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

Place-Based Differences in the Association Between Greenspace and Suicide-Related Outcomes Among Young People

PURPOSE

This study investigated place-based differences in the association between greenspace and suicide-related outcomes (SROs) among young people, guided by the following two objectives: (1) Contextualize place-based differences in the association between greenspace and SRO prevalence among young people at the community level in five different urbanities (urban, suburban, micropolitan, small towns, and rural/isolated communities) and (2) identify which greenspace metrics (quantity, quality, or accessibility) are most protective for SROs at the community level.

METHODS

Publicly available greenspace datasets were used to derive greenspace quantity, quality, and accessibility metrics. SRO emergency department visits for young people were identified from 2016-2019 in North Carolina, USA. Generalized linear models investigated the association between greenspace metrics and community-level drivers of SRO prevalence. Shapely additive explanations confirmed the most important greenspace variables in accurately predicting community-level SRO prevalence.

RESULTS

The prevalence of SROs was highest in communities with the least amount of public greenspace; this association was most pronounced in suburban communities, with SROs 27% higher in suburban communities with low quantities of greenspace (PRRUrban: 1.11, confidence interval [CI]: 1.08-1.13; PRRSuburban: 1.27, CI: 1.10-1.46; PRRSmallTowns: 1.21, CI: 1.05-1.39), and in communities with the worst greenspace accessibility (i.e., furthest distance to nearest greenspace) (PRRUrban: 1.07, CI: 1.04-1.10; PRRRural&Isolated: 1.95, CI: 1.54-2.49).

DISCUSSION

Our analysis provides place-based, community-specific findings to guide targeted greenspace interventions aimed at addressing the rising prevalence of SROs among young people. Our findings suggest that greenspace quantity interventions may be most effective in urban, suburban, and small-town communities, and greenspace accessibility interventions may be most useful in urban and rural/isolated communities.

Inadequate Social Housing and Health: The Case of Oliver Bond House, The Liberties, Dublin

Background

Inadequate housing is an important social justice issue that adversely affects health.

Methods

Drawing on an extended ethnography case study, this paper presents the results of a resident-led survey to highlight the health consequences of inadequate social housing, as residents wait for a 'fair regeneration' of their social housing 'flats' estate within a gentrifying inner-city Dublin neighbourhood.

Results

Four key concerns were identified by residents as part of this analysis: (1) substandard housing conditions which are physically harmful to health; (2) the emotional toll of an unsafe social environment; (3) lack of child friendly and community green spaces; and (4) constrained mobility due to inaccessible housing design.

Conclusions

The results highlight the urgent need to place greater priority on the maintenance of the existing social housing stock and demonstrate the need for public housing policies that recognize the quality and quantity of adequate housing provision, where care is at the heart of housing policies. The paper also presents a novel 'City of Care' framework, following the need to develop an ethics of care within cities where public health, community wellbeing, solidarity, residents' empowerment, and social justice principles are at the forefront. Given that housing is an essential contributor to good health, it is now time for a joint public housing and public health agenda to create healthier homes by confronting the everyday impact of inadequate housing to tackle social inequalities more broadly.

How can plant-enriched natural environments benefit human health: a narrative review of relevant theories

Plant-enriched environments, the most common terrestrial landscapes, are usually coded as "green space" in urban studies. To understand how these natural environments can benefit human health, many theories have been developed, such as the well-known Attention Restoration Theory. Nowadays, more theories are emerging with regard to various and complex health dimensions. In this context, we searched online databases (from 2000 to 2022) and conducted a narrative review aiming to introduce relevant theories concerning psychological (e.g. Perceptual Fluency Account and Conditioned Restoration Theory), physiological (e.g. volatile organic compounds and environmental microbiomes), and behavioural (e.g. physical activity and social contact) perspectives. We also slightly mentioned some limitations and directions to be considered when using these theories. These results may offer general readers insights into the value of nature exposure and also help relevant researchers with study design and result interpretation.

Climate Change Perception and Mental Health. Results from a Systematic Review of the Literature

Climate change is one of the main global challenges and influences various aspects of human health. Numerous studies have indeed demonstrated an association between extreme climate-related events and physical and mental health outcomes, but little is still known about the association between the perception/awareness of climate change and mental health. In accordance with the PRISMA 2020 guidelines, a search was conducted on PubMed and Scopus. The protocol was registered on PROSPERO. The included studies were original observational studies published in English, reporting the association between the perception/awareness of climate change and mental health. A total of 3018 articles were identified. A total of 10 observational studies were included. The period covered in the included studies ranged between 2012 and 2022. Climate change perception is consistently associated with adverse mental health effects across different types of estimates. In particular, the studies identified an association between a higher level of perception/awareness of climate change and depression, anxiety, eco-anxiety, stress, adjustment disorder, substance use, dysphoria, and even thoughts of suicide. Qualitative data underscore the impact on daily activities, contributing to feelings of loss and suicidal ideation. Moreover, climate change perception correlates with lower well-being and resilience. The association between awareness of climate change and mental health is a complex and still poorly explored phenomenon. The main limitations are the high heterogeneity in terms of exposure assessment and data reporting, which hinders quantitative analysis. These results show that climate change perception impacts mental health. Better understanding the phenomenon represents an opportunity to inform public health interventions that promote mental well-being.

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

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

Understanding the relationship between built environment features and physical activity in the Caribbean: A scoping review

Background

Transforming the urban infrastructure to become safe, inclusive and sustainable remains a challenge in most developing settings. The Caribbean has high burdens of physical inactivity and non-communicable diseases. Therefore, understanding the role of the built environment (BE) in modifying individual activity is important for informing the design of community interventions to improve levels of physical activity (PA). Anecdotally, there is limited evidence on the BE in the Caribbean, however evidence from other Small Island Developing States (SIDS) and from Latin America (LA) may offer useful information given their similar urbanization profiles and shared geo-collaborative histories.

Objective

Our review identifies and characterizes individual features of the BE and examines their relationships with PA outcomes.

Methods

We systematically searched a range of multi-discipline research databases, including studies from SIDS and LA that objectively measured BE features as an exposure and PA as an outcome between 2010 and 2021. Grey literature was not considered for this review. We characterized BE measures into 9 neighbourhood design domains using the Walkability for Health framework, and mapped gaps in the published evidence. We performed a narrative summary of BE-PA relationships, focusing on association strength and direction of effect.

Results

Fifty-one studies from published scientific literature in Brazil, Colombia, Mexico, Chile, and Singapore were included that described 306 BE-PA relationships. The BE was mostly characterized by number of and proximity to spaces for social interaction, green spaces, increasing housing density or street connectivity, and mixed residential and commercial land use. BE-PA relationships, although inconsistent, largely promoted PA.

