Correction: Cervinka, R.; et al. Investigating the Qualities of a Recreational Forest: Findings from the Cross-Sectional Hallerwald Case Study. Int. J. Environ. Res. Public Health 2020, 17, 1676.

In the original article [...].

Investigating the Qualities of a Recreational Forest: Findings from the Cross-Sectional Hallerwald Case Study.

Prior research shows that forests contribute to human health and well-being. In this sense, this cross-sectional case study, adopting the principles of citizen science, assessed the restorative potential of places in the Hallerwald, an Austrian community forest. A convenience sample of adult forest visitors (n = 99, 64% females) completed a survey during a guided 2.5 h forest tour. The German questionnaire assessed the qualities of defined places in the forest. We also investigated changes in mood states, perceived stress, restoration, connectedness, and mindfulness before and after visiting the forest. In cooperation with a local working group, we developed the new Widen One's Mind (WOM) scale, which showed good scale characteristics. All places received high scores in their potential to increase restoration and vitality and to widen one's mind. Positive affect, restoration, connectedness with nature and the forest, and mindfulness increased pre- versus post-visits, whereas negative affect and perceived stress decreased. The findings of this study suggest that in recreational forests, visitors experience beneficial mental effects such as stress reduction in addition to physical exercise. To facilitate regional development goals, we recommend evaluating places in forests regarding the potential effects on the health and well-being as well as citizen participation before initiating extensive remodeling.

Gender aspects of recreational sun-protective behavior: results of a representative, population-based survey among Austrian residents.

PURPOSE: Lifetime risk for melanoma skin cancer is enlarged by sunlight exposure and reduced by sun protection. Austrian melanoma incidence and mortality rates are constantly rising with higher rates in males. Thus, we aimed at investigating gender-specific recreational sun exposure habits among the Austrian population. METHODS: We conducted a telephone survey among 1500 adults (50.5% females) representing sociodemographic characteristics of the Austrian population. Using a structured questionnaire, we studied gender-specific sun exposure-related knowledge, motives to tan, and behavior. RESULTS: Overall, using sunscreen, wearing sunglasses, and seeking shade were among the three most frequent sun safe measures. Basic skin health knowledge and tanning motives were similar among genders, although females protected themselves more. In general, sunburn occurrence (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.0-1.8), skin type IV (OR = 2.4, 95% CI = 1.3-4.5), ex-/non-smoking (OR = 1.4-1.6, 95% CI = 1.0-2.1), low motives to tan (both OR = 1.3, 95% CI = 1.0-1.7), no outdoor sport (OR = 1.3, 95% CI = 1.0-1.7), all P < 0.05, as well as the use of sunscreen with lower SPF values (OR = 1.0-3.0, 95% CI = 1.4-4.3) and male gender (OR = 1.6, 95% CI = 1.2-2.0), both P < 0.001, increased the odds of practicing low sun protection. CONCLUSION: The results of this investigation suggest considering gender specificity when planning Public (Skin) Health-related educative campaigns and programs, for example, by highlighting the appearance-related benefits of sun light avoidance.

Perceived Relevance of Educative Information on Public (Skin) Health: Results of a Representative, Population-Based Telephone Survey.

Individual skin health attitudes are influenced by various factors, including public education campaigns, mass media, family, and friends. Evidence-based, educative information materials assist communication and decision-making in doctor-patient interactions. The present study aims at assessing the prevailing use of skin health information material and sources and their impact on skin health knowledge, motives to tan, and sun protection. We conducted a questionnaire survey among a representative sample of Austrian residents. Print media and television were perceived as the two most relevant sources for skin health information, whereas the source physician was ranked third. Picking the information source physician increased participants' skin health knowledge (p = 0.025) and sun-protective behavior (p < 0.001). The study results highlight the demand for targeted health messages to attain lifestyle changes towards photo-protective habits. Providing resources that encourage pro-active counseling in every-day doctor-patient communication could increase skin health knowledge and sun-protective behavior, and thus, curb the rise in skin cancer incidence rates.

Public (Skin) Health perspectives of gender differences in tanning habits and sun protective behaviour: a cross-sectional questionnaire survey.

BACKGROUND: Life-style-associated exposure to sunlight is a contributory factor for acute and chronic skin damage including malign melanoma. The aim of the present study was to investigate the current gender-specific attitudes and motives regarding sun tanning and sunlight protective behaviour among Austrian residents. METHODS: In this cross-sectional study, a convenient sample of 563 Austrian inhabitants participated in a self-reported questionnaire-based outdoor survey. We subjected the data obtained to statistical analysis to get insight into socio-demographic and sun risk behaviour-related inter-group differences (smoking habits as well as gender). RESULTS: The survey revealed significant gender differences in respect to sun protective behaviour and knowledge on adverse health effects of ultraviolet light exposure. Female participants achieved a higher knowledge score, showed higher risk awareness, and performed more sun protection (all p < 0.0001). Male participants were more likely to underestimate the dangers of unprotected sun exposure, consistently resulting in a higher frequency of reported sunburns in men (p = 0.005). Although smoking habits were gender-independent, smokers compared with non-smokers sun bathed more frequently with less sun protection (all p < 0.0001), and were less sportive (p = 0.035). CONCLUSIONS: The study provides empirical data contributing to the development of novel approaches for target group and gender-specific Public (Skin) Health education programs and information materials. Revised strategies for improved skin health promotion and skin cancer prevention should focus on the benefits of sun light avoidance regarding long-term deterioration of physical appearance and attractiveness.

