Coping with Stress in Deprived Urban Neighborhoods: What Is the Role of Green Space According to Life Stage?

A greening theory of change: How neighborhood greening impacts adolescent health disparities

Neighborhoods are one of the key determinants of health disparities among young people in the United States. While neighborhood deprivation can exacerbate health disparities, amenities such as quality parks and greenspace can support adolescent health. Existing conceptual frameworks of greening-health largely focus on greenspace exposures, rather than greening interventions. In this paper, we develop and propose a Greening Theory of Change that explains how greening initiatives might affect adolescent health in deprived neighborhoods. The theory situates greening activities and possible mechanisms of change in the context of their ability to modify distal social determinants of health factors, stemming from macrostructural and historical processes that lead to resource inequalities, affecting both the social and built environment in which adolescents live and develop. The framework illustrates both short- and long-term health, economic, and security effects of greening. We also describe how the theory informed the development of Project VITAL (Vacant lot Improvement to Transform Adolescent Lives) in Baltimore, MD, which aims to (1) build a citywide sharable database on vacant lot restoration activities, (2) evaluate the impact of greening initiatives on adolescent health outcomes, (3) conduct cost-effectiveness analyses, and (4) develop best practices for greening programs for improved adolescent health.

Neighborhood Walkability Is Associated With Lower Burden of Cardiovascular Risk Factors Among Cancer Patients

Background

Modifiable cardiovascular risk factors constitute a significant cause of cardiovascular disease and mortality among patients with cancer. Recent studies suggest a potential link between neighborhood walkability and favorable cardiovascular risk factor profiles in the general population.

Objectives

This study aimed to investigate whether neighborhood walkability is correlated with favorable cardiovascular risk factor profiles among patients with a history of cancer.

Methods

We conducted a cross-sectional study using data from the Houston Methodist Learning Health System Outpatient Registry (2016-2022) comprising 1,171,768 adults aged 18 years and older. Neighborhood walkability was determined using the 2019 Walk Score and divided into 4 categories. Patients with a history of cancer were identified through International Classification of Diseases-10th Revision-Clinical Modification codes (C00-C96). We examined the prevalence and association between modifiable cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia, and obesity) and neighborhood walkability categories in cancer patients.

Results

The study included 121,109 patients with a history of cancer; 56.7% were female patients, and 68.8% were non-Hispanic Whites, with a mean age of 67.3 years. The prevalence of modifiable cardiovascular risk factors was lower among participants residing in the most walkable neighborhoods compared with those in the least walkable neighborhoods (76.7% and 86.0%, respectively). Patients with a history of cancer living in very walkable neighborhoods were 16% less likely to have any risk factor compared with car-dependent-all errands neighborhoods (adjusted OR: 0.84, 95% CI: 0.78-0.92). Sensitivity analyses considering the timing of events yielded similar results.

Conclusions

Our findings demonstrate an association between neighborhood walkability and the burden of modifiable cardiovascular risk factors among patients with a medical history of cancer. Investments in walkable neighborhoods may present a viable opportunity for mitigating the growing burden of modifiable cardiovascular risk factors among patients with a history of cancer.

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

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

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Disparities in greenspace access during COVID-19 mobility restrictions

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

Housing Supply and How It Is Related to Social Inequalities-Air Pollution, Green Spaces, Crime Levels, and Poor Areas-In Catalonia

We carried out a search of over 12,000 houses offered on the rental market in Catalonia and assessed the possibility of families below the poverty threshold being able to rent these homes. In this regard, we wanted to evaluate whether the economic situation of families is able to influence their social environment, surroundings, and safety. We observed how their economic situation can allow families the possibility of developing a life without exposure to health risks, and how economic constraints result in disadvantages in several areas of life. The results show how families at risk of poverty live in less favourable conditions and experience a widening of different gaps, with current prices leading to a possible poverty trap for the most disadvantaged groups. The higher the percentage of the population below the threshold, the lower the possibility of not being able to rent a house compared to areas with a lower prevalence of population below the threshold. This association was observed both when considering the risk linearly and non-linearly. Linearly, the probability of not renting a house was reduced by 8.36% for each 1% increase in the prevalence of population at risk of extreme poverty. In the second, third and fourth percentage quartiles, the probability of not being able to rent a house decreased by 21.13%, 48.61%, and 57.79%, respectively. In addition, the effect was different inside and outside of metropolitan areas, with the former showing a decrease of 19.05% in the probability of renting a house, whereas outside metropolitan areas the probability increased by 5.70%.

