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

Built environment and loneliness in later life: productive engagement as the pathway

OBJECTIVES

The built environment is increasingly recognized as being associated with late-life loneliness. However, the pathway remains understudied. This study investigated the mediating effects of productive engagement in relationships between the built environment and loneliness.

METHODS

We conducted a cross-sectional analysis of data from 4,409 community-dwelling people aged 65 years and above in China. We employed the Chinese version of the De Jong Gierveld Loneliness Scale to assess loneliness. The built environment comprises residential density, street connectivity, park-based and vegetation-based green space, land use mix, and the number of and distance to the nearest recreational, health, shopping and community services within 300-meter and 500-meter buffer areas. Structural equation modeling was used.

RESULTS

Only green space (parks) had a direct effect on loneliness. Residential density and green space (parks) had an indirect effect on loneliness through volunteering. The number of recreational services had an indirect effect on loneliness through recreational and sporting activities, although distance to the nearest recreational services did not. All the significant results were only found within 300-meter rather than 500-meter buffers.

CONCLUSIONS

Our findings have implications for environmental gerontology theory and practice. Providing more green space and recreational services can significantly improve older adults' helping behavior, social activities and sporting activities, which can further reduce older adults' loneliness.

Positive relationship between bird diversity and human mental health: an analysis of repeated cross-sectional data

BACKGROUND

An increasing body of research has examined the link between biodiversity of birds and human mental health, but most studies only use cross-sectional data. Few studies have used longitudinal or repeated cross-sectional data to investigate the mental health benefits of bird diversity. The aim of this study is to analyse the relationship between bird diversity and mental health at the national level using a unique repeated cross-sectional dataset.

METHODS

I used repeated cross-sectional health data from the German National Cohort health study, collected between March, 2014, and September, 2019, and annual bird citizen science data to investigate the effects of bird-diversity exposure on mental health. Mental health was measured using the summary score of the Patient Health Questionnaire depression module 9 (SumPHQ) and the Short Form Health Survey-12 Mental Health Component Scale. As a proxy for bird diversity, I created a unique indicator called reporting-rate richness and combined it with the health data. Reporting-rate richness measures the number of bird species within postcode areas across Germany in probabilities while accounting for variation in survey efforts. Alternative indicators of bird diversity, such as bird-species richness or abundance, were also calculated. Associations between bird diversity and mental health were estimated using linear regression with region and time fixed effects, adjusted for a range of sociodemographic and environmental confounders and spatial autocorrelation. Interaction terms between income levels and reporting-rate richness were also analysed to examine the moderating effect of socioeconomic status.

FINDINGS

I did the analyses for an unbalanced (n=176 362) and balanced (n=125 423) dataset, with the balanced dataset comprising only regions (postcode areas) in which health data were available for each year. The linear fixed-effects regression analysis indicated a significant negative association between reporting-rate richness and SumPHQ, as observed in both the unbalanced dataset (β -0·02, p=0·017) and the balanced dataset (β -0·03, p=0·0037). Similarly, regression results with both datasets showed a positive relationship between reporting-rate richness and Mental Health Component Scale (MCS; unbalanced β 0·02, p=0·0086; balanced β 0·03, p=0·0018). The moderator analyses revealed a significant influence of socioeconomic status on the relationship between reporting-rate richness and mental health. The robustness of these findings was confirmed through sensitivity analyses.

INTERPRETATION

The results suggest that a greater likelihood of having many different bird species in a person's area of residence might positively contribute to mental health, especially for people with lower socioeconomic status. These findings could have implications for biodiversity conservation and health policy decisions, as governments are facing challenges such as global biodiversity loss and growing public mental health problems.

FUNDING

None.

Current methodologies of greenspace exposure and mental health research-a scoping review

Introduction

Greenspaces can provide an important resource for human mental health. A growing body of literature investigates the interaction and the influence of diverse greenspace exposures. In order to gain a comprehensive understanding of the complex connection between greenspace and mental health, a variety of perspectives and methodological combinations are needed. The aim of this review is to assess the current methodologies researching greenspace and mental health.

Methods

A scoping review was conducted. Four electronic databases (Pubmed, Embase, PsycInfo, Web of Science) were searched for relevant studies. A wide range of greenspace and mental health keywords were included to provide a comprehensive representation of the body of research. Relevant information on publication characteristics, types of greenspaces, mental health outcomes, and measurements of greenspace exposure and mental health was extracted and assessed.

Results

338 studies were included. The included studies encompassed a multitude of methods, as well as outcomes for both greenspace and mental health. 28 combinations were found between seven categories each for greenspace and mental health assessment. Some pairings such as geoinformation systems for greenspace assessment and questionnaires investigating mental health were used much more frequently than others, implying possible research gaps. Furthermore, we identified problems and inconsistences in reporting of greenspace types and mental health outcomes.

Discussion

The identified methodological variety is a potential for researching the complex connections between greenspace and mental health. Commonly used combinations can provide important insights. However, future research needs to emphasize other perspectives in order to understand how to create living environments with mental health benefits. For this purpose, interdisciplinary research is necessary.

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.

Understanding Newcomer Challenges and Opportunities to Accessing Nature and Greenspace in Riverdale, Hamilton, Ontario: A Neighborhood-Centered Photovoice Study

BACKGROUND

Access to and engagement with greenspace is related to improved health benefits. We sought to collaborate with community members as partners in research and co-creators in knowledge to better understand which components within a newcomer-dense community help or hinder individual and community efforts to access greenspace and nature-based activities.

METHODS

We used photovoice methodology to engage with local residents in focus groups, photowalks, and photo-elicitation interviews. Themes were developed using direct content analysis.

RESULTS

A total of 39 participants (ages 11-70 years; median years in Canada of 3.25 years) were engaged in this program of research. From the analysis, we developed four themes: (a) peace and beauty; (b) memories of home; (c) safety and cleanliness; and (d) welcoming strengthened and new opportunities. Participants associated nature with peace, citing it as "under-rated" but "vital" to the neighborhood. Via photographs and stories, participants also shared a multitude of safety concerns that prevent their access to green/outdoor spaces for healthy active living programs or activities (e.g., woodchip-covered playgrounds, ample amounts of garbage littering the park and school grounds, lack of timely ice removal on sidewalks, limited safe biking paths, and unsafe motor vehicle practices at the crosswalks surrounding local parks).

CONCLUSION

To translate the key ideas and themes into an informed discussion with policy and decision-makers, we held an in-person exhibition and guided tour where community members, the lead photovoice researcher, and SCORE! principal investigator shared information about each theme in the form of a pseudo-narrative peppered with prepared discussion questions.

The impact of COVID-19 lockdown on postpartum mothers in London, England: An online focus group study

Aims

This study examines the impact of COVID-19 lockdown on postpartum mothers in England, with the aim of identifying opportunities to improve maternal experience and wellbeing. The postpartum/postnatal period is widely acknowledged as a time when mothers require greater levels of support from multiple sources. However, stay-at-home orders, commonly known as "lockdown," deployed in some countries to limit COVID-19 transmission reduced access to support. In England, many postpartum mothers navigated household isolation within an intensive mothering and expert parenting culture. Examining the impact of lockdown may reveal strengths and weaknesses in current policy and practice.

