research, to understand how these aforementioned elements influence our current relations with nature. The article concludes by emphasising the urgency of developing narratives and histories that redirect temporal trajectories towards a better future, while respecting and acknowledging diverse narratives of individual experience. It calls for collaborative efforts from the medical humanities to contribute to a more comprehensive understanding of the complex relationship between mental health, nature and ecological crisis.

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

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

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

Introduction

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

Methods

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

Results

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

Conclusions

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

The effects of different designs of indoor biophilic greening on psychological and physiological responses and cognitive performance of office workers

Impression on biophilic designs influences the effects of indoor greening. The current study aimed to investigate the effects of different biophilic designs in office rooms on the psychological and physiological responses and the cognitive performance of office workers. Indoor greening rooms with Japanese and tropical designs were used along with the green-free (control) design in this study. The heart rate variability of the participants was not affected by green designs. However, there was improvement in impressions on tropical and Japanese designs in office rooms. In particular, the Japanese design was more effective in decreasing negative emotions than the tropical design. The electroencephalography during 5-min exposure to the greening designs showed limited frequency bands and regions of interest affected by the greenery design. Taken together with the psychological data, indoor greening with the tropical design promoted positive mood states. Meanwhile, indoor greening in the Japanese design, inhibited negative mood states. However, there were no significant differences between the two designs in terms of cognitive task performance. Hence, indoor greening increases neural efficiency during cognitive tasks.

Moderating Effects of Individual Traits on the Association Between Nature and Patient Wait Experiences

OBJECTIVES

We empirically investigated to what extent plants in the emergency department (ED) waiting areas influence patient wait experiences (i.e., anxiety, perceived service quality, and perception of wait time) depending on individual differences in cognitive thinking styles and one's bonds with the natural world.

BACKGROUND

Positive effects of nature on patient experiences in healthcare environments are well established by empirical research findings. However, evidence is scarce on the impact of nature on patient wait experiences and the roles of patient traits often related to their backgrounds.

METHODS

A within-subjects study was conducted (N = 116) with two virtually built ED waiting rooms: with versus without indoor and outdoor plants.

RESULTS

Findings confirmed that plants lower anxiety and improve perceptions of service quality and wait time. Cognitive thinking style significantly moderated how plants affected patient wait experiences. Although participants with higher connectedness to nature showed more positive responses to the nature condition, connectedness to nature did not significantly affect the association between nature and wait experiences.

CONCLUSIONS

This study contributes to the existing body of knowledge on nature's effects in healthcare environments by examining the roles of individual differences in patients' and visitors' cognitive styles and connectedness to nature. Results highlighted the impact of these differences in patient experiences for effective implications of nature in waiting areas of healthcare facilities.

Engagement with nature and proinflammatory biology

BACKGROUND

Prior evidence indicates that contact with nature improves physical health, but data explicitly linking engagement with nature to biological processes are limited.

DESIGN

Leveraging survey and biomarker data from 1,244 adults (mean age = 54.50 years, range = 34-84 years) from the Midlife in the United States (MIDUS II) study, we examined associations between nature engagement, operationalized as the frequency of pleasant nature encounters, and systemic inflammation. Concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen were measured from fasting blood samples. Analyses adjusted for sociodemographic, health behavior, and psychological well-being covariates.

RESULTS

More frequent positive nature contact was independently associated with lower circulating levels of inflammation.

CONCLUSIONS

These findings add to a growing literature on the salubrious health effects of nature by demonstrating how such experiences are instantiated in downstream physiological systems, potentially informing future interventions and public health policies.

Mental health is positively associated with biodiversity in Canadian cities

Cities concentrate problems that affect human well-being and biodiversity. Exploring the link between mental health and biodiversity can inform more holistic public health and urban planning. Here we examined associations between bird and tree species diversity estimates from eBird community science datasets and national forest inventories with self-rated mental health metrics from the Canadian Community Health Survey. We linked data across 36 Canadian Metropolitan Areas from 2007-2022 at a postal code level. After controlling for covariates, we found that bird and tree species diversity were significantly positively related to good self-reported mental health. Living in a postal code with bird diversity one standard deviation higher than the mean increased reporting of good mental health by 6.64%. Postal codes with tree species richness one standard deviation more than the mean increased reporting of good mental health by 5.36%. Our results suggest that supporting healthy urban ecosystems may also benefit human well-being.

Structure-specific variation in per- and polyfluoroalkyl substances toxicity among genetically diverse Caenorhabditis elegans strains

Background

There are >14,500 structurally diverse per- and polyfluoroalkyl substances (PFAS). Despite knowledge that these "forever chemicals" are in 99% of humans, mechanisms of toxicity and adverse health effects are incompletely known. Furthermore, the contribution of genetic variation to PFAS susceptibility and health consequences is unknown.

