Natural outdoor environments and adults' health : associations, effect modifiers and mediators

This thesis aims at (a) evaluating the association between natural outdoor environments (NOE) and health in adults and potential effect modifiers of this association, and (b) investigating the possible mechanism of this association. Data was derived from two cross-sectional studies (including a nested one) and one experimental study. Exposure assessment included residential NOE exposure, and contact with NOE (objectively measured with smartphones and event-based exposures). Health outcomes included mainly subjectively mental health. The potential effect modifier of gender, age, socioeconomic status, urbanisation degree/city and exposure time was evaluated. The possible mechanisms investigated were: (NOE) physical activity, stress/restoration, social contacts, noise, and air pollution. Results of the present work suggest that NOE exposure (both residential and contact with NOE) was positively associated with adults’ chronic health, mainly for green space and greenery, and specially for surrounding greenness. Event-based exposure to NOE was also positively associated to adults’ acute health effects. No strong conclusions could be drawn about groups of population that could benefit more from NOE exposure. Physical activity might not be a mediator of the NOE-health associations. Stress reduction/restoration and air pollution might be partial mediators of these associations. The relationship between NOE exposure -NOE physical activity could be modified by various factors. We highlight the limitations of existing studies in the field and provide recommendations for future research. In the meanwhile, urban planners and policy makers should consider all the mechanisms, targeting the entire population, and use “just green enough” strategies supported by anti-gentrification policies.Els objectius d’aquesta tesi eren (a) avaluar l’associació entre entorns naturals exteriors (ENE) i la salut dels adults i el potencial efecte modificador d’aquesta associació i (b) investigar els possibles mecanismes d’aquesta associació. En la present tesi s’han utilitzat dades de dos estudis transversals (incloent un estudi niat) i un estudi experimental. L’estimació de l’exposició incloïa l’exposició residencial a ENE i el contacte amb ENE (mesurat objectivament amb smartphones i l’exposició basada-en-event). Els resultats en salut avaluats incloïen principalment la salut mental subjectiva. Els potencials modificadors d’efecte que es van explorar eren el gènere, l’edat, l’estat socioeconòmic, el nivell d’urbanització/la ciutat i el temps d’exposició. Els possibles mecanismes investigats eren: l’activitat física (en ENE), l’estrès/restauració, els contactes socials, el soroll i la contaminació atmosfèrica. Els resultats d’aquesta tesi suggereixen que l’exposició a ENE (tant residencial com el contacte amb l’ENE) estava associada positivament amb l’estat de salut dels adults a llarg termini. Les associacions es trobaven sobretot per espais verds i verdor, especialment el verdor circumdant. L’exposició basada-en-event als ENE estava associada positivament als efectes en salut en adults a curt termini. No es va poder concloure res sobre els grups de població que es podien beneficiar més de l’exposició als ENE. L’activitat física podria no ser un mediador de l’associació ENE-salut. La reducció de l’estrès, la restauració i la contaminació atmosfèrica podrien ser mediadors parcials de l’associació. La relació entre exposició a ENE i l’activitat física (en ENE) podria ser modificada per varis factors. Aquesta tesi recalca les limitacions dels estudis existents en el camp i proporciona recomanacions sobre recerca futura. Mentrestant, els planificadors urbans i els legisladors haurien de considerar tots els possibles mecanismes, dirigir-se a tota la població i utilitzar estratègies “només suficientment verdes” acompanyades per polítiques d’anti-gentrificació

Natural outdoor environments and adults' health : associations, effect modifiers and mediators

