Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers

Nature Prescriptions and Indigenous Peoples: A Qualitative Inquiry in the Northwest Territories, Canada

Nature prescription programs have become more common within healthcare settings. Despite the health benefits of being in nature, nature prescriptions within the context of Indigenous Peoples have received little attention. We therefore sought to answer the following question: What are circumpolar-based physicians' and Indigenous Elders' views on nature prescribing in the Northwest Territories, Canada? We carried out thirteen semi-structured interviews with physicians between May 2022 and March 2023, and one sharing circle with Indigenous Elders in February 2023. Separate reflexive thematic analysis was carried out to generate key themes through inductive coding of the data. The main themes identified from the physician interviews included the importance of cultural context; barriers with nature prescriptions in the region; and the potential for nature prescriptions in the North. Reflections shared by the Elders included the need for things to be done in the right way; the sentiment that the Land is not just an experience but a way of life; and the importance of traditional food as a connection with Nature. With expanding nature prescription programs, key considerations are needed when serving Indigenous communities. Further investigation is warranted to ensure that nature prescriptions are appropriate within a given context, are inclusive of supporting Land-based approaches to health and wellbeing, and are considered within the context of Indigenous self-determination.

Kokedama and essential oils had a relaxing psychophysiological effect on Taiwanese women during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, we designed an indoor nature activity program for citizens with a relaxing effect similar to forest bathing to promote their physical and mental health. We integrated an indoor horticultural activity (Kokedama) with the breathing of Pseudotsuga menziesii (P. menziesii) and Lavandula angustifolia (L. angustifolia) essential oils (EOs) with the goal of creating a nature-inspired environment in an indoor setting where participants would feel as if immersed in a forest atmosphere.

METHODS

Taiwanese women participated in the experiment, using two Saturday mornings, one Saturday in a university classroom in the city center; and the other Saturday in a workshop in a Suburban Park. Intra-group comparisons were used to assess the Physiological responses to urban and suburban environmental stimuli and measured self-reported psychological responses. We recorded parameters associated with heart-rate variability and brainwaves. We also administered the State-Trait Anxiety Inventory-State (STAI-S) questionnaire before and after the participants had completed the entire program.

RESULTS

After the participants had breathed the P. menziesii and L. angustifolia EOs, the levels of some physiological parameters increased (standard deviation of normal-to-normal intervals, normalized high frequency, and high alpha wave) and those of others decreased (normalized low frequency, low- to high-frequency ratio power, high beta wave, and gamma wave). These findings were corroborated by the data from the STAI-S questionnaires.

CONCLUSIONS

The psychophysiological data from this study provide significant scientific evidence for the health benefits of an indoor nature activity program in women.

An exploratory framework for mapping, mechanism, and management of urban soundscape quality: From quietness to naturalness

BACKGROUND

Despite growing attention from researchers and governments, challenges persist in comprehensively assessing urban sound quality by integrating both quietness and naturalness aspects.

GOALS

This study aimed to develop an innovative soundscape quality index that concurrently evaluates quietness and naturalness in urban soundscapes. Our objectives included conducting urban soundscape quality mapping, analyzing influential mechanisms, and identifying priority zones for sound environment management.

APPROACHES

We collected sound pressure level (SPL) and raw audio data, from which we computed a normalized difference soundscape index (NDSI). With a dataset comprising 28 explanatory variables encompassing land use, built environment, vegetation characteristics, and temporal factors, we employed the random forest (RF) model to predict 10 indicators, including eight SPL-related indices, NDSI, and the QNS (quietness and naturalness soundscape) index. Crucially, we utilized SHAP (SHapley Additive exPlanations) values to interpret the RF model.

FINDINGS

Spatial variations in quietness and naturalness were evident, closely associated with road networks and vegetation, respectively, with discernible temporal variations. The top three variables influencing QNS were distance to major roads, normalized difference vegetation index (NDVI), and proportion of tree coverage. Moreover, interaction effects highlighted dual negative or synergistic promoting effects on QNS from factors such as road width, human disturbance, vegetation configurations, and land cover. Notably, these mechanisms were successfully applied to six typical tourist attractions in Xiamen city, where five types of management zones were mapped based on priority considerations of population density and soundscape quality. Interestingly, natural soundscape reserves were highly correlated with city parks, high-risk zones predominantly overlapped with road networks, and potential zones comprised inner communities between streets.

SIGNIFICANCE

The framework demonstrated effectiveness in mapping, exploring mechanisms, and guiding management strategies for the urban sound environment.

Greenspaces And Cardiovascular Health

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.

Urban professionals' restorative tourism: exploring the role of perceived environmental restorativeness, push and pull motivations and destination attributes on tourism expectations

Introduction

Urban professionals often seek respite from their daily routines through restorative tourism, driven by a complex interplay of motivations that include both internal "push" factors and external "pull" factors. This study investigates the intricate relationship between the perceived environmental restorativeness of tourist destinations and the expectations of urban professionals engaging in restorative tourism. Furthermore, it examines how push and pull motivations mediate this relationship while also considering the moderating effect of destination attributes.

Methods

The multiple regression analyses on the survey data collected from 221 urban professionals with restorative tourism experiences provided quantitative evidence regarding the hypothesized relationships among perceived environmental restorativeness, push and pull motivations, destination attributes, and tourism expectations.

Results

The results showed that perceived environmental restorativeness has a positive effect on urban professionals' tourism expectations; urban professionals' pull motivation and push motivation each play a mediating role between perceived environmental restorativeness and tourist expectations; and restorative tourism destination attributes have a moderating effect between perceived environmental restorativeness and push motivation, as well as the relationship between perceived environmental restorativeness and pull motivation.

Discussion

This study provides essential theoretical contributions to restorative tourism and practical implications when designing restorative tourism destinations that target urban professionals.

Urban park qualities driving visitors mental well-being and wildlife conservation in a Neotropical megacity

Green infrastructure has been widely recognized for the benefits to human health and biodiversity conservation. However, knowledge of the qualities and requirements of such spaces and structures for the effective delivery of the range of ecosystem services expected is still limited, as well as the identification of trade-offs between services. In this study, we apply the One Health approach in the context of green spaces to investigate how urban park characteristics affect human mental health and wildlife support outcomes and identify synergies and trade-offs between these dimensions. Here we show that perceived restorativeness of park users varies significantly across sites and is mainly affected by safety and naturalness perceptions. In turn, these perceptions are driven by objective indicators of quality, such as maintenance of facilities and vegetation structure, and subjective estimations of biodiversity levels. The presence of water bodies benefited both mental health and wildlife. However, high tree canopy coverage provided greater restoration potential whereas a certain level of habitat heterogeneity was important to support a wider range of bird species requirements. To reconcile human and wildlife needs in green spaces, cities should strategically implement a heterogeneous green infrastructure network that considers trade-offs and maximizes synergies between these dimensions.

Beneficial effects of short-term exposure to indoor biophilic environments on psychophysiological health: Evidence from electrophysiological activity and salivary metabolomics

BACKGROUND

The utilization of short-term natural exposure as a health intervention has great potential in the field of public health. However, previous studies have mostly focused on outdoor urban green spaces, with limited research on indoor biophilic environments, and the physiological regulatory mechanisms involved remain unclear.

