The Relationship between Nature Deprivation and Individual Wellbeing across Urban Gradients under COVID-19

Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis

Prior reviews have highlighted that nature exposure was a valuable coping strategy enchancing mental health during the COVID-19 pandemic. However, no existing reviews have determined the quality of evidence and risk of bias of the empirical studies supporting this claim. To address this gap, we employed a Navigation Guide systematic review and meta-analysis approach to investigate associations between nature exposure and mental health during the pandemic. Searches in PubMed, Web of Science, Scopus, CINAHL, and PsycInfo retrieved relevant articles published between January 1, 2020, and March 4, 2024. We used the Navigation Guide methodology to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment to evaluate the overall quality of evidence. Our search retrieved 113 studies that met the inclusion criteria and reported diverse types of exposure, including nature availability, nature visit frequency, green space accessibility, and green space type, alongside associations with 12 mental health outcomes. Meta-analyses found access to gardens was associated with lower odds of depression [(Pooled OR=0.71, 95%CI=0.61, 0.82), I2=0%, n=3] and anxiety [(Pooled odds ratio [OR]=0.73, 95%CI=0.63, 0.84), I2=0%, n=3]. Increased time in green spaces were associated with lower level of stress [(Pooled Corr=-0.11, 95%CI=-0.17, -0.05), I2=0%, n=2]. Higher frequency of visits to nature was associated with improved mental well-being [(Pooled standardized beta estimate during COVID-19 period [ES]=0.10, 95%CI=0.07, 0.14), I2=0%, n=2] and general mental health [(Pooled standardized beta estimate [ES]=0.11, 95%CI=0.03-0.38), I2=82%, n=2]. However, the number of pooled studies was small and the overall quality of evidence was "very low" for all outcomes, and high levels of bias were observed (26% of studies had high, 71% probably high). Nonetheless, given the trends in the results, nature-based solutions emphasizing exposure to gardens and green spaces near the home may have promoted psychological resilience during this public health crisis.

A systematic review of the relationship between natural environments and physiological and mental health during different stages of the COVID-19 pandemic

COVID-19 has altered how individuals interact with natural environments. Numerous studies have investigated the effects of such environments on health. However, how natural environments influenced individuals' physiological and mental health during various stages of the COVID-19 pandemic remains unclear. Therefore, we conducted this study to investigate the effects of natural environments on individuals' physiological and mental health during different stages of the pandemic; we also identified factors that mediated these effects. Overall, we evaluated the importance of natural environments during challenging times. This study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The pandemic period was divided into three stages on the basis of severity: pandemic (March 2020 - February 2022), easing (February 2022-September 2022), and post-acute COVID pandemic (September 2022 - present). An initial pool of 3018 studies was narrowed down to a final sample of 73 studies. During the pandemic stage, individuals frequenting public green spaces exhibited improved well-being, reduced stress levels, and a sense of nature deprivation. Private green spaces played crucial roles in maintaining health during the pandemic stage. Highquality window views were associated with improved well-being and reduced depression. During the easing stage, the environmental quality of public green spaces influenced individuals' perceived safety and sense of belonging. And coastal areas were the preferred natural destinations in this stage. During the post-acute COVID pandemic stage, individuals acknowledged the importance of natural environments in maintaining physiological and mental health as they gradually returned to prepandemic normalcy. In conclusion, the COVID-19 pandemic highlighted humanity's reliance on nature. Therefore, sufficient urban spaces should be dedicated to preservation of natural environments to mitigate negative emotions arising from prolonged indoor stays.

What is Nature-Based Medicine and What Does It Do?