Objectives

We determined the toxicity of a structurally distinct set of PFAS in twelve genetically diverse strains of the genetic model system Caenorhabditis elegans.

Methods

Dose-response curves for four perfluoroalkyl carboxylic acids (PFNA, PFOA, PFPeA, and PFBA), two perfluoroalkyl sulfonic acids (PFOS and PFBS), two perfluoroalkyl sulfonamides (PFOSA and PFBSA), two fluoroether carboxylic acids (GenX and PFMOAA), one fluoroether sulfonic acid (PFEESA), and two fluorotelomers (6:2 FCA and 6:2 FTS) were determined in the C. elegans laboratory reference strain, N2, and eleven genetically diverse wild strains. Body length was quantified by image analysis at each dose after 48 hr of developmental exposure of L1 arrest-synchronized larvae to estimate effective concentration values (EC50).

Results

There was a significant range in toxicity among PFAS: PFOSA > PFBSA ≈ PFOS ≈ PFNA > PFOA > GenX ≈ PFEESA > PFBS ≈ PFPeA ≈ PFBA. Long-chain PFAS had greater toxicity than short-chain, and fluorosulfonamides were more toxic than carboxylic and sulfonic acids. Genetic variation explained variation in susceptibility to PFBSA, PFOS, PFBA, PFOA, GenX, PFEESA, PFPeA, and PFBA. There was significant variation in toxicity among C. elegans strains due to chain length, functional group, and between legacy and emerging PFAS.

Conclusion

C. elegans respond to legacy and emerging PFAS of diverse structures, and this depends on specific structures and genetic variation. Harnessing the natural genetic diversity of C. elegans and the structural complexity of PFAS is a powerful New Approach Methodology (NAM) to investigate structure-activity relationships and mechanisms of toxicity which may inform regulation of other PFAS to improve human and environmental health.

The feasibility of wildlife immersion experiences for Veterans with PTSD

Introduction

Animal-assisted interventions (AAI) offer potential physical and psychological health benefits that may assist Veterans with post-traumatic stress disorder. However, more feasibility studies are needed regarding intervention details, adverse events, reasons for study withdrawal, and animal welfare.

Methods

This mixed methods feasibility trial involved a modified crossover study in which Veterans with PTSD/PTSD symptoms were provided a series of 8 nature and wildlife immersion experiences to evaluate feasibility and preliminary efficacy. The sample included 19 Veterans with PTSD/PTSD symptoms who were followed for a mean of 15.1 weeks. The intervention was comprised of a baseline forest walk, assisting with wildlife rehabilitation, observation in a wildlife sanctuary, and bird watching. Post study bird feeders were provided for sustainability.

Results

This AAI nature/wildlife immersion intervention was feasible, acceptable, and safe to administer to Veterans with PTSD/PTSD symptoms with appropriate support. Logistical and relational facilitators were identified that supported the wildlife immersion activities. Participants reported greatly enjoying the activities. Attention to animal welfare and care was an important ethical foundation that also contributed to feasibility.

Discussion

AAI immersion experiences with wildlife are feasible and can safely be administered to Veterans with PTSD/PTSD symptoms. Logistical and relational facilitators are important to support nature and wildlife immersion activities.

Nature and human well-being: The olfactory pathway

The world is undergoing massive atmospheric and ecological change, driving unprecedented challenges to human well-being. Olfaction is a key sensory system through which these impacts occur. The sense of smell influences quality of and satisfaction with life, emotion, emotion regulation, cognitive function, social interactions, dietary choices, stress, and depressive symptoms. Exposures via the olfactory pathway can also lead to (anti-)inflammatory outcomes. Increased understanding is needed regarding the ways in which odorants generated by nature (i.e., natural olfactory environments) affect human well-being. With perspectives from a range of health, social, and natural sciences, we provide an overview of this unique sensory system, four consensus statements regarding olfaction and the environment, and a conceptual framework that integrates the olfactory pathway into an understanding of the effects of natural environments on human well-being. We then discuss how this framework can contribute to better accounting of the impacts of policy and land-use decision-making on natural olfactory environments and, in turn, on planetary health.

Valuing the health benefits of nature-based recreational physical activity in England

Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease. Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose-response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers. In 2019, 22million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million). Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs.