Conclusion

Although the review is suggestive of the benefits of the benefits of BE interventions for promoting active commuting and leisurely PA, translational research is needed to understand whether results can be successfully adapted for SIDS, which often have an urban structure defined by a single urban centre with connections to outlying communities.

Design guidelines for healing gardens in the general hospital

Introduction

Despite being recognized as a cost-effective method to enhance physical and mental health, Healing Gardens remain insufficiently popularized in outdoor spaces of hospitals. This paper aims to introduce a new perspective and offer guidelines for their implementation within general hospitals.

Methods

A methodology is proposed for formulating hospital-specific guidelines, encompassing the extraction of successful Healing Garden features from case studies, definition of key components grounded in theoretical frameworks, validation of essential features through user questionnaires, and comprehensive site analyses.

Results

The methodology was applied in a case study at Zhongnan Hospital in Wuhan. This research presents a novel perspective and robust methodology for implementing Healing Gardens in general hospital settings, potentially improving physical and mental health in a cost-efficient manner.

Discussion

This work aims to encourage the adoption of Healing Gardens as preventive medical tools in more healthcare settings. By providing a comprehensive methodology and a case study illustration, this research endeavors to stimulate broader acceptance and utilization of Healing Gardens in healthcare environments.

Is overall and timing-specific physical activity associated with depression in older adults?

Objective

Regarding the circadian rhythm regulating an individual's response to external stimulation, it remains unclear whether older adults engaged in physical activity at different times of day may be differently related to depression symptoms. Thus, this study aimed to investigate the association between overall and timing-specific physical activity and depressive symptoms in older Taiwanese adults.

Methods

This cross-sectional study was conducted at a medical center in Taipei City, Taiwan, between September 2020 and December 2021. The participants were community-dwelling older adults aged ≥65 who could walk independently and were not at high risk of cognitive dysfunction. Physical activity was measured using a triaxial accelerometer (GT3X+, ActiGraph) and categorized into timing-specific periods (morning: 06:01-12:00; afternoon: 12:01-18:00; evening: 18:01-24:00) as well as overall physical activity, which included both light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). A 15-item Geriatric Depression Scale was utilized to assess and measure depressive symptoms. Multivariate linear regression models were estimated for data analysis.

Results

A total of 180 older adults (55.0% female; 80.5 ± 7.1 years old; 18.3% at risk of depression) were included. On average, the participants spent 237.3 (± 85.7) minutes in LPA per day and 12.8 (± 17.0) minutes in MVPA per day. The results showed that overall MVPA engagement was associated with lower depressive-symptom scores [B = -1.357, 95% CI (-2.561, -0.153)] in older adults. However, no significant associations were observed between overall LPA, timing-specific MVPA and LPA, and depression in older adults.

Conclusion

To prevent depression in older adults, it is advisable to accumulate a higher amount of MVPA throughout the entire day rather than engage in LPA. Further studies employing a prospective design are necessary to validate and strengthen our findings.

Philadelphia Towards Racial and Environmental Equity (Philly TREEs): how a medical school can advance health equity through urban forestry in Philadelphia, PA, USA

Inequity in access to urban greenspaces might contribute to health disparities in the USA via multiple pathways. Academic medical centres can promote health equity in their surrounding communities by partnering with community organisations to improve greenspace access in urban environments. Academic medical centres are also uniquely positioned to advance health-equity leadership among the next generation of doctors through medical-education initiatives; of particular importance is that medical professionals are involved in advocating for the expansion of greenspace access due to its direct relationship with human health and wellness. Furthermore, by focusing educational, research, and service endeavours on addressing the most important health issues within their communities, institutions could allocate some of their resources towards community greening as a form of preventive health investment. This Personal View describes our medical-student-led pilot project Philadelphia Towards Racial and Environmental Equity (Philly TREEs) at the Perelman School of Medicine (University of Pennsylvania, Philadelphia, PA, USA), which aims to improve tree equity and community wellness in Philadelphia. We highlight this project to show how academic medical institutions can help cities to achieve urban tree-canopy goals in an equitable way through community partnership and address disparities in the environment and in health.

Spatial data collection and qualification methods for urban parks in Brazilian capitals: An innovative roadmap

Urban parks have been studied for their effects on health and the environment. Accessing park data from reliable and comparable sources remains challenging, reinforcing the importance of standardized search tools, notably in Latin America. We designed a systematized methodology to identify processes of accessing, collecting, verifying, and harmonizing urban park spatial data in all Brazilian capitals included in the Urban Health in Latin America (SALURBAL) project. We developed a research protocol using official and non-official sources combining the results of Google Maps (GMaps) points and OpenStreetMap (OSM) polygons-GMaps-OSM. Descriptive analyses included the frequency of the distribution of parks before and after harmonization stratified by data source. We used the intraclass correlation coefficient (ICC) to assess agreement in the area between official and GMaps-OSM data. Official data were obtained for 16 cities; for the remaining 11 capitals, we used GMaps-OSM. After verification and harmonization, 302 urban parks were obtained from official data and 128 from GMaps-OSM. In a sub-study of the 16 cities with official data (n = 302 parks), we simulated a collection of non-official data using GMaps-OSM and OSM only. From GMaps-OSM, we obtained 142 parks, and from OSM, 230 parks. Statistical analysis showed a better agreement between official data and OSM. After completing verification and harmonization, the complete dataset (official and GMaps-OSM) included 430 urban parks with a total area of 145.14 km2. The mean number of parks across cities was 16, with a mean size area of 0.33 km2. The median number of parks was nine, with a median area of 0.07 km2. This study highlights the importance of creating mechanisms to access, collect, harmonize, and verify urban park data, which is essential for examining the impact of parks on health. It also stresses the importance of providing reliable urban park spatial data for city officials.

Greener residential environment is associated with increased bacterial diversity in outdoor ambient air

In urban areas, exposure to greenspace has been found to be beneficial to human health. The biodiversity hypothesis proposed that exposure to diverse ambient microbes in greener areas may be one pathway leading to health benefits such as improved immune system functioning, reduced systemic inflammation, and ultimately reduced morbidity and mortality. Previous studies observed differences in ambient outdoor bacterial diversity between areas of high and low vegetated land cover but didn't focus on residential environments which are important to human health. This research examined the relationship between vegetated land and tree cover near residence and outdoor ambient air bacterial diversity and composition. We used a filter and pump system to collect ambient bacteria samples outside residences in the Raleigh-Durham-Chapel Hill metropolitan area and identified bacteria by 16S rRNA amplicon sequencing. Geospatial quantification of total vegetated land or tree cover was conducted within 500 m of each residence. Shannon's diversity index and weighted UniFrac distances were calculated to measure α (within-sample) and β (between-sample) diversity, respectively. Linear regression for α-diversity and permutational analysis of variance (PERMANOVA) for β-diversity were used to model relationships between vegetated land and tree cover and bacterial diversity. Data analysis included 73 ambient air samples collected near 69 residences. Analysis of β-diversity demonstrated differences in ambient air microbiome composition between areas of high and low vegetated land (p = 0.03) and tree cover (p = 0.07). These relationships remained consistent among quintiles of vegetated land (p = 0.03) and tree cover (p = 0.008) and continuous measures of vegetated land (p = 0.03) and tree cover (p = 0.03). Increased vegetated land and tree cover were also associated with increased ambient microbiome α-diversity (p = 0.06 and p = 0.03, respectively). To our knowledge, this is the first study to demonstrate associations between vegetated land and tree cover and the ambient air microbiome's diversity and composition in the residential ecosystem.

