The influence of proximity to city parks on blood pressure in early pregnancy

Correlation Between Neighborhood Built Environment and Leisure Walking Time Around a Riverside Park

OBJECTIVES

This study aimed to investigate whether the distance to a riverside park and the neighborhood built environment are related to individuals' leisure walking time by examining the case of the Geumho riverside park in Daegu, South Korea.

BACKGROUND

Walking, being an inexpensive means of transportation with numerous health benefits, is influenced by the conditions of neighborhood built environments.

METHODS

A survey was conducted from October 12 to November 8, 2022, including 184 adults aged 18 years or older. The dependent variable was the total weekly minutes of leisure walking, and the independent variables included the neighborhood built environment measured objectively using geographic information systems as well as demographic/individual characteristics and health attitude data. Analysis of variance was conducted to determine whether leisure walking time differed depending on the distance to the riverside park, and regression analysis was conducted to examine the association between leisure walking time and the neighborhood built environment.

RESULTS

Individuals living within a quarter-mile of the park walked an average of 155 min per week for leisure, which was significantly more than those living further than 1 mile (mean = 85.14 min/week). Moreover, greater access to the park, higher crosswalk density, and a lower road density were associated with more leisure walking time for residents.

CONCLUSIONS

The findings of this study indicate that good access to riverside parks and pedestrian-centered neighborhood environments may be related to leisure walking among residents. These findings hold significance for urban planning and the formulation of public health policies.

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Effects of land cover and air pollution on the risk of preterm births

OBJECTIVE

To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level.

METHODS

The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations.

RESULTS

The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births.

CONCLUSIONS

The results of this study show that greener areas are less associated with preterm births when compared with less green areas.

Residential greenspace and blood lipids in an essential hypertension population: Mediation through PM2.5 and chemical constituents

Fine particulate matter (PM2.5) adversely affects blood lipids, while residential greenspace exposure may improve blood lipids levels. However, the association between exposure to residential greenspace and blood lipids has not been adequately studied, especially in vulnerable populations (e.g. people with essential hypertension). This study aimed to assess the association between residential greenspace exposure and blood lipids, and to clarify whether PM2.5 and chemical constituents was mediator of it. We used a period (May 2010 to December 2011) from the Chinese national hypertension project. The residential greenspace was estimated using satellite-derived normalized difference vegetation index (NDVI). The generalized additive mixed model (GAMM) was used to assess the association between exposure to residential greenspace and blood lipids, and the mediation model was used to examine whether there was a mediating effect of PM2.5 and chemical constituents on that association. The exposure to residential greenspace was negatively associated with the decreased risk of dyslipidemia, especially short-term exposure. For example, the odd ratioshort-term for dyslipidemia was 0.915 (95% CI：0.880 to 0.950). This association was strengthened by physical activity and participants living in the North. PM2.5 and chemical constituents were important mediators in this association, with the proportion of mediators ranging from -5.02% to 26.33%. The association between exposure to residential greenspace and dyslipidemia in this essential hypertensive population, especially participants living in the North and doing daily physical activity, was mediated by PM2.5 and chemical constituents.

Association of ambient PM1 exposure with maternal blood pressure and hypertensive disorders of pregnancy in China

Evidence concerning PM₁ exposure, maternal blood pressure (BP), and hypertensive disorders of pregnancy (HDP) is sparse. We evaluated the associations using 105,063 participants from a nationwide cohort. PM₁ concentrations were evaluated using generalized additive model. BP was measured according to the American Heart Association recommendations. Generalized linear mixed models were used to assess the PM₁-BP/HDP associations. Each 10 μg/m³ higher first-trimester PM₁ was significantly associated with 1.696 mmHg and 1.056 mmHg higher first-trimester SBP and DBP, and with 11.4% higher odds for HDP, respectively. The above associations were stronger among older participants (> 35 years) or those educated longer than 17 years or those with higher household annual income (> 400,000 CNY). To conclude, first-trimester PM₁ were positively associated with BP/HDP, which may be modified by maternal age, education level, and household annual income. Further research is warranted to provide more information for both health management of HDP and environmental policies enactment.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Subjective well-being, happiness, and environmental health factors related to women planning a pregnancy or pregnant, using mobile health intervention

Objectives

To compare the environmental health results in women trying to get pregnant or pregnant using a mobile health application (Green Page) through healthcare professionals or self-completed by women, and to explore the relationship between the subjective well-being of these women with their lifestyles and environmental factors.

Methods

A descriptive study with mixed methods was conducted in 2018. A mobile health survey was used in two phases. Phase 1 was a cross-sectional study through professionals (n  =  1100) followed by phase 2, a convenience sampling through women's self-reporting (n  =  3425). A personalized report was downloadable with health recommendations for the well-being of the mother and child.

Results

Of the 3205 participants (mean age  =  33 years, SD  =  0.2 years), 1840 were planning a pregnancy and 1365 were pregnant. One in five pregnant women had a low level of happiness. Globally, subjective well-being and happiness were found to be negatively associated with lack of contact with nature, sedentary lifestyle, excess weight, environmental exposure, and older age in pregnancy. Precisely 45%, 60%, and 14% of women were exposed to tobacco, alcohol, and illegal drugs, respectively. The women self-reported levels of risk factors higher than when the tool was used by or through professionals.

Conclusions

The use of mobile health interventions focused on environmental health during planning or pregnancy periods could help improve the quality of healthcare and foster greater involvement of women in their self-care process, thus promoting empowerment, healthier environments, and lifestyles. Ensuring equity of access and data protection are global challenges to be addressed.