OBJECTIVES

To explore the affective and physiological impact of short-term exposure to indoor biophilic environments and their potential regulatory mechanisms.

METHODS

A between-group design experiment was conducted, and the psychophysiological responses of participants to the indoor plants (Vicks Plant) were measured by a method combined the subjective survey, electrophysiological measurements, and salivary biochemical analysis. Volatile organic compounds (VOCs) from plants were also detected to analyze the main substances that caused olfactory stimuli.

RESULTS

Compared with the non-biophilic environment, short-term exposure to the indoor biophilic environment was associated with psychological and physiological relaxation, including reduced negative emotions, improved positive emotions, lower heart rate, skin conductance level, salivary cortisol and pro-inflammatory cytokines, and increased alpha brainwave power. Salivary metabolomics analysis revealed that the differential metabolites observed between the groups exhibited enrichment in two metabolic pathways related to neural function and immune response: phenylalanine, tyrosine and tryptophan biosynthesis, and ubiquinone and other terpenoid-quinone biosynthesis. These changes may be associated with the combined visual and olfactory stimuli of the biophilic environment, in which D-limonene was the dominant substance in plant-derived VOCs.

CONCLUSION

This research demonstrated the benefits of short-term exposure to indoor biophilic environments on psychophysiological health through evidence from both the nervous and endocrine systems.

Nature and Mental Health in Urban Texas: A NatureScore-Based Study

In this cross-sectional study, we examined the impact of access to nature on mental health utilization in urban neighborhoods using Texas outpatient encounters data merged with NatureScoreTM (0-100; low to high nature levels) and US census data (household income, education, employment, poverty, and insurance coverage) at the zipcode level. Our sample size included 61 million outpatient encounters across 1169 zipcodes, with 63% women and 30% elderly. A total of 369,344 mental health encounters were identified, with anxiety/stress and depression encounters representing 68.3% and 23.6%, respectively. We found that neighborhoods with a NatureScore of 60+ had lower overall mental health utilization than those below 40 (RR 0.51, 95%CI 0.38-0.69). This relationship persisted for depression, bipolar disorder, and anxiety/stress and in neighborhoods with a NatureScore above 80 (p < 0.001). Compared to neighborhoods with a NatureScore below 40, those above 80 had significantly lower depression (aRR 0.68, 95%CI 0.49-0.95) and bipolar (aRR 0.59, 95%CI 0.36-0.99) health encounters after adjusting for demographic and socioeconomic factors. This novel approach, utilizing NatureScore as a proxy for urban greenness, demonstrates the correlation between a higher NatureScore and reduced mental health utilization. Our findings highlight the importance of integrating nature into our healthcare strategies to promote well-being and mental health.

Improving mental health in black men through a 24-week community-based lifestyle change intervention: the black impact program

BACKGROUND

Poor mental health is a leading cause of morbidity and mortality among Black men in the United States. Efforts to improve mental health among Black men have been hampered by a lack of access and utilization of mental health services. Physical activity and social networks have been shown to improve mental health. Thus, we examined the effect of a community team-based physical activity, health education and social needs intervention among Black men on mental health over 24 weeks.

METHODS

Black adult males (n = 74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and American Heart Association's (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's Life's Simple 7 (LS7) framework. Measures of mental health including the Center for Epidemiological Studies Depression Scale (CES-D), Patient Health Questionnaire 2-question depression screener (PHQ-2), and Perceived Stress Scale-10 (PSS-10) were completed at baseline, 12 and 24 weeks. The change in mental health scores from baseline to 12 and 24 weeks were evaluated using linear mixed-effects models adjusting for age, education, and income. The change in cardiovascular health scores, defined as objective metrics of LS7 (LS5 [blood pressure, total cholesterol, fasting glucose, body mass index and smoking]), by baseline mental health were evaluated using linear mixed-effects models with an interaction term (time*baseline mental health variable) and a random intercept for each participant.

RESULTS

Among 71 Black men (mean age 51, 85% employed) at 24 weeks, CES-D scores decreased from 10.54 to 7.90 (-2.64, 95%CI:-4.74, -0.55), PHQ-2 decreased from 1.04 to 0.63 (-0.41, 95%CI: -0.75, -0.07), and PSS-10 decreased from 14.62 to 12.91 (-1.71, 95%CI: -3.53, 0.12). A 1-unit higher CES-D at baseline was associated with less improvement in LS5 scores by -0.04 (95%CI: -0.076, -0.005) and - 0.032 (95%CI:-0.067, 0.003) units at week 12 and 24, respectively, with similar findings for PSS.

CONCLUSIONS

The Black Impact community-based lifestyle program has the potential to reduce depressive symptoms and stress in Black men. There is a dire need for larger, randomized studies to test the impact of Black Impact on mental health in Black men to advance health equity.

TRIAL REGISTRATION

Retrospectively Registered, ClinicalTrials.gov Identifier: NCT04787978.

Total Antioxidant Capacity of Saliva and Its Correlation with pH Levels among Dental Students under Different Stressful Conditions

(1) Background: This cross-sectional study conducted at the Faculty of Dental Medicine, Timisoara, Romania, between December 2022 and February 2023 aims to assess salivary total antioxidant capacity and pH levels in dental students experiencing non-stressful and stressful situations and explore potential correlations between these factors. (2) Methods: Saliva samples were collected during two different periods: before an Oral Health course and before the Oral Health exam, under stressful conditions. Ethical principles were followed, and informed consent was obtained. Data on age, gender, health status, drug use, smoking habits, and anxiety levels were recorded. Saliva was collected using the draining method and pH was measured using indicator paper strips. Total antioxidant capacity (TAC) was determined using a commercial assay kit. Statistical analysis involved descriptive statistics, Student's t-test to compare pH and TAC between study groups, and Pearson's correlation coefficient to analyze the correlation between salivary pH and TAC within each group, with p < 0.05 indicating significance. (3) Results: This study involved 80 participants, comprising 26 males and 54 females, all enrolled in the 5th year of the Oral Health course, with ages ranging from 20 to 53 and a mean age of 23.62 (±4.19) years. Pearson's correlation results show a statistically significant negative relationship between the STAI test and TAC during the stress-free period (-0.02 **, N = 80, p < 0.01). (4) Conclusions: There are variations in saliva's antioxidant capacity in response to different stress conditions. Dental students experienced a higher level of stress before academic assessments compared to the non-stress period during the course.

Effects of Linpan nature therapy on health benefits in older women with and without hypertension

Background

Nature therapy can significantly benefit the physiology and psychology of middle-aged and older people, but previous studies have focused on forest environments. The restoration potential of rural environments in urban fringe areas, which are more accessible to older people on a daily basis, has not been fully studied. This study assessed the effects of nature therapy on the physical and mental health of older women in a rural setting (locally known as Linpan) in the urban fringe area of Chengdu, China.

Methods

We recruited a total of 60 older women (65.3 ± 5.5 years old) living in cities for 3 days of nature therapy in the winter (30 subjects) and spring (30 subjects), including 20 hypertensive patients.