Exploring the Association Between the Healthcare Design Elements and Physician Well-Being: A Scoping Review

PURPOSE

To evaluate the association between elements of the built environment and physician well-being using a scoping review.

BACKGROUND

Physicians currently report low work satisfaction, high burnout and depression. The built environment has been shown to affect well-being in the general population, but its relationship to physician well-being is not well understood. Gaining a better understanding of this relationship will allow for better evidence-based design for physician well-being.

METHODS

A scoping review of the literature was conducted of Scopus and PubMed databases using key words for (1) environmental variables such as "environmental design"; (2) physician terms, such as "doctor"; and (3) outcome measures of well-being, such as "burnout." Studies were included if they had at least one measure of the built environment and one measure of physician well-being. Of 1,723 abstracts screened, 146 full-text articles were reviewed, leaving 16 articles to be included for data extraction.

RESULTS

Included studies were from all around the world, except for, notably, the United States. Robust interpretation of the data was challenging because of the lack of standardization in the assessment of environmental factors and physician well-being. Excessive noise was the variable most linked to well-being. Suitable surroundings, including lighting, furniture, and art, were also linked with satisfaction, but it was unclear whether there was an association with well-being.

CONCLUSION

Understanding how environmental factors affect physician well-being is paramount but considerably understudied. Standardization of research approach should be developed in order to produce more robust research to create evidence-based designs for physician well-being.

Associations between residential greenspace exposure and mortality in 4 645 581 adults living in London, UK: a longitudinal study

BACKGROUND

Urban greenspaces could reduce non-communicable disease (NCD) risk. The links between greenspaces and NCD-related mortality remain unclear. We aimed to estimate associations between residential greenspace quantity and access and all-cause mortality, cardiovascular disease mortality, cancer mortality, respiratory mortality, and type 2 diabetes mortality.

METHODS

We linked 2011 UK Census data of London-dwelling adults (aged ≥18 years) to data from the UK death registry and the Greenspace Information for Greater London resource. We calculated percentage greenspace area, access point density (access points per km2), and distance in metres to the nearest access point for each respondent's residential neighbourhood (defined as 1000 m street network buffers) for greenspaces overall and by park type using a geographic information system. We estimated associations using Cox proportional hazards models, adjusted for a range of confounders.

FINDINGS

Data were available for 4 645 581 individuals between March 27, 2011, and Dec 31, 2019. Respondents were followed up for a mean of 8·4 years (SD 1·4). All-cause mortality did not differ with overall greenspace coverage (hazard ratio [HR] 1·0004, 95% CI 0·9996-1·0012), increased with increasing access point density (1·0076, 1·0031-1·0120), and decreased slightly with increasing distance to the nearest access point (HR 0·9993, 0·9987-0·9998). A 1 percentage point (pp) increase in pocket park (areas for rest and recreation under 0·4 hectares) coverage was associated with a decrease in all-cause mortality risk (0·9441, 0·9213-0·9675), and an increase of ten pocket park access points per km2 was associated with a decreased respiratory mortality risk (0·9164, 0·8457-0·9931). Other associations were observed, but the estimated effects were small (eg, all-cause mortality risk for increases of 1 pp in regional park area were 0·9913, 0·9861-0·9966 and increases of ten small open space access points per km2 were 1·0247, 1·0151-1·0344).

INTERPRETATION

Increasing the quantity of, and access to, pocket parks might help mitigate mortality risk. More research is needed to elucidate the mechanisms that could explain these associations.

FUNDING

Health Data Research UK (HDRUK).

Disparities in greenspace access during COVID-19 mobility restrictions

More than half of the human population lives in cities and therefore predominantly experience nature in urban greenspace, an important contributor to wellbeing. As the world faces a pandemic which threatens the physical and mental health of billions of people, it is crucial to understand that all have the possibility to access nature exposure to alleviate some of these challenges. Here, for the first time, we integrate data from Facebook, Twitter, and Google Search users to show that people looked for greenspace during COVID-19 mobility restrictions but may not have always managed to reach it. We used a longitudinal approach, replicated in three European cities, to assess whether people spent more time in locations with more greenspace, and whether this change in urban density remained for the whole pandemic, pre-vaccine, period. We coupled this human density study with a longitudinal study of web search patterns for Parks and online discussion about urban greenspace. People searched for Parks near them more during the pandemic, particularly when they were allowed to visit them. They discussed in positive terms greenspace particularly more at the start of the pandemic. People spent more time in areas with greenspace when they could and that depended on the level of multiple deprivation of their neighbourhood. Importantly, while people sought greenspace throughout the first 20 months of the pandemic, this preference intensified through the waves of lockdown. Living in an affluent area conferred a greenspace advantage in London and Paris but we find that in Berlin greenspace in more deprived neighbourhoods were used more. Overall, urban greenspace occupied a greater place in people's lives during the pandemic. Whether people could realise greenspace access depended on the deprivation level of the neighbourhood. Public greenspace access should be integrated in national indices of deprivation given its importance for wellbeing.

Green space exposure and type 2 diabetes mellitus incidence: A systematic review

INTRODUCTION

Epidemiological studies have suggested that exposure to green spaces is associated with a lower prevalence of diabetes. The aim of this systematic review was to summarize the evidence on green spaces and diabetes mellitus II (T2DM) in longitudinal studies.

METHODS

We searched PubMed, SCOPUS, Web of Science (WoS)/Core Collection, WoS/MEDLINE, and EMBASE until February 2023. We included cohort studies that assessed the incidence of T2DM according to the level of exposure to green spaces. Two authors independently performed study selection, data extraction, and analysis of risk of bias. No meta-analysis was performed due to clinical heterogeneity between studies.

