Promoting Healthy Decision-Making via Natural Environment Exposure: Initial Evidence and Future Directions

A state-level analysis of macro-level factors associated with hospital readmissions

Investigation of the factors that contribute to hospital readmissions has focused largely on individual level factors. We extend the knowledge base by exploring macrolevel factors that may contribute to readmissions. We point to environmental, behavioral, and socioeconomic factors that are emerging as correlates to readmissions. Data were taken from publicly available reports provided by multiple agencies. Partial Least Squares-Structural Equation Modeling was used to test the association between economic stability and environmental factors on opioid use which was in turn tested for a direct association with hospital readmissions. We also tested whether hospital access as measured by the proportion of people per hospital moderates the relationship between opioid use and hospital readmissions. We found significant associations between Negative Economic Factors and Opioid Use, between Environmental Factors and Opioid Use, and between Opioid Use and Hospital Readmissions. We found that Hospital Access positively moderates the relationship between Opioid Use and Readmissions. A priori assumptions about factors that influence hospital readmissions must extend beyond just individualistic factors and must incorporate a holistic approach that also considers the impact of macrolevel environmental factors.

Experiencing nature leads to healthier food choices

Experiencing nature has been linked to a host of benefits for health and well-being. Here, we examine if exposure to nature influences the food choices that may contribute to nature's benefits. Five between-subject experiments (n = 39, n = 698, n = 885, n = 1191, and n = 913) show that individuals exposed to the natural environment choose healthier foods when compared to those exposed to urban environments or a control condition. Nature's effects are observed for various foods and beverages, across samples from three countries, and in varied contexts, such as taking a walk in a park (vs. a city street) and looking at photos of nature (vs. urban or control) scenes. These findings provide insights into the relationship between proximity to nature and health.

Potential pathways of association from green space to smartphone addiction

Green space is increasingly known to improve physical and mental health. Based on these benefits, green space might also be expected to help mitigate related harmful behavioral patterns, such as obsessive Internet use and relevant addictions. In response, we conducted a study on smartphone addiction, a new form of Internet addiction. We carried out a cross-sectional investigation in August 2022. We recruited 1011 smartphone users across China, measured the Normalized Difference Vegetation Index (NDVI) in their residential neighborhoods (in 1, 2, and 3 km buffers), and captured data on smartphone addiction via the Smartphone Addiction Scale - Short version (SAS-SV). Potential mediators between green space and smartphone addiction, including physical activity, stress, and loneliness, were also reported by participants using the Physical Activity Rating Scale-3 (PRS-3), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and 8-items UCLA Loneliness Scale scales (ULS-8). Multiple linear regression was employed to examine the relationships between green space and smartphone addiction. Structural equation modeling was performed to examine the potential pathways between these variables. Unexpectedly, NDVI in 1 km buffers was positively associated with smartphone addiction. By contrast, population density, an indicator of urbanization, was associated with lower levels of smartphone addiction levels in all NDVI buffer sizes. Meanwhile, we found NDVI was strongly associated with population density as well as other indicators of urbanization. Generally, our findings are unexpected and suggest that greenness may serve as an indicator of urbanization at national levels and that urbanization may buffer against smartphone addiction. During the hot summer, green space and indoor facilities may have competitive land uses, so future research should examine whether this association exists in other seasons and scenarios. We also recommend alternative models to systematically evaluate the effects of different components of residential environments.

Spending Time in Nature Serves as a Protective Factor against Problematic Alcohol Use: A Structural Equation Modeling Approach

Alcohol use in the U.S. continues to be a prevalent behavior with the potential for far-reaching personal and public health consequences. Risk factors for problematic drinking include negative affect and impulsive decision-making. Research suggests exposure to nature reduces negative affect, increases positive affect, and reduces impulsive choice. The purpose of the current study was to explore the relationships between exposure to nature (actively going out to nature and the level of greenness around the participant's daily life), affect, impulsive decision-making, and alcohol use, using structural equation modeling. Cross-sectional data (N = 340) collected online on Amazon MTurk were used to test the hypothesized relationships separately for alcohol consumption and alcohol-related problems. Actively spending time in nature was associated with lower negative affect and higher positive affect, while passive exposure to nature was only associated with higher positive affect. In turn, negative affect was positively related to both alcohol measures, while positive affect was related to increased alcohol consumption, but not alcohol-related problems. Impulsive decision-making was not related to nature or alcohol measures. Findings suggest that intentionally spending time in nature may protect against problematic alcohol use by reducing negative affect. These results warrant further research on nature as an adjunct treatment for reducing alcohol and substance-related harms and carry implications for public education and increasing accessibility to natural spaces.