Green place rather than green space as a health determinant: A 20-year scoping review

Numerous scientific studies, applying different approaches, have provided evidence of the links between the environment and people's health. Green spaces have been the subject of research aimed at exploring their benefits as components of the urban environment. We investigated possible causal relationships between green spaces and health, with the aim of addressing the following question. Does the mere material presence of green spaces contribute to the health of people who live in its vicinity, or are the health-promoting qualities of green spaces attributed to the ability of people to actually see, access, and enjoy them? The latter view highlights the relational dimension of places, and it entails personal relationships with places which are imbued with psychological meaning and significance for those who visit and experience them. We reviewed relevant literature, comprising a total of 189 papers on this topic that have been published over the first two decades of this century. Our findings showed that the material aspects of green spaces, such as their abundance and proximity to residences, received much more attention in studies than their quality and characteristics. However, relational rather than material measures of green spaces demonstrated statistically greater positive impacts of green spaces on health. These findings indicate that both sensory stimuli and activities and feelings attached to green spaces are essential for better health outcomes. Incorporating a relational perspective of green place-thinking into the existing literature on green spaces and health could contribute to optimizing the positive effects of green spaces and thus to the creation of healthy and livable cities.

Approach to user group-specific assessment of urban green spaces for a more equitable supply exemplified by the elderly population

The use of urban green spaces (UGS) depends on its quality, which is perceived very differently by diverse socio-demographic groups. In particular, elderly people have special demands on the UGS quality. It is essential to know these demands to create an equitable UGS supply. We present an approach to determining some qualitative aspects and the supply of cultural ecosystem services of diverse forms of UGS. This is realised by combining user demands with actual UGS features. In a concrete example, we assessed the UGS quality and supply for both the general population and the subset of elderly people. For the latter group, the activities of relaxing and observing nature, as well as the UGS feature of benches, were found to be significantly more important than for the general population. Nevertheless, this had only a minor impact on the assessed aspects of UGS quality and supply, with little differences detected between the two groups. In Dresden (Germany), we determined that almost half of the elderly population are not provided with high-quality UGS. In these areas, urban planning must increase the UGS quality while taking user demands into account to ensure just access to the positive benefits of UGS for the elderly.

Association between greenspace and blood pressure: A systematic review and meta-analysis

Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and meta-analysis to comprehensively evaluate the evidence concerning greenspaces with BP levels and prevalent hypertension. Systematic literature searches were performed in Web of Science, PubMed, and Embase up to 25 April 2021. Combined effect estimates were calculated using random-effect models for each greenspace exposure assessment method that had been examined in ≥3 studies. Sensitivity analysis, subgroup analysis, and publication bias were also conducted. Of 38 articles (including 52 analyses, 5.2 million participants in total) examining the effects of normalized difference vegetation index (NDVI) (n = 23), proportion of greenspace (n = 11), distance to greenspace (n = 9), and others (n = 9) were identified. Most studies (65%) reported beneficial associations between greenspaces and BP levels/hypertension. Our results of meta-analyses showed that higher NDVI_500m was significantly associated with lower levels of systolic blood pressure (SBP = -0.77 mmHg, 95%CI: -1.23 to -0.32) and diastolic blood pressure (DBP = -0.32 mmHg, 95%CI: -0.57 to -0.07). We also found that NDVI in different buffers and the proportion of greenspaces were significantly associated with lower odds (1-9%) of hypertension. However, no significant effect was found for distance to greenspaces. In summary, our results indicate the beneficial effects of greenspace exposure on BP and hypertension. However, future better-designed studies, preferably longitudinal, are needed to confirm and better quantify the observed benefits in BP and/or hypertension.

Socioeconomic Disparities in Hypertension by Levels of Green Space Availability: A Cross-Sectional Study in Philadelphia, PA

Green spaces have been proposed as equigenic factors, potentially mitigating health disparities. We used data from the 3887 participants residing in Philadelphia who participated in the Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey in 2014–2015 to assess whether socioeconomic disparities in hypertension are modified by availability of neighborhood-level green spaces. Socioeconomic status (SES) was measured using individual-level education and neighborhood-level median household income. Green space availability was measured using surrounding percent tree canopy cover, mean normalized difference vegetation index (NDVI), and proximity to nearest park. Using logistic regression models adjusted for age, sex, and race/ethnicity, we found that adults with higher educational attainment had significantly lower levels of hypertension (OR = 0.63, 0.57, and 0.36 for high school, some college, and college graduates, respectively, as compared to those with less than high school education), and this pattern was similar for median household income (higher prevalence in lower income areas). We found no significant interaction between education and percent tree canopy cover (p = 0.83), meaning that educational disparities in hypertension were similar across all levels of green space availability. These results held when using mean NDVI or distance to nearest park as availability measures, or when considering neighborhood-level median household income as the socioeconomic measure, although the specific patterns and significance of interactions varied by exposure and modifier. While socioeconomic disparities in hypertension are strong for adults residing in Philadelphia, green spaces did not seem to modify them.

The relationship between the neighborhood built and social environment and hypertensive disorders of pregnancy: A scoping review

BACKGROUND

Theory and limited empirical research suggest that the neighborhood environment influences maternal health outcomes. The goal of this scoping review is to summarize extant research considering the impact of the built and social environment of resident neighborhood on hypertensive disorders of pregnancy (HDP) globally.