Neighborhood Physical and Social Environments and Social Inequalities in Health in Older Adolescents and Young Adults: A Scoping Review

Poor health and well-being are prevalent among young people. Neighborhoods may play a role in promoting good health. Little is known on if and how neighborhood characteristics affect health, and social inequalities therein, among young people. In this scoping review, we asked: (1) what features of the neighborhood physical and social environments have been studied in association with the physical and mental health and well-being of young people 15 to 30 years old; and (2) to what extent have social differentials in these associations been studied, and how? We identified peer-reviewed articles (2000 to 2023) through database and snowball searches. We summarized study characteristics, exposure(s), outcome(s) and main findings, with an eye on social inequalities in health. Out of the 69 articles reviewed, most were quantitative, cross-sectional, conducted among 18-year-olds and younger, and focused on the residential neighborhood. Neighborhood social capital and mental health were the most common exposure and outcome studied, respectively. Almost half of the studies examined social inequalities in health, mostly across sex/gender, socioeconomic status, and ethnicity. Evidence gaps remain, which include exploring settings other than residential neighborhoods, studying the older age stratum of young adulthood, and assessing a broader range of social inequalities. Addressing these gaps can support research and action on designing healthy and equitable neighborhoods for young people.

Nature and well-being in seven European cities: The moderating effect of connectedness to nature

Well-being is transversal to different urban-related challenges such as increasing urbanization or adaptation to the effects of climate change. One possible response to these challenges is the use of nature in cities. The aim of this study is to investigate how the objective quantity of natural space near the home, the perception of these natural elements, and their perceived availability, moderated by the effect of connectedness to nature, could explain levels of well-being. A survey was conducted among a sample of 1343 participants living in seven European cities. Data were collected online via a questionnaire. Indicators of the objective quantity of urban natural space based on remotely sensed satellite imagery were also used. Regression models highlight the association between well-being and perceived amount of nature, accessibility to a community garden, and level of connectedness to nature. A moderating and negative effect of connectedness to nature on the association between the perceived quantity of nature and well-being was also identified. Perception of nature seems to be a better indicator of well-being than the objective one. Results highlight the importance of the social dimension of collective gardens in enhancing well-being. Connectedness to nature could facilitate appropriation of natural elements and its effects on well-being.

Finding the "Heart" in the Green: Conducting a Bibliometric Analysis to Emphasize the Need for Connecting Emotions with Biophilic Urban Planning

Although there is a robust body of literature exploring the relationship between biophilic urban planning (BUP) and public health and well-being, there is a dearth of scholarship on the emotional components of BUP. It is crucial to understand these sentiment-related elements, so planners can assign "human value" to green spaces as a strategy for emphasizing the need to thoughtfully implement and properly maintain them in urban environments. Furthermore, humans' emotional experiences with green spaces may also reveal hidden or unexpected functions of those spaces. To confirm this lack of emphasis on emotions in BUP, we used Scopus to conduct a bibliometric analysis on relevant literature published within the last twenty years (2001-2021), ultimately collecting 589 relevant peer-reviewed articles. We then utilized VOSviewer (Centre for Science and Technology Studies, Leiden University, The Netherlands) to visualize our results and identify thematic, geographic, authorship/co-authorship, publication, and temporal trends. "Green space" appeared as our most frequently occurring keyword and scholars affiliated with institutions located within the United States, the United Kingdom and China were the top producers of relevant results. Our authorship analysis resulted in 67 different clusters and three major but isolated networks. Urban Forestry and Urban Greening was the most prevalent source of publication and 2019-2021 was the most prolific period of activity to date. While the goal of our review is to underscore the dearth of controlled, interdisciplinary research on the emotional components of BUP, we also uncovered additional key gaps in scholarship that could promote future avenues of inquiry. First, by focusing on the emotional value of green spaces, practitioners can ascribe them an intangible "human value" that could, in turn, generate more community-focused designs that provide access across socioeconomic, racial and age brackets. Second, an increase in scholarly representation from developing countries could help address the "human value" of green spaces not simply as a "first-world" phenomenon. Finally, a global focus on the emotional, human connections to green spaces may help scholars and practitioners alike mitigate the growing trend of green gentrification.