Subject and methods

We conducted online focus groups involving 20 mothers living in London, England, with "lockdown babies," following up on our earlier online survey on social support and maternal wellbeing. We thematically analysed focus group transcripts, and identified key themes around Lockdown Experience and Determinants of Lockdown Experience.

Results

Participants raised some positives of lockdown, including fostering connections and protection from external expectations, but also raised many negatives, including social isolation, institutional abandonment, and intense relationships within the household. Potential reasons behind variations in lockdown experience include physical environments, timing of birth, and number of children. Our findings reflect how current systems may be "trapping" some families into the male-breadwinner/female-caregiver family model, while intensive mothering and expert parenting culture may be increasing maternal stress and undermining responsive mothering.

Conclusions

Facilitating partners to stay at home during the postpartum period (e.g., increasing paternity leave and flexible working) and establishing peer/community support to decentre reliance on professional parenting experts may promote positive postpartum maternal experience and wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01922-4.

Perceived Social Support Mediates the Relationship between Use of Greenspace and Geriatric Depression: A Cross-Sectional Study in a Sample of South-Italian Older Adults

A growing body of evidence is suggestive for the beneficial role of contact with greenspace (e.g., use of greenspace, visual access to greenspace, etc.) on mental health (e.g., depression, anxiety, etc.). In addition, several studies have pointed out the benefits of social support and social interaction on psychological wellbeing. Even if evidence on the association between contact with greenspace and perceived social support were mixed, it was supposed that the use of greenspace could enhance social interactions and perceived social support, especially among older adults. The present study aims to explore the effect of use of greenspace on geriatric depression in a sample of South-Italian older adults and the mediating role of perceived social support in this association. A structural equation model was tested in a sample of 454 older adults (60-90 years old) residing in the Metropolitan Area of Bari, Apulia. The fit indices revealed the goodness of fit of the model (CFI = 0.934; TLI = 0.900; IFI = 0.911; NFI = 0.935; RMSEA = 0.074; SRMR = 0.056). Results showed that the use of greenspace was inversely associated with geriatric depression through perceived social support. These findings underlined the relevance of perceived social support on the pathway linking use of greenspace and geriatric depressive symptoms. This evidence may be useful to policymakers to plan interventions for promoting physical access to greenspace and social participation in an age-friendly city framework.

Covid-19 and outdoor recreation - Lessons learned? Introduction to the special issue on "Outdoor recreation and Covid-19: Its effects on people, parks and landscapes"

The special issue presents international experiences with COVID-19 in the years 2020 and 2021 on outdoor recreation and nature-based tourism. To set the scene, a bibliometric and qualitative analysis illustrates and clusters recent publications on COVID-19. Against this background contributions from Japan, China, Brazil, Indonesia, Austria, Croatia, the United States, New Zealand, Taiwan, Australia, Sweden, Poland and Ireland draw a truly international picture of the pandemic crisis, the effects, coping behavior and related strategies. The papers contribute to the COVID-19 related research by documenting the shock in the field of outdoor recreation and tourism, by understanding the immediate consequences on behavior and the required managerial consequences and finally, by analyzing the possible follow up effects including long term effects, discussing resilient solutions and proposing new strategies. In the discussion section we try to answer the questions whether the high visitation rate in recreation facilities, forests, parks and protected areas will remain, and whether adapted visitor management concepts will be required. In addition, we discuss possible implications for urban planning and management. Finally, based on a changing connectedness to nature also possible positive effects by the pandemic are discussed which may lead to a new target group in outdoor recreation and nature-based tourism.

Management implications

The overview on the Covid-19 related literature suggests improvements in planning and management, such as-new concepts for destination and visitor management, considering an ongoing risk-management,-proactive urban planning and management considering short-term effects in the existing built environment as well as a long-term perspective with strategically planned green infrastructure, including not only the supply of green infrastructure, but also its accessibility, its amenities, and aspects of environmental justice,-the consideration of new target groups in tourism and outdoor recreation.

Psychological Benefits of Attending Forest School for Preschool Children: a Systematic Review

Forest school is a form of outdoor learning that takes children into regular and repeated learning experiences in natural settings. Being based on a comprehensive experience with nature, it is assumed to be beneficial for learning and to promote restorative effects on cognitive and emotional function in preschool children. This review aimed to examine the available evidence on the benefits of forest school compared to indoor school activities in children aged 3 to 6 years. We searched for studies on forest school for preschool children in PsycInfo, JSTOR, and Scopus, with no restriction on publication year. The risk of bias was assessed using Joanna Briggs’s criteria for quasi-experimental design. Of the 190 articles identified, 16 studies were reviewed (N = 1560). Higher benefits were found in children attending forest school compared to those attending indoor school in various areas of child development: cognitive function, motor coordination and balance, connectedness to nature, and health and well-being outcomes. There is, however, still a shortage of empirical evidence, and the methodological quality of most studies was limited. The literature on forest schools for preschool children in general supports positive effects in a wide range of variables that promote child health and development, but more evidence is needed to assess their effectiveness. Due to the methodological weaknesses of the reviewed studies, one should interpret their findings with caution.

Encouraging planting in urban front gardens: a focus group study

AIMS

Encouraging planting in front gardens offers mental and physical health benefits, as well as positive local environmental impacts such as reducing flood risk and improving air quality. However, urban front garden greenery has reduced in recent years. We aimed to explore adults' views regarding planting greenery in front gardens, barriers and facilitators, and their understanding of health and environmental impacts, to identify appropriate intervention mechanisms for behaviour change.

METHODS

We carried out five online focus groups with 20 participants aged 20-64 in England, purposively sampled for variation according to age, gender, home ownership, income, ethnicity and residing in an urban or suburban area. We audio recorded each focus group, transcribed it verbatim and analysed transcripts using thematic analysis.

RESULTS

Front gardening was a relaxing activity that provided benefits including increased wellbeing, fresh air and vitamin D. Planting in front gardens depended heavily on available time and space, garden orientation, local security and the weather. Front gardens could be a place for social interaction. Participants tended to prioritise neatness and tidiness over greenery. Lack of knowledge and low self-efficacy were key barriers. There was little awareness of the environmental benefits of front garden greenery; however, reducing flood risk and encouraging biodiversity were viewed positively.

CONCLUSION

Initiatives to encourage front garden planting should focus on plants that require little knowledge to acquire and care for, are suitable to the local environmental conditions and with a visual impact of neatness and bright colour. Campaigns should draw attention to local flood risk reduction and increasing biodiversity, in addition to personal health benefits.

The short term adaptation of the autonomic nervous systems (ANS) by type of urban environment and ethnicity

BACKGROUND

Previous studies examined the effects of urban environments on the Autonomic Nervous System (ANS). These studies measured the effects of environments on Heart Rate Variability (HRV) averaging different time intervals to one value. Yet, the dynamics of change, reflecting the functions and their derivatives that describe the adaptation to the new environments remain unknown. In addition, ethnic differences in the ANS adaptation were not investigated.

METHOD

Forty-eight Arab and 24 Jewish women ages 20-35 years, all healthy, non-smokers were recruited by a snowball sample. Both groups were of a similar socioeconomic status and BMI distributions. Using a portable monitor, the HRV response was continuously analyzed for 35 min of sedentary sitting in each of the three environments: a park, a city center and a residential area. LF/HF polynomial function was adapted to describe the dynamic change in each environment for each ethnic group.