METHODS

We performed a systematic search of the literature using four databases, PubMed, Web of Science, CINAHL, and Embase on July 15, 2020. We excluded articles not in English, that did not consider one or more HDP as a primary or secondary outcome, and that did not include an element of the neighborhood built or social environment as an exposure. We applied a modified version of the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies to evaluate quality of included studies.

RESULTS

Our search identified 11,385 unique abstracts for screening. Following exclusions, we included 64 articles in the final review. The majority of articles measured an element of the built environment (70.3% (44)), most commonly traffic-related air pollution (42.2% (27)). A third of articles (31.3% (20)) considered an element of the neighborhood social environment, most commonly neighborhood deprivation (10.9% (7)). Global quality ratings were mostly moderate (29.7% (19)) or weak (68.8% (44)), primarily due to inattention to neighborhood-level confounding.

CONCLUSION

Critical gaps remain in understanding how the resident neighborhood may impact HDP. Future research should focus on designing high-quality studies incorporating elements of both the built and social environment to holistically understand how context may impact maternal health.

Greenness-air pollution-physical activity-hypertension association among middle-aged and older adults: Evidence from urban and rural China

BACKGROUND

Although some evidence suggests that residential greenness may prevent hypertension in urban areas, limited attention has been paid to urban-rural disparities in the association of greenness with hypertension in rapidly urbanizing developing countries.

OBJECTIVES

The current study investigated the association between the amount of neighbourhood greenness and hypertension among middle and older aged people in Chinese urban and rural areas. It further examined whether PM_2.5 (particulate matter ≤2.5 μm in aerodynamic diameter) concentrations, physical activity, and body mass index (BMI) mediated the association of greenness with hypertension.

METHODS

We used data from 11 486 adults aged 50 years or above within the first wave of the Study on Global Ageing and Adult Health in China during 2007-2010. Hypertension was assessed by criterion-based measures of blood pressure. Residential greenness was characterized by satellite-derived Normalized Difference Vegetation Index. We employed multilevel generalized structural equation models to estimate the association between neighbourhood greenness and hypertension in urban and rural areas. Serial mediation models have been performed to test potential pathways linking greenness to hypertension.

RESULTS

In rural areas, a greater amount of residential greenness was directly associated with a decrease in the odds of hypertension (odds ratio = 0.51, 95% confidence interval 0.29-0.89). No direct association was observed in urban areas (odds ratio = 1.33, 95% confidence interval 0.94-1.89). Serial mediation models showed that the association of greenness with hypertension was completely mediated by PM_2.5 concentrations in urban areas, while the association of greenness with hypertension was only partially mediated by PM_2.5 concentrations and serial PM_2.5 concentrations-physical activity path in rural areas. There was no evidence that physical activity, air pollution-BMI path, air pollution-physical activity-BMI path, and physical activity-BMI path mediated the association in both urban and rural areas.

CONCLUSIONS

Higher neighbourhood greenness was directly associated with a lower prevalence of hypertension among middle and older aged adults in rural China but not in urban areas. The association of greenness with hypertension was completely mediated by air pollution (without any mediation effect of physical activity and BMI) in urban areas. In contrast, the association was partly mediated by air pollution, physical activity, and other unobservables in rural areas. Further longitudinal studies are warranted to prove a cause-and-effect association, which may help policymakers and practitioners to conduce effective interventions to prevent and control the prevalence of hypertension and the attendant disease burden.

Residential urban greenspace and hypertension: A comparative study in two European cities

BACKGROUND

Living in green areas has been associated with several health benefits; however, the available evidence on such benefits for hypertension is still limited. This study aimed to investigate and compare the association between residential exposure to greenspace and hypertension in Barcelona, Spain and Brussels, Belgium.

METHODS

This cross-sectional study was based on data from the 2016 Barcelona Health Interview Survey (HIS) (n = 3400) and the 2013 Belgian HIS (n = 2335). Both surveys were harmonized in terms of outcomes, confounders and exposure assessment. Residential exposure to greenspace was characterized as 1) surrounding greenspace (normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index 2 (MSAVI2)) across buffers of 100 m, 300 m, and 500 m; 2) surrounding green space across 300 m and 500 m buffers; and 3) Euclidean distance to the nearest green space. Our outcome was self-reported hypertension. We developed logistic regression models to evaluate the city-specific association between each greenspace measure and hypertension, adjusting for relevant covariates.

RESULTS

One interquartile range (IQR) increase in residential distance to the nearest green space was associated with higher risk of hypertension in Barcelona [odds ratio (OR): 1.15; 95%CI 1.03-1.29 (IQR: 262.2)], but not in Brussels [OR: 0.95; 95%CI 0.77-1.17 (IQR: 215.2)]. Stratified analyses suggested stronger associations in older participants (≥65 years) for both cities. Findings for residential surrounding green space and greenspace were not conclusive. However, in Brussels, we found protective associations in older participants for both residential surrounding greenspace metrics [NDVI 300 m buffer OR: 0.51; 95%CI 0.32-0.81 (IQR: 0.21) and MSAVI2 300 m buffer OR: 0.51; 95%CI 0.32-0.83 (IQR: 0.18)]. We did not find any indication for the modification of our evaluated associations by sex and education level.

CONCLUSION

Our study suggests that living closer to greenspace could be associated with lower risk of hypertension, particularly in older age. Future research is needed to replicate our findings in other settings and shed light on potential underlying mechanism(s).