Indoor nature integration for stress recovery and healthy eating: A picture experiment with plants versus green color

AIM

Urbanized environments may stimulate unhealthy food choices and stress. Several theories explain that exposure to green nature can counter these stress effects. Since we spend most time indoors, integrating nature in the interior could be a promising health promotion tool. Hence, we tested whether the beneficial effect of nature for stress recovery is also present in indoor settings via the use of plants or green colors, and whether it is applicable on eating behavior as a new outcome.

METHODS

The 92 participants (18-30y, 16% men) were divided into four groups. Each viewed a 6-min slideshow with room pictures containing either green plants, green objects, greyscale plants or greyscale objects to allow distinction between color- and plant-effects. Group differences were tested for the perceived restorativeness scale, psychological recovery and eating behavior. To allow psychological recovery testing, participants were exposed to a stressor before the picture slideshow via the Trier Social Stress Test. The change of self-reports (stress, positive and negative affect) and psychophysiology (heart rate and vagal-induced heart rate variability RMSSD) post-slideshow versus pre-slideshow was checked. Eating behavior outcomes included change in hunger, craving, and food choice (for fruits, vegetables and snacks).

RESULTS

From the four picture sets, the green plants pictures were reported as most mentally restorative and appeared most beneficial for post-stressor recovery of positive affect, but not for negative affect or stress recovery. The green plants group also had higher preference for vegetables and lower preference or craving for (unhealthy) snacks. Those significant group differences were mainly due to the presence of plants and only occasionally due to the green color.

CONCLUSION

Indoor green plant pictures were associated with higher mental restorativeness and healthier food choices. Integrating plants in the interior seems to be a relevant health promotion approach, while applying green colors seems less relevant.

Delay discounting, probability discounting, and interdental cleaning frequency

Background

Interdental cleaning is recommended by dentists but many people do not floss regularly. The health benefits of interdental cleaning are delayed, and sensitivity to delay is an important factor in many health behaviors. Thus, the present studies explore the relationship between frequency of flossing, and sensitivity to delayed and probabilistic outcomes.

Method

Crowd-sourced subjects were recruited in two studies (n = 584 and n = 321, respectively). In both studies, subjects reported their frequency of flossing and completed delay discounting and probability discounting tasks. Discounting was measured with area under the curve, and linear regression was used to analyze the results.

Results

Findings show that higher levels of delay discounting were associated with less frequent flossing (p < 0.001, both studies). In contrast, probability discounting was not significantly associated with flossing frequency (ns, both studies).

Conclusion

The findings are consistent with prior studies involving other health behaviors such as attendance at primary care and medication adherence. Results suggest that interventions that reduce delay discounting may help promote regular interdental cleaning, and that delay discounting is a more robust predictor of health behaviors than probability discounting. In addition, interdental cleaning appears to be a reasonable target behavior for evaluating potentially generalizable behavioral health interventions. Thus, interventions that are successful in promoting oral health behaviors should be considered as candidates for evaluation in other health behavior domains.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02328-6.

Biophilic Design as an Important Bridge for Sustainable Interaction between Humans and the Environment: Based on Practice in Chinese Healthcare Space

Since the COVID-19 epidemic, there has been an increased need for well-being and sustainable development, making biophilic design in hospital environments even more significant. However, after investigation, it was found that in many countries including China, the biophilic design of some hospitals is seriously absent, while other parts have the integration of biophilic design, but the standardization and recognition are not high. By restoring the interaction between buildings and nature, biophilic design improves the quality of environments and the health of users. The basic theoretical framework of environmental psychology is followed in this research. The health promotion mechanism, applicable natural features, and relative health advantages of hospital space and environment biophilic design are first investigated. Furthermore, according to the current status of biophilic design applications in the 12 hospitals that have the closest interaction between people and the environment. Combined with the professional and functional requirements of the healthcare spaces and the users' special demands, we propose appropriate update design methods. The goal of this study was to present ideas for healthy and efficient space environment design and to inspire sustainable environmental design for future healthcare environments.