Results

The results showed that the overall blood pressure, pulse and sleep dysfunction rating scores of the participants were significantly lower than the pretest levels, and the finger blood oxygen saturation, mid-day salivary alpha-amylase and cortisol were increased post-treatment. Increases in these biomarker indicates and increase in stress. There were significant differences in the changes in systolic blood pressure between the hypertension group (HTN) and the normal group (normal) (HTN decreased by 8.8%, normal decreased by 5.4%), salivary alpha-amylase content (HTN decreased by 0.3%, normal increased by 16.9%), and sleep dysfunction rating scores (HTN decreased by 59.6%, normal decreased by 54%). The decreases in systolic blood pressure and pulse in the winter group were higher than those in the spring group by 1.8 and 4.4%, respectively, while the increases in salivary alpha-amylase content and salivary cortisol content were lower than those in the spring group by 11.7 and 11.2%, respectively, and the decrease in sleep dysfunction rating scores was lower than that in the spring group by 7.1%.

Conclusion

Our study concluded that nature therapy based on various health activities in the Linpan has significant health effects on older women. It can regulate blood pressure and pulse in older women, relieve cardiovascular disease, improve sleep quality. Meanwhile, older women with high blood pressure experienced a more significant effect than the healthy group.

How Much Did Urban Park Use Change under the COVID-19 Pandemic? A Comparative Study of Summertime Park Use in 2019 and 2020 in Edinburgh, Scotland

The importance of urban parks was highlighted during the COVID-19 pandemic, when a number of restrictions on social gatherings were in place and people's movements were often restricted to their local neighbourhood. This study examined the changes in patterns of park use before and during COVID-19 to understand how the pandemic influenced such use. The methods involved behaviour observation and mapping, to offer a comparison of the use of parks in Edinburgh, Scotland, before and in the first year of the COVID-19 pandemic. The findings show an overall increase in use of urban parks during COVID-19, as expected, with significantly higher use in social areas, sports and fitness areas, and playground areas. However, while there was an overall increase in people visiting parks with others during COVID, in woodland areas there was an increase in lone visitors. This study shows the importance of parks for socialisation, exercise and children's play, but also for spending time alone in natural areas during COVID-19. The value of urban parks at a time of social disruption, such as the pandemic, is highlighted, and their role in supporting a variety of urban dwellers' needs points to priorities for future park planning, design and management.

Objective greenness, connectedness to nature and sunlight levels towards perceived restorativeness in urban nature

The beneficial effect of exposure to nature and immersion in natural environments on perceived well-being is well established. Nevertheless, we acknowledge an emerging need to disentangle the role of specific environmental features from individual factors that encourage a positive person-environment interaction. This study aimed at evaluating the associations between four buffer distances of greenness and dimensions of perceived restorativeness, with connectedness towards nature (CTN) as a confounder variable, in a sample of 312 visitors to a large urban park. Variables investigating ecosystem services (ES, e.g., thermal comfort) were included as covariates. Results revealed differentiated effects of greenness level, sunlight intensity, and connectedness to nature in the pathways towards dimensions of restorativeness. Greenness level at 300 m was associated with Fascination, Scope, and Being Away, while at 500 m was associated with Coherence, Scope, and Being Away. ES was found to be associated with Coherence, while CTN with the other three dimensions of restorativeness. The moderating effect of sunlight level in the relationship between NDVI buffer distances and the total score of perceived restorativeness was also confirmed. The present work is intended to offer insights on the interplay between environmental features and individual differences for implications in several contexts, including the opportunity to develop tailor-made planning for urban forestry.

Green sleep: Immediate residential greenspace and access to larger green areas are associated with better sleep quality, in a longitudinal population-based cohort

OBJECTIVE

Sleep is pivotal to health, wellbeing and functioning in daily life, but sleep difficulties are common and may be affected by modifiable qualities in the residential surrounding environment, in terms of greenspace. However, population-based studies on individual-level greenspace and sleep are limited. The objective of the current study was thus to investigate prospective associations between fine-grained individual-level residential greenspace and sleep, and moderating effects of life style (physical activity, work status) and sex, in a nationwide population-based Swedish cohort.

METHODS

Participants of the Swedish Longitudinal Occupational Survey of Health (SLOSH)-a population-based sample of adults in Sweden-were studied during 2014-2018 (19,375 individuals; 43,062 observations). Residential greenspace land cover, and coherent green area size, were assessed via high resolution geographic information systems, at 50, 100, 300, 500 and 1000 m buffers around residences. Prospective greenspace and sleep associations were assessed via multilevel general linear models, adjusting for demographic, socioeconomic (individual and neighborhood), life style and urban factors.

RESULTS

Higher greenspace availability in the immediate residential surroundings (50 m and 100 m buffer zones) was associated with less sleep difficulties, even after adjustment for confounders. Greenspace effects were generally greater among non-working individuals. Among the physically active, and among non-working, greenspace and green area size further away from home (300, 500 and 1000 m, i.e. dependent on mobility) were also associated with less sleep difficulties.

CONCLUSIONS

Residential greenspace in the immediate residential surroundings is associated with significantly less sleep difficulties. Greenspace further away from home was associated with better sleep especially among the physically active, and non-working individuals. The results highlight the importance of greenspace in the immediate residential-surrounding environment for sleep, and the need to integrate health and environmental policies, urban planning and greening.

Nature As Medicine: The 7th (Unofficial) Pillar of Lifestyle Medicine

There are 6 Official Pillars of Lifestyle Medicine, and now mounting evidence supports daily exposure to nature and fresh air as vital to optimizing overall physical and mental health. Time spent in nature has been shown to help lower blood pressure, reduce nervous system arousal, enhance immune system function, reduce anxiety and increase self-esteem. The positive effects of time spent in nature span different occupations, ethnic groups, financial status and individuals with a variety of chronic illnesses and disabilities. "Forest Bathing" is the term coined by Japanese researchers for walking in the woods. It is suspected that aerosols from trees, when inhaled during a forest walk, are one factor responsible for elevated immune system Natural Killer (NK) cells, which help fight off infections and tumor growth. In a culture of ever-increasing technology and screen time, now more than ever it is crucial to educate and empower individuals to incorporate nature into therapeutic treatment regimens. This article will demonstrate the potential benefits of nature, share evidence supporting nature as medicine and provide tools to help engage individuals to spend more time outdoors.

Greenspace as Workplace: Benefits, Challenges and Essentialities in the Physical Environment

There is a scarcity of knowledge regarding the potential benefits of human-nature contact within the context of working life. Even more limited is the research that focuses on working outdoors and the setting in which it takes place. This study aimed to obtain insight into key aspects of the physical environment relevant for the experienced benefits and challenges of workers exploring office work outdoors. We conducted interviews with key informants as well as photo registration and mapping of the different green spaces in the environments of six small or medium-sized workplaces. The information gathered was used as background knowledge for exploratory qualitative interviews, which were conducted while walking in natural settings chosen by the interviewees. With a landscape architectural perspective and an inductive approach, we explored employees' experiences of bringing office work outdoors. The following themes emerged: 'Simplicity,' 'Safeness', 'Comfort', and 'Contact with Nature' were experienced as key aspects in relation to the physical environment, whereas 'Sociality', 'Well-being', and 'Functioning' stood out as the main benefits and, 'Digital dependency' and 'Illegitimacy' as challenges to overcome. Based on the identification of potential benefits and their prerequisites, we propose implications for practice and research that can be useful when focusing on bringing office work outdoors.