Neighborhood Social and Built Environment and Disparities in the Risk of Hypertension: A Cross-Sectional Study

Citizens’ participation in urban environmental quality assessment is important when identifying local problems in the sustainable development and environmental planning policy. The principal aim of this study was to analyze whether any social differences exist between the joint effect of built neighborhood quality and exposure to urban green spaces and the risk of hypertension. The study sample consisted of 580 participants residing in 11 districts in Kaunas city, Lithuania. Using geographic information systems (GIS), individual data on the socioeconomic status (SES) and health were linked to the participants’ perceptions of the environmental quality and exposure to green spaces (NDVI). We used multivariate logistic regression to estimate associations as odds ratios (OR). Those study participants with lower education and those study participants with higher education on low incomes rated their health significantly worse. Low SES persons residing in areas with low exposure to green spaces had a significantly higher risk of hypertension when sex, age, family status, smoking, and income were accounted for (OR 1.83, 95% CI 1.01–3.36). This citizen science study provided evidence that the social environment and the quality of the built environment had a complex effect on disparities in the risk of hypertension.

An external exposome-wide association study of hypertensive disorders of pregnancy

It is widely recognized that exogenous factors play an important role in the development of hypertensive disorders of pregnancy (HDP). However, only a few external environmental factors have been studied, often separately, with no attempt to examine the totality of the external environment, or the external exposome. We conducted an external exposome-wide association study (ExWAS) using the Florida Vital Statistics Birth Records including 819,399 women with live births in 2010-2013. A total of 5784 factors characterizing women's surrounding natural, built, and social environment during pregnancy from 10 data sources were collected, harmonized, integrated, and spatiotemporally linked to the women based on pregnancy periods using 250 m buffers around their geocoded residential addresses. A random 50:50 split divided the data into discovery and replication sets, and a 3-phase procedure was used. In phase 1, associations between HDP and individual factors were examined, and Bonferroni adjustment was performed. In phase 2, an elastic net model was used to perform variable selection among significant variables from phase 1. In phase 3, a multivariable logistic regression model including all variables selected by the elastic net model was fitted. Variables that were significant in both the discovery and replication sets were retained. Among the 528 and 490 variables identified in Phase 1, 232 and 224 were selected by the elastic net model in Phase 2, and 67 and 48 variables remained statistically significant in Phase 3 in the discovery and replication sets, respectively. A total of 12 variables were significant in both the discovery and replication sets, including air toxicants (e.g., 2,2,4-trimethylpentane), meteorological factors (e.g., omega or vertical velocity at 125mb pressure level), neighborhood crime and safety (e.g., burglary rate), and neighborhood sociodemographic status (e.g., urbanization). This is the first large external exposome study of HDP. It confirmed some of the previously reported associations and generated unexpected predictors within the environment that may warrant more focused evaluation.

Connections-between Daily Greenness Exposure and Health Outcomes

A compelling body of research demonstrates that exposure to nature, especially trees, is beneficial to human health. We know little, however, about the extent to which understory vegetation that does not reach the height of trees, impacts human health. An additional gap in our knowledge concerns the extent to which daily variations in exposure to various forms of vegetation are related to human health outcomes. Many previous findings describing such connections were achieved in laboratory settings or through semi-controlled experiments, which do not reflect the dynamic variations of people's daily exposure to nature. Thus, we conducted an online survey to address these questions. We used the National Land Cover Dataset 2011 and Google Street View images to estimate participants' daily exposure to nature, and two standard questionnaires (General Health SF-12 and the Perceived Stress Scale) to assess health. Results show that greater exposure to trees in daily life is associated with better health outcomes. Specifically, higher neighborhood concentrations of tree canopy are related to better physical health, overall health and an increased capacity to control stress. In contrast, the results exploring the health associations of understory vegetation were inconsistent. In most cases, understory vegetation had a negative relationship with stress and mental health measures.

Influence of residential greenness on adverse pregnancy outcomes: A systematic review and dose-response meta-analysis

BACKGROUND

With the development of urbanization, there is a decreasing tendency for people contact with natural greenness. Whether maternal exposure to greenness has an impact on pregnancy complications and pregnancy outcomes remains to be confirmed.

OBJECTIVES

To estimate the association and dose-response relationship between residential greenness and pregnancy outcomes.

DATA SOURCES

PubMed, Embase, Ovid, Scopus and Web of Science from inception to 1st December 2019 were searched.

SYNTHESIS METHODS

The summary regression coefficient (β) and odds ratio (OR) with corresponding 95% confidence interval (95%CI) were calculated. The linear dose-response relationship between greenness and adverse pregnancy outcomes was also investigated.

RESULTS

Overall, 36 studies with a total of 11,983,089 participants were included. Birth weight was significantly higher in highest level of greenness exposure group compared to lowest level group (e.g. β:20.22, 95%CI:13.50-26.93 at 100 m buffer). The odds of low birth weight (LBW) decreased in the highest level of group compared to lowest level group (e.g. OR:0.86, 95%CI:0.75-0.99 at 100 m buffer). The odds of small for gestational age (SGA) also decreased in the highest group (OR:0.93, 95%CI:0.88-1.00 at 100 m buffer). In addition, maternal exposure to greenness was associated with increased head circumference and decreased mental disorders. The dose-response models showed a 2% decrease risk of LBW per 0.1 normalized difference vegetation index (NDVI) increase within 300 m buffer (OR:0.98, 95%CI:0.97-0.99, P < 0.001) and a 1% decrease risk of SGA per 0.1 NDVI increase within 300 m buffer (OR:0.99, 95%CI:0.98-1.00, P = 0.037). No significant associations were found on preterm birth, gestational age, gestational diabetes mellitus, gestational hypertension or preeclampsia.