RESULTS

Green area exposure was associated with 90% immediate change while in built-up areas, the change in HRV is about 40% adaptive (changing gradually). The adaptive process of HRV may stabilize after 15 min in the city center yet not even after 35 min in the residential environment. The total change (immediate + adaptive) reached 24% in city centers and 10% in residential areas. Changes in HRV rates in the park and the city center environments were higher among Arab women as compared to Jewish women but similar between the two groups in the residential area. The distributions of LF/HF in each time cohort were normal, meaning that shifting the focus to analyze functions of change in HRV, opens the possibility to employ analytic methods that assume the normal distribution.

CONCLUSIONS

Changing the focus from average levels of HRV to functions of change and their derivatives brings new insight into the understanding of the ANS response to environmental challenges. ANS short term adaptation to different environments is gradual and spans differently both in magnitude of response and latencies between different environments. Importantly, in green areas, the response is immediate unlike the adaptation to urban environments that is significantly more gradual. The ethnic differences in ANS adaptation is also noteworthy. In addition, adaptation proceeesses are normaly distributed in each time cohort suggesting a possible novel ANS index.

Convergence Analysis of Cross-Province Human Well-Being in China: A Spatiotemporal Perspective

China's economy has been experiencing a new development mode that emphasizes an environmentally friendly green economy and high living standards. The concept of human well-being has become increasingly prominent in recent years to replace GDP per capita as an important indicator for evaluating happiness. In the context of the green economy, it is of great significance to incorporate environmental indicators for evaluating human well-being. To this end, this paper constructs a new human well-being evaluation indicator system including environmental sustainability, and then evaluates the well-being levels of 30 provinces in China from 2011 to 2020 using a comprehensive evaluation method. Then, various statistical methods and visualization methods are used to deeply analyze the spatiotemporal changes in the well-being scores of Chinese provinces during the sample period. Finally, the spatial convergence model was used to verify if cross-province well-being scores would converge to a common steady state. The findings are as follows. (1) The scores of the environmental sustainability subsystem greatly vary from province to province. This is because the local governments have attached great importance to the construction of green ecological civilization in recent years, thus increasing the investment in protecting the ecological environment. (2) From temporal dimensions, overall human well-being scores of 30 provinces slightly increased year after year. In geography, eastern provinces have the highest human well-being scores, followed by northeast, northwest, and southwest provinces. (3) In terms of the scores of the four subsystems, we find that nearly all provinces have their advantages and disadvantages. (4) From the results of the spatial convergence models, both absolute and conditional β convergence have been verified, indicating that the human well-being of all provinces will converge to the common steady state in the future.

Neighborhood Beauty and the Brain in Older Japanese Adults

People have a preference for, and feel better in, beautiful natural environments. However, there are no epidemiological studies on the association between neighborhood beauty and neuroimaging measures. We aimed to determine association between neighborhood beauty and regional brain volume. Participants were 476 community-dwelling older adults from the Neuron to Environmental Impact across Generations (NEIGE) study. Subjective neighborhood beauty was assessed through participants’ perception of beautiful scenery within 1 km of their home. Objective measures of neighborhood indicators (green spaces, blue spaces, and plant diversity) within 1 km of participants’ homes were obtained using a geographic information system. Volumes of brain regions associated with experience of beauty were measured using magnetic resonance imaging. We estimated associations between neighborhood beauty and regional brain volume using linear regression. Of the participants, 42% rated their neighborhoods as very beautiful, and 17% rated them as not at all beautiful. Higher subjective neighborhood beauty was associated with larger bilateral medial orbitofrontal cortex and insula volumes (all p for trend < 0.01). Brain volume was not associated with objective neighborhood measures. Subjective neighborhood beauty was associated with brain regions related to rewards and decision making, suggesting that these brain regions underpin the perception of neighborhood beauty.

"Dignity as a Small Candle Flame That Doesn't Go Out!": An Interpretative Phenomenological Study with Patients Living with Advanced Chronic Obstructive Pulmonary Disease

Long-term illness, such as chronic obstructive pulmonary disease (COPD), can expose people to existential suffering that threatens their dignity. This qualitative study explored the lived experiences of patients with advanced COPD in relation to dignity. An interpretative phenomenological approach based on lifeworld existentials was conducted to explore and understand the world of the lived experience. Twenty individuals with advanced COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) were selected using a purposive sampling strategy. In-depth interviews were used to collect data, which were then analysed using Van Manen's phenomenology of practice. The existential experience of dignity was understood, in essence, as "a small candle flame that doesn't go out!". Four intertwined constituents illuminated the phenomenon: "Lived body-balancing between sick body and willingness to continue"; "Lived relations-balancing between self-control and belongingness"; "Lived Time-balancing between past, present and a limited future"; and "Lived space-balancing between safe places and non-compassionate places". This study explains how existential life phenomena are experienced during the final phases of the COPD trajectory and provides ethical awareness of how dignity is lived. More research is needed to investigate innovative approaches to manage complex care in advanced COPD, in order to assist patients in discovering their inner resources to develop and promote dignity.

The association between adverse childhood experiences, neighborhood greenspace, and body mass index: A cross-sectional study

An association between adverse childhood experiences (ACEs) and elevated body mass index (BMI) has been found in previous investigations. ACEs' effects on BMI have been primarily considered via individual-level physiological and behavioral frameworks. Neighborhood factors, such as greenspace, are also associated with BMI and may merit consideration in studies examining ACEs-BMI associations. This exploratory study examined associations of BMI with ACEs and neighborhood greenspace and tested whether greenspace moderated ACEs-BMI associations. Methods entailed secondary analysis of cross-sectional data. ACEs and BMI were captured from 2012/2013 Philadelphia ACE Survey and 2012 Southeastern Household Heath Survey data; greenspace percentage in participants' (n = 1,679 adults) home neighborhoods was calculated using National Land Cover Database data. Multi-level, multivariable linear regression 1) examined associations between BMI, ACEs, (0 ACEs [reference], 1-3 ACEs, 4 + ACEs), and neighborhood greenspace levels (high [reference], medium, low) and 2) tested whether greenspace moderated the ACEs-BMI association (assessed via additive interaction) before and after controlling for sociodemographic and health-related covariates. Experiencing 4 + ACEs (β = 1.21; 95 %CI: 0.26, 2.15; p = 0.01), low neighborhood greenspace (β = 1.51; 95 %CI: 0.67, 2.35; p < 0.01), and medium neighborhood greenspace (β = 1.37; 95 %CI: 0.52, 2.21; p < 0.01) were associated with BMI in unadjusted models. Only low neighborhood greenspace was associated with BMI (β = 0.95; 95 %CI: 0.14, 1.75; p = 0.02) in covariate-adjusted models. The ACEs-greenspace interaction was not significant in unadjusted (p = 0.89-0.99) or covariate-adjusted (p = 0.46-0.79) models. In conclusion, when considered simultaneously, low neighborhood greenspace, but not ACEs, was associated with BMI among urban-dwelling adults in covariate-adjusted models.