Green perspectives for public health: a narrative review on the physiological effects of experiencing outdoor nature.

Natural environments offer a high potential for human well-being, restoration and stress recovery in terms of allostatic load. A growing body of literature is investigating psychological and physiological health benefits of contact with Nature. So far, a synthesis of physiological health outcomes of direct outdoor nature experiences and its potential for improving Public Health is missing. We were interested in summarizing the outcomes of studies that investigated physiological outcomes of experiencing Nature measuring at least one physiological parameter during the last two decades. Studies on effects of indoor or simulated Nature exposure via videos or photos, animal contact, and wood as building material were excluded from further analysis. As an online literature research delivered heterogeneous data inappropriate for quantitative synthesis approaches, we descriptively summarized and narratively synthesized studies. The procedure started with 1,187 titles. Research articles in English language published in international peer-reviewed journals that investigated the effects of natural outdoor environments on humans by were included. We identified 17 relevant articles reporting on effects of Nature by measuring 20 different physiological parameters. We assigned these parameters to one of the four body systems brain activity, cardiovascular system, endocrine system, and immune function. These studies reported mainly direct and positive effects, however, our analyses revealed heterogeneous outcomes regarding significance of results. Most of the studies were conducted in Japan, based on quite small samples, predominantly with male students as participants in a cross-sectional design. In general, our narrative review provided an ambiguous illustration of the effects outdoor nature exerted on physiological parameters. However, the majority of studies reported significant positive effects. A harmonizing effect of Nature, especially on physiological stress reactions, was found across all body systems. From a Public Health perspective, interdisciplinary work on utilizing benefits of Nature regarding health promotion, disease prevention, and nature-based therapy should be optimized in order to eventually diminish given methodological limitations from mono-disciplinary studies.

Connectedness to nature and public (skin) health perspectives: results of a representative, population-based survey among Austrian residents.

Connectedness to nature (CN) influences motivation to have contact with outdoor natural environments. Spending leisure time in natural environments is beneficial for human health and well-being. Besides these positive effects, health risks of open-air activities are mainly related to unprotected sun light exposure-associated acute and chronic skin hazards. Thus, we conducted a cross-sectional, representative telephone survey among Austrian residents to study the association of perceived CN level with sun-exposure knowledge, tanning habits, and sun protective behaviour. In total, 1,500 study subjects (50.5% females) participated in this questionnaire survey. Although knowledge about tanning and motives to tan were similar among genders, females performed more photoprotective measures and were more connected to nature (all p < 0.001) compared to males. Older age and outdoor sport were significant gender-independent predictor variables influencing perceived CN level. Additionally, level of education was relevant in male CN, whereas non-smoking and higher knowledge were predictive of female CN. This survey provides so far unreported empirical data on the relationship between nature connectedness and skin health-relevant recreational habits of Austrian residents. The findings suggest to integrate hitherto neglected gender-specific Public (Skin) Health promotion when counselling on the manifold health advantages of outdoor activities.

Perceived relevance of educative information on public (skin) health: a cross-sectional questionnaire survey.

OBJECTIVES: Unprotected leisure time exposure to ultraviolet radiation from the sun or artificial tanning beds is the most important environmental risk factor for melanoma, a malignant skin cancer with increasing incidences over the past decades. The aim of the present study was to assess the impact of skin health information provided by several sources and different publishing issues on knowledge, risk perception, and sun protective behavior of sunbathers. METHODS: A cross-sectional questionnaire survey was conducted among Austrian residents (n=563) spending leisure time outdoors in August 2010. RESULTS: Print media, television, and family were perceived as the most relevant sources of information on skin health, whereas the source physician was only ranked as fourth important source. Compared to other sources, information provided by doctors positively influenced participants' knowledge on skin risk and sun protective behavior resulting in higher scores in the knowledge test (p=0.009), higher risk perception (p<0.001), and more sun protection (p<0.001). Regarding gender differences, internet was more often used by males as health information source, whereas females were more familiar with printed information material in general. CONCLUSIONS: The results of this survey put emphasis on the demand for information provided by medical professionals in order to attain effective, long-lasting promotion of photoprotective habits.

Are nature lovers happy? On various indicators of well-being and connectedness with nature.

Connectedness with nature (CN) is seen as a personal disposition relevant for environmental as well as human health. In five questionnaire studies (N = 547) we systematically investigated the relationship between various operationalizations of well-being and CN. CN was assessed with two different tools in parallel. All significant correlations were controlled for the effects of age and gender. Psychological well-being, meaningfulness and vitality were found to be robustly correlated with CN. We highlight the relevance of CN with respect to human health and further discuss conceptual differences unraveled by the concurrent application of two CN-tools.