RESULTS

We included 13 cohort studies with a sample size ranging from 1700 to 1 922 545 participants. Studies presented different ways of defining (quartiles, percentages) and measuring (tools, buffers) green spaces. Similarly, the definition of T2DM was heterogeneous (self-reports, medical records, clinical criteria). Twelve studies showed that individuals with higher exposure to green spaces had a decreased incidence of T2DM. Out of these 12 studies, 10 revealed statistically significant differences. All studies were of high methodological quality, except for one.

CONCLUSION

Our findings suggest that exposure to green space could be a protective factor for the development of T2DM. Promoting policies to preserve and increase green space could help to reduce T2DM at the community level. More standardization of green space exposure definition is needed in studies on green space and T2DM.

Residential greenspace and risk of cancer: A prospective cohort study from the UK Biobank

BACKGROUND

Growing evidence suggests that proximity to greenspace is linked to multiple health outcomes, but its association with the risk of cancer is not fully understood. The mechanism for greenspace's influences on cancer incidence may be through reducing depressive symptoms and increasing physical activity. Our study aimed to investigate the associations between exposure to residential greenspace and the risk of common types of cancer and whether the associations were modified or mediated by depressive symptoms and physical activity.

METHODS

This prospective cohort study included 401,189 participants in the UK Biobank between 2006 and 2010 who were free of cancer and followed up until 2021. Residential greenspace was defined as the percentage of outdoor greenspace surrounding the residential location of each participant across 1000 m and 300 m buffers, which were estimated with land use data. Electronic health records were used to assess the incidence of 25 types of cancer. Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) per an interquartile range (IQR) increase of greenspace after multiple comparisons using Bonferroni correction.

RESULTS

During a median follow-up of 12.4 years, a total of 43,273 incident cancer cases were documented. We found that exposure to greenspace at a 1000 m buffer was significantly associated with prostate cancer (HR = 0.93, 95 % CI: 0.89-0.96), and suggestively associated with oral cavity (HR = 0.86, 95 % CI: 0.76-0.98) and bladder cancer (HR = 1.08, 95 % CI: 1.01-1.15), but not with other cancers. Moreover, the association between greenspace and prostate cancer was mediated by physical activity, and was modified by depressive symptoms (P for heterogeneity = 0.022). Similar findings were also observed for greenspace at a 300 m buffer.

CONCLUSION

Our study revealed an association between exposure to greenspace and prostate cancer, but not with other cancers.

The Economic Value of Health Benefits Associated with Urban Park Investment

The allocation of resources towards the development and enhancement of urban parks offers an effective strategy for promoting and improving the health and well-being of urban populations. Investments in urban parks can result in a multitude of health benefits. The increased usage of greenspace by park users has been linked to positive physical and mental health outcomes. Additionally, the expansion of greenspace in urban areas can mitigate harmful impacts from air pollutants, heat, noise, and climate-related health risks. While the health benefits attributed to urban parks and greenspaces are well documented, few studies have measured the economic value of these benefits. This study applied a novel ecohealth economic valuation framework to quantify and estimate the potential economic value of health benefits attributed to the development of a proposed park in the downtown core of Peterborough, Canada. The results indicated that development of the small urban park will result in annual benefits of CAD 133,000 per year, including CAD 109,877 in the avoided economic burden of physical inactivity, CAD 23,084 in health savings associated with improved mental health, and CAD 127 in health savings attributed to better air quality. When including the economic value of higher life satisfaction, the economic benefit is more than CAD 4 million per year. The study demonstrates the value of developing and enhancing urban parks as a strategy to improve population health and well-being, and as a means of cost savings to the medical system.

Cross-sectional associations of different types of nature exposure with psychotropic, antihypertensive and asthma medication

BACKGROUND

Exposure to natural environments is thought to be beneficial for human health, but the evidence is inconsistent.

OBJECTIVE

To examine whether exposure to green and blue spaces in urban environments is associated with mental and physical health in Finland.

METHODS

The Helsinki Capital Region Environmental Health Survey was conducted in 2015-2016 in Helsinki, Espoo and Vantaa in Finland (n=7321). Cross-sectional associations of the amounts of residential green and blue spaces within 1 km radius around the respondent's home (based on the Urban Atlas 2012), green and blue views from home and green space visits with self-reported use of psychotropic (anxiolytics, hypnotics and antidepressants), antihypertensive and asthma medication were examined using logistic regression models. Indicators of health behaviour, traffic-related outdoor air pollution and noise and socioeconomic status (SES) were used as covariates, the last of these also as a potential effect modifier.

RESULTS

Amounts of residential green and blue spaces or green and blue views from home were not associated with medications. However, the frequency of green space visits was associated with lower odds of using psychotropic medication (OR=0.67, 95% CI 0.55 to 0.82 for 3-4 times/week; 0.78, 0.63 to 0.96 for ≥5 times/week) and antihypertensive (0.64, 0.52 to 0.78; 0.59, 0.48 to 0.74, respectively) and asthma (0.74, 0.58 to 0.94; 0.76, 0.59 to 0.99, respectively) medication use. The observed associations were attenuated by body mass index, but no consistent interactions with SES indicators were observed.

CONCLUSIONS

Frequent green space visits, but not the amounts of residential green or blue spaces, or green and blue views from home, were associated with less frequent use of psychotropic, antihypertensive and asthma medication in urban environments.

Adherence to Mediterranean Diet and Risk of Pancreatic Cancer: Systematic Review and Meta-Analysis

Pancreatic cancer (PC) represents the 6th cause of cancer death. Although the aetiology of PC is not completely understood, numerous risk factors have been identified in association with this cancer, among them diet. However, little is known about the association between the Mediterranean Diet (MedDiet) and the risk of PC. For this reason, we conducted a systematic review with meta-analysis according to the PRISMA guidelines, searching on three databases (PubMed/MEDLINE, Scopus, and EMBASE). The protocol was registered in PROSPERO. Both fixed and random effect models were performed. The Effect size was reported as a hazard ratio (HR) with a 95% Confidence Interval (CI). A total of eight articles were included. The methodological quality of the included meta-analyses was high. Our results show that a higher adherence to the MedDiet is associated with a lower risk of PC [HR:0.82 (0.76-0.88) p < 0.001, based on 1,301,320 subjects]. The results were also confirmed in sensitivity and subgroups analyses (avoidance of potential overlapping effects, type of tools used to assess dietary intake and the diagnosis of PC, prevalence and incidence of PC risk, country where the studies took place, sex, and cancer site). Promoting a higher adherence to the MedDiet could be an effective approach to reduce the risk of PC.