Linking ecosystems to public health based on combination of social and ecological systems

Promotion of public health is one of the most important benefits of ecosystems. Nevertheless, the relationship between ecosystems and social health' needs is not well understood. Therefore, a study was done to investigate the potential of natural (forests and rangelands) and artificial (urban parks and gardens) ecosystems in ensuring the five dimensions of public health (i.e. physical, mental, spiritual, social and environmental) in the social systems (urban and rural societies). Therefore, 47 health indicators were used in order to relate different ecosystems and social' needs to five dimensions of public health through questionnaire. The results indicated that natural ecosystems had the greatest potential in providing mental, spiritual and environmental health due to ecological characteristics of wilderness and aesthetic. The artificial ecosystems had the greatest potential in providing physical and social health due to their easy access. However, there was a match between social health' needs and ecosystem potential in the rural areas. The study highlighted the need for promotion of ecological indicators related to mental health in urban areas by enhancing silence and aesthetic in artificial ecosystems. Presented framework can provide comprehensive information on the weaknesses and strengths of different ecosystems to promote public health based on social needs and fixing the weaknesses of artificial ecosystems in urban areas.

Susceptibility to stress and nature exposure: Unveiling differential susceptibility to physical environments; a randomized controlled trial

BACKGROUND

Emerging epidemiological evidence indicates nature exposure could be associated with greater health benefits among groups in lower versus higher socioeconomic positions. One possible mechanism underpinning this evidence is described by our framework: (susceptibility) adults in low socioeconomic positions face higher exposure to persistent psychosocial stressors in early life, inducing a pro-inflammatory phenotype as a lifelong susceptibility to stress; (differential susceptibility) susceptible adults are more sensitive to the health risks of adverse (stress-promoting) environments, but also to the health benefits of protective (stress-buffering) environments.

OBJECTIVE

Experimental investigation of a pro-inflammatory phenotype as a mechanism facilitating greater stress recovery from nature exposure.

METHODS

We determined differences in stress recovery (via heart rate variability) caused by exposure to a nature or office virtual reality environment (10 min) after an acute stressor among 64 healthy college-age males with varying levels of susceptibility (socioeconomic status, early life stress, and a pro-inflammatory state [inflammatory reactivity and glucocorticoid resistance to an in vitro bacterial challenge]).

RESULTS

Findings for inflammatory reactivity and glucocorticoid resistance were modest but consistently trended towards better recovery in the nature condition. Differences in recovery were not observed for socioeconomic status or early life stress.

DISCUSSION

Among healthy college-age males, we observed expected trends according to their differential susceptibility when assessed as inflammatory reactivity and glucocorticoid resistance, suggesting these biological correlates of susceptibility could be more proximal indicators than self-reported assessments of socioeconomic status and early life stress. If future research in more diverse populations aligns with these trends, this could support an alternative conceptualization of susceptibility as increased environmental sensitivity, reflecting heightened responses to adverse, but also protective environments. With this knowledge, future investigators could examine how individual differences in environmental sensitivity could provide an opportunity for those who are the most susceptible to experience the greatest health benefits from nature exposure.

Different greenness exposure in Europe and respiratory outcomes in youths. A systematic review and meta-analysis

The existing evidence on the association between greenness and respiratory outcomes remains inconclusive. We aimed at systematically summarizing existing literature on greenness exposure and respiratory outcomes in European children and adolescents, with a preliminary attempt to qualify the distribution of dominant tree species across different geographical areas and bioclimatic regions. Overall, 4049 studies were firstly identified by searching PubMed/MEDLINE, EMBASE, Scopus, Web of Science, GreenFile and CAB direct, up to 29 August 2023. Eighteen primary studies were included in the systematic review and six were meta-analyzed. No overall significant association was observed between the Normalized Difference Vegetation Index, assessed within 500-m buffers (i.e. NDVI-500), and the odds of asthma for 0.3-increase in the exposure (OR: 0.97, 95% CI from 0.53 to 1.78). Similarly, an overall exposure to the NDVI-300 highest tertile, as compared to the lowest tertile, was not significantly associated with asthma (OR: 0.65, 95% CI from 0.22 to 1.91): heterogeneity among studies was significant (p = 0.021). We delineated some key elements that might have mostly contributed to the lack of scientific consensus on this topic, starting from the urgent need of harmonized approaches for the operational definition of greenness. Additionally, the complex interplay between greenness and respiratory health may vary across different geographical regions and climatic conditions. At last, the inconsistent findings may reflect the heterogeneity and complexity of this relationship, rather than a lack of scientific consensus itself. Future research should compare geographical areas with similar bioclimatic parameters and dominant or potentially present vegetation species, in order to achieve a higher inter-study comparability.