The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak

Research has consistently shown that access to parks and gardens is beneficial to people's health and wellbeing. In this paper, we explore the role of both public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak that took place in the UK in the first half of 2020. It makes use of the longitudinal COVID-19 Public Experiences (COPE) study, with baseline data collected in March/April 2020 (during the first peak) and follow-up data collected in June/July 2020 (after the first peak) which included an optional module that asked respondents about their home and neighbourhood (n = 5,566). Regression analyses revealed that both perceived access to public green space (e.g. a park or woodland) and reported access to a private green space (a private garden) were associated with better subjective wellbeing and self-rated health. In line with the health compensation hypothesis for green space, private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away. This interaction was however only present during the first COVID-19 peak when severe lockdown restrictions came into place, but not in the post-peak period when restrictions were being eased. The study found few differences across demographic groups. A private garden was relatively more beneficial for men than for women during but not after the first peak. The results suggest that both public and private green space are an important resource for health and wellbeing in times of crisis.

Coping with post-hurricane mental distress: The role of neighborhood green space

BACKGROUND

Although increases in the prevalence of mental distress have been reported after natural disasters, less is known about the role the environment may play in mitigating posttraumatic stress disorder (PTSD) in hurricane-impacted communities.

AIM

This study aims to investigate the extent to which concentration and perceived quality of neighborhood greenness are associated with lower levels of PTSD, along with potential mechanisms through which these effects occur.

METHODS

We conducted a cross-sectional survey of individuals (N=272) from 30 Houston neighborhoods that were affected during Hurricane Harvey. Perceived quality of neighborhood green space was measured using a scale adapted from the Neighborhood Open Space (NOS) scale, and concentration of greenness was measured objectively using the normalized difference vegetation index (NDVI). Probable PTSD was measured using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and hurricane-related distress using the Impact of Event Scale (IES-R). Generalized linear mixed models were used to fit individual models. Based on the results, structural equation models were employed to test direct and indirect pathways simultaneously. Models were adjusted for neighborhood- and individual-level confounders.

RESULTS

Greater perceived quality of neighborhood green space was significantly associated with lower likelihoods of probable PTSD and hurricane-related distress. The effects of perceived green space quality on hurricane-related distress were mediated by higher levels of emotional resilience. Social cohesion, although significantly correlated with PTSD and distress, did not mediate the effect of perceived green space quality on either. Neighborhood NDVI was significantly associated with hurricane-related distress, but not with PTSD.

CONCLUSION

We conclude that living in neighborhoods with greater perceived quality of green space was associated with lower levels of post-hurricane distress, with mediation especially through the emotional resilience pathway. These findings suggest that in disaster recovery policy frameworks, more attention should be paid to the benefits of high-quality neighborhood green infrastructure.

Social and environmental risks as contributors to the clinical course of heart failure

Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.

Residential exposure to air pollution and access to neighborhood greenspace in relation to hair cortisol concentrations during the second and third trimester of pregnancy

BACKGROUND

Exposure to air pollution during pregnancy has been associated with adverse pregnancy outcomes in studies worldwide, other studies have described beneficial effects of residential greenspace on pregnancy outcomes. The biological mechanisms that underlie these associations are incompletely understood. A biological stress response, which implies release of cortisol, may underlie associations of air pollution exposure and access to neighborhood greenspaces with health.

METHODS

We explored residential exposure to air pollution and residential access to neighborhood greenspaces in relation to hair cortisol concentrations of participants in a prospective pregnancy cohort study in Flanders, Belgium. Hair samples were collected at the end of the second pregnancy trimester (n = 133) and shortly after delivery (n = 81). Cortisol concentrations were measured in 3-cm scalp-near hair sections, to reflect second and third pregnancy trimester cortisol secretion. We estimated long-term (3 months before sampling) residential exposure to fine particulate matter (PM_2.5), nitrogen dioxide (NO₂) and black carbon (BC), assessed residential distance to major roads and residential access to neighborhood greenspaces (NHGS). Associations between residential exposures and hair cortisol concentrations were studied using linear regression models while adjusting for season of sampling.