CONCLUSIONS

This review confirms an inverse association between residential greenness and adverse pregnancy outcomes. Findings of our study provide evidences for pregnant women to increase greenness exposure.

Maternal exposure to ambient particulate matter and green spaces and fetal renal function

Exposure to air pollution has been associated with different harmful effects and exposure to greenspace has been related to improved human health. However, the available evidence on the impact of these exposures on renal function is still scarce. The aim of this study was to determine the relationship between exposure to ambient levels of PM₁, PM_2.5, PM₁₀ and indicators of exposure to traffic as well as greenspace during pregnancy and fetal renal function based on the umbilical cord blood. This study was based on 150 pregnant women residing in Sabzevar, Iran (2018). Multiple linear regression models were developed to estimate the association of glomerular filtration rate (GFR), creatinine (Cr) and blood urea nitrogen (BUN) with exposure to air pollution, traffic, and greenspace (one at a time) controlled for relevant covariates. There was an inverse significant association between exposure to PM₁, PM_2.5, PM₁₀ and total street length in a 100 m buffer around the home and eGFR. Increase in distance to major road and residential surrounding greenness (100 m buffer) was associated with increase in eGFR. We observed a significant direct association between exposure to PMs as well as street length in 100 m buffer and serum level of Cr. There was also an inverse association between distance to major road and NDVI in 100 m buffer and Cr. The associations for blood urea nitrogen (BUN) were not statistically significant. Our results suggest that exposure to air pollution during pregnancy could have negative impact and exposure to greenspace could have positive impact on renal function of fetal.

Human Health-Environment Interaction Science: An emerging research paradigm

During recent decades, the growing interactions between human well-being and the environment have led to the development of new research paradigms. A number of disciplines have recognized the importance of the human-environment relationship in all aspects of human life from an economic, ecological, social and political perspective. In conformity with this trend, we conducted a bibliometric review of scientific publications on the interactions between two main research domains: human-centered and environmental-centered sciences. The aim is to provide a temporal and spatial perspective on how these research domains have paired up and co-evolved along a common pathway towards a new research paradigm, named Human Health-Environment Interaction Science (HHEIS). Our results revealed a constant growth over time in the scientific production concerning HHEIS. The network and cluster analyses showed a progressive overlapping of keywords among studies published in environmental and human health journals to a match of principal keywords. As a statistical indicator of this trend, the similarity index showed an increase in the number of keywords for both research domains. In terms of country productivity, the US, UK and China are in the lead, while EU countries are the most interconnected. Our review demonstrates the existence of HEIS as a comprehensive paradigm encompassing research findings with implications for human and environmental interaction. An overview of the history of HHEIS and the implications of current EU research-funding initiatives have been provided.

Green spaces and mortality: a systematic review and meta-analysis of cohort studies

BACKGROUND

Green spaces have been proposed to be a health determinant, improving health and wellbeing through different mechanisms. We aimed to systematically review the epidemiological evidence from longitudinal studies that have investigated green spaces and their association with all-cause mortality. We aimed to evaluate this evidence with a meta-analysis, to determine exposure-response functions for future quantitative health impact assessments.

METHODS

We did a systematic review and meta-analysis of cohort studies on green spaces and all-cause mortality. We searched for studies published and indexed in MEDLINE before Aug 20, 2019, which we complemented with an additional search of cited literature. We included studies if their design was longitudinal; the exposure of interest was measured green space; the endpoint of interest was all-cause mortality; they provided a risk estimate (ie, a hazard ratio [HR]) and the corresponding 95% CI for the association between green space exposure and all-cause mortality; and they used normalised difference vegetation index (NDVI) as their green space exposure definition. Two investigators (DR-R and DP-L) independently screened the full-text articles for inclusion. We used a random-effects model to obtain pooled HRs. This study is registered with PROSPERO, CRD42018090315.

FINDINGS

We identified 9298 studies in MEDLINE and 13 studies that were reported in the literature but not indexed in MEDLINE, of which 9234 (99%) studies were excluded after screening the titles and abstracts and 68 (88%) of 77 remaining studies were excluded after assessment of the full texts. We included nine (12%) studies in our quantitative evaluation, which comprised 8 324 652 individuals from seven countries. Seven (78%) of the nine studies found a significant inverse relationship between an increase in surrounding greenness per 0·1 NDVI in a buffer zone of 500 m or less and the risk of all-cause mortality, but two studies found no association. The pooled HR for all-cause mortality per increment of 0·1 NDVI within a buffer of 500 m or less of a participant's residence was 0·96 (95% CI 0·94-0·97; I², 95%).

INTERPRETATION

We found evidence of an inverse association between surrounding greenness and all-cause mortality. Interventions to increase and manage green spaces should therefore be considered as a strategic public health intervention.

FUNDING

World Health Organization.