Linking the Urban Environment and Health: An Innovative Methodology for Measuring Individual-Level Environmental Exposures

Environmental exposures (EE) are increasingly recognised as important determinants of health and well-being. Understanding the influences of EE on health is critical for effective policymaking, but better-quality spatial data is needed. This article outlines the theoretical and technical foundations used for the construction of individual-level environmental exposure measurements for the population of a northern English city, Bradford. The work supports 'Connected Bradford', an entire population database linking health, education, social care, environmental and other local government data over a period of forty years. We argue that our current understanding of environmental effects on health outcomes is limited both by methodological shortcomings in the quantification of the environment and by a lack of consistency in the measurement of built environment features. To address these shortcomings, we measure the environmental exposure for a series of different domains including air quality, greenspace and greenness, public transport, walkability, traffic, buildings and the built form, street centrality, land-use intensity, and food environments as well as indoor dwelling qualities. We utilise general practitioners' historical patient information to identify the precise geolocation and duration of a person's residence. We model a person's local neighbourhood, and the probable routes to key urban functions aggregated across the city. We outline the specific geospatial procedure used to quantify the environmental exposure for each domain and use the example of exposure to fast-food outlets to illustrate the methodological challenges in the creation of city and nationwide environmental exposure databases. The proposed EE measures will enable critical research into the relationship and causal links between the built environment and health, informing planning and policy-making.

The impact of health resource enhancement and its spatiotemporal relationship with population health

Objective

This study investigated the impact of health resource enhancement on health and spatiotemporal variation characteristics from 2000 to 2010 at the county level.

Methods

Multiscale Geographically Weighted Regression and curve fitting were used to explore the characteristics of spatiotemporal impact and divergence mechanism of health resource enhancement on population health.

Results

From 2000 to 2010, China's population health continued to rise steadily, and health resource allocation improved. Population health demonstrated the significant spatial autocorrelation, and its spatial clustering patterns were relatively fixed. Health resource allocation was relatively equal. Health technicians per 1,000 persons had a significant positive effect on population health in 2000 and 2010. Meanwhile, its impact tends to be consistent across regions, and the impact scale has been continuously expanding. A quantitative relationship exists between population health and health resource inputs. When life expectancy ranged from 73.68 to 84.08 years, the death rate ranged from 6.27 to 9.00%, and the infant mortality rate ranged from 0.00 to 6.33%, investments in health resources, especially related to health technicians, were beneficial for population health.

Conclusions

The government should improve the science and rationality of health resource planning. Planning meets regional realities by combining the impacts of economy and geography. The influence of health resources on population health depends on the overall allocation of health technicians. The number of health technicians needs to be further increased to improve the health resources' effective allocation between regions.

Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study

Nursing home residents' well-being is often proxy-rated in studies, and few studies have explored the association between resident-rated person-centered climate, garden greenery, and resident-rated well-being. A cross-sectional study was conducted. Questionnaire data from a convenient sample of 470 nursing home residents in a city in Southeast China in 2021 were analyzed using multiple linear regressions, with block-wise models. The instruments used were the Person-centered Climate Questionnaire-Patient version, the Nursing Home Greenery Index, and, for well-being, the EuroQol-Visual Analogue Scale, the Life Satisfaction Questionnaire, and the 9-item Patient Health Questionnaire (depression symptoms). In the unadjusted models, the person-centered climate was positively associated with general health (β 0.29, p < 0.001), person-centered climate and greenery with life satisfaction (β 0.39, and 0.18; both p < 0.001), and negatively with depression (β -0.28, and β -0.23, both p < 0.001). After adjusting for personal and nursing home characteristics, the associations between person-centered climate, greenery, and well-being remained statistically significant. The three models explained 36%, 35%, and 21% of the variance in general health, life satisfaction, and depression, respectively. This study provides knowledge on person-centered climate in long-term care and the access to greenery.

Associations of ambient temperature with mortality for ischemic and hemorrhagic stroke and the modification effects of greenness in Shandong Province, China

BACKGROUND

Evidence is scant on the relative and attributable contributions of ambient temperature on stroke subtypes mortality. Few studies have examined modification effects of multiple greenness indicators on such contributions, especially in China. We quantified the associations between ambient temperature and overall, ischemic, and hemorrhagic stroke mortality; further examined whether the associations were modified by greenness.

METHODS

We conducted a multicenter time-series analysis from January 1, 2013 to December 31, 2019. we adopted a distributed lag non-linear model to evaluate county-specific temperature-stroke mortality associations. We then applied a random-effects meta-analysis to pool county-specific effects. Attributable mortality was calculated for cold and heat, defined as temperatures below and above the minimum mortality temperature (MMT). Finally, We conducted a multivariate meta-regression to determine associations between greenness and stroke mortality risks for cold and heat, using normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) as quantitative indicators of greenness exposure.

RESULTS

In the study period, 138,749 deaths from total stroke were reported: 86,873 ischemic and 51,876 hemorrhagic stroke. We observed significant W-shaped relationships between temperature and stroke mortality, with substantial differences among counties and regions. With MMT as the temperature threshold, 17.16 % (95 % empirical CI, 13.38 %-19.75 %) of overall, 20.05 % (95 % eCI, 16.46 %-22.70 %) of ischemic, and 12.55 % (95 % eCI, 5.59 %-16.24 %) of hemorrhagic stroke mortality were attributable to non-optimum temperature (combining cold and heat), more mortality was caused by cold (14.94 %; 95 % eCI, 11.57 %-17.34 %) than by heat (2.22 %; 95 % eCI, 1.54 %-2.72 %). Higher levels of NDVI, SAVI and EVI were related to mitigated effects of non-optimum temperatures-especially heat.

CONCLUSIONS

Exposure to non-optimum temperatures aggravated stroke mortality risks; increasing greenness could alleviate that risks. This evidence has important implications for local communities in developing adaptive strategies to minimize the health consequences of adverse temperatures.

Urban Green Space and Subjective Well-Being of Older People: A Systematic Literature Review

A growing number of articles have identified and reported the benefits and importance of urban green spaces for improving human well-being, but there is a significant knowledge gap regarding the impact of urban green spaces on the subjective well-being of older adults. The literature search (August 2015-August 2022) was derived from two major scientific databases, Google Scholar, and Web of Science. As a result, 2558 articles were found, 1527 of which were retrieved from WOS and the rest from Google Scholar. Bibliometric methods and VOSviewer software were used to screen and organize the articles in the relevant fields. Finally, 65 articles met the review criteria. The included studies aim to capture the benefits of various features of urban green spaces in meeting or enhancing the subjective well-being needs of older adults. The results of our review further support the existence of a strong link between older adults' subjective well-being and various features of urban green spaces, providing new insights for future in-depth reexamination and policy development. Furthermore, the relationship between urban green spaces and older adults' subjective well-being depends not only on the urban green spaces themselves but also on the characteristics of the older adult population that uses them.