Urban greenspace and anxiety symptoms during the COVID-19 pandemic: A 20-month follow up of 19,848 participants in England

This study examined the association between greenspace and the growth trajectories of anxiety symptoms during the COVID-19 pandemic. Using data from 19,848 urban residents in England who were followed for 20 months between March 2020 and October 2021, we found that living in an area with higher greenspace coverage (exposure) was associated with fewer anxiety symptoms independent of population density, area deprivation levels, socio-demographics, and health profiles. There was limited evidence that greenspace was related to the change of anxiety symptoms over time. No association with anxiety trajectories was found when considering distance to nearest greenspace (proximity), highlighting potentially differential mental health effects of simply having access to local parks and recreation areas versus living in areas of greater natural environment land cover. These findings have important implications for mental health intervention and policymaking.

Daily space-time activities, multiple environmental exposures, and anxiety symptoms: A cross-sectional mobile phone-based sensing study

BACKGROUND

Few mobility-based studies have investigated the associations between multiple environmental exposures, including social exposures, and mental health.

OBJECTIVE

To assess how exposure to green space, blue space, noise, air pollution, and crowdedness along people's daily mobility paths are associated with anxiety symptoms.

METHODS

358 participants were cross-sectionally tracked with Global Positioning System (GPS)-enabled mobile phones. Anxiety symptoms were measured at baseline using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire. Green space, blue space, noise, and air pollution were assessed based on concentric buffers of 50 m and 100 m around each GPS point. Crowdedness was measured by the number of nearby Bluetooth-enabled devices detected along the mobility paths. Multiple linear regressions with full covariate adjustment were fitted to examine anxiety-environmental exposures associations. Random forest models were applied to explore possible nonlinear associations and exposure interactions.

RESULTS

Regression results showed null linear associations between GAD-7 scores and environmental exposures. Random forest models indicated that GAD-7-environment associations varied nonlinearly with exposure levels. We found a negative association between green space and GAD-7 scores only for participants with moderate green space exposure. We observed a positive association between GAD-7 scores and noise levels above 60 dB and air pollution concentrations above 17.2 μg m^-3. Crowdedness was positively associated with GAD-7 scores, but exposure-response functions flattened out with pronounced crowdedness of >7.5. Blue space tended to be positively associated with GAD-7 scores. Random forest models ranked environmental exposures as more important to explain GAD-7 scores than linear models.

CONCLUSIONS

Our findings indicate possible nonlinear associations between mobility-based environmental exposures and anxiety symptoms. More studies are needed to obtain an in-depth understanding of underlying anxiety-environment mechanisms during daily life.

Build Healthier: Post-COVID-19 Urban Requirements for Healthy and Sustainable Living

The COVID-19 pandemic has brought a renewed interest in urban environment and healthy living and the changes in urban environments which can make for a healthier living. Today, more than 50% of the global population lives in urban areas, and in Europe the number is 75%. We present a narrative review to explore considerations and necessary requirements to achieve health and well-being within strategies for healthy design and urban planning whilst rethinking urban spaces for a post-COVID-19 and carbon-neutral future. The achievement of health and well-being demands healthy design strategies, namely, (1) moving from the concept of infrastructure for processes to the infrastructure for healthy living—requirements for healthy places, cycling, walking, disintegrating the role of polluting traffic from the urban environments, social vulnerability and equality; (2) physical space that will achieve standards of ‘liveable communities’—open, green space requirements and standards for any built environment; (3) mainstreaming ‘in-the-walking distance’ cities and neighbourhoods for healthy physical activities for daily living; (4) exploring any of the new concepts that connect the nexus of urban spaces and public health and improving of the population’s well-being. Public health needs to be prioritised systematically in planning of built environments, energy generations, sustainable food production, and nutrition.

The relationship between greenspace and personal exposure to PM2.5 during walking trips in Delhi, India

The presence of urban greenspace may lead to reduced personal exposure to air pollution via several mechanisms, for example, increased dispersion of airborne particulates; however, there is a lack of real-time evidence across different urban contexts. Study participants were 79 adolescents with asthma who lived in Delhi, India and were recruited to the Delhi Air Pollution and Health Effects (DAPHNE) study. Participants were monitored continuously for exposure to PM_2.5 (particulate matter with an aerodynamic diameter of less than 2.5 μm) for 48 h. We isolated normal day-to-day walking journeys (n = 199) from the personal monitoring dataset and assessed the relationship between greenspace and personal PM_2.5 using different spatial scales of the mean Normalised Difference Vegetation Index (NDVI), mean tree cover (TC), and proportion of surrounding green land use (GLU) and parks or forests (PF). The journeys had a mean duration of 12.7 (range 5, 53) min and mean PM_2.5 personal exposure of 133.9 (standard deviation = 114.8) μg/m³. The within-trip analysis showed weak inverse associations between greenspace markers and PM_2.5 concentrations only in the spring/summer/monsoon season, with statistically significant associations for TC at the 25 and 50 m buffers in adjusted models. Between-trip analysis also indicated inverse associations for NDVI and TC, but suggested positive associations for GLU and PF in the spring/summer/monsoon season; no overall patterns of association were evident in the autumn/winter season. Associations between greenspace and personal PM_2.5 during walking trips in Delhi varied across metrics, spatial scales, and season, but were most consistent for TC. These mixed findings may partly relate to journeys being dominated by walking along roads and small effects on PM_2.5 of small pockets of greenspace. Larger areas of greenspace may, however, give rise to observable spatial effects on PM_2.5, which vary by season.

How Gardening in Detroit Influences Physical and Mental Health

Gardening has the potential to improve health by providing access to nature, vegetables, and physical activity. However, scarce research exists on the health impacts of gardening on racial and ethnic minority urban populations in the United States. This study used qualitative interviews to examine the perceived physical and mental health effects of gardening in a primarily African American sample of 28 gardeners. Prominent physical health impacts attributed to gardening included providing an enjoyable source of activity, management of chronic diseases, and improved physical functioning. Participants also reported that gardening improved their mood, relieved stress, was an important part of their spirituality, contributed to their personal growth, and provided an opportunity for helping others. These findings suggest that gardening may improve physical and mental health among diverse groups.

Reciprocal Inclusion of Microbiomes and Environmental Justice Contributes Solutions to Global Environmental Health Challenges

Generations of colonialism, industrialization, intensive agriculture, and anthropogenic climate change have radically altered global ecosystems and by extension, their environmental microbiomes. The environmental consequences of global change disproportionately burden racialized communities, those with lower socioeconomic status, and other systematically underserved populations. Environmental justice seeks to balance the relationships between environmental burden, beneficial ecosystem functions, and local communities. Given their direct links to human and ecosystem health, microbes are embedded within social and environmental justice. Considering scientific and technological advances is becoming an important step in developing actionable solutions to global equity challenges. Here we identify areas where inclusion of microbial knowledge and research can support planetary health goals. We offer guidelines for strengthening a reciprocal integration of environmental justice into environmental microbiology research. Microbes form intimate relationships with the environment and society, thus microbiologists have numerous and unique opportunities to incorporate equity into their research, teaching, and community engagement.