Research on key acoustic characteristics of soundscapes of the classical Chinese gardens

Soundscapes have played an important role in the design and building of classical Chinese gardens. In Chinese classical poetry, biophonies such as bird calls, and geophonies such as wind, are the preferable sound sources. Although these major sound sources have been categorized and summarized by scholars extensively, little research has been conducted to analyze the physical characteristics and preference matrix of these preferred sound sources. Moreover, the perceived loudness of sound in classical Chinese gardens has received more attention from scholars than acoustic frequency. In this study, we selected 12 sound sources that are most typically present in classical Chinese gardens based on extensive literature research on Chinese classical poetry, and acquired respective audio samples from the BBC's library of Sound Effects. Through the spectrogram analyses, pitch detection algorithm and LSTM audio classification methods, the sound sources were classified into discrete sound sources with pitch variation and continuous sound sources with spectral characteristics of white noise or pink noise. The reasoning behind the preference for these two types of sound sources was then discussed from physical and mental healing perspectives, which aims to help provide perspectives on the associated implications in the planning of urban green spaces.

In situ psycho-cognitive assessments support self-determined urban green exercise time

Prescribed nature walks frequently yield improvements to mood and cognition as observed in experimental studies. Research that uses real life settings such as self-determined time exercising outdoors for restorative health benefits may more accurately elicit effects than time-specified study protocols. This study examined in situ psycho-cognitive outcomes of routine walks in urban greenspace to test the concept that self-set exposure duration and not context alone is related to magnitude of psycho-cognitive benefit. Pre-post measurements taken on a diverse participant pool of individuals walking in urban parks and recruited on random days over a two-week period found significant associations between outdoor activity duration and cognitive and mood improvements. Greater outdoor walking duration linearly predicted stronger processing speeds but non-linearly in tests of other cognitive domains. Results of fixed effects model for mean mood change following green exercise show outdoor walking influenced mood change at highest levels of significance, even after accounting for individual level variability in duration. Mood improved for all durations of outdoor walking under a random effects model with high significance. Untethering fixed intervals of outdoor exercise from formal study design revealed briefer but more frequent nature engagement aligned with nature affinity. The influence of unmeasured factors, e.g., nature affinity or restorative conditioning, for prescriptive durations of urban green exercise merits further investigation toward designing wellbeing interventions directed at specific urban populations.

Effect of the decreased frequency of going out on the association between anxiety and sleep disorder during the COVID-19 pandemic: a mediation analysis

PURPOSE

The objective of the present study was to examine the relationship between anxiety and sleep disorder during the COVID-19 pandemic and to evaluate whether sleep disorder is mediated by the decreased frequency of going out.

METHODS

The data of a total of 1976 residents aged 18 years and over who had responded to a self-reported questionnaires at a health survey in 2020 were analyzed. The subjects were divided into four groups based on their response to the questionnaire on anxiety about the COVID-19 pandemic. Sleep disorder was measured using the Athens Insomnia Scale (AIS). A cross-sectional analysis was performed to examine the association between anxiety about the COVID-19 pandemic and AIS scores. Mediation analysis was used to calculate the association between anxiety and AIS scores during the COVID-19 pandemic, with decreased frequency of going out as a potential mediating variable.

RESULTS

In the cross-sectional study, the level of anxiety about the COVID-19 pandemic was significantly associated with the AIS score (p < 0.001). On mediation analysis, the direct effect of the relationship showed that anxiety positively influenced AIS scores (β = 0.283, p < 0.01). The indirect effect of the relationship showed that the decreased frequency of going out positively mediated the relationship between anxiety and AIS scores (β = 0.342, p < 0.05). The decreased frequency of going out accounted for almost 10% of the AIS score.

CONCLUSION

The present study found that anxiety about the COVID-19 pandemic was significantly associated with sleep disorder, with the decreased frequency of going out mediating this association.

Air pollution and myocardial infarction; effect modification by sociodemographic and environmental factors. A cohort study from Denmark

Air pollution is associated with increased risk of myocardial infarction (MI), but it is unresolved to what extent the association is modified by factors such as socioeconomic status, comorbidities, financial stress, residential green space, or road traffic noise. We formed a cohort of all (n = 1,964,702) Danes, aged 50-85 years, with 65,311 cases of MI during the followed-up period 2005-2017. For all participants we established residential five-year running average exposure to particulate matter <2.5  μm (PM_2.5), ultrafine particles (UFP, <0.1  μm), elemental carbon (EC) and nitrogen dioxide (NO₂). We evaluated risk in population strata, using Aalen additive hazards models to estimate absolute risk and Cox proportional hazards models to estimate relative risk of MI with 95% confidence intervals (CI). PM_2.5 and the other pollutant were associated with MI. Lower education and lower income were associated with higher absolute risks of MI from air pollution, whereas no clear effect modification was apparent for relative risk estimates. For example, 5 μg/m³ higher PM_2.5 was associated with HR for MI of 1.16 (95% CI: 1.10-1.22) among those with only mandatory education and 1.13 (95% CI: 1.03-1.24) among those with long education. The corresponding rate differences per 100,000 person years were 243 (95% CI: 216-271) and 358 (95% CI: 338-379), respectively. Higher level of comorbidity was consistently across all four pollutants associated with both higher absolute and relative risk of MI. In conclusion, people with comorbid conditions or of lower SES appeared more vulnerable to long-term exposure to air pollution and more cases of MI may be prevented by focused interventions in these groups.

Bibliothek als Ereignis

In 18 Jahren wird die Generation Alpha ihr Studium beginnen, somit auch in die Universitätsbibliotheken strömen und diese mitgestalten können. Der Beitrag zeigt mögliche Erfahrungen und Erkenntnisse, die die Studierenden von ihrem ersten Besuch in der Universitätsbibliothek 2040 mitnehmen können und wie Offenheit in Wissenschaft und Gesellschaft das Bibliothekswesen beeinflusst.

[Health-Related Goals of Digital Prevention and Health Promotion in Families]

STUDY AIM

There is an increase in digital technologies to support health promotion. The majority of offerings is aimed at the individual but are less adapted to social life constellations such as families. The goal of this is study was to highlight the need and the requirements for an addressee-oriented app development. This was to be achieved by determining the initial situation and health goals of the surveyed families in the fields of exercise, nutrition and relaxation, and identifying points of intersection of the family members for a health app.

METHODS

The online survey was conducted with n=1008 parents (Ø 48 years, 59% female, 39.3% male, 1.7% diverse) on health status as well as exercise, nutrition and relaxation, smartphone use, app features and gamification. Quantitative data analysis (frequency analyses, Chi2 test, factor analysis, and single-factor analysis of variance) was performed using IBM SPSS Analytics (25; Armonk, NewYork).

