Impact of Green Space Exposure on Children's and Adolescents' Mental Health: A Systematic Review

Unique associations among multiple facets of greenspace exposure and emotional and behavioral adjustment in preadolescence: A daily diary study

Research has shown that the frequency, duration, and intensity of greenspace exposure are significantly associated with children's adjustment. However, most studies have examined these facets separately. There is a lack of research that integrates them to offer a more comprehensive understanding of their unique associations with adjustment. This study investigates the unique associations between various facets of greenspace exposure and children's emotional (happiness and emotional problems) and behavioral (helping behavior and direct aggression) adjustment at both the daily and individual levels. The sample included 509 children (235 boys; Mage = 10.58 years, SD = 0.85 years) who completed a 14 days diary on greenspace exposure and adjustment. Multilevel analyses revealed that greenspace exposure (versus nonexposure) was associated with adjustment, and the various facets showed unique associations with adjustment. Specifically, on days when children were exposed to greenspace with more attributes than usual, they reported greater same-day happiness and fewer emotional problems. Compared with children who were exposed to greenspace with fewer attributes, children who were exposed to greenspace with more attributes on average presented greater happiness and more helping behaviors. With respect to duration, on days when children spent more time in greenspace than usual, they reported greater same-day happiness and more helping behaviors. However, frequency was not significantly associated with adjustment at either level. Our findings underscore the importance of enhancing the attributes of greenspace in the construction of child-friendly cities. Practitioners may consider increasing the number of opportunities for children to be exposed to greenspace with rich attributes in greenspace-based intervention programs.

Longitudinal associations between greenspace exposure, structural brain development, and mental health and academic performance during early adolescence

BACKGROUND

Greenspace exposure is associated with positive mental health and academic outcomes. This preregistered longitudinal study examines whether the influence of greenspace exposure on structural brain development partially explains these associations.

METHODS

We analyzed data from the Adolescent Brain Cognitive Development (ABCD) study (N=7102), to test the relationship between greenspace exposure at age 9-10 and brain structure two years later, as well as change over time. Additionally, we tested whether brain structural development statistically mediated the associations of greenspace exposure with mental health and academic performance.

RESULTS

Greenspace exposure was associated with greater total surface area (SA) and cortical volume (CV), greater cortical thickness (CT) in temporal regions and the insula, lower thickness in the caudal middle frontal and superior frontal gyri, greater SA across several regions, and greater volume of the caudate nucleus, putamen, and nucleus accumbens. In analyses studying change in brain structure over time, higher greenspace exposure was associated with greater growth of total SA, lower average thickness reduction, and reduced total CV growth as well as changes at the regional level. We also found significant indirect effects of the association of greenspace exposure with academic performance and mental health through both total and regional cortical structure.

CONCLUSIONS

Greenspace exposure is linked to structural neurodevelopment, which is, in turn, associated with better mental health and academic achievement. Our findings underscore the importance of greenspace in supporting brain development and positive outcomes in children and adolescents.

Orienteering promoting community and nature connectedness in Italian VET students. An ethnographic Study of a nature-based intervention

This ethnographic study examines the effects of a health-promotion intervention involving orienteering in urban parks for first-year Italian vocational students. Green exercise, known to enhance psychological well-being and foster a sense of kinship with nature and community, was chosen to address risk factors in vocational education and training (VET) institutions. Orienteering offers mental and physical benefits while encouraging participation. This study involved 53 students (mean age 14.51) from a VET institution in Milan, employing interviews with teachers and ethnographic observations. Findings indicate that the intervention promoted group cooperation, reduced conflicts, and helped students develop navigation skills while exploring their city. It also strengthened students' connestion with nature and community spaces, fostering a sense of belonging and engagement.

Multisystemic resilience and its impact on youth mental health: reflections on co-designing a multi-disciplinary, participatory study

Youth depression is a global emergency. Redressing this emergency requires a sophisticated understanding of the multisystemic risks and biopsychosocial, economic, and environmental resources associated with young people's experiences of no/limited versus severe depression. Too often, however, personal risks and a focus on individual-level protective resources dominate accounts of young people's trajectories towards depression. Further, studies of depression in high-income countries (i.e., "western") typically inform these accounts. This article corrects these oversights. It reports on the methodology of the Wellcome-funded R-NEET study: a multidisciplinary, multisystemic, mixed method longitudinal study of resilience among African youth whose status as "not in education, employment or training" (NEET) makes them disproportionately vulnerable to depression. Co-designed by academics, community-based service providers and youth in South Africa and Nigeria, with partnerships in the United Kingdom, Canada and the United States, the R-NEET study is identifying the physiological, psychological, social, economic, institutional, and environmental risks and resources associated with distinct trajectories of depression. Using the methodology of the R-NEET study as exemplar, this article advances an argument for understanding resilience as a contextually and culturally rooted capacity that draws on the multiple, co-occurring systems that young people depend upon to support their wellbeing. Acknowledging and harnessing the multiple systems implicated in resilience is critical to researchers and mental health providers who seek to support young people to thrive, and to young people themselves when protecting or promoting their mental wellbeing.

Profiling adolescent participation in wildlife activities and its implications on mental health: evidence from the Young-HUNT study in Norway

Background

Adolescent mental health challenges are on the rise globally, and Norway is no exception. Wildlife activities (WAs) have been increasingly promoted as a potential measure to improve adolescent well-being. However, there is limited research on the extent of adolescent participation in these activities and its association with mental distress among Norwegian adolescents.

Aim

This study has a twofold aim: to explore the degree of adolescent participation in WAs and to examine the association between this participation and mental distress.

Methods

The study design was cross-sectional, using Young-HUNT data from Norway collected between 2017 and 2019. A total of 6,361 participants were included in the final sample. Participants were categorized based on their level of participation in WAs, and ordinal regression analysis was conducted to assess factors associated with their level of wildlife activity. Furthermore, multivariate linear regression analysis assessed the association between wildlife activity and mental distress.

Results

The majority of participants reported low levels (34.6%) or medium levels (53.2%) of engagement in WAs. Adjusted analyses showed that higher levels of participation in WAs were associated with a range of factors, particularly female sex, having both parents born in Norway, and maintaining a medium or high level of physical activity. A weak yet statistically significant relationship was identified between higher levels of wildlife activity and increased mental distress among the participants.

Conclusion

Various sociodemographic, lifestyle, and social factors influence the involvement in WAs. The observed weak but significant association between higher participation in WAs, and increased mental distress raises questions about the assumption that nature and WAs are universally beneficial for adolescent mental health. These results highlight the need for further research to explore the underlying mechanisms of this relationship. These findings also caution policymakers against making generalized claims about the mental health benefits of WAs without a deeper consideration of individual and contextual factors.

EnvironMental Health: A Framework for an Emerging Field at the Intersection of the Environment and Mental Health Crises

Understanding how the environment shapes our mental and cognitive health is imperative to support efforts that promote healthy and sustainable living conditions. The etiology of mental health conditions remains often unclear, and social factors have received more scrutiny than natural or built environments. We present a conceptual framework illustrating the emerging intersection between the environment and neuropsychological health, intended to structure and guide research and funding, as well as public health and environmental initiatives. We conducted a scoping review of reviews of existing evidence on the impacts of the environment on mental and cognitive health. We found that an extensive body of work was focused on chemical hazards and the built environment and their associations with neurological and mental health, including attention-deficit/hyperactivity disorder (ADHD), autism, dementia, and mood. We identified emerging areas of research intersecting environmental factors such as air, water, light, and green space with schizophrenia and behavioral health. Our analysis of the intersections between the environment and mental and cognitive health allows for the identification of knowledge clusters and gaps, contextualizing needs and opportunities for future research and funding strategies. These significant connections showcase the importance of understanding the relationships between the environment and mental and cognitive health. With this work, we assert that the protection of the environment and its integration into healthcare can bring cascading benefits and synergies to mental and cognitive health and well-being and address the social and economic burden of the mental health crises.