This thesis aims at (a) evaluating the association between natural outdoor environments (NOE) and health in adults and potential effect modifiers of this association, and (b) investigating the possible mechanism of this association. Data was derived from two cross-sectional studies (including a nested one) and one experimental study. Exposure assessment included residential NOE exposure, and contact with NOE (objectively measured with smartphones and event-based exposures). Health outcomes included mainly subjectively mental health. The potential effect modifier of gender, age, socioeconomic status, urbanisation degree/city and exposure time was evaluated. The possible mechanisms investigated were: (NOE) physical activity, stress/restoration, social contacts, noise, and air pollution. Results of the present work suggest that NOE exposure (both residential and contact with NOE) was positively associated with adults’ chronic health, mainly for green space and greenery, and specially for surrounding greenness. Event-based exposure to NOE was also positively associated to adults’ acute health effects. No strong conclusions could be drawn about groups of population that could benefit more from NOE exposure. Physical activity might not be a mediator of the NOE-health associations. Stress reduction/restoration and air pollution might be partial mediators of these associations. The relationship between NOE exposure -NOE physical activity could be modified by various factors. We highlight the limitations of existing studies in the field and provide recommendations for future research. In the meanwhile, urban planners and policy makers should consider all the mechanisms, targeting the entire population, and use “just green enough” strategies supported by anti-gentrification policies.Els objectius d’aquesta tesi eren (a) avaluar l’associació entre entorns naturals exteriors (ENE) i la salut dels adults i el potencial efecte modificador d’aquesta associació i (b) investigar els possibles mecanismes d’aquesta associació. En la present tesi s’han utilitzat dades de dos estudis transversals (incloent un estudi niat) i un estudi experimental. L’estimació de l’exposició incloïa l’exposició residencial a ENE i el contacte amb ENE (mesurat objectivament amb smartphones i l’exposició basada-en-event). Els resultats en salut avaluats incloïen principalment la salut mental subjectiva. Els potencials modificadors d’efecte que es van explorar eren el gènere, l’edat, l’estat socioeconòmic, el nivell d’urbanització/la ciutat i el temps d’exposició. Els possibles mecanismes investigats eren: l’activitat física (en ENE), l’estrès/restauració, els contactes socials, el soroll i la contaminació atmosfèrica. Els resultats d’aquesta tesi suggereixen que l’exposició a ENE (tant residencial com el contacte amb l’ENE) estava associada positivament amb l’estat de salut dels adults a llarg termini. Les associacions es trobaven sobretot per espais verds i verdor, especialment el verdor circumdant. L’exposició basada-en-event als ENE estava associada positivament als efectes en salut en adults a curt termini. No es va poder concloure res sobre els grups de població que es podien beneficiar més de l’exposició als ENE. L’activitat física podria no ser un mediador de l’associació ENE-salut. La reducció de l’estrès, la restauració i la contaminació atmosfèrica podrien ser mediadors parcials de l’associació. La relació entre exposició a ENE i l’activitat física (en ENE) podria ser modificada per varis factors. Aquesta tesi recalca les limitacions dels estudis existents en el camp i proporciona recomanacions sobre recerca futura. Mentrestant, els planificadors urbans i els legisladors haurien de considerar tots els possibles mecanismes, dirigir-se a tota la població i utilitzar estratègies “només suficientment verdes” acompanyades per polítiques d’anti-gentrificació

Determining the health benefits of green space: does gentrification matter?

Urban green space is demonstrated to benefit human health. We evaluated whether neighborhood gentrification status matters when considering the health benefits of green space, and whether the benefits are received equitably across racial and socioeconomic groups. Greater exposure to active green space was significantly associated with lower odds of reporting fair or poor health, but only for those living in gentrifying neighborhoods. In gentrifying neighborhoods, only those with high education or high incomes benefited from neighborhood active green space. Structural interventions, such as new green space, should be planned and evaluated within the context of urban social inequity and change.The researched presented in this paper received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No.678034 and grant agreement No. 730243). This research contributes tothe Maria de Maetzu Unit of Excellence grant (MDM-2015-0552) at the Institute for Environmental Science and Technology. In addition, JJTC was funded by the Spanish government's Juan de la Cierva incorporation fellowship (IJCI-2016-31100) and MTM was funded by the Juan dela Cierva formation fellowship (FJCI-2017-33842). The dataset used in analyses for this paper, NYC Community Health Survey, 2009–2013 was obtained from the Bureau of Epidemiology Services in the New York City Department of Health and Mental Hygien

Mental health outcomes in Barcelona: the interplay between gentrification and greenspace