RESULTS

The majority of those surveyed considered their state of health to be good. The minority met the WHO reference values for physical activity and nutrition. In addition, the respondents were exposed to a high level of stress with simultaneously low coping skills. The identified target areas were active relaxation measures, nutrition, general competence, physical activity, nature activities and sports-recreation opportunities. Significant differences were found in age, in the active relaxation measures [F(2)=3.367; p=0.035] and sports-recreation opportunities [F(2)=7.480; p=0.001].

CONCLUSION

The study reveals intersections of families' content for a behavior change process with digital support. The interest in individual offers differs between the age groups of the children surveyed. Further research should identify health app usage preferences in families and in different family constellations as well as a family-friendly approach.

Playground Design: Contribution to Duration of Stay and Implications for Physical Activity

BACKGROUND

The study goal was to identify playground features associated with visitor length of stay and physical activity.

METHODS

We observed playground visitors over 4 days during summer 2021 in 60 playgrounds in 10 US cities, selected based on design, population density, and poverty levels. We observed 4278 visitors and documented their length of stay. We observed an additional 3713 visitors for 8 min, recording their playground location, activity level, and use of electronic media.

RESULTS

People stayed an average of 32 min (range 5 min-4 h). Stay time varied by group size, with larger groups staying longer. The presence of restrooms increased the likelihood of staying longer by 48%. Playground size, mature trees, swings, climbers, and spinners were associated with longer stays. When a teen was a part of the group observed, the group was 64% less likely to stay longer. The use of electronic media was associated with lower amounts of moderate-to-vigorous physical activity compared to non-media users.

CONCLUSIONS

To increase population-level physical activity and time spent outdoors, playground features associated with a longer stay should be considered when renovating or building new playgrounds.

Onsite restorative effect of a rural ecological farm versus an urban public greenery space

Accessible urban greenery allows short breaks and leisure activities while experiencing nature. Studies have shown that contact with nature elicits psychological and physical health benefits. However, the immediate impact and influence of exposure to artificial versus rural ecological nature have yet to be examined. This study investigates their psychophysiological restorative effects onsite, specifically when individuals view a ubiquitous urban public greenery space or a more indigenous ecological forest-like nature area, to compare levels of restorativeness and relaxation. Participants were asked to sit and view a scene onsite for 6 min while their facial muscle tension was recorded. The data were used to evaluate the degree of facial relaxation for both scenes. In addition, participant self-reports measured perceived restorativeness after the 6-min period. The self-reported data showed that the ecological farm scene was rated significantly higher for perceived restorativeness (t [49.136] = 9.094, p < .001) after 6 min of viewing. The muscle tension analysis showed that facial tension significantly declined when participants viewed the farm scene compared to the urban greenery space. These results, especially those on the farm, show that nature with more forest-like and rural elements elicited more powerful restorative effects and significantly lowered facial muscle tension (t [65] =  − 2.785, p < .05), thus verifying that a more ecological nature landscape provides immediate, significant health benefits through attention recovery and reduced facial muscle stress.

Green Physical Activity Indicator: Health, Physical Activity and Spending Time Outdoors Related to Residents Preference for Greenery

Spending time in the natural outdoor environment is a part of a healthy lifestyle. This study focused on identifying elements of green infrastructure that have a positive impact on both increasing physical activity, spending time outdoors and improving overall health. The aim of the research was to identify which elements of the settlement units' green and blue infrastructure, related to residents' preferences for greenery, influence more physical activity and spending time in green spaces and improve the healthy feeling of users as perceived by respondents. A total of 721 respondents from Poland took part in the survey. Using multiple regression models, the factors that influence an increase in outdoor physical activity Green Physical Activity Index (GPAI) were: using green spaces for exercise, spending time outdoors, exposure to nature and sufficiently large amounts of green space in the neighborhood and proximity to places to walk the dog. In contrast, physical activity has been shown to improve feeling healthy (health declaration). The main findings show that the increase in physical activity outdoors (GPAI) is positively influenced by factors related to respondents' reasons for being outdoors, rather than the attractiveness and availability of green infrastructure. The research confirmed the necessity of arranging green areas with rich offerings in terms of a variety of activities for leisure visitors, to give them more opportunities for being outdoors.

Psychological Distress Impact of Coronavirus Disease (COVID-19) Outbreak on Three Continents: A Systematic Review and Meta-analysis

BACKGROUND

The dire state of coronavirus disease (COVID-19) outbreak has had a substantial psychological impact on society.

METHODS

A systematic search was performed through Medline, PubMed, Embase, Scopus, and Web of Science, to investigate the impact of the COVID-19 pandemic on the psychological health of individuals in various countries. Subgroup analyses considered gender and classification of countries into three continents of America, Europe, and Asia. Only studies that used the COVID-19 Peritraumatic Distress Index (CPDI) questionnaire as a tool to assess mental distress were included in this meta-analysis. Heterogeneity among studies was assessed by I² statistic, and the random-effects model was utilized to obtain the pooled prevalence.

RESULTS

This pooled analysis included a large data sample of 21 studies consisting of 94,414 participants. The pooled prevalence of the psychological distress during the time of COVID-19 pandemic by CPDI for the continent of Asia was 43% (34.6% mild-to-moderate and 8.4% severe) which was greater than that for Europe (35%; 30% mild-to-moderate and 5% severe) but lower than that for America (64.3%; 45.8% mild to moderate and 18.5% severe). In addition, the prevalence of psychological distress according to CPDI was higher in females (48%; 40% mild to moderate, 13% severe) compared with males (59%; 36% mild to moderate and 5% severe).

CONCLUSIONS

Our findings suggest that psychological distress in the Americas is a larger problem than in Asia and European continents. Females appear to be more vulnerable and may therefore require further attention in terms of preventive and management strategies. Implementation of both digital and molecular biomarkers is encouraged to increase objectivity and accuracy of assessing the dynamic changes in mental health in the current and future pandemics.

The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-Analysis

Urban residents have a higher risk of hypertension and psychological stress than rural residents. Aside from medical interventions, understanding how to control hypertension and alleviate the stress of urban populations has become a public concern. As an alternative medical measure, forest therapy has shown the effects of normalizing blood pressure (BP) and reducing stress increasingly in recent literature, but this is still inconclusive. In order to systematically verify forest therapy’s effects on the BP and mental stress of urban residents, we conducted meta-analyses to assess the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration (SCC; a stress biomarker) between the forest therapy group and urban control group. We searched 4 online databases, and 21 studies on BP involving 2270 participants and 13 studies on SCC involving 1786 participants were included. Through the meta-analysis, the mean difference and confidence interval (CI) estimates indicated that forest therapy significantly reduced participants’ SBP −3.44 (95% CI −5.74, −1.14), DBP −3.07 (95% CI −5.59, −0.54), and SCC −0.07 (95% CI −0.10, −0.04), as compared with urban control. Yet, there was substantial heterogeneity (I2 = 72.87−88.59%) among these studies. We also found that each prediction interval (PI) for SBP (95% PI −13.30, 6.42), DBP (95% PI −15.54, 9.41), and SCC (95% PI −0.18, 0.05) were all much wider than the CIs and contained values above 0. This means that forest therapy may reduce SBP, DBP, and SCC on average, but may not exclude adverse results. Meta-regression analyses showed that participants’ age and baseline SBP levels determined the heterogeneity among SBP studies. After forest therapy, older participants and those with higher baseline SBP levels had greater SBP-lowering effects. Among DBP studies, the primary source of heterogeneity was participants’ baseline DBP levels; participants with higher baseline DBP levels had greater DBP reduction. In subgroup analyses, we discovered that longer-term forest therapy programs (≥20 min) resulted in a greater reduction in BP and SCC than shorter-term forest therapy programs (<20 min). Additionally, seated viewing, walking, or multi-session programs in forests were observed to have similar effects on reducing BP and SCC. Despite extensive analyses, the study did not identify any sources of heterogeneity among forest therapy programs for lowering SCC levels. Overall, we conclude that forest therapy programs have beneficial therapeutic effects on urban residents’ physio-psychological health through lowering BP and relieving stress (reducing SCC). This finding provides solid evidence of the contribution of forest therapy to urban residents’ health and wellbeing.

Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods

BACKGROUND

There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems.

METHODS

We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model.

RESULTS

A model significantly fit our data (rel χ² = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction.

CONCLUSIONS

Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.

Green spaces, especially nearby forest, may reduce the SARS-CoV-2 infection rate: A nationwide study in the United States

The coronavirus pandemic is an ongoing global crisis that has profoundly harmed public health. Although studies found exposure to green spaces can provide multiple health benefits, the relationship between exposure to green spaces and the SARS-CoV-2 infection rate is unclear. This is a critical knowledge gap for research and practice. In this study, we examined the relationship between total green space, seven types of green space, and a year of SARS-CoV-2 infection data across 3,108 counties in the contiguous United States, after controlling for spatial autocorrelation and multiple types of covariates. First, we examined the association between total green space and SARS-CoV-2 infection rate. Next, we examined the association between different types of green space and SARS-CoV-2 infection rate. Then, we examined forest-infection rate association across five time periods and five urbanicity levels. Lastly, we examined the association between infection rate and population-weighted exposure to forest at varying buffer distances (100 m to 4 km). We found that total green space was negative associated with the SARS-CoV-2 infection rate. Furthermore, two forest variables (forest outside park and forest inside park) had the strongest negative association with the infection rate, while open space variables had mixed associations with the infection rate. Forest outside park was more effective than forest inside park. The optimal buffer distances associated with lowest infection rate are within 1,200 m for forest outside park and within 600 m for forest inside park. Altogether, the findings suggest that green spaces, especially nearby forest, may significantly mitigate risk of SARS-CoV-2 infection.

Relaxing Effects of Breathing Pseudotsuga menziesii and Lavandula angustifolia Essential Oils on Psychophysiological Status in Older Adults

We evaluated the effects of breathing Pseudotsuga menziesii (P. menziesii) and Lavandula angustifolia (L. angustifolia) essential oils (EOs) during a horticultural activity on older adults. A total number of 92 older adult (71.2 ± 7.7 years old) participants were guided through a leaf printing procedure. In the meantime, water vapor and EOs were diffused in an orderly manner. The heart rate variability-related parameters as well as the brain waves were recorded. In addition, we also collected data for the State-Trait Anxiety Inventory-State (STAI-S) questionnaires before and after the whole indoor natural activity program. The physiological parameters including standard deviation of normal to normal intervals, normalized high frequency (nHF), and high alpha wave increased while the normalized low frequency (nLF), the ratio of LF-to-HF power, high beta wave, and gamma wave decreased following the breathing of P. menziesii and L. angustifolia EOs. These changes indicated a relaxing effect of breathing both EOs during a horticultural activity on older adults. Our results demonstrated a beneficial effect of P. menziesii EO which is as good as a well-known relaxant L. angustifolia EO. This notion was supported by the results of STAI-S. Here we developed an indoor natural activity program for older adults to promote physical and mental health.

Behavioral economics: who are the investors with the most sustainable stock happiness, and why? Low aspiration, external control, and country domicile may save your lives—monetary wisdom

Slight absolute changes in the Shanghai Stock Exchange Index (SHSE) corresponded to the city’s immediate increases in coronary heart disease deaths and stroke deaths. Significant fluctuations in the Shenzhen Stock Exchange Index (SZSE) corresponded to the country’s minor, delayed death rates. Investors deal with money, greed, stock volatility, and risky decision-making. Happy people live longer and better. We ask the following question: Who are the investors with the highest and most sustainable stock happiness, and why? Monetary wisdom asserts: Investors apply their deep-rooted values (avaricious love-of-money aspiration and locus of control, Level 2) as a lens to frame critical concerns in the proximal-immediate (Shanghai Stock Exchange Index changes, Level 1) and the omnibus-distal contexts (domicile: city vs. country, Level 2) to maximize expected utility (portfolio changes, Level 1) and ultimate serenity (stock happiness, Level 1). We collected multilevel data—the longitudinal SHSE and 227 private investors’ daily stock happiness and portfolio changes for 36 consecutive trading days in four regions of China. Investors had an average liquid asset of $76,747.41 and $54,660.85 in stocks. This study is not a “one-shot” game with “nothing at stake.” We classified Shanghai and Beijing as the city and Shenzhen and Chongqing as the country. Our cross-level 3-D visualization reveals that regardless of SHSE volatility, investors with low aspiration, external control, and country domicile enjoy the highest and most sustainable stock happiness with minimum fluctuations. Independently, investors with low aspiration, external control, and country domicile tend to make fewer portfolio changes than their counterparts. Behaviorally, less is more, debunking the myth—risky decisions excite stock happiness. Our longitudinal study expands prospect theory, incorporates attitude toward money, and makes robust contributions to behavioral economics and business ethics. We help investors and ordinary citizens make happy, healthy, and wealthy decisions. Most importantly, the life you save may be your own.

Durations of virtual exposure to built and natural landscapes impact self-reported stress recovery: evidence from three countries

Exposure to natural landscapes can benefit human health. However, several knowledge gaps remain regarding the impacts of duration and cultural differences on the health benefits of nature. If these gaps are filled, designers and planners can better design landscapes for stress recovery. This study examined the effects of durations of virtual exposure to the built and natural environments across three countries using an experimental design. Two-hundred and seventy people from USA, Taiwan, and Thailand were induced with an acute stressor and then randomly assigned to watch 360° videos of urban or natural landscapes for 1, 5, or 15 min. Self-reported stress recovery data were collected before and after the exposure. The results suggested that gender and duration of exposure to virtual natural landscapes impacted stress recovery. Female participants recovered from stress more when exposed to the virtual natural landscapes than urban landscapes. Among those participants who were exposed to virtual natural landscapes, 5 min of exposure resulted in greater stress recovery than shorter or longer durations of exposure. Perceived familiarity did not influence the extent of stress recovery. These findings support previous research on how nature exposure is related to stress recovery and varies by dosage, leading to better understanding toward landscape design. Future studies should explore other measures of stress, different landscape designs, participants’ immersion, and levels of control in simulated nature scenes.