Factors influencing the effectiveness of nature-based interventions (NBIs) aimed at improving mental health and wellbeing: An umbrella review

Several systematic reviews support nature-based interventions (NBIs) as a mechanism of enhancing mental health and wellbeing. However, the available evidence for the effectiveness of these interventions is fragmentary and mixed. The heterogeneity of existing evidence and significant fragmentation of knowledge within the field make it difficult to draw firm conclusions regarding the effectiveness of NBIs. This can only limit the development of interventions to support personal and planetary wellbeing, potentially resulting in ineffective and ill-targeted investment decisions. These concerns have hindered the translation of research evidence into practice and guidelines are urgently required to assist researchers, practitioners and policymakers in developing interventions to promote environmental stewardship and meet the health needs of diverse communities. A higher-order or meta-level synthesis is required to make sense of this evidence. This umbrella review synthesises evidence on the barriers and enablers to nature-based interventions through a summative review of existing published systematic reviews and meta-analyses. A systematic search in PsycINFO, PubMed, Greenfile, Web of Science, Embase, Scopus, Academic Search Complete (EBSCO), Environment Complete (EBSCO), Cochrane Library, CINAHL, Health Policy Reference Centre and Google Scholar was performed. This is a mixed method review, and systematic reviews with both quantitative and qualitative data synthesis were included. 64 systematic reviews were included in the synthesis. The descriptive data, extracted from each study, forms an overview of the characteristics of available evidence on nature-based interventions. A narrative synthesis is used to present the potential factors influencing the outcomes of NBIs. The risk of bias of the systematic reviews was assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. Directions for future research, potential quality needs and recommendations for future research, policymaking, and practice are discusssed.

Impact of Park Redesign and Renovation on Children's Health-Related Quality of Life

Despite increasing interest in the role of parks on children's health, there has been little empirical research on the impact of park interventions. We used a quasi-experimental pre-post study design with matched controls to evaluate the effects of park redesign and renovation on children's health-related quality of life (QoL) in underserved neighborhoods in New York City, with predominantly Hispanic and Black populations. Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported health-related QoL of 201 children aged 3-11 years living within a 0.3-mile radius of 13 renovated parks compared to 197 children living near 11 control parks before and after the park intervention. Health-related QoL was measured using a modified version of the KINDL questionnaire that assessed children's physical and emotional well-being, self-esteem, and well-being in home, peer, and school functioning. Linear mixed regression model was used to examine the difference in difference (DID) between the intervention vs. control group for QoL. We found a significant differential improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID = 6.35, 95% confidence interval [CI] = 0.85-11.85, p = 0.024). The effect was particularly strong among girls (DID = 7.88, p = 0.023) and children of the lowest socio-economic background (p < 0.05). No significant DID was found in other KINDL domains. Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings lend support for investments in neighborhood parks to advance health equity.

Ambient air pollution, urban green space and childhood overweight and obesity: A health impact assessment for Barcelona, Spain

BACKGROUND

The burden of childhood overweight and obesity attributable to ambient air pollution and a lack of urban green spaces (UGS) remains unknown. This study aimed to estimate the attributable cases of childhood overweight and obesity due to air pollution and insufficient UGS exposure in Barcelona, Spain.

METHODS

We applied a quantitative health impact assessment approach. We collected childhood overweight and obesity prevalence levels and exposure data from 69 spatial basic health zones in Barcelona. We estimated particulate matter (PM2.5) and nitrogen dioxide (NO2) levels using land use regression models, normalized difference vegetation index (NDVI) levels using remote sensing and percentage of green area (%GA) using land use. We estimated relative risks, population attributable fractions, and preventable overweight/obesity cases in children under following scenarios: Compliance of World Health Organization (WHO) air quality guidelines (AQGs) for (1) PM2.5 and (2) NO2; achieving (3) city-target NDVI levels and (4) 25% green area (%GA) recommendations. The analyses were stratified by socioeconomic deprivation index (in quintiles). Uncertainty was quantified using Monte Carlos simulations.

RESULTS

Compliance of WHO AQGs could prevent 0.4% [253 (95%CI, -604; 1086)] and 4.2% [3000 (95%CI, 1009; 4943)] of childhood overweight/obesity cases due to excess PM2.5 and NO2 levels in Barcelona, respectively. Compliance of NDVI and %GA targeted levels could prevent 6% [4094 (95%CI, 1698; 6379)] and 10% [6853 (95%CI, 1440; 12779)] of childhood overweight/obesity cases respectively. The preventable burdens of childhood overweight/obesity cases were slightly higher in middle-class socioeconomic areas due to the higher adverse exposure levels at baseline (high air pollution, less UGS).

DISCUSSION

Compliance with WHO AQGs and achieving UGS targets can reduce childhood overweight and obesity levels in Barcelona, and potentially in other locations as well. This underscores the need for policies that foster healthier urban environments of high environmental quality in order to protect child health.

Life in green: Associations between greenspace availability and mental health over the lifecourse - A 40-year prospective birth cohort study

BACKGROUND

The beneficial impacts of greenspace availability on mental health are well-documented. However, longitudinal evidence using a spatial lifecourse perspective is rare, leaving the dynamics of how greenspace influences mental health across the lifecourse unclear. This study first uses prospective birth cohort data to examine the associations between greenspace availability in childhood (0-16 years) and mental health in adolescence (16 years) and between greenspace availability and mental health across adulthood (18-40 years).

METHOD

Data were obtained from the Christchurch Health and Development Study, comprised 1,265 cohort members born in Christchurch, New Zealand, in 1977. Mental health outcomes including depressive symptoms, anxiety disorders and suicidal ideation were assessed in adolescence (16 years), and in adulthood (18-40 years). Greenspace availability from birth to age 40 years was measured as the proportion of vegetated areas within circular buffers (radius from 100m to 3000m) around members' geocoded residential addresses using a time-series impervious surfaces data from 1985 to 2015. Bayesian Relevant Lifecourse exposure models examined the associations between childhood greenspace availability and adolescent mental health and tested for critical/sensitive age periods. Generalised Estimating Equation logistic regression models assessed the associations between greenspace availability and mental health across adulthood. These analyses were adjusted for various important individual, family, and area-level covariates.

RESULTS

No associations were found between childhood greenspace availability and any adolescent mental health conditions. However, in adulthood, a one standard deviation increase in greenspace availability within 1500m and 2000m buffers was associated with a 12% and 13% reduced risk of depressive symptoms, respectively, after adjusting for various covariates.

DISCUSSION

This study supports the protective effects of greenspace on adult depressive symptoms, highlighting the significance of employing a spatial lifecourse epidemiology framework to examine the long-term effects of environmental factors on health over the lifecourse.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Investigating heart rate responses of children to active travel: a mixed effects modeling analysis

BACKGROUND

The active travel concept has gained recognition as an effective method to enhance physical activity in children's everyday mobility. Yet, there is a notable gap of quantitative evidence on its direct impacts, especially regarding physiological outcomes that can concretely demonstrate its influences on physical intensity and overall health of children.

METHODS

This study investigates the effects of active travel on children, focusing on trip-level physiological responses, specifically heart rate. Through a mixed survey design, we obtained a repeated-measures dataset from a cohort of 73 children (average age 13) across three Austrian secondary schools, each observed for 7 days. By applying mixed effects modelling approach, both fixed and random effects to children's heart rates were explored.