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

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

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

Introduction

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

Methods

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

Results

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

Discussion

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

Conclusion

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

Exploring the Modifying Role of GDP and Greenness on the Short Effect of Air Pollutants on Respiratory Hospitalization in Beijing

It is unclear whether Gross Domestic Product (GDP) and greenness have additional modifying effects on the association between air pollution and respiratory system disease. Utilizing a time-stratified case-crossover design with a distributed lag linear model, we analyzed the association between six pollutants (PM2.5, PM10, NO2, SO2, O3, and CO) and 555,498 respiratory hospital admissions in Beijing from 1st January 2016 to 31st December 2019. We employed conditional logistic regression, adjusting for meteorological conditions, holidays and influenza, to calculate percent change of hospitalization risk. Subsequently, we performed subgroup analysis to investigate potential effect modifications using a two-sample z test. Every 10 μg/m3 increase in PM2.5, PM10, NO2, SO2, and O3 led to increases of 0.26% (95%CI: 0.17%, 0.35%), 0.15% (95%CI: 0.09%, 0.22%), 0.61% (95%CI: 0.44%, 0.77%), 1.72% (95%CI: 1.24%, 2.21%), and 0.32% (95%CI: 0.20%, 0.43%) in admissions, respectively. Also, a 1 mg/m3 increase in CO levels resulted in a 2.50% (95%CI: 1.96%, 3.04%) rise in admissions. The links with NO2 (p < 0.001), SO2 (p < 0.001), O3 (during the warm season, p < 0.001), and CO (p < 0.001) were significantly weaker among patients residing in areas with higher levels of greenness. No significant modifying role of GDP was observed. Greenness can help mitigate the effects of air pollutants, while the role of GDP needs further investigation.

Menopause and High Altitude: A Scoping Review-UIAA Medical Commission Recommendations

Mateikaitė-Pipirienė, Kastė, Dominique Jean, Peter Paal, Lenka Horakova, Susi Kriemler, Alison J. Rosier, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, and Linda E. Keyes for the UIAA MedCom writing group on Women's Health in the Mountains. Menopause and high altitude: A scoping review-UIAA Medical Commission Recommendations. High Alt Med Biol. 25:1-8, 2024. Background: Older people are an important fraction of mountain travelers and climbers, many of them postmenopausal women. The aim of this work was to review health issues that older and postmenopausal women may experience at high altitude, including susceptibility to high-altitude illness. Methods: We performed a scoping review for the UIAA Medical Commission series on Women's Health in the mountains. We searched PubMed and Cochrane libraries and performed an additional manual search. The primary search focused on articles assessing lowland women sojourning at high altitude. Results: We screened 7,165 potential articles. The search revealed three relevant articles, and the manual search another seven articles and one abstract. Seven assessed menopausal low-altitude residents during a high-altitude sojourn or performing hypoxic tests. Four assessed high-altitude residents. We summarize the results of these 11 studies. Conclusions: Data are limited on the effects of high altitude on postmenopausal women. The effects of short-term, high-altitude exposure on menopause symptoms are unknown. Menopause has minimal effect on the physiological responses to hypoxia in physically fit women and does not increase the risk of acute mountain sickness. Postmenopausal women have an increased risk of urinary tract infections, which may be exacerbated during mountain travel. More research is needed on the physiology and performance of older women at high altitude.

Clean and sustainable environment problems in forested areas related to recreational activities: case of Lithuania and Turkey

Introduction

With the acceleration of social life, people's interest and demand for forestry recreation activities is increasing. However, with this increase, it is inevitable that negative environmental effects will occur. Particularly mass participation poses an important risk for environmental sustainability. In this context, the aim of this study is to determine the recreational activities organized in forest areas in Turkey and Lithuania, the environmental effects of these activities and the precautions to be taken.

Methods

In Turkey and Lithuania, interviews were conducted to determine the attitudes of experts involved in recreational activity processes towards a clean environment and environmental sustainability. A semi-structured interview form was used in the interviews with forest operators and other experts. The sample group of the research consists of 17 experts from Turkey and Lithuania.

Results

According to the results of the research, recreational activities are organized in forest areas in both countries, but the most important problem related to these activities is waste production. In addition, there is also damage to the natural environment. Although there are legal regulations in both countries, there are no definite results in solving environmental problems.

Conclusions

It can be said that necessary measures such as raising awareness of people and ecological education should be taken in order to ensure the right of individuals to live in a safe and clean environment and at the same time to ensure sustainability in forest areas. as the improvement of legal regulation.

Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States

BACKGROUND AND AIM

Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate.

METHODS

We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1 km buffer. Reflecting clinical criteria, a score of ≥5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using Köppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace.

RESULTS

The 21,611 eligible participants were 65 ± 10 years old on average, 55% female, 81% White, 12% Black, 10% Hispanic/Latino, and 31% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95% CI, 0.86 to 1.11) climates.

CONCLUSIONS

Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.