RESULTS

Three-month mean residential NO₂ and BC concentrations were positively associated with third pregnancy trimester hair cortisol concentrations (p = 0.008 and p = 0.017). Access to a large NHGS (10 ha or more within 800 m from residence) was negatively associated with third trimester hair cortisol concentrations (p = 0.019). Access to a large NHGS significantly moderated the association between residential proximity to major roads and second trimester hair cortisol concentrations (p = 0.021). Residential distance to major roads was negatively associated with second trimester hair cortisol concentrations of participants without access to a large NHGS (p = 0.003). The association was not significant for participants with access to a large NHGS. The moderation tended towards significance in the third pregnancy trimester (p < 0.10).

CONCLUSIONS

Our findings suggest a positive association between long-term residential exposure to air pollution and biological stress during pregnancy, residential access to neighborhood greenspaces may moderate the association. Further research is needed to confirm our results.

TRIAL REGISTRATION

The IPANEMA study is registered under number  NCT02592005 at clinicaltrials.gov .

Active by nature: exploring cancer survivors' exercise barriers, facilitators, preferences, and psychosocial benefits of engaging in outdoor physical activity

Introduction

Large numbers of cancer survivors struggle with mental health after cancer diagnosis. Cancer survivors are encouraged to engage in physical activity in order to improve physical and mental health. Additional benefits to physical activity engagement in natural environments have been reported but this has not been explored in cancer survivors.

Methods

Study participants had to be over the age of 19, a Canadian resident, and have had a cancer diagnosis. Recruitment to complete an online survey occurred through social media and snowball sampling. The data collected included physical activity participation, preferences and location, barriers and facilitators of engagement in outdoor physical activity, nature-related questions, and measures of psychosocial health. The sample was split by the number of outdoor physical activity minutes (> 150 min per week). Correlations were computed to examine the role of outdoor physical activity minutes on measured psychosocial health outcomes.

Results

One hundred and fourteen (N = 114) cancer survivors completed the online questionnaire. More than half of the respondents indicated that an outdoor environment was central to their physical activity of choice with walking identified as the most common outdoor physical activity. Group support was the main expected facilitator of success in an outdoor walking program. Outdoor active participants were significantly more motivated and confident to be physically active and reported significantly more benefit and enjoyment in being physically active than outdoor inactive participants. Minutes of outdoor physical activity was significantly correlated with subjective happiness, nature relatedness, and higher quality of life. No significant correlations were found between minutes of outdoor physical activity and generalized anxiety.

Conclusion

While future research is needed to further explore the role of nature in cancer survivor psychosocial health, we believe that our data suggests preference and benefit for outdoor physical activity in cancer survivors.

"It made me feel brighter in myself"- The health and well-being impacts of a residential front garden horticultural intervention

Residential gardens make up 30% of urban space in the UK, yet unlike many other green space typologies, their role in the health and well-being agenda has largely been overlooked. A horticultural intervention introduced ornamental plants to 38 previously bare front gardens (≈ 10 m²) within an economically deprived region of North England, UK. Measures of perceived stress and diurnal cortisol profiles (as an indicator of health status) were taken pre- and post-intervention (over 3 months). Residents reported significant decreases in perceived stress post-intervention. This finding was aligned with a higher proportion of 'healthy' diurnal cortisol patterns post-intervention, suggesting better health status in those individuals. All residents derived one or more reported socio-cultural benefits as a result of the front garden plantings, although overall scores for subjective well-being did not increase to a significant level. Further qualitative data suggested that the gardens were valued for enhancing relaxation, increasing positive emotions, motivation, and pride of place. The results indicate that adding even small quantities of ornamental plants to front gardens within deprived urban communities had a positive effect on an individual's stress regulation and some, but not all, aspects of subjective well-being. The research highlights the importance of residential front gardens to human health and well-being, and thus their contribution to the wider debates around city densification, natural capital and urban planning.

Development and validation of an inventory to measure stressful events: Findings from a population-based survey

Background: Development of tools for measuring stress has been considered by mental health researchers for many years. The purpose of this study was to develop and validate a "Stressful Events Inventory"(SEI) using exploratory and confirmatory factor analyses.

Methods: Using a representative sample (n=6000) from all people who reside in Tehran, the validity of the inventory was confirmed by exploratory and confirmatory factor analyses, and its reliability was also confirmed by Cronbach's alpha.