RESULTS

According to results from developed mixed linear models (maximum R2 = 0.22), it revealed a significant positive association between active travel mode(s) engagement and heightened physiological responses (Low, Medium and High active level of trip compare to None: β = 1.81, 5.01 and 8.34, t-value = 4.70, 10.29 and 21.34), indicating that increased usage of active travel modes led to elevated heart rate values. Additionally, subjective perceptions also played an important role in influencing children's physiological responses. Feelings of exhausted, anxiety, and stress contributing to a higher heart rate (β = 14.79, 16.69 and 1.99, t-value = 20.42, 5.67 and 3.0), while unhappiness was associated with a lower heart rate (β = -5.96, t-value = -14.62). Effects of social interactions were also found during the trip. The presence of adults was associated with a calming effect (β = -1.92, t-value = -5.72), whereas solo travel resulted in lower heart rate compared to travel with peers (β = -1.95, t-value = -6.59).

CONCLUSION

Our article innovatively employs mixed survey methods and heart rate data to quantitatively demonstrate the positive association between engagement in active travel modes and heightened physiological responses in children, elucidating the intricate interplay of subjective perceptions and social interactions during trips, thus offering valuable insights into the health implications of active travel at a trip level. Future research will keep on leveraging survey and experimental methods.

How Built Environment Characteristics Influence Social Interactions During Neighbourhood Walks Among Urban Inhabitants

As an accessible and low-risk mode of transportation and recreational activity, walking both produces and is produced by socio-spatial urban features. The health benefits of walking transcend physical fitness, remaining integral to mental health and to fostering social connectedness in urban communities. Understanding what drives walking behaviour, therefore, warrants attention from a public health perspective. This qualitative case study focuses on the social interactions of inhabitants during neighbourhood walks and how built environment features influence walking patterns and experience. Using diaries, maps, and semi-structured interviews with 45 inhabitants of a mid-sized Canadian city, this research investigates the influence of permanent and temporary physical features on the perceived quality of inhabitants' walks. The findings show the public visibility of urban modifications influences walking behaviour and improves social interactions, leading to a heightened sense of belonging and community. Inhabitant-led modifications in the urban space were mostly neighbourhood-bound and voyeuristic, whereas administrative interventions were more successful for collectivization. Both types of interventions are argued to foster social connectedness through different mechanisms, with positive impacts on inhabitants' health and wellbeing. The findings underscore the relevance of community-led and administratively planned interventions in built environments in positioning public health policies associated with social cohesion and connectedness.

Advocating for planetary health is an essential part of advocating for children's health

Burning of fossil fuels along with deforestation and ecological disruption have led to the warming of the Earth and climate change. Children are especially vulnerable to adverse health effects of climate change associated changes in the air, soil, and water as their organs are still developing, have a faster breathing rate, higher per pound ingested and inhaled exposures, and greater relative body surface area. To protect this vulnerable population, health care professionals need to play a leading role. In 2015, the American Academy of Pediatrics (AAP) updated their original 2007 Global Climate Change and Children's Health policy statement (again updated in 2024) stating that, "failure to take prompt, substantive action would be an act of injustice to all children." Health care professionals need to educate themselves and their patients of the health risks posed by climate change and incorporate climate change counseling into their practice. They also need to go beyond the framework of the healthcare system and work collaboratively with communities, corporations, and governments to advocate for policies and solutions to mitigate and adapt to climate change. The health and wellbeing of future generations rests upon the actions we take today. IMPACT: Summarizes the adverse effects of increased anthropogenic activity and burning of fossil fuels on planetary and human health Details the increased vulnerability of children to environmental assaults and their long-term effects Provides guidance and resources to health care professionals to empower them to act as advocates for systemic and structural changes that protect children's health.

A Systematic Review of the Impact of Changes to Urban Green Spaces on Health and Education Outcomes, and a Critique of Their Applicability to Inform Economic Evaluation

Several reviews have consolidated the evidence on the impact of living near an urban green space on improving health and education outcomes and reducing mortality. However, there is limited evidence on the effectiveness or cost-effectiveness of specific improvements to these urban green spaces, which would help decision-makers make informed decisions on how to invest in urban green spaces. Therefore, this review synthesizes the impact of more specific changes to, or investments in, urban green spaces on health and education outcomes, synthesizes the cost-effectiveness of these interventions, and critiques the applicability of the evidence for an economic evaluation. We find that interventions targeted towards improving play areas or fitness equipment tended to have mostly positive impacts on physical activity, while interventions on improving walking path, or the overall greenery showed a more mixed impact on physical activity. There were only two studies on the impact of changes to urban green spaces on mental health, with only one finding a positive association of the intervention with depression, and there were no studies measuring the impact of changes to urban green spaces and educational outcomes. From a cost-effectiveness perspective, we find that typically very small improvements are required to make the interventions a cost-effective policy choice; however, we found several limitations with using the existing evidence to estimate the cost-effectiveness of the intervention. Overall, we found that most of the evidence does suggest that improvements to urban green spaces can lead to improvements in physical activity, but further research is needed on the impact on mental health and educational outcomes. Furthermore, additional evidence with longer time horizons, multi-sectoral benefits, distributional outcomes, and more consistent outcome measures would assist in informing cost-effectiveness and may ultimately lead to improved decision-making around investments for urban green spaces in specific contexts.

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

BACKGROUND

Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15-26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.

METHODS

To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.

RESULTS

Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.

CONCLUSIONS

These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

Understanding the interactions that children and young people have with their natural and built environments: A survey to identify targets for active travel behaviour change in Wales

Active travel offers many societal benefits, including improving people's mental and physical health and minimising our impacts on the environment. Increasing active travel is particularly important amongst children and young people (CYP), who are building habits which they will carry into adulthood. Studies on active travel amongst CYP are limited, however, with most research focusing on adult participants or on adult perceptions of children. This study sought to understand CYP's interactions with the built and natural environment-and therefore their access to active travel-through the Capability, Opportunity, Motivation, Behaviour (COM-B) model. With a stakeholder group representing local government, youth organisations and active travel organisations, we co-created two bilingual questionnaires-one for young people aged 12-16 years living in Wales and the other for parents of young people aged 12-16 years living in Wales. Both questionnaires collected information on behaviour and perceived capability, opportunity and motivation of CYP to engage with their natural and built environments. The questionnaires included a discrete choice experiment (DCE), which proposed a series of binary choice questions indicating preferences based on landscape, journey time and type of travel. A total of 124 questionnaires (38 young people and 86 parents) were returned for analysis. These data indicate that CYP's time spent outdoors is not dependent upon geography (rural/urban/suburban), season, or school holidays. There was a significant difference in capability, opportunity and motivation between parents and CYP, with parents over-estimating the psychological capability of CYP to engage outdoors. The preference data indicate that active travel is the favoured mode of transport, with both CYP and parents stating that they would increase travel time in order to travel actively. While this response is not consistent with respondent's day-to-day travel choices, it suggests that the limitations to active travel may be psychological capability and automatic motivation, rather than a lack of opportunity.

The use of Enhanced Vegetation Index for assessing access to different types of green space in epidemiological studies

BACKGROUND

Exposure to green space can protect against poor health through a variety of mechanisms. However, there is heterogeneity in methodological approaches to exposure assessments which makes creating effective policy recommendations challenging.

OBJECTIVE

Critically evaluate the use of a satellite-derived exposure metric, the Enhanced Vegetation Index (EVI), for assessing access to different types of green space in epidemiological studies.

METHODS

We used Landsat 5-8 (30 m resolution) to calculate average EVI for a 300 m radius surrounding 1.4 million households in Wales, UK for 2018. We calculated two additional measures using topographic vector data to represent access to green spaces within 300 m of household locations. The two topographic vector-based measures were total green space area stratified by type and average private garden size. We used linear regression models to test whether EVI could discriminate between publicly accessible and private green space and Pearson correlation to test associations between EVI and green space types.