Does the Spatial Pattern of Plants and Green Space Affect Air Pollutant Concentrations? Evidence from 37 Garden Cities in China

Relevant studies have demonstrated that urban green spaces composed of various types of plants are able to alleviate the morbidity and mortality of respiratory diseases, by reducing air pollution levels. In order to explore the relationship between the spatial pattern of urban green spaces and air pollutant concentrations, this study takes 37 garden cities with subtropical monsoon climate in China as the research object and selects the urban air quality monitoring data and land use type data in 2019 to analyze the relationship between the spatial pattern and the air pollutant concentration through the landscape metrics model and spatial regression model. Moreover, the threshold effect of the impact of green space on air pollutant concentrations is estimated, as well. The results showed that the spatial pattern of urban green space was significantly correlated with the concentrations of PM_2.5 (PM with aerodynamic diameters of 2.5 mmor less), NO₂ (Nitrogen Dioxide), and SO₂ (Sulfur dioxide) pollutants in the air, while the concentrations of PM₁₀ (PM with aerodynamic diameters of 10 mmor less) pollutants were not significantly affected by the green space pattern. Among them, the patch shape index (LSI), patch density (PD) and patch proportion in landscape area (PLAND) of forest land can affect the concentration of PM_2.5, NO₂, and SO₂, respectively. The PLAND, PD, and LSI of grassland and farmland can also have an additional impact on the concentration of SO₂ pollutants. The study also found that there was a significant threshold effect within the impact mechanism of urban green space landscape pattern indicators (LSI, PD, PLAND) on the concentrations of PM_2.5, NO₂, and SO₂ air pollutants. The results of this study not only clarified the impact mechanism of the spatial pattern of urban green space on air pollutant concentrations but also provided quantitative reference and scientific basis for the optimization and updating of urban green space to promote public health.

Sociodemographic Variations in the Availability of Urban Green Spaces in an Older Swedish Population

Urban green spaces (UGS) can have a positive impact on health and thereby potentially ease the strain on the health care system. However, the availability and benefits seem to vary between different sociodemographic groups. The aim of this study was to investigate associations between sociodemographic factors and availability to UGS among people aged 65 years or older. Data on sociodemographic variables and residential coordinates were obtained for three cross-sectional cohorts in two cities (Malmö and Kristianstad) and three years (2010, 2015, and 2019). Three measures of urban green spaces; total (UGS), public (PGS) and quiet (QGS), within 300 m were used to determine availability. The results indicated higher availability to both total and publicly available urban green spaces for groups with lower socioeconomic status (SES) is positive from a health perspective. However, availability to high qualitative publicly available urban green spaces, from a noise perspective, was lower, indicating the opposite.

Altered Food Behavior and Cancer: A Systematic Review of the Literature

There is evidence of an association between cancer and certain types of altered eating behaviors, including orthorexia, food cravings, and food addiction. Given the growing interest in the topic throughout the scientific community we conducted a systematic review to summarize current evidence on the development of altered food behavior, including food addiction and cancer. The Cochrane Collaboration and the Meta-analysis Of Observational Studies in Epidemiology guidelines were followed to perform this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the process and results. The structured literature search was conducted on 19 April 2022, on PubMed/Medline and Scopus, combining free-text terms and medical subject headings. A total of seven articles were included once the selection process was completed. Food craving has been associated with different types of cancer in adults and young patients, as well as with orthorexia; conversely, compulsive eating has only been explored in patients with prolactinoma treated with dopamine agonists. This systematic review explored a new area of research that warrants further investigation. More research is required to better understand the relationship between cancer and food behavior.

Evolving norms: social media data analysis on parks and greenspaces perception changes before and after the COVID 19 pandemic using a machine learning approach

This study provides a novel approach to understand human perception changes in their experiences of and interactions with public greenspaces during the early months of COVID-19. Using social media data and machine learning techniques, the study delivers new understandings of how people began to feel differently about their experiences compared to pre-COVID times. The study illuminates a renewed appreciation of nature as well as an emerging but prominent pattern of emotional and spiritual experiences expressed through a social media platform. Given that most park and recreational studies have almost exclusively examined whether park use increased or decreased during the pandemic, this research provides meaningful implications beyond the simple extensional visit pattern and lends weight to the growing evidences on changing perceptions over and the positive psychological impacts of nature. The study highlights the preeminent roles parks and greenspaces play during the pandemic and guides a new direction in future park development to support more natural elements and nature-oriented experiences from which emotional and spiritual well-being outcomes can be drawn.

The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications

Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.

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.

Effects of residential greenness on attention in a longitudinal study at 8 and 11-13 years

In an urbanizing world, with 55% of the population living in cities, it is essential to design friendly and healthy ones. An emerging body of evidence has associated greenspace exposure with improved cognitive development, including attentional function; however, the longitudinal studies looking at the association with attentional function are still scarce. Therefore, the objective of this study was to analyze the association of the exposure to greenspace and attention in school children. This study was based on 751 participants at 8 years and 598 at 11-13 years of two sub-cohorts of the INMA cohort study in Gipuzkoa and Asturias, Spain. Greenspace exposure at home was characterized using four indicators: (i) average of Normalized Difference Vegetation Index (NDVI) and (ii) Vegetation Continuous Field (VCF) in buffers of 100 m, 300 m, and 500 m around the residential address, (ii) availability of a green space within 300 m from the residential address, and (iv) residential distance to green spaces. Participants' attention was characterized twice at ages of 8 and 11 years, using the computerized Attentional Network Test (ANT). General linear models were used for the cross-sectional analyses and linear mixed effects model for the longitudinal analyses. Our cross-sectional analyses showed a statistical significant protective association between average NDVI at 300 m and inattentiveness (-7.20, CI 95%: 13.74; -0.67). In our longitudinal analyses, although we generally observed beneficial associations between greenspace exposure and attention, none attained statistical significance. No statistically significant indirect effect were seen for NO₂. Our findings add to the emerging body of evidence on the role of green spaces in neurodevelopment, which can provide the evidence base for implementing intervention aimed at promoting neurodevelopment in urban children.