Effect of nature-based physical activity on post-traumatic growth among healthcare providers with post-traumatic stress

The purpose of this randomized control trial was to observe the effect of nature-based physical activity in achieving post traumatic growth and to estimate the combined effect of nature and physical activity on the psychophysiological outcomes. A 3-month therapy was provided to participants meeting eligibility criteria to receive the walk-in nature (experimental group) or sit-in nature (control group) in the 1:1 ratio. At baseline and 3-month follow-up, participants were assessed with Trauma Symptom Checklist 40, Traumatic Stress Scale, Post-Traumatic Growth Inventory (PTGI), Cortisol, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Brain-Derived Neurotropic Factor (BDNF) and heart rate variability. There was a significant effect of nature-based physical activity on traumatic stress and post-traumatic growth in comparison with the sit-in control. A significant post-interventional difference was observed in the mean PTGI score [F = 5.412, p = 0.022] between the experimental and control groups after 3 months of intervention. All the biochemical estimates, including CRP, BDNF, IL-6, and cortisol levels, were significantly altered in both post-intervention study groups (p < 0.01). Taken together, these results show that nature-based physical activity significantly improves psychophysiological outcomes induced as a result of post-traumatic growth and also reduces traumatic stress.

Relationship between the Duration of Urban Nature and a Lower Waist-Hip Ratio

Obesity is a prevalent health issue. Evidence suggests that the availability of urban nature may reduce the risks of obesity. However, several knowledge gaps remain. This study explores the relationships between the dose (distance, duration and frequency) of urban nature and demographic factors towards obesity risks among people in Thailand. A total of 111 participants in three urban and peri-urban nature locations answered a survey regarding their distance from green spaces, frequency of visits, and duration of their typical stay, as well as their socio-demographics, and waist-hip ratio (WHR). The results suggested that at least 1-2 h per typical visit to nature predicted low-risk WHR in women. Male participants are more likely to have a high-risk WHR. Increasing age predicted low-risk WHR. Spending more time in green spaces predicted lower odds of high-risk WHR, while distance did not predict the odds. This research is one of the first to study the relationship between time spent in nature and obesity, and one of the first nature and health studies conducted in Thailand. Given that Thailand is one of the countries most affected by obesity in Southeast Asia, this study is relevant and essential. Future research should explore the quality factors of the park with longer duration of stay.

An ecological dynamics perspective on designing urban nature environments for wellbeing and health-enhancing physical activity

The latest World Health Organization report on green and blue space and mental health (2021) calls for greater, and better, urban nature environments, i. e., “wilder” urban parks, tree-laden sidewalks, and overall presence of nature in the urban environment. Evidence shows that living close to and interacting with nature promotes benefits to numerous health and well-being indicators. The present article narratively reviews what are the aspects of urban nature environments that enhance health and wellbeing markers, which aspects are preferred among users and visitors of urban nature environments, and how can the benefits for health and wellbeing be understood from a theoretical perspective. Finally, guided by the ecological dynamics framework, suggestions are put forward on how designers and planners of urban nature environments can consider affordances to promote physical activity behavior, health and wellbeing; and how exercise and health researchers and professionals may channel the interaction of individuals with the nature environment in their interventions and programs.

An Investigation of Virtual Reality Nature Experiences in Patients With Metastatic Breast Cancer: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Connection with nature has well-established physical and psychological benefits. However, women with metastatic breast cancer (MBC) are often unable to access nature because of physical limitations, psychological barriers, and treatment demands. Virtual reality (VR) nature experiences offer an alternative means of connecting with nature and may be of particular benefit to patients with cancer who are house- or hospital-bound.

OBJECTIVE

This study aims to explore whether VR nature experiences are associated with physical and psychological benefits for women with MBC who are disconnected with nature.

METHODS

This secondary analysis of a previous randomized controlled crossover trial recruited participants from the emailing lists of breast cancer support organizations. Participants were provided VR headsets for daily use in their homes for over 3 weeks. In the first week, participants used 1 of 2 VR nature experiences (Ripple or Happy Place) daily, followed by a 1-week washout period, before using the other VR experience every day for the final week. Outcomes assessed changes between baseline and postintervention scores in quality of life (EQ-5D-5L), pain (Brief Pain Inventory Short Form), fatigue (Functional Assessment of Chronic Illness Therapy-fatigue), depression (Depression, Anxiety, and Stress Scale-depression), anxiety (Depression, Anxiety, and Stress Scale-anxiety), and spiritual well-being (Functional Assessment of Chronic Illness Therapy- Spiritual Well-being) and investigated whether benefits were greater in participants who were not strongly connected with nature at baseline.

RESULTS

A total of 38 women with MBC completed the VR interventions and were included in the analyses. Participants reported significantly less fatigue (P=.001), less depression (P<.001), and greater quality of life (P=.02) following the interventions than at baseline. Women with a weaker connection to nature reported greater fatigue (P=.03), depression (P=.006), and anxiety (P=.001), and poorer spirituality (P=.004) than their strongly connected counterparts. Only those with a weaker baseline connection with nature showed improvements in depression following the intervention (P=.03), with similar trends observed in fatigue (P=.07) and quality of life (P=.10).

CONCLUSIONS

This study provides preliminary evidence that feeling connected with nature is associated with better physical and psychological status in patients with MBC and that VR nature interventions might be beneficial for this clinical population. Future studies should focus on activities that encourage connection with nature (rather than simply exposure to nature) and investigate the aspects of VR nature interventions that have the greatest therapeutic potential.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619001480178; https://tinyurl.com/et6z3vac.

Time Outdoors in Nature to Improve Staff Well-Being: Examining Changes in Behaviors and Motivations Among University Staff in the Use of Natural Outdoor Environments Since the Emergence of the COVID-19 Pandemic

Background

Work-related stress is of growing concern to employers because of its significant implications for employee dissatisfaction, reduced productivity, and lowered emotional and physical health. Job-related stress is particularly acute among staff members in higher education, negatively impacting the professional work and personal welfare of staff. During the COVID-19 pandemic, stress levels increased, due to work- and non-work-related factors. Work expectations and environments shifted, as did new non-work responsibilities, such as care of dependents. As a result, many people were forced to spend much more time at home. Given the anticipated levels of stress (higher) and the change in time spent at home (increased), we sought to explore if adults were spending more time outdoors, as compared to pre-pandemic times, and if so, for what purposes. We hypothesized that people would be spending more time outdoors in nature during the pandemic, and that they would be doing so to achieve some of the well-documented benefits including managing stress, and bolstering mental health and wellbeing. We further hypothesized that some staff would experience barriers to spending time outdoors in natural outdoor environments (NOEs), potentially limiting their ability to experience these beneficial effects.

Materials and Methods

This study surveyed 507 staff from a large United States university to examine the degree to which staff were spending time in natural outdoor environments (NOEs) during the pandemic (two time-points, compared to pre-pandemic), and whether and how nature-based routines changed as a result of its emergence. The study also examined whether staff were motivated to spend time in nature to improve their mental health and/or wellbeing.

Results

The majority of respondents reported spending more time in NOEs since COVID-19 emerged, particularly early in the pandemic. Respondents reported doing so for restorative purposes, including stress relief, improved mental health, and improved physical health. Relative accessibility of NOEs, both in terms of proximity and number of barriers to access, significantly impacted both time outdoors and the number of NOEs used. Access to safe, high-quality NOEs was not experienced equally across staff respondents; barriers to access tended to be higher among staff living with dependents or others in their household, and for staff who identify as non-White.