Results: Eleven major sets of stressful events were identified as follow: political problems (α=0.731), neighborhood’s problems (α=0.739), livelihood problems (α=0.609), fear of the future (α=0.663), educational events (α=0.635), educational changes (α=0.704), individual changes (α=0.463), occupational difficulties (α=0.64), housing problems (α=0.69), problems related to occupational relations (α=0.46), and family problems (α=0.69). The value of correlation between the factors was equal to 0.82 and the value of variance determined by these factors was 0.49 (r^2=0.49). In the confirmatory factor analysis, these factors also had an appropriate fitness (RMSEA=0.02).

Conclusion: The developed instrument has suitable psychometric properties, which make it appropriate for future research on psychosocial stress.

Biophobia and Urban Restorativeness

Natural areas are now known to be important resources for the health and wellbeing of urban dwellers, through, for example, the opportunities they provide for cognitive and emotional restoration. However, urban populations have also been found not to engage with these spaces and to display some form of biophobia which may hinder them from perceiving any of these benefits. This concept of biophobia is thought to entail both our innate physiological responses to the perceived danger from non-human threats such as spiders and snakes and our cultural attachment to material comfort. The word is often used with derogatory connotations, even if it is part of an evolutionary mechanism honed over thousands of years to keep humans alive. This review presents the current state of knowledge on urban biophobia as well as evidence of instances in which built and mixed urban environments were found to be more restorative than natural ones for the urban population, in order to assess any connection within the two. A series of recommendations for further research but also for the practical implementation of natural areas in cities capable of attracting a wide variety of people regardless of their fears or preferences are also formulated. Only by investigating the psychological and physiological responses of urban dwellers to their daily environments can we hope to design interventions which will remain relevant for the modern world.

Effect of residential exposure to green space on maternal blood glucose levels, impaired glucose tolerance, and gestational diabetes mellitus

BACKGROUND

Residential surrounding green spaces can affect human health. However, limited studies have examined their impacts on maternal blood glucose homeostasis outcomes.

OBJECTIVE

We examined the associations of residential exposure to green space with maternal blood glucose levels, gestational impaired glucose tolerance (IGT), and gestational diabetes mellitus (GDM).

METHODS

Pregnant women were recruited from a prospective birth cohort between October 2012 and September 2015. Exposure to green space was calculated as the mean value of the normalized difference vegetation index (NDVI) within a 300-m circular buffer area surrounding each residence. Maternal glucose was measured between 24 and 28 weeks of gestation, and gestational IGT and GDM were diagnosed using valid methods. We estimated the associations of residential NDVI with maternal glucose levels using multiple linear regression models with adjustment for age, education, BMI, passive smoking during pregnancy, parity, season of conception, income, and urbancity. We estimated the relative risks of residential NDVI with IGT and GDM using a generalized estimating equation model with modified Poisson regression. The mediation effects of residential exposure to air pollution and maternal physical activity were assessed using causal mediation analysis.

RESULTS

Of 6807 pregnant women, 751 (11.3%) and 604 (8.8%) were diagnosed with IGT and GDM, respectively. One SD increment of residential NDVI was associated with a decrease of 0.06 mmol/L (95% CI: -0.07, -0.05), 0.09 mmol/L (95% CI: -0.13, -0.05), and 0.06 mmol/L (95% CI: -0.09, -0.03) in maternal fasting glucose levels, 1-h glucose levels, and 2-h glucose levels, respectively, as well as reduced risks of incident IGT (RR: 0.92, 95% CI: 0.86, 0.99) and GDM (RR: 0.85, 95% CI: 0.79, 0.92). The association between residential NDVI and maternal fasting glucose levels was partly mediated by maternal exposure to PM_2.5.

CONCLUSION

Living with higher levels of green space was significantly associated with decreased maternal glucose levels and attenuated risks of incident maternal IGT and GDM. Our findings provide evidence linking green space to better maternal glucose outcomes. More studies are needed to further explore the maternal and child health benefits related to our findings.