Urgent Biophilia: Green Space Visits in Wellington, New Zealand, during the COVID-19 Lockdowns

Urgent biophilia describes the conscious desire of humans to seek interactions with nature during periods of stress. This study examines the changes in frequency and reason for visiting urban green spaces by residents of Wellington, New Zealand, to determine whether resident behavior during a stressful period exemplifies the principles of urgent biophilia. The COVID-19 pandemic and resulting lockdowns were used as the study period due to the significant physical and mental health stressors they triggered. Pedestrian and cyclist counters located in key urban green spaces in Wellington were used to collect data on visits pre- and post-pandemic. Two surveys were used to assess residents’ reasons for visiting urban green spaces during lockdowns. Increased green space visits were seen during the strictest lockdowns, though there was some variation in visits depending on the location of the green space. The most frequently reported reason for visiting green spaces during lockdown was mental wellbeing, followed by recreation. These results suggest that Wellington residents used urban green spaces as a coping mechanism during stressful lockdown periods for wellbeing benefits, exemplifying the principles of urgent biophilia. Urban planners and policymakers must consider and implement urban green infrastructure as a public health resource.

Experiencing Urban Green and Blue Spaces in Urban Wetlands as a Nature-Based Solution to Promote Positive Emotions

Green and blue spaces are nature-based solutions (NBSs) that evoke positive emotions of experiencers therein. There is an impetus to optimize wetland forest landscapes by planning the geographical arrangement of metrics that promote positive emotion. The facial expressions of nature experiencers in photos, downloaded from social media databases with landscape metrics, were evaluated for emotions and given scores. Happy and sad scores were rated by FireFACE v1.0 software and positive response index (PRI) was calculated as happy score minus sad score. Spatial areas and tree height were evaluated from Landsat 8 images and digital model maps, respectively. Visitors at middle and senior ages smiled more frequently in southern parts than in northern parts, and females had higher happy scores and PRI than males. Both green- and blue-space areas had positive relationships with PRI scores, while blue spaces and their area to park area ratios had positive contributions to happy scores and PRI scores in multivariate linear regression models. Elevation had a negative relationship with positive facial emotion. Overall, based on spatial distributions of blue-space area and elevation, regional landscape was optimized so people perceived more happiness in wetlands around Zhejiang and Shanghai, while people in wetlands of Jiangxi and Hubei showed more net emotional expressions.

Residential greenness and hair cortisol levels during the first trimester of pregnancy

BACKGROUND AND AIM

Studies have shown that increased maternal cortisol level is associated with child adverse health outcomes. Hair cortisol (HC) is suitable for assessing long-term circulating cortisol concentration. Only two previous studies reported beneficial associations between cortisol and residential greenness during pregnancy and no study focused on the first trimester. Our aim was to evaluate the association between residential greenness and first trimester HC levels among pregnant women in Israel.

METHODS

Women were recruited during second and third trimesters. Hair samples were collected from the scalp and retrospective HC levels during the first trimester were quantified for 217 women. HC levels were natural log transformed and outliers were excluded. Based on geocoded birth address, small area sociodemographic status (SES) and mean residential surrounding greenness were calculated using high-resolution satellite-based Normalised Difference Vegetation Index (NDVI) data at 100, 300 and 500-m buffers in a cross-sectional approach. In addition, longitudinal exposure to mean greenness during a week preconception and during the first trimester were calculated. Missing covariates were imputed and linearity of the associations were evaluated. Generalized linear models were used to estimate the crude and adjusted associations controlled for the relevant covariates.

RESULTS

After exclusion of outliers, for 211 women, crude and adjusted beneficial associations between exposure to higher mean NDVI and HC levels were observed for all the exposure measures. An increase in 1 interquartile range of greenness (100 m buffer) was associated with a statistically significant lower estimated natural log mean HC level (-0.27 95% CI: -0.44; -0.11). The associations were robust to adjustment for covariates. The findings were consistent for different buffers, for the longitudinal approach, when all observations were included in the analysis and slightly stronger associations were observed for women with addresses geocoded at the home or street level. For most of the exposure measures, stronger associations were observed among those of lower sociodemographic status.

CONCLUSION

Our findings that more greenness associated with reduced maternal cortisol levels measured in the hair during the first trimester, could have substantial implications for urban planners and public health professional. If our observations will be replicated, it may present a useful avenue for public-health intervention to promote health through the provision of greenness exposure during early pregnancy, specifically to disadvantage populations.

Association between neighborhood environments and suicidal ideation among Korean adults

BACKGROUND

The relationship between neighborhood environments and suicide has not been well studied. In the present study, relations between suicidal ideation and social and physical environments were investigated in Korean adults.

METHODS

This nationwide cross-sectional study was conducted using data from the 2013 Korea Community Health Survey. The final analysis included 221,038 individuals aged ≥ 19 years. A multivariate regression model was used to examine the independent effects of environments on suicidal ideation.

RESULTS

Approximately 9.4% of participants had experienced suicidal ideation. Stepwise multivariate regression analysis showed that trusting neighbors and all five physical environments were independently associated with suicidal ideation. As regards physical environments, relations with suicidal ideation varied across subgroups: satisfaction with overall safety was to be strongly and consistently related to less suicidal ideation.

LIMITATIONS

Causality and the impact of unmeasured confounders were not addressed.

CONCLUSION

Neighborhood environments may reduce suicidal ideation.

Ethnic Differences in Environmental Restoration: Arab and Jewish Women in Israel

Throughout the last few decades, plenty of attention has been paid to restorative environments that positively affect human psychological health. These studies show that restorative environments affect human beings emotionally, physiologically, and cognitively. Some studies focus on the cognitive effects of exposure to restorative environments. A widely used index that measures the cognitive response is the Perceived Restoration Potential Scale (PRS). Most studies employing the PRS have examined differences in human cognitive response between types of urban environments mainly urban versus green ones. We use Hartig's questionnaire to expose differences between types of urban environments and ethnic groups. Variances between Arab and Jewish women were calculated in four environments: home; park; residential and central city environments. The effect of intervening variables such as exposure to thermal, noise, social and CO loads and social discomfort were tested. We find that dissimilar to urban typical built-up environments, green areas are highly restorative. Furthermore, differences in the restorativeness of different urban environments are low though significant. These differences depend on their function, aesthetic qualities, and amount of greenery. Ethno-national differences appear to affect the experience of restoration. While both ethnic related groups experienced a tremendous sense of restoration in parks, Jewish women enjoyed slightly higher levels of restoration mainly at home and in residential environments compared to Arab women who experienced higher sense of restorativness in central city environments. Jewish women experienced higher sense of being away and fascination. From the intervening variables, social discomfort explained 68 percent of the experience of restoration, noise explained 49 percent, thermal load explained 43 percent and ethnicity 14 percent of the variance in PRS.

Evaluating and comparing the green wall retrofit suitability across major Australian cities

Urban densification continues to present a unique set of economic and environmental challenges. A growing shortage of green space and infrastructure is intrinsically linked with urban growth and development. With this comes the loss of ecosystem services such as urban heat island effects, reduction of air quality and biodiversity loss. Vertical greenery systems (VGS) offer an adaptive solution to space-constrained areas that are characteristic of dense urban areas, and can potentially improve the sustainability of cities. However, in order to promote VGS uptake, methods are required to enable systematic appraisal of whether existing walls can be retrofitted with VGS. Further, feasibility studies that quantify the potential for retrofit suitability of VGS across entire urban areas are lacking. This study established an evaluation tool for green wall constructability in urban areas and validated the assessment tool by determining the quantity of walls in five major Australian cities that could potentially have VGS incorporated into the existing infrastructure. Each wall was analysed using an exclusionary set of criteria that evaluated and ranked a wall based on its suitability to VGS implementation. Sydney and Brisbane recorded the greatest proportional length of walls suitable for VGS, with 33.74% and 34.12% respectively. Conversely, Perth's urban centre was the least feasible site in which to incorporate VGS, with over 97% of surveyed walls excluded, mainly due to the prevalence of <1 m high fence lines and glazed shopfronts. This study aimed to evaluate feasibility assessments of green wall retrofitability in highly urbanised areas with the intention of creating an analytical method that is accessible to all. This method, coupled with the promising number of feasible walls found in this study, emphasises the need for more government policy and incentives encouraging green wall uptake and could play a pivotal role in the expansion of green infrastructure and urban forestry.