One's personal health and well-being can improve with activity in natural environments or decline without it. Many chronic illnesses to which personal nature deficiency contributes-including anxiety, depression, attention deficit, diabetes, hypertension, myopia, and obesity-have been exacerbated with the pandemic. That those illnesses may be preventable, treatable, and even reversible with an added nature-based approach may seem novel, but it is not. Though the field of nature-based medicine is just emerging in the U.S., it has been taught and practiced in Asia and the EU for decades. As the prescriptive, evidence-based use of natural settings and nature-based interventions, it aims to prevent and treat disease and improve well-being. Nature-based medicine blends particular activity in nature with the science of medicine to attempt to empower self-care safely, effectively, and happily. Its vision is to be readily available to all, regardless of proximity to blue (water-related) or green (land-related) space. The common sense of nature-based medicine belies its scientific evidence base, which is growing but not well-known, so it may seem unfamiliar to prescribe nature to patients. It will take education, training and practice to help patients access nature-based medicine and to help clinicians prescribe it.

Natural environments, psychosocial health, and health behaviors in a crisis - A scoping review of the literature in the COVID-19 context

The COVID-19 outbreak led to major restrictions globally, affecting people's psychosocial health and their health behaviors. Thus, the purpose of this scoping review was to summarize the available research regarding nature and health in the COVID-19 context. Keywords relating to natural environments and COVID-19 were combined to conduct a systematic online search in six major databases. Eligibility criteria were a) published since 2020 with data collected in the COVID-19 context b) peer-reviewed, c) original empirical data collected on human participants, d) investigated the association between natural environments and psychosocial health or health behaviors, and e) English, German, or Scandinavian languages. Out of 9126 articles being screened, we identified 188 relevant articles, representing 187 distinct studies. Most research focused on adults in the general population and was predominantly conducted in the USA, Europe, and China. Overall, the findings indicate that nature may mitigate the impact of COVID-19 on psychological health and physical activity. Through a systematic thematic analysis of the extracted data, three primary themes were identified: 1) type of nature assessed, 2) psychosocial health and health behaviors investigated, and 3) heterogeneity in the nature-health relationship. Research gaps in the COVID-19 context were identified regarding I) nature characteristics that promote psychosocial health and health behaviors, II) investigations of digital and virtual nature, III) psychological constructs relating to mental health promotion, IV) health-promoting behaviors other than physical activity, V) underlying mechanisms regarding heterogeneity in the nature-health relationship based on human, nature, and geographic characteristics, and VI) research focusing on vulnerable groups. Overall, natural environments demonstrate considerable potential in buffering the impact of stressful events on a population level on mental health. However, future research is warranted to fill the mentioned research gaps and to examine the long-term effects of nature exposure during COVID-19.

Nature-Based Pediatric Occupational Therapy: A Scoping Review

AIMS

Our purpose was to explore the scope of nature-based interventions used in pediatric occupational therapy and identify gaps in existing literature.

METHODS

This scoping review was guided by Arksey and O'Malley's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. We searched CINAHL, PubMed, PsycINFO, Web of Science, Embase, MEDLine, and gray literature, and we hand-searched included articles' references. We included studies published through June, 2021 that were in English, described a service provided by occupational therapists, with a population with at least 50% of participants ages 0-21 years, with nature as a primary context and treatment modality. Studies were excluded if they only described animal-assisted therapies or human-made structures.

RESULTS

A total of 12 articles (two reporting quasi-experimental studies; 10 gray literature) met inclusion criteria. Articles described a variety of interventions, but there was a lack of rigor in included articles and no clear conceptualization of nature-based pediatric occupational therapy.

CONCLUSIONS

Despite practitioner interest in the topic, there are two primary gaps in the literature: lack of a clear conceptualization of nature-based practices for occupational therapy and lack of articulation of the unique contribution of occupational therapy to nature-based practices.

Exploring Key Factors Driving Urban Foraging Behavior in Garden and Non-Garden Locations

Since the occurrence of COVID-19 and food price inflation, alternative forms of food procurement increased in popularity. The present study is dedicated to urban foraging and aims to explore key factors driving food foraging behavior in the U.S. Two specific foraging behaviors, namely "leaving food behind" or "taking it all", have been investigated in a gardening and non-gardening location. Leaving food behind is crucial to sustainable foraging practices, as it allows plants and ecosystems to recover and promotes fairness in foraging communities. Data was procured from an online consumer survey and analyzed using SmartPLS 4, which allowed the use of partial least square structural equation modeling (PLS-SEM). PLS-SEM is particularly suitable for complex exploratory studies as it does not require distributional assumptions. Results indicate that nature and food attitudes predict attitudes toward urban foraging. Foraging attitudes, such as food foraging is challenging and food foraging benefits people and the planet, which are the most important drivers for taking or leaving behaviors in both types of locations. These findings are of relevance to managers in municipalities, landscape designers, horticultural businesses, and other stakeholders who create, shape, and govern landscapes used for food foraging.