Experiences of the Urban Green Local Environment as a Factor for Well-Being among Adults: An Exploratory Qualitative Study in Southern Sweden

The amount and quality of greenness in the local outdoor environment has repeatedly been linked to human well-being. Different types of green areas are likely required in order to meet the various needs of people throughout the course of their lives and with regard to individual social and economic living conditions. The aim of the present study was to increase the understanding of different pathways between green environments, well-being and health. We conducted 16 interviews to explore perceptions and experiences among adults residing in a semi-urban to urban area and derived categories and subcategories from the data using content analysis. We identified six categories; promoting activities, supporting social contacts, stimulating sensory impressions, providing a retreat, offering ways to influence and creating a sense of coherence, and we recognized that the availability to, and contrasts between and maintenance of the environment were experienced as prerequisites for health-promoting properties of the green local environment. The results illustrate a rich variety in potential pathways through which the green local environment may promote well-being. The study highlights the need to plan the local environment from multiple perspectives, as well as carefully considering prerequisites of various kinds in order for the green environment to support health across the life-course.

A Scoping Review Mapping Research on Green Space and Associated Mental Health Benefits

BACKGROUND

There is a growing interest in research investigating the association between green space (GS) and mental health and wellbeing (HWB), in order to understand the underlying mechanisms. Accordingly, there is a need to map the literature and create an overview of the research.

METHODS

A scoping review approach was used to map literature on GS, including context and co-exposures (the GS exposome), and their associations with mental HWB. The review considers mental HWB definitions and measurements and how GS is characterized. Furthermore, the review aims to identify knowledge gaps and make recommendations for future research.

RESULTS

We identified a great diversity in study designs, definitions, outcome measures, consideration of the totality of the GS exposome, and reporting of results. Around 70% of the 263 reviewed studies reported a positive association between some aspect of GS and HWB. However, there is a limited amount of research using randomized controlled crossover trails (RCTs) and mixed methods and an abundance of qualitative subjective research.

CONCLUSIONS

The discords between study designs, definitions, and the reporting of results makes it difficult to aggregate the evidence and identify any potential causal mechanisms. We propose key points to consider when defining and quantifying GS and make recommendations for reporting on research investigating GS and mental HWB. This review highlights a need for large well-designed RCTs that reliably measure the GS exposome in relation to mental HWB.

Associations of green space metrics with health and behavior outcomes at different buffer sizes and remote sensing sensor resolutions

Satellite data is increasingly used to characterize green space for health outcome studies. Literature suggests that green space within 500 m of home is often used to represent neighborhood suitable for walking, air pollution and noise reduction, and natural healing. In this paper, we used satellite data of different spatial resolutions to derive normalized difference vegetation index (NDVI), an indicator of surface greenness, at buffer distances of 50, 100, 250 and 500 m. Data included those of 2 m spatial resolution from WorldView2, 5 m resolution from RapidEye and 30 m resolution from Landsat. We found that, after radiometric calibrations, the RapidEye and WorldView2 sensors had similar NDVI values, while Landsat imagery tended to have greater NDVI; however, these sensors showed similar vegetation distribution: locations high in vegetation cover being high in NDVI, and vice versa. We linked the green space estimates to a health survey, and identified that higher NDVI values were significantly associated with better health outcomes. We further investigated the impacts of buffer size and sensor spatial resolution on identified associations between NDVI and health outcomes. Overall, the identified health outcomes were similar across sensors of different spatial resolutions, but a mean trend was identified in bigger buffer size being associated with greater health outcome.

Are urban landscapes associated with reported life satisfaction and inequalities in life satisfaction at the city level? A cross-sectional study of 66 European cities

With more than half the world's population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environments might improve, and reduce inequalities in, quality of life (QoL). Although studies suggest city-level characteristics hold independent influence on QoL, they generally lack a theoretically informed approach to understanding how the whole city landscape might be implicated, have paid scant attention to inequalities in QoL and often focus on small numbers of cities or countries. We applied theory and methods from landscape ecology to explore associations between cities' land cover/use, residents' reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012, 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries. Multilevel binary logistic models found that specific land use measures were associated with life satisfaction, including the amount of a city which was: residential (OR:0.991, 95%CI 0.984–0.997); isolated structures (OR:1.046, 95 CI 1.002–1.091); roads (OR:0.989, 95%CI 0.982–0.996); pastures (OR: 1.002, 95% CI 1.002–1.003) and herbaceous vegetation (OR:0.998, 95%CI 0.997–0.100). A more even distribution of land cover/use (β: 1.561, 95%CI -3.021 to −0.102) was associated with lower inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic – that is, could create equality. Our findings can aid urban planners to develop and build cities that can contribute to improving, and narrowing inequalities in, residents' life satisfaction.