Do we know enough to quantify the impact of urban green spaces on mortality? An analysis of the current knowledge

OBJECTIVES

The addition of green spaces (GS) in cities is perceived as an efficient solution to combat climate change and biodiversity loss while also improving human health. Quantitative health impact assessment (QHIA) is a powerful tool to assess the health benefits of GS and support policy-making decisions. In France, a preliminary analysis of the literature led to the decision of developing guidance for QHIA applied to GS and mortality. This paper focuses on the choice of exposure-response functions (ERF) for those QHIA.

STUDY DESIGN

Literature review and analysis of the key steps of QHIA.

METHODS

Articles providing ERF for all-cause, cardiovascular and respiratory mortality in relation to GS were identified through a literature review and ranked based on a quality score. ERF from the articles with the highest scores was pooled in meta-analyses.

RESULTS

In total, 13 ERF were selected for all-cause mortality, 10 for cardiovascular mortality and 5 for respiratory mortality. Meta-risk for a 0.1 increase in the normalised differential vegetation index were, 0.96 (95% confidence interval [CI] 0.94; 0.97), 0.98 (95% CI 0.96; 0.99) and 0.97 (95% CI 0.92; 1.02) for all-cause, cardiovascular and respiratory mortality, respectively.

CONCLUSIONS

While current knowledge makes it possible to use QHIA on GS and mortality, interdisciplinary research is still needed to clarify the shape of the relationship and its temporality and to assess exposure in a meaningful way for decision-making.

Green Space and Health in Mainland China: A Systematic Review

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China's rapid urbanization and economic growth.

Role of Restorativeness in Improving the Psychological Well-Being of University Students

Many university students experience high levels of study-related fatigue, hence, necessitating opportunities for restoration. They could potentially benefit from campus-based physical activities that provide them with effective restoration breaks and allow them to return to their studies cognitively refreshed. Thus, a cross-sectional study was conducted to assess the association between perceived restorativeness among postgraduates and their psychological well-being by using the four constructs of Kaplan's attention restoration theory (ART): fascination, being away, extent, and compatibility. In this study, nature view windows were also used as a moderator. Malaysian postgraduate students [n = 192; 94 females; age in years (M = 30.64, SD = 2.73)] completed the Ryff's scale of psychological wellbeing (PWB) and perceived restorativeness scale for activity (PRAS). This study used the partial least squares-structural equation model (PLS-SEM) to examine these relationships. The results demonstrate that three ART constructs, namely, being away, fascination, and compatibility, are significant predictors of psychological well-being across the sample size. Furthermore, for participants who reside in university dormitories, windows that overlook nature can enhance the relationship of being away, compatibility, and fascination to psychological well-being, compared with those with less natural views. Thus, this study confirmed the moderating effect of nature view windows and provided insight into the ART constructs that facilitate and enhance restorative experiences. By strengthening ART with additional factors, this study has also contributed toward the improvement of the psychological well-being of university students.

Exposure to nature and mental health outcomes during COVID-19 lockdown. A comparison between Portugal and Spain

BACKGROUND

To control the spread of the SARS-CoV-2 virus, countries around the world implemented lockdowns with varying intensities. Lockdowns, however, have been associated with a deterioration of mental health, including post-traumatic stress symptoms, anger and anxiety. Exposure to nature might reduce stress and provide relaxation opportunities.

OBJECTIVE

Firstly, we aimed to determine which sociodemographic, housing and lockdown-related characteristics were associated with changes in exposure to nature during the COVID-19 lockdown in Portugal and Spain. Secondly, we sought to estimate the associations of these changes with mental health, and test whether these associations differed according to sociodemographic characteristics and between the two countries, which experienced different restrictions and epidemiological situations.

METHODS

A cross-sectional study was conducted between March 27 and May 6, 2020, using an online questionnaire to measure changes in exposure to nature (including private green space and other greenery, views of nature from home and public natural spaces); sociodemographic, housing and lockdown-related characteristics; stress levels (visual stress scale); psychological distress (General Health Questionnaire - 12 items) and somatization (somatization scale). Adjusted regression models were fitted to estimate associations.

RESULTS

This study included 3157 participants (1638 from Portugal, 1519 from Spain). In Portugal, maintaining/increasing the use of public natural spaces during the lockdown was associated with lower levels of stress (adjusted beta -0.29; 95%CI -0.49, -0.08) and maintaining/increasing the frequency of viewing nature from home was associated with reduced psychological distress (0.27; -0.51, -0.03), somatization (-0.79; -1.39, -0.20), and stress levels (-0.48; -0.74, -0.23). In Spain, maintaining/increasing contact with private green space and greenery was associated with lower stress levels: for contact with indoor plants (-0.52; -0.96, -0.07) and for use of private community green spaces (-0.82; -1.61, -0.03).

CONCLUSION

Exposure to nature was associated with better mental health outcomes during lockdowns, but the natural features associated with improved mental health differed between the two countries. Nature should be incorporated into urban planning interventions and housing design and exposure to nature should be promoted during lockdowns.

Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond

The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.

Evaluating the Mental-Health Positive Impacts of Agritourism; A Case Study from South Korea

The stressful lifestyle of urban dwellers has increased the demand for green-based leisure activities; considering such growing demand, this paper investigated the potential mental health benefits of agritourism activities. The assessments were based on a questionnaire survey of two groups: visitors of agritourism sites around Seoul and a control group staying home (n = 200). In addition to measuring the participants’ well-being level and stress level, they were also asked to self-estimate their immediate mood after their activities of the day. The analysis was conducted with R version 4.1.0 to explore the potential relationships and interactions between the activity of the day, perceived psychological factors, and the immediate emotional outcomes. Findings reveal that visitors to the agritourism sites perceived considerable improvement in their immediate mood compared to the control group who stayed home. Results indicate a significant interaction between self-reported wellbeing and agritourism activities and a combined effect on improved mood. Therefore, agritourism can potentially be a resource for a positive mood boost and improved mental health. The suggested practical implications can be applied as strategies to evoke the feeling of more connection to the agritourism activities and raise awareness of potential mental health outcomes.

Self-reported well-being and the importance of green spaces - A comparison of garden owners and non-garden owners in times of COVID-19

This study focuses on the effects of the use of green spaces on the self-reported well-being measures of life satisfaction and mental well-being during the COVID-19 pandemic. We compare two distinct groups of people: garden owners and non-garden owners. We collected quantitative data and data from an open-ended question online from 495 people living in all regions of Germany in May 2020. To analyze our quantitative data, we used a combination of descriptive statistics and hierarchal regressions. Here, results indicated that garden owners had substantially greater life satisfaction and mental well-being than non-garden owners. Additionally, the two groups differed statistically significant in many socioeconomic factors (e.g., income, age, fear of job loss), in the context of time spent outside, as well as personality traits. Our analyses suggest that these differences are valuable for understanding differences between the two groups' self-reported well-being. To analyze the open-ended question, we followed the main steps of a qualitative content analysis. Here, we found that the vast majority of participants associated positive meanings (e.g., freedom and joy) with private gardens and public green spaces during the pandemic. Our findings have implications for policies to promote and support the design and use of public green spaces. Overall, our findings support governmental decisions in Germany (as elsewhere) to keep public green spaces open during the first wave of the outbreak of COVID-19, suggesting that green spaces provide valuable support for self-reported well-being in these difficult times of COVID-19 contagion.