Older people and nature: the benefits of outdoors, parks and nature in light of COVID-19 and beyond- where to from here?

The COVID-19 pandemic has taken a significant toll on people's health and wellbeing globally. In the pandemic, parks, gardens and other local green spaces have been recognised as vital to people's physical and mental health. Emerging global evidence shows increased access to local parks and recreational activities and a new appreciation of the natural surroundings. Various movements and organisations globally have called for actions to embrace recent trends and changes in relation to the planning of public spaces and urban built environments to enable better access to parks and nature. The crisis, however, has exposed the inequities around access to green space where vulnerable populations such as older people and those in low socioeconomic areas are particularly affected. The crisis presents an opportunity to positively impact on society, and an opportunity to consolidate new emerging trends to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.

Go Greener, Less Risk: Access to Nature Is Associated with Lower Risk Taking in Different Domains during the COVID-19 Lockdown

Specific risk attitude and risky behavior had an important boost during the coronavirus disease 2019 (COVID-19) pandemic. In this contribution, we hypothesize that access to nature during home confinement will decrease both the tendency to passive risk taking and alcohol intake. To do so, we interviewed through an online survey two samples of Italian residents during the strict lockdown due to the first wave of the COVID-19 pandemic. Specifically, in Study 1, participants were 1519 Italian residents coming from different Italian regions, whilst in Study 2, participants were 182 students at a university of southern Italy who were monitored for one week. In Study 1, the hierarchical regression analysis attested that access to nature during the lockdown mitigated the tendency to passive risk taking, over and beyond the effect of socio-demographic variables and the psychological construct of impulsiveness, an important personality correlate of risk taking. In Study 2, the hierarchical regression showed that access to green was associated with fewer glasses of alcohol drunk in a week of lockdown. This effect held over and above the effect of socio-demographic variables and the drinking behavior before the outbreak of the COVID-19 pandemic. In both studies, findings confirmed the beneficial effect of access to nature in specific risk-taking domains. Theoretical future directions, as well as practical implications for the management of the COVID-19 emergency by policymakers, are discussed.

Neighbourhood greenspace and smoking prevalence: Results from a nationally representative survey in England

OBJECTIVE

The current study investigated whether people are less likely to be smokers when they live in greener neighbourhoods, and whether such an association is attributable to lower rates of ever-smoking and/or higher rates of smoking cessation.

METHOD

Using a representative sample of the adult population of England (N = 8,059), we investigated the relationships between neighbourhood greenspace and three inter-related smoking outcomes (current smoking, ever-smoking and smoking cessation).

RESULTS

After controlling for a range of individual and area-level covariates, including socioeconomic status, income and education, living in the highest greenspace quartile was associated with a 20% lower prevalence of current smoking, compared to living in the lowest greenspace quartile (PR = 0.80, CI = 0.67, 0.96, p < .017). Neighbourhood greenspace was not significantly associated with ever-smoking. However, amongst ever-smokers, residing in the two highest quartiles of neighbourhood greenspace quartiles (vs. 1st quartile) was associated with a 10% and 12% higher prevalence of smoking cessation (PR = 1.10, CI = 1.02, 1.18, p = .012; PR = 1.12, CI = 1.02, 1.22, p = .016, respectively). This suggests that the association between greenspace and current smoking is due to a higher likelihood of smoking cessation, rather than lower rates of ever- smoking. The associations between greenspace, current smoking and smoking cessation were similar in magnitude to those of having high (vs. low) household income and were largely unmoderated by socioeconomic measures.

IMPLICATIONS

Our findings advocate the need to protect and invest in local greenspaces, to maximise the public health benefits they may afford. Improving access to greenspace may constitute an overlooked public health strategy for reducing smoking prevalence.