Neonatal blood pressure in association with prenatal air pollution exposure, traffic, and land use indicators: An ENVIRONAGE birth cohort study

Elevated blood pressure (BP) in early life may lead to cardiovascular morbidity and mortality in later life. Air pollution exposure has been associated with increased BP in adults and children, but the contribution of prenatal air pollution exposure has rarely been assessed. In addition, we are not aware of any study on neonatal BP and maternal residential traffic and land use indicators during pregnancy. We investigated the association between newborn BP and prenatal air pollution, traffic and land use indicators, using data from 427 term (gestational age > 36 weeks) births from the ENVIRONAGE birth cohort. Newborn BP was measured using an automated device within 4 days after birth. Daily maternal residential air pollutants during pregnancy, including particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM_2.5) and ≤10 μm (PM₁₀), black carbon (BC), and nitrogen dioxide (NO₂), were modelled using a high-resolution spatial-temporal model. The association between newborn BP and air pollution during the last 15 weeks of pregnancy was assessed using distributed lag models. Each 5 μg/m³ increment in prenatal PM_2.5 exposure was associated with a 2.4 mm Hg (95% CI, 0.5 to 4.2) higher systolic and a 1.8 mm Hg (95% CI, 0.2 to 3.5) higher diastolic BP at birth. Overall estimates for PM₁₀ were similar but those for NO₂ and BC did not reach significance. Associations between newborn BP and exposures during the last 4 to 5 weeks of pregnancy were significant for all pollutants. An IQR (20.3%) increment in percentage residential greenness in a 5 km radius was associated with a 1.2 mm Hg (95% CI, -2.5 to 0.1; p = 0.07) lower systolic and a 1.2 mm Hg (95% CI, -2.4 to -0.0; p = 0.05) lower diastolic BP. An IQR (4.1%) increment in percentage industrial area in a 5 km radius was associated with a 1.0 mm Hg (95% CI, 0.1 to 1.9; p = 0.03) higher diastolic BP. Residential traffic indicators did not significantly associate with newborn BP. Prenatal air pollution exposure, greenness, and industrial area at maternal residence may affect offspring BP from birth onwards.

Nature and mental health: An ecosystem service perspective

A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

Nature and mental health: An ecosystem service perspective

A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

[Green environments and forests in cities: Benefits and risks for human health according to the "one health" approach]

The new One Health approach proposes to view the human-animal-ecosystems relations as a continuum. This systemic approach proves very valuable when examining the links between wooded green spaces in urban areas and the health of city dwellers (more than half of the world population). These links and their diversity and complexity are now beginning to be adequately documented by the scientific literature. Some benefits and risks for human health can now be better analysed enabling areas for useful action in the future to be identified.

Community greenness, blood pressure, and hypertension in urban dwellers: The 33 Communities Chinese Health Study

BACKGROUND

Living in greener areas has many health benefits, but evidence concerning the effects on blood pressure remains mixed. We sought to assess associations between community greenness and both blood pressure and hypertension in Chinese urban dwellers, and whether the associations were mediated by air pollution, body mass index, and physical activity.

METHODS

We analyzed data from 24,845 adults participating in the 33 Communities Chinese Health Study, which was conducted in Northeastern China during 2009. We measured each participant's blood pressure according to a standardized protocol. We assessed community greenness using two satellite-derived vegetation indexes - the Normalized Difference Vegetation Index (NDVI) and the Soil Adjusted Vegetation Index (SAVI). Particulate matter ≤2.5 μm and nitrogen dioxide were used as proxies of ambient air pollution. We applied generalized linear mixed models to investigate the association between greenness and blood pressure. We also performed mediation analyses.

RESULTS

Living in greener areas was associated with lower blood pressure and hypertension prevalence; an interquartile range increase in both NDVI_500-m and SAVI_500-m were significantly associated with reductions in systolic blood pressure of 0.82 mm Hg (95% CI: -1.13, -0.51) and 0.89 mm Hg (95% CI: -1.21, -0.57), respectively. The same increases in greenness were also significantly associated with a 5% (95% CI: 1%, 8%) and 5% (95% CI: 1%, 9%) lower odds of having hypertension, respectively. These associations remained consistent in sensitivity analyses. The associations were stronger among women than men. Air pollutants and body mass index partly mediated the associations, but there was no evidence of mediation effects for physical activity.

CONCLUSIONS

Our findings indicate beneficial associations between community greenness and blood pressure in Chinese adults, especially for women. Air pollution and body mass index only partly mediated the associations.

Spatial Accessibility of Urban Forests in the Pearl River Delta (PRD), China

The Pearl River Delta (PRD) is one of the most important economic zones both in China and in the world. Its rapid economic development has been associated with many environmental problems such as the loss of forests in urban areas. We estimated the accessibility of forests in the PRD by quantifying spatial proximity and travel time. We found that distances from a large proportion of the points of interest (POIs) (~45%) and urban lands (~38%, where ~49 urban residents live) to the nearest forests were greater than 1000 m; suggesting a low spatial proximity to forests. Urban parks—important outdoor recreational areas—appeared to have insufficient forest coverage within their 1000 m buffer zones. When forest accessibility was measured by travel time under optimal modes of transport; it was less than 15 min for most urban lands (~95%), which accommodates 98% of the total urban population. More importantly; the travel time to the nearest forest was negatively correlated with gross domestic product density (GDPd), but not with population density (POPd). The GDPd and POPd; however; increased log-linearly with the Euclidean distance to the nearest forest. In addition to the low proximity to forests; there existed inequalities among urban residents who live in areas with different levels of GDPd and POPd. Future urban planning needs not only to increase the total coverage of urban forests; but also to improve their spatial evenness across the urban landscapes in the PRD.

Greenspace seems protective of both high and low blood pressure among residents of an Alpine valley

BACKGROUND

There is some data suggesting that residential greenspace may protect against high blood pressure in urbanized areas, but there is no evidence of effects on hypotension, in less urbanized areas, and in idiosyncratic geographic contexts such as mountain valleys.