Green space and suicide mortality in Japan: An ecological study

Although numerous studies have investigated the effect of green space on mental health, as yet, little is known about the association between green space and suicide. To address this deficit, we conducted the first Japan-wide study of the relationship between green space and suicide mortality. Results from spatial analyses of municipality-level panel data for the 1975-2014 period that included 886,440 suicide deaths with a fixed-effect estimator showed that green space was associated with suicide mortality, and that this relationship was conditioned by the form of greenness, level of urbanity and demographic characteristics. In densely populated cities, park density (parks per 1000 of the population) was associated with reduced suicide mortality among females aged 18 and above and among males aged 18 to 39 and aged 65 and above. In small- and medium-sized cities, park coverage (% by area) was linked to fewer suicide deaths among middle-aged and older females (aged 40 and above). In contrast, in non-cities (rural areas), parks were not associated with suicide mortality whereas woodland coverage (% by area) was linked to reduced suicide deaths among middle-aged and older males (aged 40 and above). Our findings suggest that urban green space and rural forest coverage may have a protective effect against self-harming behavior. Future suicide prevention efforts should consider an increased greening of the residential environment in terms of both availability and accessibility, especially with better designs that accommodate population needs and local conditions.

A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study

Background

The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders.

Objective

In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status.

Methods

A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition.

Results

Our results show that being female (β=1.1; t=2.5; P=.01) and working at the frontline (β=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (β=–1.5; t=–2.5; P=.01) and anxiety (β=–1.1; t=–2.4; P=.02).

Conclusions

It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout.

Perceived urban green and residents' health in Beijing

Green space serves urban residents in various functions including promoting health, but the roles of different types of green space are unclear. A survey titled "Healthy Neighborhood" was conducted in Beijing from May to July 2019 to examine and compare the associations between three types of perceived green space (park green, public-square green and utility green) and three aspects of residents' health (physical health, mental health and social health). Results from the multilevel modeling (MLM) analysis show that the perceived park green has a positive correlation with mental health, and all three types of perceived green space correlate with social health positively. No significant correlation of any type of green space is detected on participants' physical health, nor any relation of public-square green or utility green to their mental health. Overall the role of urban green space is stronger on social health than physical and mental health. The findings support the complementary roles of different types of green space, and suggest that expansion in utility greens could be as effective as investing in more costly park and public-square greens, especially in their benefit in promoting social health.

Exposure to green space and prevention of anxiety and depression among young people in urban settings: a global scoping review

Purpose

There is a mental health crisis, particularly among young people. Despite many young people living in urban settings, reviews about the association between exposure to green or natural environments and mental health tend to focus on either children or adults. The aim of this review is to examine the scope of the global literature for this age group, to inform a systematic review on the role of exposure to green space in preventing anxiety and depression amongst young people aged 14–24 years.

Design/methodology/approach

Seven databases were searched for quantitative and qualitative sources published from January 2000 to June 2020. This identified 201 sources and their characteristics are described here. Gaps in the literature are also highlighted.

Findings

The number of relevant studies published per year has increased over time. Most studies are set in North America (28%) or Europe (39%). The most common study designs were observational (34%) or experimental (28%). A wide range of exposures and interventions are described.

Research limitations/implications

This review included literature from predominantly high-income countries and has shown the under-representation of low-middle income countries and lack of ethnic diversity in study populations. It has also highlighted the lack of clinical measures of anxiety and depression as outcomes.

Originality/value

This inter-disciplinary review has contributed to the field by describing the geographic distribution of the literature and the broad range of exposures to green spaces being reported. Unlike previous scoping reviews, this review focused specifically on young people and on measures of anxiety and depression and their pre-cursers.

Moving Beyond Disciplinary Silos Towards a Transdisciplinary Model of Wellbeing: An Invited Review

The construct of wellbeing has been criticised as a neoliberal construction of western individualism that ignores wider systemic issues such as inequality and anthropogenic climate change. Accordingly, there have been increasing calls for a broader conceptualisation of wellbeing. Here we impose an interpretative framework on previously published literature and theory, and present a theoretical framework that brings into focus the multifaceted determinants of wellbeing and their interactions across multiple domains and levels of scale. We define wellbeing as positive psychological experience, promoted by connections to self, community and environment, supported by healthy vagal function, all of which are impacted by socio-contextual factors that lie beyond the control of the individual. By emphasising the factors within and beyond the control of the individual and highlighting how vagal function both affects and are impacted by key domains, the biopsychosocial underpinnings of wellbeing are explicitly linked to a broader context that is consistent with, yet complementary to, multi-levelled ecological systems theory. Reflecting on the reciprocal relationships between multiple domains, levels of scale and related social contextual factors known to impact on wellbeing, our GENIAL framework may provide a foundation for a transdisciplinary science of wellbeing that has the potential to promote the wellbeing of individuals while also playing a key role in tackling major societal challenges.

Association between Urban Greenspace and Health: A Systematic Review of Literature

The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases—PubMed/Medline and Excerpta Medica dataBASE (EMBASE)—were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological limitations of the included studies, the results have shown almost univocally that urban greenspaces harbour potentially beneficial effects on physical and mental health and well-being.

Using greenspace and nature exposure as an adjunctive treatment for opioid and substance use disorders: Preliminary evidence and potential mechanisms

The demand for opioid medication to effectively treat pain has contributed to the surging opioid crisis, which is a major source of morbidity and mortality in the U.S. More than 100,000 people begin opioid maintenance treatment (OMT) annually, the standard pharmacotherapy for opioid use disorder (OUD). Although OMT is the standard care for OUD, patients often experience or develop a heightened sensitivity to pain (hyperalgesia) as a result of the opioid medication, and also have high rates of stress, affective, and anxiety-related conditions. These conditions are interactive with other behavioral and environmental correlates of opioid and other substance use disorders including impulsive decision-making (e.g., harmful opioid use associated with increased delay discounting), and a lack of alternative (i.e., substance-free) and social reinforcement. Collectively these complex and multifaceted factors constitute significant predictors of lack of adherence to OMT (and other pharmacotherapies) and relapse. There is an urgent need, therefore, to develop novel adjunctive treatments that preserve the benefits of OMT and various pharmacotherapies, and simultaneously diminish continued pain and hyperalgesia, reduce stress and anxiety-related conditions, target relevant behavioral mechanism such as impulsive choice, and also serve to enhance the value of alternative and substance free activities. Here, we discuss evidence that an environmental manipulation - access to greenspace and nature - could serve as a potential adjunctive treatment to standard pharmacotherapies by targeting multiple biological and behavioral mechanisms that standard pharmacotherapies do not address.