RESULTS

Mean EVI for a 300 m radius surrounding households in Wales was 0.28 (IQR = 0.12). Total green space area and average private garden size were significantly positively associated with corresponding EVI measures (β = < 0.0001, 95% CI: 0.0000, 0.0000; β = 0.0001, 95% CI: 0.0001, 0.0001 respectively). In urban areas, as average garden size increases by 1 m2, EVI increases by 0.0002. Therefore, in urban areas, to see a 0.1 unit increase in EVI index score, garden size would need to increase by 500 m2. The very small β values represent no 'measurable real-world' associations. When stratified by type, we observed no strong associations between greenspace and EVI.

IMPACT

It is a widely implemented assumption in epidiological studies that an increase in EVI is equivalent to an increase in greenness and/or green space. We used linear regression models to test associations between EVI and potential sources of green reflectance at a neighbourhood level using satellite imagery from 2018. We compared EVI measures with a 'gold standard' vector-based dataset that defines publicly accessible and private green spaces. We found that EVI should be interpreted with care as a greater EVI score does not necessarily mean greater access to publicly available green spaces in the hyperlocal environment.

Effect of nature on the mental health and well-being of children and adolescents: meta-review

BACKGROUND

Urbanisation is taking place worldwide and rates of mental illness are rising. There has been increasing interest in 'nature' and how it may benefit mental health and well-being.

AIMS

To understand how the literature defines nature; what the characteristics of the nature intervention are; what mental health and well-being outcomes are being measured; and what the evidence shows, in regard to how nature affects the mental health and well-being of children and adolescents.

METHOD

A meta-review was conducted, searching three databases for relevant primary and secondary studies, using key search terms including 'nature' and 'mental health' and 'mental well-being'. Inclusion criteria included published English-language studies on the child and adolescent population. Authors identified the highest quality evidence from studies meeting the inclusion criteria. Data were extracted and analysed using descriptive content analysis.

RESULTS

Sixteen systematic reviews, two scoping reviews and five good quality cohort studies were included. 'Nature' was conceptualised along a continuum (the 'nature research framework') into three categories: a human-designed environment with natural elements; a human-designed natural environment; and a natural environment. The nature 'intervention' falls into three areas (the 'nature intervention framework'): access, exposure and engagement with nature, with quantity and quality of nature relevant to all areas. Mental health and well-being outcomes fit along a continuum, with 'disorder' at one end and 'well-being' at the other. Nature appears to have a beneficial effect, but we cannot be certain of this.

CONCLUSIONS

Nature appears to have a beneficial effect on mental health and well-being of children and adolescents. Evidence is lacking on clinical populations, ethnically diverse populations and populations in low- and middle-income countries. Our results should be interpreted considering the limitations of the included studies and confidence in findings.

The impact of poverty and socioeconomic status on brain, behaviour, and development: a unified framework

In this article, we, for the first time, provide a comprehensive overview and unified framework of the impact of poverty and low socioeconomic status (SES) on the brain and behaviour. While there are many studies on the impact of low SES on the brain (including cortex, hippocampus, amygdala, and even neurotransmitters) and behaviours (including educational attainment, language development, development of psychopathological disorders), prior studies did not integrate behavioural, educational, and neural findings in one framework. Here, we argue that the impact of poverty and low SES on the brain and behaviour are interrelated. Specifically, based on prior studies, due to a lack of resources, poverty and low SES are associated with poor nutrition, high levels of stress in caregivers and their children, and exposure to socio-environmental hazards. These psychological and physical injuries impact the normal development of several brain areas and neurotransmitters. Impaired functioning of the amygdala can lead to the development of psychopathological disorders, while impaired hippocampus and cortex functions are associated with a delay in learning and language development as well as poor academic performance. This in turn perpetuates poverty in children, leading to a vicious cycle of poverty and psychological/physical impairments. In addition to providing economic aid to economically disadvantaged families, interventions should aim to tackle neural abnormalities caused by poverty and low SES in early childhood. Importantly, acknowledging brain abnormalities due to poverty in early childhood can help increase economic equity. In the current study, we provide a comprehensive list of future studies to help understand the impact of poverty on the brain.

Impact of Park Redesign and Renovation on Children's Quality of Life

Despite increasing interest in the role of parks on children's health, there has been little empirical research on the impact of park interventions. We used a quasi-experimental pre-post study design with matched controls to evaluate the effects of park redesign and renovation on children's quality of life (QoL) in underserved neighborhoods in New York City, with predominantly Hispanic and Black populations. Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported QoL of 201 children aged 3-11 years living within a 0.3-mile radius of 13 renovated parks compared to 197 children living near 11 control parks before and after the park intervention. QoL was measured using a modified version of the KINDL questionnaire, a health-related QoL scale that assessed children's physical and emotional well-being, self-esteem, and well-being in home, peer, and school functioning. Linear mixed regression model was used to examine the difference in difference (DID) between the intervention vs. control group for QoL. We found a significant differential improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID = 6.35, 95% Confidence Interval [CI] = 0.85-11,85, p = 0.024). The effect was particularly strong among girls (DID = 7.88, p = 0.023) and children of the lowest socio-economic background (p < 0.05). No significant DID was found in other KINDL domains. Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings lend support for investments in neighborhood parks to advance health equity.

Towards a Green Equal City: Measuring and matching the supply-demand of green exposure in urban center

Exposure to green environments is crucial for human health. However, urbanization has reduced the contact of urban residents with natural environments, causing a mismatch between the supply and demand for green exposure. Research in this field is hindered by the lack of long-term, reliable data sources and methodologies, leading to insufficient consideration of temporal variations in green exposure. This study presented a comprehensive methodology for assessing green exposure at a fine scale utilizing satellite images for urban tree canopy identification. We conducted a case study in the core area of Beijing from 2010 to 2020 and examined the effects of urban renewal and alleviation efforts. The results revealed a slight decrease in green exposure for the elderly over the decade, with minimal changes in equity. In contrast, green exposure for children has increased, with increasing inequality. Moreover, urban renewal has improved green exposure for nearly half of the low-supply blocks. However, a significant mismatch was observed between supply and demand for blocks with increased demand but limited supply. This study enhances the assessment of green exposure and provides guidance for planning and constructing a "Green Equal City".

Advancing Youth Justice: The Child and Adolescent Psychiatrist's Role

Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.

The relationship between urban greenspace perception and use within the adolescent population: A focused ethnography

INTRODUCTION

Greenspace is beneficial for improving adolescent mental health, yet healthcare professionals still do not understand the connection between the built environment and subjective mental well-being. We also need to understand how this population uses greenspace and how they feel when in it.

AIM

The aim of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace and to explore how they feel when they are in greenspace.

DESIGN

Focused ethnography.

METHODS

Data were collected between June 2022 and August 2022 using participant observation, photo elicitation and semi-structured interviews. Braun and Clarke's (2006) six phases of thematic analysis were used to guide data collection and analysis.

RESULTS

A total of 11 adolescents between ages 12 and 18 who resided in and around Newark, NJ, were recruited. Three themes were identified from the data: (1) A tranquil space in an unsafe place; (2) Park means family connection with burgeoning independence; and (3) My park: Sense of ownership and responsibility.

CONCLUSIONS

This study deepens the understanding between subjective mental well-being and urban greenspace exposure. Adolescents accepted responsibility for maintaining "my park", which strengthens community cohesion, detailing the importance of youth input during urban planning.