Anthropause appreciation, biophilia, and ecophilosophical contemplations amidst a global pandemic

In 2020, COVID-19 mitigation measures, including lockdowns and travel bans to curtail disease transmission, inadvertently led to an "Anthropause" - a unique global pause to anthropogenic activities. While there was a spike in ecological studies measuring Anthropause effects on environmental indicators, people's experiences of the Anthropause or its potential to inspire change were hardly considered. Hence, we aimed to measure people's appreciation of the environmental outcomes of the Anthropause, ecophilosophical contemplations about the pandemic, and experiences of lockdown-triggered biophilia (human's innate love for and draw towards nature) and test the hypothesis that these experiences would be consistently more prominent among the already environmentally inclined. To that end, we developed and tested three measures on a representative sample of 993 New Zealanders. Anthropause Appreciation received the highest overall mean ratings, followed by Lockdown-Biophilia and Eco-Contemplation. Pre-existing pro-environmental dispositions and behaviours did not consistently influence our three measures as expected. Demographic variables had little influence, while experiences of financial and mental health impacts due to COVID-19 had no influence. We interpreted the limited influence of explanatory variables as indicative of a degree of uniformity in people's experiences. High appreciation of Anthropause benefits suggests that the public may be supportive of policies and ways of living that can lead to similar outcomes post-pandemic - offering environmental policymakers and communicators a basis for action. Ecophilosophical contemplations and biophilic draw among the public suggest an awareness of the significance of the human-nature relationship - offering a symbolic global keystone for communicating and advocating conservation and the many values of pauses in life to connect with nature. Building women's environmental leadership capabilities and the ongoing greening of Christianity may be essential steps for global post-pandemic environmental behaviour transformations.

Reconceptualizing Women's Wellbeing During the Pandemic: Sport, Fitness and More-Than-Human Connection

This paper explores the gendered, disruptive effects and affective intensities of COVID-19 and the ways that women working in the sport and fitness sector were prompted to establish more-than-human connection through technologies, the environment, and objects. Bringing together theoretical and embodied insights from object interviews with 17 women sport and fitness professionals (i.e., athletes, coaches, instructors) in Aotearoa New Zealand, this paper advances a relational understanding of the multiple human and nonhuman forces that shape and transform women's wellbeing during pandemic. Drawing upon particular feminist materialisms (i.e., Barad, Braidotti, Bennett), we reconceptualize wellbeing to move beyond biomedical formulations of health or illness. Through our analysis and discussion, we trace embodied ways of knowing that produce wellbeing as a more-than-human entanglement, a gendered phenomenon that can be understood as an ongoing negotiation of affective, material, cultural, technological and environmental forces during a period of disruption and uncertainty.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

Tourism as a Tool in Nature-Based Mental Health: Progress and Prospects Post-Pandemic

The healthcare sector recognises the role of nature in mental health. The tourism sector is equipped to take people to national parks. The conservation sector gains support from visitors. Theoretical frameworks for mental health benefits from nature tourism include: tourism destinations and activities; tourist personalities and life histories; sensory and emotional components of tourist experiences; and intensity and duration of memories. Mental health deteriorated worldwide during the COVID-19 pandemic. Recovery of global economic productivity requires immediate, accessible, affordable mental health measures at national scales, and nature-based approaches provide the best option. Different countries have adopted a variety of public, private, or voluntary mechanisms. Some focus on design of activities, others on provision of facilities. Costs and implementation depend on key research questions: marginal benefits of nature tour guides or psychologists compared to self-guided nature experiences; comparisons between repeated brief visits and one-off nature holidays; effects of biodiversity, flagship species, and scenic or wilderness quality; and differences between individuals, depending on personalities, life histories, and mental health status and symptoms.