Decision Tree Analyses to Explore the Relevance of Multiple Sex/Gender Dimensions for the Exposure to Green Spaces: Results from the KORA INGER Study

Recently, attention has been drawn to the need to integrate sex/gender more comprehensively into environmental health research. Considering theoretical approaches, we define sex/gender as a multidimensional concept based on intersectionality. However, operationalizing sex/gender through multiple covariates requires the usage of statistical methods that are suitable for handling such complex data. We therefore applied two different decision tree approaches: classification and regression trees (CART) and conditional inference trees (CIT). We explored the relevance of multiple sex/gender covariates for the exposure to green spaces, measured both subjectively and objectively. Data from 3742 participants from the Cooperative Health Research in the Region of Augsburg (KORA) study were analyzed within the INGER (Integrating gender into environmental health research) project. We observed that the participants’ financial situation and discrimination experience was relevant for their access to high quality public green spaces, while the urban/rural context was most relevant for the general greenness in the residential environment. None of the covariates operationalizing the individual sex/gender self-concept were relevant for differences in exposure to green spaces. Results were largely consistent for both CART and CIT. Most importantly we showed that decision tree analyses are useful for exploring the relevance of multiple sex/gender dimensions and their interactions for environmental exposures. Further investigations in larger urban areas with less access to public green spaces and with a study population more heterogeneous with respect to age and social disparities may add more information about the relevance of multiple sex/gender dimensions for the exposure to green spaces.

Nonlinear Relationships among the Natural Environment, Health, and Sociodemographic Characteristics across US Counties

Background: The aim of this study was to explore the nonlinear relationships between natural amenities and health at the intersection of sociodemographic characteristics among primary care patients with chronic conditions. Methods: We used survey data from 3409 adults across 119 US counties. PROMIS-29 mental and physical health summary scores were the primary outcomes. The natural environment (measured using the County USDA Natural Amenities Scale (NAS)) was the primary predictor. Piecewise spline regression models were used to explore the relationships between NAS and health at the intersection of sociodemographic factors. Results: We identified a nonlinear relationship between NAS and health. Low-income individuals had a negative association with health with each increase in NAS in high-amenity areas only. However, White individuals had a stronger association with health with each increase in NAS in low-amenity areas. Conclusions: In areas with low natural amenities, more amenities are associated with better physical and mental health, but only for advantaged populations. Meanwhile, for disadvantaged populations, an increase in amenities in high-amenity areas is associated with decreases in mental and physical health. Understanding how traditionally advantaged populations utilize the natural environment could provide insight into the mechanisms driving these disparities.

Short-term NO2 exposure and cognitive and mental health: A panel study based on a citizen science project in Barcelona, Spain

BACKGROUND

The association between short-term exposure to air pollution and cognitive and mental health has not been thoroughly investigated so far.

OBJECTIVES

We conducted a panel study co-designed with citizens to assess whether air pollution can affect attention, perceived stress, mood and sleep quality.

METHODS

From September 2020 to March 2021, we followed 288 adults (mean age = 37.9 years; standard deviation = 12.1 years) for 14 days in Barcelona, Spain. Two tasks were self-administered daily through a mobile application: the Stroop color-word test to assess attention performance and a set of 0-to-10 rating scale questions to evaluate perceived stress, well-being, energy and sleep quality. From the Stroop test, three outcomes related to selective attention were calculated and z-score-transformed: response time, cognitive throughput and inhibitory control. Air pollution was assessed using the mean nitrogen dioxide (NO₂) concentrations (mean of all Barcelona monitoring stations or using location data) 12 and 24 h before the tasks were completed. We applied linear regression with random effects by participant to estimate intra-individual associations, controlling for day of the week and time-varying factors such as alcohol consumption and physical activity.

RESULTS

Based on 2,457 repeated attention test performances, an increase of 30 μg/m³ exposure to NO₂ 12 h was associated with lower cognitive throughput (beta = -0.08, 95% CI: -0.15, -0.01) and higher response time (beta = 0.07, 95% CI: 0.01, 0.14) (increase inattentiveness). Moreover, an increase of 30 μg/m³ exposure to NO₂ 12 h was associated with higher self-perceived stress (beta = 0.44, 95% CI: 0.13, 0.77). We did not find statistically significant associations with inhibitory control and subjective well-being.

CONCLUSIONS

Our findings suggest that short-term exposure to air pollution could have adverse effects on attention performance and perceived stress in adults.

Association between Daily Pattern of Physical Activity and Depression: A Systematic Review

Recent research suggested that daily pattern of physical activity (PA) may have an important association with depression, but findings are limited and contradictory. Our aim was to conduct a systematic review of the literature to summarize the literature evidence on the association between timing of PA and depression. A comprehensive search of PubMed/Medline and Scopus databases has been performed, and a total of five manuscripts have been thoroughly reviewed. The performed descriptive analysis shows lower levels of PA among individuals with depression or depressive symptoms, although evidence on the 24 h pattern of PA and depression is limited. An interesting finding is the association between lower PA during the morning, higher PA late in the evening (night), and depression or depressive symptoms. However, definitive conclusions could not be drawn due to the observational nature of the studies, their limited number, the high heterogeneity in the sample populations, and the studies’ differing outcome definitions and exposure assessments. Future studies considering not only the level of PA but also its daily variability might be important to further explore this novel area of research.

Rethinking the distribution of urban green spaces in Mexico City: Lessons from the COVID-19 outbreak

The COVID-19 pandemic has exposed inequalities that are expected to widen if no action is taken to support the most marginalized populations. One such inequality is the distribution of urban green spaces (UGS), which are essential to pandemic recovery. Cities that aim to be inclusive and resilient should assess whether access to their UGS is equitably distributed among the population and identify the areas where these spaces are most needed. This study therefore examines the equity of access to UGS in Mexico City at the neighborhood level using network analysis. First, access to UGS was identified at a threshold of 300 m, regardless of UGS size. Second, access was differentiated by the functional level of the UGS, which primarily depends on their size, with larger UGS having more extensive catchment areas. The results of this study suggest a deficit of access to small green spaces in most of the neighborhoods of Mexico City, with the neighborhoods with higher rates of poverty showing an even lower average of UGS access. The results further highlight which neighborhoods in Mexico City should receive priority attention and funding for UGS to mitigate the disproportionate effects of public health crises. This is critical for future city planning and may be used as a roadmap for identifying priority neighborhoods in other cities with similar segregation patterns.

Park Characteristics and Changes in Park Visitation before, during, and after COVID-19 Shelter-in-Place Order

The COVID-19 pandemic has limited people’s visitation to public places because of social distancing and shelter-in-place orders. According to Google’s community mobility reports, some countries showed a decrease in park visitation during the pandemic, while others showed an increase. Although government responses played a significant role in this variation, little is known about park visitation changes and the park attributes that are associated with these changes. Therefore, we aimed to examine the associations between park characteristics and percent changes in park visitation in Harris County, TX, for three time periods: before, during, and after the shelter-in-place order of Harris County. We utilized SafeGraph’s point-of-interest data to extract weekly park visitation counts for the Harris County area. This dataset included the size of each park and its weekly number of visits from 2 March to 31 May 2020. In addition, we measured park characteristics, including greenness density, using the normalized difference vegetation index; park type (mini, neighborhood, community, regional/metropolitan); presence of sidewalks and bikeways; sidewalk and bikeway quantity; and bikeway quality. Results showed that park visitation decreased after issuing the shelter-in-place order and increased after this order was lifted. Results from linear regression models indicated that the higher the greenness density of the park, the smaller the decrease in park visitation during the shelter-in-place period compared to before the shelter-in-place order. This relationship also appeared after the shelter-in-place order. The presence of more sidewalks was related to less visitation increase after the shelter-in-place order. These findings can guide planners and designers to implement parks that promote public visitation during pandemics and potentially benefit people’s physical and mental health.