IMPLICATIONS FOR PRACTICE

Implications from this study suggest that environmental interventions may help ameliorate an ongoing mental health care crisis among adolescents. Healthcare providers should consider the built environment as another approach to promoting mental health.

PATIENT OR PUBLIC CONTRIBUTION

None other than research participants.

Built Environment, Natural Environment, and Mental Health

Mental health disorders have become a global problem, garnering considerable attention. However, the root causes of deteriorating mental health remain poorly understood, with existing literature predominantly concentrating on socioeconomic conditions and psychological factors. This study uses multi-linear and geographically weighted regressions (GWR) to examine the associations between built and natural environmental attributes and the prevalence of depression in US counties. The findings reveal that job sprawl and land mixed use are highly correlated with a lower risk of depression. Additionally, the presence of green spaces, especially in urban area, is associated with improved mental health. Conversely, higher concentrations of air pollutants, such as PM2.5 and CO, along with increased precipitation, are linked to elevated depression rates. When considering spatial correlation through GWR, the impact of population density and social capital on mental health displays substantial spatial heterogeneity. Further analysis, focused on two high depression risk clustering regions (northwestern and southeastern counties), reveals nuanced determinants. In northwestern counties, depression rates are more influenced by factors like precipitation and socioeconomic conditions, including unemployment and income segregation. In southeastern counties, population demographic characteristics, particularly racial composition, are associated with high depression prevalence, followed by built environment factors. Interestingly, job growth and crime rates only emerge as significant factors in the context of high depression risks in southeastern counties. This study underscores the robust linkages and spatial variations between built and natural environments and mental health, emphasizing the need for effective depression treatment to incorporate these multifaceted factors.

The Health-Related and Learning Performance Effects of Air Pollution and Other Urban-Related Environmental Factors on School-Age Children and Adolescents-A Scoping Review of Systematic Reviews

PURPOSE OF REVIEW

This scoping review aims to assess the impact of air pollution, traffic noise, heat, and green and blue space exposures on the physical and cognitive development of school-age children and adolescents. While existing evidence indicates adverse effects of transport-related exposures on their health, a comprehensive scoping review is necessary to consolidate findings on various urban environmental exposures' effects on children's development.

RECENT FINDINGS

There is consistent evidence on how air pollution negatively affects children's cognitive and respiratory health and learning performance, increasing their susceptibility to diseases in their adult life. Scientific evidence on heat and traffic noise, while less researched, indicates that they negatively affect children's health. On the contrary, green space exposure seems to benefit or mitigate these adverse effects, suggesting a potential strategy to promote children's cognitive and physical development in urban settings. This review underscores the substantial impact of urban exposures on the physical and mental development of children and adolescents. It highlights adverse health effects that can extend into adulthood, affecting academic opportunities and well-being beyond health. While acknowledging the necessity for more research on the mechanisms of air pollution effects and associations with heat and noise exposure, the review advocates prioritizing policy changes and urban planning interventions. This includes minimizing air pollution and traffic noise while enhancing urban vegetation, particularly in school environments, to ensure the healthy development of children and promote lifelong health.

"A sign that I am not alone": A grounded theory-informed qualitative study on spirituality after suicide bereavement

Suicide bereavement is known to be highly distressing and to negatively affect the mental health of the bereaved. The role of religion and spirituality after suicide bereavement remains understudied. We aimed to specifically explore the role of spirituality after suicide bereavement by conducting a qualitative study through semi-structured interviews with fifteen people bereaved by suicide. The grounded theory-informed thematic analysis identified five main themes, namely "continuing bonds with the deceased," "lightening the burden," "grounded spirituality," "perceptual and conceptual shift" and "the movement of giving." For many participants, spirituality was a resource that facilitated the process of accepting their loss by offering a larger entity to which to hand over their suffering. Moreover, the continuing bonds with the deceased helped them to get through this ordeal. Our results can enable mental health professionals to better understand how spirituality can facilitate post-traumatic growth in people bereaved by suicide.

Green Space and Internalizing or Externalizing Symptoms Among Children

Importance

Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare.

Objective

To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms.

Design, Setting, and Participants

Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included.

Exposures

Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment.

Main Outcome and Measures

Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples.

Results

Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood.

Conclusions and Relevance

In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.

A systematic review of audit tools for evaluating the quality of green spaces in mental health research

Research showing the relationship between exposure to green space and health has yielded conflicting results, possibly due to the oversight of green space quality in quantitative studies. This systematic review, guided by the PRISMA framework (registered under Prospero ID CRD42023279720), focused on audit tools for green space quality in mental health research. From 4028 studies, 13 were reviewed, with 77 % linking better mental health outcomes to higher green space quality. Eight tools, especially Public Open Space and Dillen et al. tools demonstrated strong correlations with mental health. Certain green space qualities like grass, pathways, and water elements showed positive health associations. Future research should aim for standardized quality metrics and robust methodologies to support causal inferences and efficient assessments.

Which individual, social, and urban factors in early childhood predict psychopathology in later childhood, adolescence and young adulthood? A systematic review

Background

A comprehensive picture is lacking of the impact of early childhood (age 0-5) risk factors on the subsequent development of mental health symptoms.

Objective

In this systematic review, we investigated which individual, social and urban factors, experienced in early childhood, contribute to the development of later anxiety and depression, behavioural problems, and internalising and externalising symptoms in youth.

Methods

Embase, MEDLINE, Scopus, and PsycInfo were searched on the 5th of January 2022. Three additional databases were retrieved from a mega-systematic review source that focused on the identification of both risk and protective indicators for the onset and maintenance of prospective depressive, anxiety and substance use disorders. A total of 46,450 records were identified and screened in ASReview, an AI-aided systematic review tool. We included studies with experimental, quasi-experimental, prospective and longitudinal study designs, while studies that focused on biological and genetical factors, were excluded.

Results

Twenty studies were included. The majority of studies explored individual-level risk factors (N = 16). Eleven studies also explored social risk factors and three studied urban risk factors. We found evidence for early predictors relating to later psychopathology measures (i.e., anxiety and depression, behavioural problems, and internalising and externalising symptoms) in childhood, adolescence and early adulthood. These were: parental psychopathology, exposure to parental physical and verbal violence and social and neighbourhood disadvantage.

Conclusions

Very young children are exposed to a complex mix of risk factors, which operate at different levels and influence children at different time points. The urban environment appears to have an effect on psychopathology but it is understudied compared to individual-level factors. Moreover, we need more research exploring the interaction between individual, social and urban factors.

Dynamic greenspace exposure, individual mental health status and momentary stress level: A study using multiple greenspace measurements

Previous research on the relationship between greenspace exposure and mental health has largely taken a residence-based approach to exposure assessment, ignoring the dynamic nature of people's daily movements. Moreover, most studies evaluated greenspace from an overhead perspective, whereas an eye-level perspective could potentially offer a more comprehensive understanding of individuals' encounters with greenspaces. Based on our survey in two communities in Hong Kong (Sham Shui Po and Tin Shui Wai), we captured people's eye-level greenspace exposure based on their travel routes and visited places using GPS trajectories, streetscape images, and deep learning methods. We then compared the results with those obtained with an overhead greenness exposure measure (the normalized difference vegetation index [NDVI]). The results indicate that these two greenspace measurements are not associated with each other, implying that they encompass distinct facets of greenspace, which may have different effects on mental health. Further, we examined the associations between various greenspace exposure measures and mental health using GPS trajectories and ecological momentary assessment data. The results reveal a negative association between eye-level greenspace exposure and momentary stress, while no similar association was observed when using the top-down NDVI as an indicator of greenspace exposure. Moreover, compared to the total volume of greenspace exposure, the distance-weighted average of greenspace exposure based on dynamic mobility contexts has a stronger association with individual overall mental health. Lastly, the relationship between greenspace exposure and mental health varies between the two communities with different socio-economic attributes. The study indicates that policymakers should focus not only on residential neighborhoods and overhead greenspace but also consider the dynamic environments and socio-economic contexts that people are embedded in.