Nature's contributions in coping with a pandemic in the 21st century: A narrative review of evidence during COVID-19

While COVID-19 lockdowns have slowed coronavirus transmission, such structural measures also have unintended consequences on mental and physical health. Growing evidence shows that exposure to the natural environment (e.g., blue-green spaces) can improve human health and wellbeing. In this narrative review, we synthesized the evidence about nature's contributions to health and wellbeing during the first two years of the COVID-19 pandemic. We found that during the pandemic, people experienced multiple types of nature, including both outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public parks) depended on lockdown severity and socio-cultural contexts. Other forms of nature exposure, such as spending time in private gardens and viewing outdoor greenery from windows, may have increased. The majority of the evidence suggests nature exposure during COVID-19 pandemic was associated with less depression, anxiety, stress, and more happiness and life satisfaction. Additionally, nature exposure was correlated with less physical inactivity and fewer sleep disturbances. Evidence was mixed regarding associations between nature exposure and COVID-related health outcomes, while nature visits might be associated with greater rates of COVID-19 transmission and mortality when proper social distancing measures were not maintained. Findings on whether nature exposure during lockdowns helped ameliorate health inequities by impacting the health of lower-socioeconomic populations more than their higher-socioeconomic counterparts for example were mixed. Based on these findings, we argue that nature exposure may have buffered the negative mental and behavioral impacts of lockdowns during the COVID-19 pandemic. Recovery and resilience during the current crises and future public health crises might be improved with nature-based infrastructure, interventions, designs, and governance.

Nature's contributions in coping with a pandemic in the 21st century: A narrative review of evidence during COVID-19

While COVID-19 lockdowns have slowed coronavirus transmission, such structural measures also have unintended consequences on mental and physical health. Growing evidence shows that exposure to the natural environment (e.g., blue-green spaces) can improve human health and wellbeing. In this narrative review, we synthesized the evidence about nature's contributions to health and wellbeing during the first two years of the COVID-19 pandemic. We found that during the pandemic, people experienced multiple types of nature, including both outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public parks) depended on lockdown severity and socio-cultural contexts. Other forms of nature exposure, such as spending time in private gardens and viewing outdoor greenery from windows, may have increased. The majority of the evidence suggests nature exposure during COVID-19 pandemic was associated with less depression, anxiety, stress, and more happiness and life satisfaction. Additionally, nature exposure was correlated with less physical inactivity and fewer sleep disturbances. Evidence was mixed regarding associations between nature exposure and COVID-related health outcomes, while nature visits might be associated with greater rates of COVID-19 transmission and mortality when proper social distancing measures were not maintained. Findings on whether nature exposure during lockdowns helped ameliorate health inequities by impacting the health of lower-socioeconomic populations more than their higher-socioeconomic counterparts for example were mixed. Based on these findings, we argue that nature exposure may have buffered the negative mental and behavioral impacts of lockdowns during the COVID-19 pandemic. Recovery and resilience during the current crises and future public health crises might be improved with nature-based infrastructure, interventions, designs, and governance.

Analysis of students' positive emotions around the green space in the university campus during the COVID-19 pandemic in China

Green space around the university campus is of paramount importance for emotional and psychological restorations in students. Positive emotions in students can be aroused when immersed in green space and naturalness. However, to what extent can perceived naturalness influence students' positive emotion remains unclear, especially in the context of COVID-19 countermeasures. This study, therefore, attempts to investigate in-depth the nature and strength of the relationships between students' positive emotion and their perceived naturalness, place attachment, and landscape preference, which are potentially varying across universities in different social and environmental contexts and different restrictions policies regarding the COVID-19 pandemic. A course of questionnaire-based surveys was administered on two university campuses in Heilongjiang and Hunan Provinces, China, resulting in 474 effective samples. Structural equation modeling was used to explore the hypothetical conceptual framework of latent variables and the indicators. The findings indicate that the higher students' perceived naturalness results in greater positive emotion. Students' perceived naturalness in green spaces of campus has a positive effect on their place attachment and landscape preference. Moreover, the difference between mediate effects of place attachment and landscape preference were addressed, which verifies the contextual influences.