Greenspace, Inflammation, Cardiovascular Health, and Cancer: A Review and Conceptual Framework for Greenspace in Cardio-Oncology Research

Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. Cancer survivors have significantly elevated risk of poor cardiovascular (CV) health outcomes due to close co-morbid linkages and shared risk factors between CVD and cancer, as well as adverse effects of cancer treatment-related cardiotoxicity. CVD and cancer-related outcomes are exacerbated by increased risk of inflammation. Results from different pharmacological interventions aimed at reducing inflammation and risk of major adverse cardiovascular events (MACEs) have been largely mixed to date. Greenspaces have been shown to reduce inflammation and have been associated with CV health benefits, including reduced CVD behavioral risk factors and overall improvement in CV outcomes. Greenspace may, thus, serve to alleviate the CVD burden among cancer survivors. To understand pathways through which greenspace can prevent or reduce adverse CV outcomes among cancer survivors, we review the state of knowledge on associations among inflammation, CVD, cancer, and existing pharmacological interventions. We then discuss greenspace benefits for CV health from ecological to multilevel studies and a few existing experimental studies. Furthermore, we review the relationship between greenspace and inflammation, and we highlight forest bathing in Asian-based studies while presenting existing research gaps in the US literature. Then, we use the socioecological model of health to present an expanded conceptual framework to help fill this US literature gap. Lastly, we present a way forward, including implications for translational science and a brief discussion on necessities for virtual nature and/or exposure to nature images due to the increasing human-nature disconnect; we also offer guidance for greenspace research in cardio-oncology to improve CV health outcomes among cancer survivors.

Is Greenness Associated with Dementia? A Systematic Review and Dose-Response Meta-analysis

PURPOSE OF REVIEW

We assessed the relation between environmental greenness and risk of dementia and cognitive impairment, based on a systematic review and meta-analysis up to March 30, 2022, characterizing whenever possible the shape of the association using dose-response meta-analysis.

RECENT FINDINGS

Twelve studies were included in this review, either using normalized difference vegetation index (NDVI) or land use/cover (LU/LC) methodology to assess greenness. Comparing the highest versus lowest exposure categories of greenness assessed using the NDVI (6 studies) or LU/LC (6 studies), we found no association with dementia. Dose-response meta-analysis of the association between greenness measured by LU/LC and dementia, based on only 3 studies, indicated a U-shaped association, but estimates were imprecise. Our systematic review and meta-analysis provided some evidence of a slight inverse association between greenness and dementia at intermediate exposure levels, but not at high levels. Potential methodological limitations, such as exposure misclassification and unmeasured confounding, may have affected the results.

Psychosocial and Biological Outcomes of Immersive, Mindfulness-Based Treks in Nature for Groups of Young Adults and Caregivers Affected by Cancer: Results from a Single Arm Program Evaluation from 2016-2021

The COVID-19 pandemic has left many individuals suffering from “connection deficit disorder” given changes to the way we work, go to school, socialize, and engage in daily activities. Young adults affected by cancer between the ages of 18–39 have known this connection deficit long before the pandemic. Being diagnosed and treated for cancer during this time can significantly disrupt engagement in important educational, career, social, and reproductive pursuits, and contribute to increased stress, anxiety, depression, and other negative outcomes. Experiencing meaningful connection—with nature, with peers who understand, and with oneself, may help assuage this adverse effect of disconnect. A single arm within-subjects program evaluation was conducted to examine outcomes following participation in immersive, multi-night, mindfulness-based treks in nature in a sample of young adults (n = 157) and caregivers (n = 50) affected by cancer from 2016–2021. Pre to post-trek changes included significant (p < 0.001) self-reported improvements in feeling connected to nature (d = 0.93–0.95), peers (d = 1.1–1.3), and oneself (d = 0.57–1.5); significant (p < 0.001) improvements on PROMIS Anxiety (d = 0.62–0.78), Depression (d = 0.87–0.89), and Sleep Disturbance (d = 0.37–0.48) short forms; and significant (p < 0.05) changes in pro-inflammatory biomarkers (d = 0.55–0.82). Connection-promoting experiences like this have the potential to improve health and wellbeing in this population and serve as a model for others.

Determination of Motivating Factors of Urban Forest Visitors through Latent Dirichlet Allocation Topic Modeling

Despite the unique characteristics of urban forests, the motivating factors of urban forest visitors have not been clearly differentiated from other types of the forest resource. This study aims to identify the motivating factors of urban forest visitors, using latent Dirichlet allocation (LDA) topic modeling based on social big data. A total of 57,449 cases of social text data from social blogs containing the keyword "urban forest" were collected from Naver and Daum, the major search engines in South Korea. Then, 17,229 cases were excluded using morpheme analysis and stop word elimination; 40,110 cases were analyzed to identify the motivating factors of urban forest visitors through LDA topic modeling. Seven motivating factors-"Cafe-related Walk", "Healing Trip", "Daily Leisure", "Family Trip", "Wonderful View", "Clean Space", and "Exhibition and Photography"-were extracted; each contained five keywords. This study elucidates the role of forests as a place for healing, leisure, and daily exercise. The results suggest that efforts should be made toward developing various programs regarding the basic functionality of urban forests as a natural resource and a unique place to support a diversity of leisure and cultural activities.

Outdoor Recreation for Older Adults in Scotland: Qualitatively Exploring the Multiplicity of Constraints to Participation

Active ageing can lead to better health outcomes in older people. Examining constraints to outdoor recreation for older people, including outdoor physical activity, may therefore assist with developing strategies for active ageing. Findings are presented from a study seeking to understand the constraints to older peoples' access to outdoor recreation in Scotland, and this paper aimed to examine the multitude of constraints that discourage or prevent older people from accessing the outdoors and the ways in which these constraints are hierarchical (or not). This paper adopted a qualitative methodology using the hierarchical leisure constraints model (HLCM) as a lens to analyse the data, presenting the data in three vignettes. The paper identified multiple co-occurring constraints and considered these in relation to expectations based on the HLCM. Recognising that constraints to outdoor recreation for older people are multiple, co-occurring and mutually reinforcing may enable more effective solutions to be developed to overcome them.