Impacts of sociodemographic factors, identities and neighbourhood safety on the relationship between urban green space and adolescent mental well-being: Findings from Tāmaki Makaurau Auckland, Aotearoa New Zealand

This study explored the relationship between green space accessibility (GSA) in residential area and adolescents' mental well-being, and whether the relationship was moderated by sociodemographic factors (sex, ethnicity, neighbourhood deprivation), identities (gender and sexuality minority, disability) and perceived neighbourhood safety simultaneously. Data from 3813 adolescents who lived in Tāmaki Makaurau Auckland, Aotearoa New Zealand were obtained from the Youth19 Rangatahi Smart Survey. A Gaussian-based two-step floating catchment area method was employed to measure the spatial accessibility to green space at the neighbourhood level. The World Health Organization-5 Well-being Index was used to assess emotional well-being (EW), and the Reynolds Adolescent Depression Scale-short form was employed to measure depressive symptoms (DS). Through moderation analyses, results showed that perceived neighbourhood safety plays a vital role in the GSA - mental well-being association, with a negative trend in adolescents who reported being less safe in neighbourhoods. Adverse associations of GSA were found in gender and sexuality minority, disabled, Asian and Pacific adolescents, under the condition of not feeling safe in neighbourhoods all the time. The results showed marginalised adolescents tended to feel less safe in neighbourhoods, have lower EW and a higher level of DS. Additionally, the results from bivariate correlations showed there were inequalities in GSA for adolescents who lived in most deprived neighbourhoods and adolescents of Māori ethnicity. This study provides novel evidence of the importance of safe and inclusive green space for effectively promoting mental health and mitigating health inequalities of adolescents in urban areas.

Advancing Understanding on Greenspace and Mental Health in Young People

Mental distress among young people has increased in recent years. Research suggests that greenspace may benefit mental health. The objective of this exploratory study is to further understanding of place-based differences (i.e., urbanity) in the greenspace-mental health association. We leverage publicly available greenspace data sets to operationalize greenspace quantity, quality, and accessibility metrics at the community-level. Emergency department visits for young people (ages 24 and under) were coded for: anxiety, depression, mood disorders, mental and behavioral disorders, and substance use disorders. Generalized linear models investigated the association between greenspace metrics and community-level mental health burden; results are reported as prevalence rate ratios (PRR). Urban and suburban communities with the lowest quantities of greenspace had the highest prevalence of poor mental health outcomes, particularly for mood disorders in urban areas (PRR: 1.19, 95% CI: 1.16-1.21), and substance use disorders in suburban areas (PRR: 1.35, 95% CI: 1.28-1.43). In urban, micropolitan, and rural/isolated areas further distance to greenspace was associated with a higher prevalence of poor mental health outcomes; this association was most pronounced for substance use disorders (PRRUrban: 1.31, 95% CI: 1.29-1.32; PRRMicropolitan: 1.47, 95% CI: 1.43-1.51; PRRRural 2.38: 95% CI: 2.19-2.58). In small towns and rural/isolated communities, poor mental health outcomes were more prevalent in communities with the worst greenspace quality; this association was most pronounced for mental and behavioral disorders in small towns (PRR: 1.29, 95% CI: 1.24-1.35), and for anxiety disorders in rural/isolated communities (PRR: 1.61, 95% CI: 1.43-1.82). The association between greenspace metrics and mental health outcomes among young people is place-based with variations across the rural-urban continuum.

The social determinants of mental health and disorder: evidence, prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

Impacts of compounding drought and heatwave events on child mental health: insights from a spatial clustering analysis

BACKGROUND

Concurrent heatwave and drought events may have larger health impacts than each event separately; however, no US-based studies have examined differential mental health impacts of compound drought and heatwave events in pediatric populations.

OBJECTIVE

To examine the spatial patterns of mood disorders and suicide-related emergency department (ED) visits in children during heatwave, drought, and compound heatwave and drought events. We tested whether the occurrence of compound heatwave and drought events have a synergistic (multiplicative) effect on the risk of mental health related outcomes in children as compared to the additive effect of each individual climate hazard. Lastly, we identified household and community-level determinants of geographic variability of high psychiatric burden.

METHODS

Daily counts of psychiatric ED visits in North Carolina from 2016 to 2019 (May to Sept) for pediatric populations were aggregated at the county scale. Bernoulli cluster analyses identified high-risk spatial clusters of psychiatric morbidity during heatwave, drought, or compound heatwave and drought periods. Multivariate adaptive regression models examined the individual importance of household and community-level determinants in predicting high-risk clustering of mood disorders or suicidality across the three climate threats.

RESULTS

Results showed significant spatial clustering of suicide and mood disorder risks in children during heatwave, drought, and compound event periods. Periods of drought were associated with the highest likelihood of spatial clustering for suicide and mood disorders, where the risk of an ED visit was 4.48 and 6.32 times higher, respectively, compared to non-drought periods. Compounding events were associated with a threefold increase in both suicide and mood disorder-related ED visits. Community and household vulnerability factors that most contributed to spatial clustering varied across climate hazards, but consistent determinants included residential segregation, green space availability, low English proficiency, overcrowding, no broadband access, no vehicle access, housing vacancy, and availability of housing units.

CONCLUSION

Findings advance understanding on the locations of vulnerable pediatric populations who are disproportionately exposed to compounding climate stressors and identify community resilience factors to target in public health adaptation strategies.

Exposure to Residential Green Space and Bone Mineral Density in Young Children

Importance

Bone mass accrual is influenced by environmental and lifestyle factors. Targeted interventions at the early stages of life might decrease fracture and/or osteoporosis risk later in life.

Objective

To investigate whether early-life exposure to residential surrounding green space is associated with a change in bone mineral density in young children.

Design, Setting, and Participants

In this prospective birth cohort study (ENVIRONAGE [Environmental Influence on Aging in Early Life]), mother-child pairs from Flanders, Belgium, were recruited at birth and followed up for 4 to 6 years, between October 1, 2014, and July 31, 2021. Data analysis was conducted between January and February 2022.

Exposures

Green space was estimated for high green (>3 m vegetation height), low green (≤3 m vegetation height ), and total green (sum of high and low) within several radii (100-3000 m) around the residence after geocoding of the addresses.

Main Outcomes and Measures

Radial bone mineral density was assessed using quantitative ultrasound measurement at follow-up, measured as the mean of the axially transmitted speed of sound in meters per second. Multiple linear and logistic regression models were used while accounting for relevant covariates and potential confounders.

Results

The study population comprised 327 children (180 [55.0%] female; mean [SD] age, 4.6 [0.4] years at the follow-up evaluation). Early-life exposure to residential green space was associated with increased childhood bone health. An IQR increment in total green (21.2%) and high green (19.9%) space within 500 m was associated with an increase of 27.38 m/s (95% CI, 9.63-45.13 m/s) and 25.30 m/s (95% CI, 7.93-42.68 m/s) in bone mineral density, respectively. Additionally, an IQR increase in total (25.2%) and high (23.2%) green space within 1000 m was associated with a 67% (odds ratio, 0.33; 95% CI, 0.17-0.61) and 61% (odds ratio, 0.39; 95% CI, 0.18-0.75) lower risk of having a bone density lower than the sex-specific 10th percentile (3567.6 m/s for girls and 3522.8 m/s for boys).