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.

Self-reported participation in outdoor and nature-based recreation before and during the COVID-19 pandemic supports psychological health and well-being

Restrictions associated with the COVID-19 pandemic significantly altered daily lives and affected human health and well-being. Outdoor and nature-based activities could potentially mitigate some of these negative impacts. To assess the impact of the COVID-19 pandemic on outdoor recreation and subjective well-being, we combined two samples of U.S. adults collected from April 30^th - June 15^th, 2020 and from August 7^th - August 26^th, 2020 (total n = 2178) using Qualtrics XM. During the pandemic, participation in outdoor activities declined by 35%, participation in nature-based activities declined by 33%, and subjective well-being declined by 24%. Participation in outdoor activities and nature activities prior to the pandemic and during the pandemic predicted smaller declines in subjective well-being. Results highlight the importance of outdoor recreation for building resilience to changes in subjective well-being before and during global crises like the COVID-19 pandemic.

Mental health and well-being in times of COVID-19: A mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults

The role of parks and nature to support well-being during the COVID-19 pandemic is uncertain. To examine this topic, we used mixed-methods data collected in April-May 2020 from US adults aged ≥55 in the COVID-19 Coping Study. We quantitatively evaluated the associations between number of neighborhood parks and depression, anxiety, and loneliness; and conducted qualitative thematic analysis of participants' outdoor experiences. Among urban residents, depression and anxiety were inversely associated with the number of neighborhood parks. Thematic analysis identified diverse engagement in greenspaces that boosted physical, mental, and social well-being. The therapeutic potential of outdoor and greenspaces should be considered for interventions during future epidemics.

Geographies of infections: built environment and COVID-19 pandemic in metropolitan Melbourne

This paper uses spatial statistical techniques to reflect on geographies of COVID-19 infections in metropolitan Melbourne. We argue that the evolution of the COVID-19 pandemic, which has become widespread since early 2020 in Melbourne, typically proceeds through multiple built environment attributes - diversity, destination accessibility, distance to transit, design, and density. The spread of the contagion is institutionalised within local communities and postcodes, and reshapes movement practices, discourses, and structures of administrative politics. We demonstrate how a focus on spatial patterns of the built environment can inform scholarship on the spread of infections associated with COVID-19 pandemic and geographies of infections more broadly, by highlighting the consistency of built environment influences on COVID-19 infections across three waves of outbreaks. A focus on the built environment influence seeks to enact visions of the future as new variants emerge, illustrating the importance of understanding geographies of infections as global cities adapt to 'COVID-normal' living. We argue that understanding geographies of infections within cities could be a springboard for pursuing sustainable urban development via inclusive compact, mixed-use development and safe public transport.

The Role of Urban Environment Design on Health During the COVID-19 Pandemic: A Scoping Review

The COVID-19 pandemic has had a significant impact on the ways and times of living and using urban spaces, specifically referring to the dimension of daily life. The restrictive measures introduced during the lockdown periods have necessarily led to a re-evaluation of proximity scale bringing particularly attention to issues relating to public transport and mobility and to the quality and distribution of open public spaces. This scoping review explores the relationship between the urban environment design and health referring to the constraints imposed by the COVID-19 pandemic in the period from 2020 to 2021, with two main objectives: (i) to investigate the recurring urban design topics and issues related to the spatial and social needs stressed by the emergency; (ii) to identify the urban design measures both experienced during the health emergency and proposed in view of a post-COVID urban and territorial planning as they are considered impactful on health promotion. The search strategy was based on a set of keywords searched in two electronic databases which allowed the identification of a total of 1,135 contributions. After defining the eligibility criteria, we proceeded to the screening process concluded with the inclusion of 19 studies. The analysis of the contributions led to the systematization of six main urban topics-and to the corresponding spatial requirements and project proposals-highlighted as relevant and supportive in terms of the promotion of inhabitant's public health: (i) transport, mobility and accessibility; (ii) green and outdoor spaces; (iii) public and pedestrians' spaces; (iv) care services and health network; (v) communications; (vi) public and business services. The resulting framework is useful for guiding healthy city planning toward public policies, tools, regulations, urban measures, and emergency contrast provisions, that contribute to increasing the effectiveness in terms of safety and well-being.