OBJECTIVES

The current study aimed to investigate the associations between residential greenspace and blood pressure in an alpine valley in Austria.

METHODS

We conducted a cross-sectional survey of a representative sample of 555 adults living in the Lower Inn Valley, Austria. Several definitions of blood pressure were employed: continuously-measured systolic (SBP) and diastolic blood pressure (DBP), doctor-diagnosed hyper- and hypotension, and high- and low blood pressure medication use. Greenspace metrics considered were: Normalized Difference Vegetation Index (NDVI), Soil Adjusted Vegetation Index (SAVI), and tree cover as measures of surrounding greenness in circular buffers of 100 m, 300 m, 500 m, and 1000 m around the home; distance to different types of structured green space; and having a domestic garden and a balcony. Relationships were examined across different definitions of blood pressure and greenspace and evaluated for potential effect modification by demographic factors, presence of a domestic garden/balcony, adiposity, and traffic sensitivity.

RESULTS

Higher overall greenness was associated with 30-40% lower odds of hyper/hypotension and 2-3 mm Hg lower SBP. Similar pattern was revealed for tree cover, however, associations with hypertension were less consistent across buffers, and SBP and DBP were lower only in association with greenness in the 100-m buffer. Having a domestic garden also seemed protective of high DBP. Residing near to forests, agricultural land, or urban green spaces was not related to blood pressure. Higher NDVI_500-m was stronger associated with lower SBP in those having a domestic garden, while the effect on DBP was stronger in overweight/obese participants.

CONCLUSION

These findings support the idea that greenspace should be considered as protective of both high and low blood pressure, however, underlying mechanisms remain insufficiently understood.

The nexus between climate change, ecosystem services and human health: Towards a conceptual framework

This paper addresses the impact that changes in natural ecosystems can have on health and wellbeing focusing on the potential co-benefits that green spaces could provide when introduced as climate change adaptation measures. Ignoring such benefits could lead to sub-optimal planning and decision-making. A conceptual framework, building on the ecosystem-enriched Driver, Pressure, State, Exposure, Effect, Action model (eDPSEEA), is presented to aid in clarifying the relational structure between green spaces and human health, taking climate change as the key driver. The study has the double intention of (i) summarising the literature with a special emphasis on the ecosystem and health perspectives, as well as the main theories behind these impacts, and (ii) modelling these findings into a framework that allows for multidisciplinary approaches to the underlying relations between human health and green spaces. The paper shows that while the literature based on the ecosystem perspective presents a well-documented association between climate, health and green spaces, the literature using a health-based perspective presents mixed evidence in some cases. The role of contextual factors and the exposure mechanism are rarely addressed. The proposed framework could serve as a multidisciplinary knowledge platform for multi-perspecitve analysis and discussion among experts and stakeholders, as well as to support the operationalization of quantitative assessment and modelling exercises.

The influence of proximity to city parks and major roads on the development of arterial hypertension

AIMS

The aim of this study was to examine the relation between residential distance from major roads and city parks and the development of arterial hypertension.

METHODS

In this study, we used data of the population included in the MONICA survey (Lithuania). In total, 739 participants without arterial hypertension were selected for the present study. Poisson regression with robust variance estimation was used to evaluate the associations between distances from a major road and a city park expressed as categorical variables and the incidence of arterial hypertension, adjusting for individual risk factors.

RESULTS

For persons living at a distance of 151-300 m and > 300 m from city parks, relative risks were 1.49 (95% CI 1.03-2.15) and 1.51 (95% CI 1.10-2.07) respectively, as compared to a ≤ 150 m distance from city parks. For persons living further than 200 m away from a major road, the relative risk for the residential distance from city parks > 150 m was 2.36 ( p = 0.029) times higher, as compared to a ≤ 150 m distance from city parks. We found that an increased risk of arterial hypertension was associated with the distance from a city park > 350 m and the distance to a major road < 200 m (RR = 1.48, 95% CI 1.03-2.12) as compared to living ≤ 350 m to a city park and ≥ 200 m away from a major road.

CONCLUSIONS

An increase in the incidence of arterial hypertension was associated with a shorter distance to a major road and a greater distance to a city park. The effect modification of a shorter distance to a major road on the association between a greater distance to city parks and the incidence of arterial hypertension was identified.

Exploring pathways linking greenspace to health: Theoretical and methodological guidance

BACKGROUND

In a rapidly urbanizing world, many people have little contact with natural environments, which may affect health and well-being. Existing reviews generally conclude that residential greenspace is beneficial to health. However, the processes generating these benefits and how they can be best promoted remain unclear.

OBJECTIVES

During an Expert Workshop held in September 2016, the evidence linking greenspace and health was reviewed from a transdisciplinary standpoint, with a particular focus on potential underlying biopsychosocial pathways and how these can be explored and organized to support policy-relevant population health research.

DISCUSSIONS

Potential pathways linking greenspace to health are here presented in three domains, which emphasize three general functions of greenspace: reducing harm (e.g. reducing exposure to air pollution, noise and heat), restoring capacities (e.g. attention restoration and physiological stress recovery) and building capacities (e.g. encouraging physical activity and facilitating social cohesion). Interrelations between among the three domains are also noted. Among several recommendations, future studies should: use greenspace and behavioural measures that are relevant to hypothesized pathways; include assessment of presence, access and use of greenspace; use longitudinal, interventional and (quasi)experimental study designs to assess causation; and include low and middle income countries given their absence in the existing literature. Cultural, climatic, geographic and other contextual factors also need further consideration.