Greenspace is widely related to mental health benefits, but this relationship may vary by social group. Gentrification, as linked to processes of unequal urban development and conflict, potentially impacts health outcomes. This study explores the relationships between greenspace and mental health and between gentrification and mental health associations. It also further examines gentrification as an effect modifier in the greenspace-mental health association and SES as an effect modifier in the gentrification-mental health association. We used cross-sectional Barcelona (Spain) data from 2006, which included perceived mental health status and self-reported depression/anxiety from the Barcelona Health Survey. Greenspace exposure was measured as residential access to (1) all greenspace, (2) greenways and (3) parks in 2006. Census-tract level gentrification was measured using an index including changes in sociodemographic indicators between 1991 and 2006. Logistic regression models revealed that only greenways were associated with better mental health outcomes, with no significant relationship between mental health and parks or all greenspace. Living in gentrifying neighborhoods was protective for depression/anxiety compared to living in non-gentrifying neighborhoods. However, only residents of gentrifiable census tracts benefited from the exposure to greenways. SES was not found to be an effect modifier in the association between gentrification and mental health. Future research should tackle this study's limitations by incorporating a direct measure of displacement in the gentrification status indicator, accounting for qualitative aspects of greenspace and user's perceptions. Gentrification may undermine the health benefits provided by greenspace interventions.This project is based on data obtained in the context of GREENLULUS (Green Locally Unwanted Land Uses) (http://www.bcnuej.org/projects/greenlulus/ accessed on 11 August 2021), coordinated by Prof. Isabelle Anguelovski at UAB-ICTA-IMIM, which is a Horizon 2020- and European Research Council-funded project that analyses the conditions under which urban greening projects in distressed neighborhoods redistribute access of environmental amenities to historically marginalized groups (GA678034). H.C. and M.T.M. received funding from the Juan de la Cierva fellowship program of the Spanish Ministry of Economy and Competitiveness (FJCI-2017-33842 and IJC-2018-035322-I). This work/research/etc. contributes to the “María de Maeztu” Programme for Units of Excellence of the Spanish Ministry of Science and Innovation (CEX2019-000940-M)

Residential proximity to urban play spaces and childhood overweight and obesity in Barcelona, Spain: A population-based longitudinal study

Findings on the relationship between play spaces and childhood overweight and obesity are mixed and scarce. This study aimed to investigate the associations between residential proximity to play spaces and the risk of childhood overweight or obesity and potential effect modifiers. This longitudinal study included children living in the city of Barcelona identified in an electronic primary healthcare record database between 2011 and 2018 (N = 75,608). Overweight and obesity were defined according to the WHO standards and we used 300 m network buffers to assess residential proximity to play spaces. We calculated the risk of developing overweight or obesity using Cox proportional hazard models. A share of 29.4% of the study population developed overweight or obesity, but we did not find consistent associations between play space indicators and overweight or obesity. We did not find any consistent sign of effect modification by sex, and only some indications of the modifying role of area socioeconomic status and level of exposure. Although it is not possible to draw clear conclusions from our study, we call for cities to continue increasing and improving urban play spaces with an equitable, healthy, and child-friendly perspective.This study used the play spaces exposure data from the Horizon 2020 and European Research Council (ERC) funded Green Locally Unwanted Land Uses (GREENLULUS) project (grant agreement number 678034) and the Spanish Ministry of Science and Innovation (Maria de Maeztu, CEX2019-000940-M). Access to the SIDIAP database and linkage to play space exposure was funded by La Marató de TV3 Foundation (grant number 201621–30) as part of the Urban environment and childhood obesity in Catalonia (ECHOCAT) project. T.D.-S. acknowledges receiving financial support from the Instituto de Salud Carlos III (ISCIII; Miguel Servet 2021: CP21/00023) which is co-funded by the European Union

Residential green spaces and mortality: a systematic review

BACKGROUND: A number of studies have associated natural outdoor environments with reduced mortality but there is no systematic review synthesizing the evidence. OBJECTIVES: We aimed to systematically review the available evidence on the association between long-term exposure to residential green and blue spaces and mortality in adults, and make recommendations for further research. As a secondary aim, we also conducted meta-analyses to explore the magnitude of and heterogeneity in the risk estimates. METHODS: Following the PRISMA statement guidelines for reporting systematic reviews and meta-analysis, two independent reviewers searched studies using keywords related to natural outdoor environments and mortality. DISCUSSION: Our review identified twelve eligible studies conducted in North America, Europe, and Oceania with study populations ranging from 1645 up to more than 43 million individuals. These studies are heterogeneous in design, study population, green space assessment and covariate data.We found that the majority of studies show a reduction of the risk of cardiovascular disease (CVD) mortality in areas with higher residential greenness. Evidence of a reduction of all-cause mortality is more limited, and no benefits of residential greenness on lung cancer mortality are observed. There were no studies on blue spaces. CONCLUSIONS: This review supports the hypothesis that living in areas with higher amounts of green spaces reduces mortality, mainly CVD. Further studies such as cohort studies with more and better covariate data, improved green space assessment and accounting well for socioeconomic status are needed to provide further and more complete evidence, as well as studies evaluating the benefits of blue spaces.This project was funded by the CERCA Institutes Integration Program (SUMA 2013) [promoted and managed by the Secretariat for Universities and Research of the Ministry Economy and Knowledge of the Government of Catalonia (SUR), the Agency for Management of University and Research Grants (AGAUR) and the CERCA Institute]. Payam Dadvand is funded by a Ramón y Cajal fellowship (RYC-2012-10,995) awarded by the Spanish Ministry of Economy and Competitiveness. Margarita Triguero-Mas is funded by a pre-doctoral grant from the Catalan Government (AGAUR FI-DGR-2013)

Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project

Background: Commuting routes with natural features could promote walking or cycling for commuting. Commuting through natural environments (NE) could have mental health benefits as exposure to NE can reduce stress and improve mental health, but there is little evidence. This study evaluates the association between NE and commuting, whether active or not, and the association between commuting (through NE), whether active or not, and mental health. We also evaluate the moderating effect of NE quality on the association between NE commuting and mental health. Methods: This cross-sectional study was based on adult respondents (n = 3599) of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in four European cities in Spain, the Netherlands, Lithuania and the United Kingdom. Data on commuting behavior (active commuting at least one day/week, daily NE commuting) and mental health were collected with questionnaires. Associations were estimated with multilevel analyses including random intercepts at city- and neighborhood level. Results: Adjusted multilevel analyses showed that daily NE commuters were more often active commuters (OR 1.42; 95% CI 1.19, 1.70). There was no association between active commuting and mental health, but daily NE commuters had on average a 2.74 (95% CI 1.66, 3.82) point higher mental health score than those not commuting through NE. The association with mental health was stronger among active commuters (4.03, 95% CI 2.13, 5.94) compared to non-active commuters (2.21; 95% CI 0.90, 3.51) when daily commuting through NE, but NE quality did not have a moderating effect. Conclusions: Daily NE commuting was associated with better mental health, especially for active commuters. Daily NE commuters were likely to be active commuters. Active commuting itself was not associated with mental health. These findings suggest that cities should invest in commuting routes with nature for cycling and walking.The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 282996. W.L. Zijlema is supported by a Sara Borrell grant from the Instituto de Salud Carlos III (CD17/00195)

Public transport strikes and their relationships with air pollution, mortality, and hospital admissions

There is limited suggestive evidence of relationships between public transport strikes and either increased air pollution or worse population health. In this study we aimed to assess whether public transport strikes were associated with increases in health events (overall, cardiovascular and respiratory mortality, and cardiovascular and respiratory hospitalizations). We also explored whether air pollution mediated those associations. We used data from the city of Barcelona (Spain) for the period 2005-2016 on strikes, health events, and ambient air pollution (nitrogen dioxide, nitrogen monoxide, particulate matter (PM) with an aerodynamic diameter ≤10 μm, PM with an aerodynamic diameter ≤2.5μm, PM with an aerodynamic diameter ≤1μm, number of particles with a diameter greater than 5 nm per cm3 (particle number concentration), and black carbon). We used linear and quasi-Poisson regression models to explore the associations between air pollution and public transport strikes and between public transport strikes and health outcomes. We also investigated potential causal mediation by air pollution. Overall, this study suggested that public transport strikes are associated with increased overall mortality, respiratory mortality, and respiratory hospitalizations. However, our findings suggest that such increases are not mediated by the increase in air pollution. Our results indicate the need to further investigate these relationships and potential mechanisms

Quality of life benefits of urban rooftop gardening for people with intellectual disabilities or mental health disorders

Background: The number of urban community gardens, including those on rooftops, is increasing. However, few studies have explored the benefits of these gardens for people with intellectual disabilities or mental health disorders. We evaluated the association between urban rooftop gardening and quality of life of individuals with moderate to very marked disability. Methods: We collected quality of life information with a preliminary version of the INTEGRAL Scale questionnaire from all gardeners (n = 54) and among a comparison group of nongardeners (n = 43). We also conducted semi-structured interviews with participants and technicians, and made field observations. Results: Our results indicated that urban rooftop gardening was associated with better personal development and suggested enhanced physical and emotional well-being, sense of purpose, social inclusion, interpersonal relations (including new perspectives on the urban environment and the changes in social roles), and general quality of life. Conclusion: Our study extends the evidence on the potential benefits of urban rooftop gardening in general, and specifically for those with intellectual disabilities and mental health disorders.The research presented in this article received funding from the Town Council of Barcelona and from the European Research Council under the European Union’s Horizon 2020 research and innovation program (grant agreement no. 678034). These sponsors had no role in the design or analysis of this study. No copyrighted material was used in this manuscript