Aging in Place During a Pandemic: Neighborhood Engagement and Environments Since the COVID-19 Pandemic Onset

BACKGROUND AND OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic may fundamentally change neighborhood environments and ways of aging in place. This research aimed to investigate perceptions of and engagement in neighborhoods since the pandemic onset among aging Americans.

RESEARCH DESIGN AND METHODS

Data were from the COVID-19 Coping Study, a longitudinal cohort study of health and well-being of U.S. adults aged 55 years or older during the COVID-19 pandemic. In the present analysis, we conducted a qualitative thematic analysis of responses to an open-ended survey question about how respondents felt that COVID-19 has affected their neighborhood and relationships with neighbors. The survey data were collected June-September 2020 and analyzed for a random-stratified subsample of 1,000 study participants. Sampling quotas for age, gender, race/ethnicity, and education aimed to match the U.S. population aged 55 years or older (average age: 67.7 years).

RESULTS

We identified 4 overarching themes: altered neighborly social interactions, support levels, and community environments; and no observed changes. Geographic factors that affected neighborhood engagement included age structure, sociopolitical diversity, urbanicity/rurality, and walkability; while individual factors included age, race/ethnicity, socioeconomic status, political orientation, health status, duration of residence, lifestyle, and personality.

DISCUSSION AND IMPLICATIONS

The results highlight resilience among aging adults and their neighbors, sources of individual and community vulnerability, and opportunities to strengthen social infrastructure to support aging in place since the pandemic onset.

Sensory and Emotional Components in Tourist Memories of Wildlife Encounters: Intense, Detailed, and Long-Lasting Recollections of Individual Incidents

To quantify the role of senses and emotions in creating memorable tourism experiences, we need measurement frameworks that match how memories are created. This study examines that process through directed-content qualitative analysis of tourist encounters with wildlife. Data are derived from: interviews with 20 experienced wildlife tourism experts in 12 countries; 3000 social media posts on tourism enterprise and wildlife encounter websites; and participant observations and records of 168 memorable encounters involving >100 wildlife species, >850 tourists, and ~10,000 h in total, ranging over five decades. Across all data sources, senses and emotions differed between tourist interests and personalities, wildlife species and behaviours, and encounter circumstances. All senses were reported, with the most frequent being sight, followed by sound and smell, and, rarely, touch or taste. Descriptions were fine-grained and complex. The emotions reported were awe, joy, wonder, delight, thrill, amazement, envy, aww (cute-emotion), surprise, elation, satisfaction, interest, boredom, disappointment, sadness, embarrassment, concern, pity, distress, disgust, anxiety, shock, alarm, fear, and panic. Some experiences generated powerful recalls persisting for decades. Short-term, intense, and finely detailed senses and emotions defined experiences, created memories, and determined satisfaction, wellbeing, and subsequent outcomes. More accurate methods are needed to measure and characterise senses, emotions, and memories in tourism experience.

Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver

BACKGROUND

The COVID-19 pandemic has impacted both physical and mental health. This study aimed to understand whether exposure to green space buffered against stress and distress during the COVID-19 pandemic while taking into account significant stressors of the pandemic.

METHODS

We leveraged a cross-sectional survey on green space exposure and mental health among residents of Denver, CO that ran from November 2019 through January 2021. We measured objective green space as the average NDVI (normalized difference vegetation index) from aerial imagery within 300m and 500m of the participant's residence. Perceived green space was measured through Likert scores on five questions about vegetation near the home that captured perceived abundance, visibility, access, usage, and quality of green space. We used generalized linear models to assess the relationship between each green space exposure variable and perceived stress (PSS-4), depression (CES-D-10), or anxiety (MMPI-2) adjusted for sociodemographic and COVID-19 impact variables.