CONCLUSIONS

While the existing evidence affirms beneficial impacts of greenspace on health, much remains to be learned about the specific pathways and functional form of such relationships, and how these may vary by context, population groups and health outcomes. This Report provides guidance for further epidemiological research with the goal of creating new evidence upon which to develop policy recommendations.

Blood pressure in young adulthood and residential greenness in the early-life environment of twins

BACKGROUND

Previous research shows that, besides risk factors in adult life, the early-life environment can influence blood pressure and hypertension in adults. However, the effects of residential traffic exposure and residential greenness in the early-life on blood pressure in young adulthood are currently unknown.

METHODS

Ambulatory (24-h) blood pressures of 278 twins (132 pairs) of the East Flanders Prospective Twins Study were obtained at the age of 18 to 25 years. Prenatal and adulthood residential addresses were geocoded and used to assign prenatal and postnatal traffic and greenness indicators. Mixed modelling was performed to investigate blood pressure in association with greenness while adjusting for potential confounding factors.

RESULTS

Night-time systolic blood pressure was inversely associated with greenness at the residential address in twins living at the same address their entire life (non-movers, n = 97, 34.9%). An interquartile increase in residential greenness exposure (1000 m radius) was associated with a 3.59 mmHg (95% CI: -6.0 to -1.23; p = 0.005) lower adult night systolic blood pressure. Among twins who were living at a different address than their birth address at time of the measurement (n = 181, 65.1%), night-time blood pressure was inversely associated with residential surrounding greenness at adult age as well as with residential greenness in early-life. However after additional adjustment for residential greenness exposure in adulthood, only residential greenness exposure in early-life was significantly associated with night systolic blood pressure. While no significant effect of adult residential greenness with adult blood pressure was observed, while accounting for the early-life greenness exposure.

CONCLUSIONS

Lower residential greenness in the early-life environment was independently associated with a higher adult blood pressure. This indicates that residential greenness has persistent effects on blood pressure.

Using systematic observations to understand conditions that promote inter-racial experiences in neighbourhood parks

We analysed observations from 31 neighbourhood parks, with each park mapped into smaller target areas for study, across five US cities generated using the System for Observing Play and Recreation in the Community (SOPARC). In areas where at least two people were observed, less than one-third (31.6%) were populated with at least one white and one non-white person. Park areas that were supervised, had one or more people engaged in vigorous activity, had at least one male and one female present, and had one or more teens present were significantly more likely to involve interracial groups (p<0.01 for each association). Observations in parks located in interracial neighbourhoods were also more likely to involve interracial groups (p<0.05). Neighbourhood poverty rate had a significant and negative relationship with the presence of interracial groups, particularly in neighbourhoods that are predominantly non-white. Additional research is needed to confirm the impact of these interactions. Urban planning and public health practitioners should consider the health benefits of interracial contact in the design and programming of neighbourhood parks.

Parks and Green Areas Are Associated with Decreased Risk for Hyperlipidemia

This study aimed to investigate the association between parks and green areas and hyperlipidemia in adults with groups stratified by moderate physical activity as a behavioral modification using the 2009 Korean Community Health Survey data and 212,584 participants enrolled in this study. The geographical codes of study participants were all matched on the basis of the amount of parks and green areas in each administrative district. Compared with participants living in the highest quartile of parks and green areas (Quartile 4), those living in the lowest quartile of green and park area (Quartile 1) were at an increased risk of physician-diagnosed hyperlipidemia and hyperlipidemia currently under treatment. Participants in the lowest quartile of parks and green areas were likely not to engage in any moderate physical activity. After classifying hyperlipidemia risk depending on the presence of moderate physical activity, those participating in moderate physical activity were less likely to have hyperlipidemia in all quartiles of parks and green areas than those not engaging in moderate physical activity. We found that parks and green areas were associated with decreased hyperlipidemia risk. Physical activity, which may benefit from the presence of parks and green areas, may reduce hyperlipidemia risk.

Making green infrastructure healthier infrastructure

Increasing urban green and blue structure is often pointed out to be critical for sustainable development and climate change adaptation, which has led to the rapid expansion of greening activities in cities throughout the world. This process is likely to have a direct impact on the citizens' quality of life and public health. However, alongside numerous benefits, green and blue infrastructure also has the potential to create unexpected, undesirable, side-effects for health. This paper considers several potential harmful public health effects that might result from increased urban biodiversity, urban bodies of water, and urban tree cover projects. It does so with the intent of improving awareness and motivating preventive measures when designing and initiating such projects. Although biodiversity has been found to be associated with physiological benefits for humans in several studies, efforts to increase the biodiversity of urban environments may also promote the introduction and survival of vector or host organisms for infectious pathogens with resulting spread of a variety of diseases. In addition, more green connectivity in urban areas may potentiate the role of rats and ticks in the spread of infectious diseases. Bodies of water and wetlands play a crucial role in the urban climate adaptation and mitigation process. However, they also provide habitats for mosquitoes and toxic algal blooms. Finally, increasing urban green space may also adversely affect citizens allergic to pollen. Increased awareness of the potential hazards of urban green and blue infrastructure should not be a reason to stop or scale back projects. Instead, incorporating public health awareness and interventions into urban planning at the earliest stages can help insure that green and blue infrastructure achieves full potential for health promotion.