Conclusions and Relevance

In this study of children aged 4 to 6 years, higher bone mineral density and a lower risk of having low bone density were associated with higher residential green space exposure during childhood. These findings highlight the importance of early-life exposure to residential green space on bone health during critical periods of growth and development, with long-term implications.

Integrating the Physical Environment Within a Population Neuroscience Perspective

Population neuroscience recognises the role of the environment in shaping brain, behaviour, and mental health. An overview of current evidence from neuroscientific and epidemiological studies highlights the protective effects of nature on cognitive function and stress reduction, the detrimental effects of urban living on mental health, and emerging concerns relating to extreme weather events and eco-anxiety. Despite the growing body of evidence in this area, knowledge gaps remain due to inconsistent measures of exposure and a reliance on small samples. In this chapter, attention is given to the physical environment and population-level studies as a necessary starting point for exploring the long-term impacts of environmental exposures on mental health, and for informing future research that may capture immediate emotional and neural responses to the environment. Key data sources, including remote sensing imagery, administrative, sensor, and social media data, are outlined. Appropriate measures of exposure are advocated for, recognising the value of area-level measures for estimating exposure over large study samples and spatial and temporal scales. Although integrating data from multiple sources requires consideration for data quality and completeness, deep learning and the increasing availability of high-resolution data present opportunities to build a more complete picture of physical environments. Advances in leveraging detailed locational data are discussed as a subsequent approach for building upon initial observations from population studies and improving understanding of the mechanisms underlying behaviour and human-environment interactions.

Association between greenspace exposure and suicide-related outcomes across the lifespan: A systematic review

A growing number of studies have linked greenspace exposure to suicide, but findings are inconsistent. We conducted a systematic review on the associations between greenspace exposure and suicide-related outcomes (namely, suicide mortality, self-harm, and suicidal ideation) up until January 6, 2023. We used the Mixed Methods Appraisal Tool (or MMAT) to assess the quality of the included studies. In total, 23 studies met our inclusion criteria, consisting of 14 ecological, four cross-sectional, three longitudinal, and two experimental studies. Most studies were published in 2022 and conducted in Europe (n = 10), Asia (n = 7), and North America (n = 5), with one worldwide analysis. Various indicators were used to assess greenspace exposure including objective measures (e.g., level of surrounding greenness, quantity, structural features, tree canopy coverage), and greenspace use (e.g., duration and frequency). Suicide mortality was the most studied outcome (n = 14). Quality assessment showed that most (87 %) of the included observational studies used representative samples. Protective associations of exposure to greenspace were reported for suicide mortality (9/14 or 64 %), self-harm (n = 3/5 or 60 %) and suicidal ideation (n = 4/6 or 67 %), with nine or 36 % studies reporting no association. Most of the included studies adjusted for key covariates such as age, sex, and socioeconomic status at various aggregate levels (e.g., household, city). For greenspace exposure and suicide mortality, studies stratified by sex (n = 10) showed larger protective associations for females (n = 7) than for males (n = 4). However, the included studies showed high heterogeneity in terms of exposure indicators and greenspace definitions. Experimental studies and studies using youth samples were rare. While more research is warranted, preliminary findings suggest protective associations between greenspace exposure and suicide-related outcomes.

Advancing Population Health Through Open Environmental Data Platforms

Data stand as the foundation for studying, evaluating, and addressing the multifaceted challenges within environmental health research. This chapter highlights the contributions of the Canadian Urban Environmental Health Research Consortium (CANUE) in generating and democratizing access to environmental exposure data across Canada. Through a consortium-driven approach, CANUE standardizes a variety of datasets - including air quality, greenness, neighborhood characteristics, and weather and climatic factors - into a centralized, analysis-ready, postal code-indexed database. CANUE's mandate extends beyond data integration, encompassing the design and development of environmental health-related web applications, facilitating the linkage of data to a wide range of health databases and sociodemographic data, and providing educational training and events such as webinars, summits, and workshops. The operational and technical aspects of CANUE are explored in this chapter, detailing its human resources, data sources, computational infrastructure, and data management practices. These efforts collectively enhance research capabilities and public awareness, fostering strategic collaboration and generating actionable insights that promote physical and mental health and well-being.

A systematic review on the relationship between the built environment and children's quality of life

BACKGROUND

Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children's QoL could inform public health programs and urban planning and design.

OBJECTIVE

We aimed to review and synthesize the evidence of the relationship between built environment features and children's QoL.

METHODS

Five research databases were searched for quantitative peer-reviewed studies on children between 2 and 18 years, published in English or German between January 2010 and August 2023. Only primary research was considered. Included studies (n = 17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment framework: (1) neighborhood green and blue space, (2) neighborhood infrastructure, and (3) neighborhood perception.

RESULTS

Green space was positively associated with children's QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed.

CONCLUSIONS

Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent measures of both concepts will help advance this area of research.

Understanding the pathways between the use of urban green spaces and self-rated health: A case study in Mexico City

In recent decades, extensive research has demonstrated the positive impact of urban green spaces (UGS) on public health through several pathways. However, in the context of Latin America, particularly Mexico City, there remains a notable scarcity of evidence linking UGS use to health outcomes and an insufficient understanding of the pathways or factors underlying these associations. Therefore, this study employs Structural Equation Modeling (SEM) to investigate the intricate pathways between UGS use and residents' perceived health in Mexico City, a densely populated urban center. The SEM integrates three key mediators: sentiments towards UGS, UGS quality, and time spent within these spaces. Survey data was collected through an online survey distributed via social media in May 2020 (n = 1,707). The findings indicate a minor yet significant direct link between UGS use and self-reported health (0.0427, p < 0.1). Conversely, the indirect pathways through sentiments towards UGS, UGS quality, and time spent in UGS were highly significant (0.1950, p < 0.01), underscoring their substantial role as mediators in the UGS use-health association. While a comprehensive understanding of the mechanisms linking perceived health to UGS use in Mexico City requires further research, this study proposes that fostering positive sentiments towards UGS, enhancing UGS quality, and encouraging extended visits to green areas could potentially amplify the perceived health benefits associated with UGS use among residents. These insights offer valuable inputs for policymaking, emphasizing the importance of integrating public perspectives to optimize nature-based solutions and broaden their positive impact within Mexico City.

Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study

In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.

Multisystemic approaches to researching young people's resilience: Discovering culturally and contextually sensitive accounts of thriving under adversity

As our understanding of the process of resilience has become more culturally and contextually grounded, researchers have had to seek innovative ways to account for the complex, reciprocal relationship between the many systems that influence young people's capacity to thrive. This paper briefly traces the history of a more contextualized understanding of resilience and then reviews a social-ecological model to explain multisystemic resilience. A case study is then used to show how a multisystemic understanding of resilience can influence the design and implementation of resilience research. The Resilient Youth in Stressed Environments study is a longitudinal mixed methods investigation of adolescents and emerging adults in communities that depend on oil and gas industries in Canada and South Africa. These communities routinely experience stress at individual, family, and institutional levels from macroeconomic factors related to boom-and-bust economic cycles. Building on the project's methods and findings, we discuss how to create better studies of resilience which are able to capture both emic and etic accounts of positive developmental processes in ways that avoid the tendency to homogenize children's experience. Limitations to doing multisystemic resilience research are also highlighted, with special attention to the need for further innovation.

Effects of a School-Based Physical Activity Intervention on Adolescents' Mental Health: A Cluster Randomized Controlled Trial

BACKGROUND

The aim of this study was to evaluate the effectiveness of a school-based multicomponent physical activity intervention on mental health of adolescents.