RESULTS

We found significantly higher depression scores for all covid periods compared to the "before covid" period, and significantly higher anxiety scores during the "fall wave" compared to earlier periods. Adjusted for sociodemographic and pandemic stressors, we found that spending a lot of time in green space (usage) was significantly associated with lower anxiety and depression. We also observed significantly lower depression scores associated with NDVI in both buffers (objective abundance) and significantly lower anxiety scores with perceived abundance of green space. There was some evidence of lower anxiety scores for people reporting having high quality green spaces near the home (quality). We did not observe significant associations for any green space metric and perceived stress after adjustment for confounding variables.

CONCLUSION

Our work provides further evidence of mental health benefits associated with green space exposure during the COVID-19 pandemic even after adjustment for sociodemographic variables and significant pandemic-related stressors.

Greenspace and park use associated with less emotional distress among college students in the United States during the COVID-19 pandemic

The COVID-19 pandemic has negatively affected many people's psychological health. Impacts may be particularly severe among socially vulnerable populations such as college students, a group predisposed to mental health problems. Outdoor recreation and visits to greenspaces such as parks offer promising pathways for addressing the mental health challenges associated with COVID-19. During the early stages of the pandemic (March-May 2020), we surveyed 1280 college students at four large public universities across the United States (U.S.) to assess how, and why, outdoor recreation and park use changed since the emergence of COVID-19. We also measured students' self-reported levels of emotional distress (a proxy for psychological health) and assessed potential demographic and contextual correlates of distress, including county-level per capita park area and greenness, using generalized linear models. We found that 67% of students reported limiting outdoor activities and 54% reported reducing park use during the pandemic. Students who reduced their use of outdoor spaces cited structural reasons (e.g., lockdowns), concerns about viral transmission, and negative emotions that obstructed active lifestyles. Students who maintained pre-pandemic park use levels expressed a desire to be outdoors in nature, often with the explicit goal of improving mental and physical health. Emotional distress among students was widespread. Models showed higher levels of emotional distress were associated with reducing park use during the pandemic and residing in counties with a smaller area of parks per capita. This study of U.S. college students supports the value of park-based recreation as a health promotion strategy for diverse populations of young adults during a time of crisis.

The longitudinal associations of physical activity, time spent outdoors in nature and symptoms of depression and anxiety during COVID-19 quarantine and social distancing in the United States

Stressors associated with COVID-19 pandemic stay-at-home orders are associated with increased depression and anxiety and decreased physical activity. Given that physical activity and time spent outdoors in nature are associated with improved mental health, we examined the longitudinal association of these variables during the pandemic. Over 20,000 adults who participated in the U.S. Kaiser Permanente Research Bank, did not report COVID-19 symptoms, and responded to an online baseline and 3 follow-up surveys over approximately 3 months formed the cohort. Physical activity was assessed from a modified survey, time spent outdoors was assessed from one question, and anxiety and depression scores were assessed from validated instruments. Almost 60% were women, 82.8% were non-Hispanic white, and more than 93% of respondents were over the age of 50. Less in-person contact with friends and visiting crowded places was highly prevalent (>80%) initially and decreased somewhat (>70%). Participants in the lowest physical activity category (no physical activity) had the highest depression and anxiety scores compared to each successive physical activity category (p < 0.001). Spending less time outdoors was associated with higher depression and anxiety scores. This effect was greater for participants in the younger age categories compared with older age categories. The effect of less time spent outdoors on anxiety (p = 0.012) and depression (p < 0.001) scores was smaller for males than females. Results suggest that physical activity and time outdoors is associated with better mental health. People should be encouraged to continue physical activity participation during public health emergencies.