Conclusion

Spending time outdoors may have served as a protective factor for many university staff against some of the potentially detrimental effects of the pandemic, particularly reduced mental health and well-being. Universities can contribute to the ongoing well-being of their staff by supporting access to safe, high-quality NOEs on or adjacent to campus. This may also serve to reduce disparities in access to nature and experience of its benefits. Universities may also consider alternative work arrangements for staff to allow for more time for health and wellness self-care during the work day, including spending time outdoors in nature.

Change of Residents’ Attitudes and Behaviors toward Urban Green Space Pre- and Post- COVID-19 Pandemic

The COVID-19 pandemic has changed and influenced people’s attitudes and behaviors toward visiting green spaces. This paper aims to explore the association between residents’ health and urban green spaces (UGS) through an in-depth study of changes in residents’ use of UGS under the influence of the COVID-19 pandemic. The Wuhan East Lake Greenway Park was selected as the location for the field survey and in-depth interviews. At the same time, an online survey was also conducted (total number = 302) regarding participants’ physical and mental health and their attitude and behavior toward the UGS. A paired sample t-test and binary logistic regression were performed to investigate the association between participants’ health and UGS during COVID-19. The results show that: (1) the COVID-19 pandemic has primarily changed the leisure patterns of parks, with potential impacts on the physical and mental health of participants; (2) the purpose, frequency, timing, and preferred areas of participants’ park visits have changed to varying degrees after the pandemic, highlighting the important role and benefits of UGSs; (3) the physical and mental health of participants and urban development issues reflected by UGS use are prominent. This study reveals that awareness of the construction and protection of UGSs is an important prerequisite for ensuring the health of urban residents.

Mapping of Research in the Field of Forest Therapy-Related Issues: A Bibliometric Analysis for 2007-2021

Exposure to forest environments promotes human health. The number of relevant studies in this area has increased rapidly. However, an overall review of relevant analyses from the perspectives of bibliometrics and visualization is lacking. A scientometric analysis of 2,545 publications from 2007 to 2021 via the Web of Science database was conducted to identify the knowledge structure and frontiers objectively. The publications were subsequently analyzed in terms of the distribution of journals and countries, citation bursts, major subject areas, and evolutionary stages. The findings showed that the knowledge foundation of forest therapy was multidisciplinary with most published in the fields of environmental sciences and ecology but lacking input from social disciplines. The research hotspots evolved from the early focus on individual benefits obtained from nature to increasing attention on human well-being at the social-ecological scale. More rigorous experiments with strict randomized controlled trials and blinding are needed to accommodate the trend of forest therapy toward non-pharmacological treatments. According to Shneider's four-stage theory, forest therapy research is in the third stage of the scientific research process. More future studies utilizing novel technologies and decision-making frameworks to solve practical issues are needed for introducing health into policies and promoting human well-being.

Cognitive-Emotional Benefits of Weekly Exposure to Nature: A Taiwanese Study on Young Adults

Empirical evidence of nature’s benefits to cognitive and emotional well-being is emerging. In this study, 48 Taiwanese young adults (24 indoors and 24 outdoors in urban greenspace) completed four weekly 45 min exposure sessions. The study explores whether the outdoor group surpasses the indoor group in cognitive and emotional well-being and nature connectedness. There were no significant differences for the indoor group across different measurements of rumination and connectedness to nature. However, the outdoor group displayed a significant reduction in rumination post-test compared to the one week prior and the first session. Similarly, for sessions two, three, and four and one month post-test, the outdoor group’s connectedness to nature was significantly higher than pre-test. Specific autobiographical memory was enhanced while overgeneral autobiographic memory was reduced during the third and fourth sessions, though these changes were not sustained at one-month follow-up. Surprisingly, both groups yielded similar results in decreased depression, anxiety, and stress. A significantly higher number of outdoor group participants had employed nature exposure for coping with stress or emotions after the program. We discuss the implications of this for counseling services for young adults and highlight future research possibilities, including formulating a nature-exposure protocol and a program evaluation for consolidating evidence-based nature prescription.

Between the Library and Lectures: How Can Nature Be Integrated Into University Infrastructure to Improve Students' Mental Health

The university campus provides the backdrop to a student's education and social journey. For many students, the transition from secondary school through to graduation can be one of upheaval, geographical, financial and social change. Evidence suggests increasing levels of mental health difficulties among UK university students. The university campus is a possible resource to mitigate wellbeing issues through facilitating the salutogenic effects of engagement with nature. This mixed method research examines the opportunity to integrate nature through interventions for University of Sheffield undergraduate students. It uses a green prescription style activity and a specially designed mobile phone app. Through focus groups the participants' experience reveals the necessity for a whole university approach that considers intervention and campus design simultaneously. This study's findings qualify research into young adult's experience of urban green spaces and their tangible connection to plants such as trees. Policy and practice implications include the requirement for a coherent approach to understanding the place-attachment aspects to nature in the university environment. Further afield, there is a need for collaborative wellbeing interventions and urban green space development within the UK context.

Frontiers in Social–Ecological Urbanism

This paper describes a new approach in urban ecological design, referred to as social–ecological urbanism (SEU). It draws from research in resilience thinking and space syntax in the analysis of relationships between urban processes and urban form at the microlevel of cities, where social and ecological services are directly experienced by urban dwellers. The paper elaborates on three types of media for urban designers to intervene in urban systems, including urban form, institutions, and discourse, that together function as a significant enabler of urban change. The paper ends by presenting four future research frontiers with a potential to advance the field of social–ecological urbanism: (1) urban density and critical biodiversity thresholds, (2) human and non-human movement in urban space, (3) the retrofitting of urban design, and (4) reversing the trend of urban ecological illiteracy through affordance designs that connect people with nature and with each other.

Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis

Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.

Environmental Justice in Greater Los Angeles: Impacts of Spatial and Ethnic Factors on Residents' Socioeconomic and Health Status

Environmental justice advocates that all people are protected from disproportionate impacts of environmental hazards. Despite this ideal aspiration, social and environmental inequalities exist throughout greater Los Angeles. Previous research has identified and mapped pollutant levels, demographic information, and the population’s socioeconomic status and health issues. Nevertheless, the complex interrelationships between these factors remain unclear. To close this knowledge gap, we first measured the spatial centrality using sDNA software. These data were then integrated with other socioeconomic and health data collected from CalEnvironScreen, with census tract as the unit of analysis. Finally, structural equation modeling (SEM) was executed to explore direct, indirect, and total effects among variables. The results show that the White population tends to reside in the more segregated areas and lives closer to green space, contributing to higher housing stability, financial security, and more education attainment. In contrast, people of color, especially Latinx, experience the opposite of the environmental benefits. Spatial centrality exhibits a significant indirect effect on environmental justice by influencing ethnicity composition and pollution levels. Moreover, green space accessibility significantly influences environmental justice via pollution. These findings can assist decision-makers to create a more inclusive society and curtail social segregation for all individuals.