METHODS

A clustered, randomized, controlled trial was employed in 8 high schools in Dhaka, Bangladesh, which were randomly assigned to either an intervention or control group; 40 students in grades 8 and 9 from each school took part in the trial (n = 160/group). Students in the intervention schools participated in a 12-week physical activity intervention with multiple components (eg, supervised circuits, lunchtime sports, health education, infographics), while control schools received no intervention. Participants completed baseline and postintervention surveys measuring depressive symptoms (Center for Epidemiologic Studies Depression Scale) and life satisfaction (Cantril Ladder), along with other sociodemographic and behavioral characteristics. Linear mixed-effects modeling was used to evaluate the intervention effects.

RESULTS

Depressive symptoms in the intervention group decreased at postintervention, but remained stable in the control group. There was an increase in life satisfaction in the intervention group and a decrease in the control group. Multivariable modeling showed that students in the intervention group had a significantly lower level of depressive symptoms (β = -4.60; 95% confidence interval, -5.76 to -3.46) and higher level of life satisfaction (β = 1.43; 95% confidence interval, 0.77 to 2.10) compared with their counterparts in the control group. Sensitivity analyses supported the positive effects of the intervention.

CONCLUSIONS

Our school-based, multicomponent physical activity intervention is effective in improving mental health indicators in adolescents. Future trials should be ramped up to include schools in rural and regional settings, using robust measures  of mental well-being.

Time trends in associations between neighbourhood and school characteristics and mental health problems among Dutch adolescents

We investigated trends in associations between physical and social neighbourhood and school characteristics and adolescent mental health problems between 2005 and 2017. Nationally representative, repeated cross-sectional data collected in the Netherlands among primary (N = 5,871) and secondary school students (N = 20,778) were analysed through cross-classified multilevel models. Hardly any evidence was found for over-time changes in associations between neighbourhood and school characteristics and adolescent mental health problems. Findings showed that for both groups of students, only social characteristics within the two contexts were associated with adolescent mental health problems. For secondary school students, school effects were larger than neighbourhood effects, while the opposite was true for primary school students. Specifically, primary school students residing in more socially fragmented or lower socioeconomic status (SES) neighbourhoods, and lower SES schools, reported more conduct problems and peer relationship problems. For secondary school students, only the SES of the neighbourhood and the school was associated with all four aspects of mental health problems. Remarkably, the direction of the associations between neighbourhood/ school SES and adolescent mental health problems varied across the different mental health outcomes. More research is warranted to replicate our findings.

Assessing the impact of blue and green spaces on mental health of disabled children: A scoping review

During recent decades, there has been a growing consideration of the role of blue and green spaces on mental health of children, but there is insufficient attention in the literature to the mental health of children with disabilities. This paper presents an overview of the evidence on how blue and green spaces affect the mental health of children with various disabilities. A database search found twenty studies eligible for the review, after several consecutive screening stages. Most studies used a cross-sectional design and were carried out in Europe. The results consistently indicate that blue and green space can reduce emotional, behavioral, and social problems in disabled children. A protective association was found between the level of blue or greenness and depressive and anxiety symptoms. Moreover, in most of the studies there were no significant changes in the result after adjusting for socioeconomic confounders. Generally, there is an identified need for more short-term exposure studies in this area, focusing on the impact of landscape design elements on mental health of disabled children. The findings of this scoping review call on urban planners, health care workers and decision makers to consider appropriate measures and interventions providing more blue and green space exposure to disabled children.

Global issues, local action: exploring local governments use of research in "tackling climate change and its impacts on health" in Victoria, Australia

BACKGROUND

Local government plays an important role in addressing complex public health challenges. While the use of research in this work is important, it is often poorly understood. This study aimed to build knowledge about how research is used by investigating its use by local government authorities (LGAs) in Victoria, Australia in responding to a new legislative requirement to prioritise climate and health in public health planning. The role of collaboration was also explored.

METHODS

Informed by Normalization Process Theory (NPT), this study adopted multiple research methods, combining data from an online survey and face-to-face interviews. Quantitative data were analysed using descriptive statistics; thematic analysis was used to analyse qualitative data.

RESULTS

Participants comprised 15 interviewees, and 46 survey respondents from 40 different LGAs. Research was most commonly accessed via evidence synthesis, and largely used to inform understanding about climate and health. When and how research was used was shaped by contextual factors including legislation, community values and practical limitations of how research needed to be communicated to decision-makers. Collaboration was more commonly associated with research access than use.

CONCLUSIONS

Greater investment in the production and dissemination of localised research, that identifies local issues (e.g. climate risk factors) and is tailored to the communication needs of local audiences is needed to foster more impactful research use in local public health policy.

Associations between the urban environment and psychotic experiences in adolescents

OBJECTIVE

In 2050 two-thirds of the world's population is predicted to live in cities, which asks for a better understanding of how the urban environment affects mental health. Urbanicity has repeatedly been found to be a risk factor, in particular for psychosis. Here, we explored what factors of the urban exposome underlie the association between urban characteristics and psychotic experiences (PE) in adolescents.

METHODS

Participants were 815 adolescents (mean age 14.84 years, SD 0.78) from an at-risk cohort (greater Rotterdam area, the Netherlands) oversampled on their self-reported emotional and behavioral problems. We used linear regression analysis to examine the association with detailed geodata on urbanicity (surrounding address density), green space density (high and low vegetation), and mixed noise levels (road, rail, air, industry, and wind power) with PE in adolescents. Analyses were adjusted for multiple socio-economic and parental confounders. Furthermore, we explored sex-interaction effects.

RESULTS

Higher surrounding address density and low greenspace density were each independently associated with more PE (B = 0.18, 95 % CI 0.02; 0.34 and B = 0.17, 95 % CI 0.01; 0.32, respectively). High mixed noise levels were only associated with more PE in boys (B = 0.23, 95 % CI 0.01; 0.46). A sex-interaction effect was found for high urbanicity (B = -0.46, 95 % CI -0.77; -0.14) and low greenspace density (B = -0.49, 95 % CI -0.73; -0.11), illustrating that these associations with PE were specific for boys.

CONCLUSION

Multiple characteristics of living in an urban area are associated with more PE in adolescent boys. Our observations provide leads for prevention of mental health problems via urban designing.

Protective effect of restorative possibilities on cognitive function and mental health in children and adolescents: A scoping review including the role of physical activity

Background The exposome approach can be a powerful tool for understanding the intertwining of social, physical, and internal influences that shape mental health and cognitive development throughout childhood. To distil conceptual models for subsequent analyses, the EU-funded project Early Environmental quality and Life-course mental health effects (Equal-Life) has conducted literature reviews on potential mediators linking the exposome to these outcomes. We report on a scoping review and a conceptual model of the role of restorative possibilities and physical activity. Methods Peer-reviewed studies published since the year 2000 in English, on the association between the exposome and mental health/cognition in children/adolescents, and quantitatively investigating restoration/restorative quality as a mediating variable were considered. Database searches were last updated in December 2022. We used an unstructured expert-driven approach to fill in gaps in the reviewed literature. Results Five records of three distinct studies were identified, indicating a scarcity of empirical evidence in this newly developing research area. Not only were these studies few in numbers, but also cross-sectional, lending only tentative support to the idea that perceived restorative quality of adolescent's living environment might mediate the association between greenspace and mental health. Physical activity emerged as a mediator leading to better psychological outcomes in restorative environments. We provide a critical discussion of potential caveats when investigating the restoration mechanism in children and propose a hierarchical model including restoration, physical activity, and relational dynamics between children and their environment, including social context, as well as restorative environments other than nature. Conclusions It is justified to further explore the role of restoration and physical activity as mediators in the association between early-life exposome and mental health/cognitive development. It is important to consider the child perspective and specific methodological caveats. Given the evolving conceptual definitions/operationalizations, Equal-Life will attempt to fill in a critical gap in the literature.