Enclave-Reinforced Inequality during the COVID-19 Pandemic: Evidence from University Campus Lockdowns in Wuhan, China

The COVID-19 pandemic has impacted urban life and created spatial and social inequalities in cities. The impacts of lifting full lockdown restrictions once fast-spreading and community-acquired infection waves were under control are still not fully understood. This study aims to explore spatial inequality reinforced in the intervals between the waves of infection during the COVID-19 pandemic. Enclave-reinforced inequality resulting from enclave-based lockdown policies in Chinese cities was investigated through an analysis of the impacts of university campus enclave closures on the accessibility and crowdedness of urban green spaces. Using a modified two-step floating catchment area (2SFCA) and inversed 2SFCA (i2SFCA) method, accessibility and crowdedness were calculated and compared under two different scenarios. Additionally, the Lorenz curve, Gini coefficient, and Theil index were used to measure and compare intra-city global and local inequalities under each scenario. The results indicate that the lockdown of university campus enclaves decreased the supply of urban green spaces. Campus closures not only exacerbated the unequal distribution of urban green space, but also reduced the inequality of crowdedness in urban parks due to increased crowdedness in parks near the closed enclaves. Moreover, both accessibility and crowdedness worsened when the calculations were weighted for population size and the total supply of green space. Enclave-based lockdown in cities reinforced spatial inequality, and it is highly complex and has multidimensional impacts on urban inequalities and environmental injustice which should be considered by urban planners and decision-makers hoping to create healthy, inclusive, resilient, and sustainable cities in the “new normal” of the COVID-19 pandemic.

Practice, benefits, and impact of personal protective equipment (PPE) during COVID-19 pandemic: Envisioning the UN sustainable development goals (SDGs) through the lens of clean water sanitation, life below water, and life on land in Fiji

BACKGROUND

The outbreak of coronavirus disease (COVID-19) highlights the global health emergency. To limit the rate of COVID-19 transmission to health care workers, adequate personal protective equipment (PPE) are required. Emerging reports indicate that the widespread usage of PPE during the COVID-19 outbreak has exacerbated plastic contamination in the ocean.

PURPOSE

This paper attempts to understand the influence of practice, benefits, and impact of PPE during the COVID-19 crisis on clean water sanitation, life below water, and life on land (SDGs 6, 14, and 15 respectively) in Fiji and assess the effectiveness of measurements taken to deal with this crisis. Fiji is a small Pacific Island Country (PIC) and the global crisis of COVID-19 entered the Fijian border on 19th, March 2020. The second wave of COVID-19 was reported on 18th, April 2021, which began at a managed quarantine facility after contact between a couple returning from India to Fiji and a soldier. Since then the number of cases has been increasing daily and posing a risk to the public.

MATERIALS AND METHOD

A personal observation was made to collect the PPE pollution on the streets, near roads, car parks, markets, and towns.

RESULTS

Widespread PPE pollution was noticed, and the common PPE found on the Vesivesi road in Suva, Fiji were facemasks (61.36%) and hand gloves (38.64%), as it is mostly used by the public, police officers, municipal waste management, shopping malls workers, and medical care workers. Face shield littering was limited due to fewer users.

CONCLUSIONS

In response to the COVID-19 pandemic, this study stresses a great concern on enabling SDGs 6, 14, and 15 and how the use of PPE during this period has impacted the natural environment. It is critical to remember that managing PPE waste during a contagious pandemic should be treated as an emergency and handled quickly.

COVID-19, the Built Environment, and Health

BACKGROUND

Since the dawn of cities, the built environment has both affected infectious disease transmission and evolved in response to infectious diseases. COVID-19 illustrates both dynamics. The pandemic presented an opportunity to implement health promotion and disease prevention strategies in numerous elements of the built environment.

OBJECTIVES

This commentary aims to identify features of the built environment that affect the risk of COVID-19 as well as to identify elements of the pandemic response with implications for the built environment (and, therefore, for long-term public health).

DISCUSSION

Built environment risk factors for COVID-19 transmission include crowding, poverty, and racism (as they manifest in housing and neighborhood features), poor indoor air circulation, and ambient air pollution. Potential long-term implications of COVID-19 for the built environment include changes in building design, increased teleworking, reconfigured streets, changing modes of travel, provision of parks and greenspace, and population shifts out of urban centers. Although it is too early to predict with confidence which of these responses may persist, identifying and monitoring them can help health professionals, architects, urban planners, and decision makers, as well as members of the public, optimize healthy built environments during and after recovery from the pandemic. https://doi.org/10.1289/EHP8888.