•

It is important to understand how urban environments might improve quality of life.

•

We explored associations between land covers and life satisfaction.

•

We also explored within-city socio-economic inequalities in life satisfaction.

•

Specific land use measures were associated with life satisfaction.

•

Land cover evenness was associated with lower inequality in life satisfaction.

Edible City Solutions—One Step Further to Foster Social Resilience through Enhanced Socio-Cultural Ecosystem Services in Cities

Nature-based solutions have not been able to actively involve citizens and to address successfully food security, poverty alleviation, and inequality in urban areas. The Edible City approach promises a strategic step towards the development of sustainable, livable, and healthy cities. We introduce the conceptional framework of Edible City Solutions (ECS), including different forms of urban farming combined with closed loop systems for sustainable water, nutrient, and waste management. We review scientific evidence on ECS benefits for urban regeneration and describe the status quo of ECS in Rotterdam, Andernach, Oslo, Heidelberg, and Havana as case studies. We provide an analysis of strengths, weaknesses, opportunities, and threats (SWOT) to explore the capacity of ECS to enhance multifunctionality of urban landscapes with special focus on social cohesion and quality of life. Based on this we identify and discuss strategies for fostering socially relevant implementations for the case study cities and beyond.

The impacts of ageing on connection to nature: the varied responses of older adults

Access to nature is important for wellbeing at all ages with significant benefits for older adults. This paper explores the impacts of older adults' age-related health conditions on nature connection, their responses to the changes and identifies the types of nature connections and greenspaces available to and prioritised by older adults. It is based on the experiences of 72 New Zealand older adults aged 65-99, living in family homes, down-sized homes and rest homes. Data were gathered through interviews, photographs and assessments of the natural features of their home environment. Nearly all participants experienced age-related changes in their ways of connecting with nature as living accommodation and especially health and mobility changed. Reduced mobility was the primary factor limiting nature experiences especially for frailer adults. In contrast, for 'younger' older adults, retirement can provide more time and opportunities to engage with nature. Nature connection opportunities are valued by nearly all adults irrespective of age and health. Accessible nature opportunities in the nearby and home environment should be available to all adults irrespective of health and accommodation type. Dedicated resources need to be provided to ensure these opportunities are present for the frailest whose opportunities to have direct contact with nature are frequently absent.

Use of green spaces, self-satisfaction and social contacts in adolescents: A population-based CASPIAN-V study

BACKGROUND

A growing body of evidence has associated contact with green spaces with improved mental health and wellbeing in adults. Social contacts has been postulated as a potential mechanism underlying such effects. However, the available evidence on the association between green spaces and self-satisfaction and also the mediatory role of social contacts in health benefits of green spaces in adolescents is still very scarce. We aimed to evaluate the association of time spent in different types of green spaces with self-satisfaction and social contacts in adolescents. We also investigated the mediatory role of social contacts in the association of green space use and self-satisfaction.

METHODS

This cross-sectional study was based on a population-representative sample of 10,856 adolescents (10-18 years old) living in urban and rural districts across 30 provinces of Iran (2015). Data on the time spent in green spaces (separately for parks, forests and private gardens), self-satisfaction, social contacts (number of friends and time spent with friends), and socio-demographic characteristics were obtained through questionnaires from parents and children. Logistic mixed effects models with recruitment centre as the random effect were developed to estimate associations adjusted for relevant covariates.

RESULTS

More time spent in green spaces was associated with improved self-satisfaction and social contacts. While for the self-satisfaction, there was no indication for effect modification by sex, socioeconomic status (SES), and urbanity, we observed stronger associations for older adolescents (> 14 years old). For social contacts, we found indications for stronger associations for boys, older adolescents, those residing in rural areas, and those from lowest and highest SES groups. Social contacts could explain more than half of the association between green spaces use and self-satisfaction.

CONCLUSIONS

Our observed enhanced self-satisfaction and social contacts associated with more time spent in green spaces could provide policymakers with measures to improve mental wellbeing of adolescents. Further studies are required to replicate our findings in other populations with different climates, cultures and lifestyles.