Measuring Neighborhood Landscapes: Associations between a Neighborhood's Landscape Characteristics and Colon Cancer Survival

Landscape characteristics have been shown to influence health outcomes, but few studies have examined their relationship with cancer survival. We used data from the National Land Cover Database to examine associations between regional-stage colon cancer survival and 27 different landscape metrics. The study population included all adult New Jersey residents diagnosed between 2006 and 2011. Cases were followed until 31 December 2016 (N = 3949). Patient data were derived from the New Jersey State Cancer Registry and were linked to LexisNexis to obtain residential histories. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI95) for the different landscape metrics. An increasing proportion of high-intensity developed lands with 80–100% impervious surfaces per cell/pixel was significantly associated with the risk of colon cancer death (HR = 1.006; CI95 = 1.002–1.01) after controlling for neighborhood poverty and other individual-level factors. In contrast, an increase in the aggregation and connectivity of vegetation-dominated low-intensity developed lands with 20–<40% impervious surfaces per cell/pixel was significantly associated with the decrease in risk of death from colon cancer (HR = 0.996; CI95 = 0.992–0.999). Reducing impervious surfaces in residential areas may increase the aesthetic value and provide conditions more advantageous to a healthy lifestyle, such as walking. Further research is needed to understand how these landscape characteristics impact survival.

Green space, air pollution, traffic noise and saliva cortisol in children: The PIAMA study

Supplemental Digital Content is available in the text.

Green space, air pollution, and traffic noise exposure may be associated with stress levels in children. A flattened diurnal cortisol slope (the decline in cortisol concentrations from awakening to evening) is an indicator of chronic stress. We examined associations of green space, ambient air pollution, and traffic noise with the diurnal cortisol slope in children 12 years of age.

Association between urban environment and mental health in Brussels, Belgium

Background

Mental health disorders appear as a growing problem in urban areas. While common mental health disorders are generally linked to demographic and socioeconomic factors, little is known about the interaction with the urban environment. With growing urbanization, more and more people are exposed to environmental stressors potentially contributing to increased stress and impairing mental health. It is therefore important to identify features of the urban environment that affect the mental health of city dwellers. The aim of this study was to define associations of combined long-term exposure to air pollution, noise, surrounding green at different scales, and building morphology with several dimensions of mental health in Brussels.

Methods

Research focuses on the inhabitants of the Brussels Capital Region older than 15 years. The epidemiological study was carried out based on the linkage of data from the national health interview surveys (2008 and 2013) and specifically developed indicators describing each participant’s surroundings in terms of air quality, noise, surrounding green, and building morphology. These data are based on the geographical coordinates of the participant’s residence and processed using Geographical Information Systems (GIS). Mental health status was approached through several validated indicators: the Symptom Checklist-90-R subscales for depressive, anxiety and sleeping disorders and the 12-Item General Health Questionnaire for general well-being. For each mental health outcome, single and multi-exposure models were performed through multivariate logistic regressions.

Results

Our results suggest that traffic-related air pollution (black carbon, NO₂, PM₁₀) exposure was positively associated with higher odds of depressive disorders. No association between green surrounding, noise, building morphology and mental health could be demonstrated.

Conclusions

These findings have important implications because most of the Brussel’s population resides in areas where particulate matters concentrations are above the World Health Organization guidelines. This suggests that policies aiming to reduce traffic related-air pollution could also reduce the burden of depressive disorders in Brussels.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10557-7.

Greenspace Interventions, Stress and Cortisol: A Scoping Review

Background: Engaging with nature can profoundly impact psychological and physiological health of persons across the lifespan. Greenspace interventions (GSI) encompass a broad range of strategic, nature-based activities for overall health and wellbeing. Within the past 20 years there has been a growing interest in the access to and management of greenspace to mediate the deleterious impact of acute and chronic stress, particularly, physiologic biomarkers of stress such as cortisol. Objective: This review aims to describe the impact of greenspace interventions on cortisol, to present the current state of the science on GSIs as they impact cortisol, and to uncover any limitations of current research strategies to best inform future research. Methods: A scoping methodology was conducted to systematically study this emerging field and inform future research by mapping the literature based on the GSI category, interventional design, cortisol metrics, and subsequent analysis of cortisol. Conclusion: Considerable heterogeneity in research design, aim(s), interventional strategy, and cortisol metrics were identified from a total of 18 studies on GSIs and cortisol outcomes. While studies demonstrated a potential for the positive association between GSIs and stress relief, more rigorous research is needed to represent GSIs as an intervention to mitigate risks of stress.

Exploring uncharted territory: Do urban greenspaces support mental health in low- and middle-income countries?

Exposure to urban greenspaces promotes an array of mental health benefits. Understanding these benefits is of paramount importance, particularly in low- and middle-income countries (LMICs), where cities are expanding at an unprecedented rate. However, the existing evidence-base for the health benefits of greenspaces has a strong bias towards high-income countries. Here we systematically assess the emerging evidence regarding the mental health benefits provided by urban greenspaces in LMICs. We carried out a scoping review to assess the extent, type and quality of evidence investigating the relationship between greenspaces and mental health in LMICs. We systematically searched the literature databases Web of Science, Medline, Embase and CAB Abstracts using key terms related to greenspaces and mental health in LMICs. We analysed the resulting studies using a narrative synthesis approach, taking into account study quality, to assess the overall effects on mental health. 36 studies met the inclusion criteria and were included in the narrative synthesis. Studies were heterogeneous in design, study population, greenspace and mental health assessment. While more than 90% of LMICs remain unstudied, we found that eight out of ten studies using validated mental health screening tools detected positive associations between greenspaces and one or more mental health outcomes. These studies mostly took place in upper-middle-income countries. However, there still is a lack of evidence from regions with the highest levels of urbanisation, and only four studies assessed lower-middle and low-income countries. Furthermore, the analysis of mediating and moderating factors indicates that the relationship between greenspaces and mental health in LMICs is context dependent and needs to be assessed in relation to locally relevant environmental and cultural settings. Based on the evidence reviewed here, exposure to urban greenspaces can support multiple mental health outcomes in upper-middle-income countries. However, we still know little about poorer, rapidly urbanising countries. Our findings highlight the need for high-quality, context specific research in those urban areas with the highest levels of urbanisation, and the need to address specific challenges regarding mediating and moderating factors. Future studies should combine robust ecological assessments of greenspaces with validated mental health screening tools.

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Green Gentrification and Health: A Scoping Review

Urban greening initiatives are often linked to enhanced human health and wellbeing, but they can also be a driver of gentrification. To date, few studies have focused on how green gentrification shapes health. In this scoping review, we analyzed existing peer-reviewed research on how greening initiatives in gentrifying neighborhoods impact health, well-being, and health pathways (e.g., physical activity, affordable housing). Using a multi-step approach to scoping the literature (including searches in PubMed, JSTOR, and Google Scholar), we identified 15 empirical studies that met our inclusion criteria. We found studies focusing on green space use, physical activity, sense of community, safety, and self-reported health. Overall, longtime, marginalized residents are negatively impacted by green gentrification as they experience a lower sense of community, feel that they do not belong in green space, and, in many studies, use green space less often than newcomers. Overall, the research in this area is limited, and more studies on mental health and cardiovascular health markers could advance this literature. Based on the limited available evidence, we suggest that public health, urban planning, and parks professionals could collaborate to enhance the use of green space for marginalized residents and their feelings of inclusion in gentrifying areas.

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

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