Mechanisms underlying the associations between different types of nature exposure and sleep duration: An 18-country analysis.

Whilst green space has been linked to healthier sleep outcomes, the roles of specific types of nature exposure, potential underlying mechanisms, and between-country variations in nature-sleep associations have received little attention. Drawing on cross-sectional survey data from an 18-country sample of adults (N = 16,077) the current study examined: 1) the relative associations between six different types of nature exposure (streetscape greenery, blue view from home, green space within 1 km, coast within 1 km, green space visits, blue space visits) and insufficient sleep (<6 h vs. 7-10 h per day); 2) whether these relationships were mediated by better mental wellbeing and/or physical activity; and 3) the consistency of these pathways among the different countries. After controlling for covariates, neighbourhood nature measures (green space, coast within 1 km) were not significantly associated with insufficient sleep; but nature visible from home (streetscape greenery, blue views) and recreational visits to green and blue spaces were each associated with less insufficient sleep. Significant nature-sleep associations were mediated, to varying degrees, by better mental wellbeing, but not self-reported physical activity. Country-level heterogeneity in the strength of nature-sleep associations was observed. Increasing nature visible from the home may represent a promising strategy for promoting healthier sleep duration at the population level, whilst nature-based interventions encouraging individuals to spend time in local green/blue spaces may be an appropriate target to assist individuals affected by insufficient sleep.

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.

Urban green space and mental health among people living alone: The mediating roles of relational and collective restoration in an 18-country sample.

Rates of living alone, especially in more urbanised areas, are increasing across many industrialised countries, with associated increases in feelings of loneliness and poorer mental health. Recent studies have suggested that access to nature (e.g. parks and green spaces) can reduce the stressors associated with loneliness, partly through providing opportunities to nurture personal relationships (relational restoration) and engage in normative community activities (collective restoration). Such associations might vary across different household compositions and socio-demographic or geographical characteristics, but these have not been thoroughly tested. Using data collected across 18 countries/territories in 2017-2018, we grouped urban respondents into those living alone (n = 2062) and those living with a partner (n = 6218). Using multigroup path modelling, we tested whether the associations between neighbourhood greenspace coverage (1-km-buffer from home) and mental health are sequentially mediated by: (a) visits to greenspace; and subsequently (b) relationship and/or community satisfaction, as operationalisations of relational and collective restoration, respectively. We also tested whether any indirect associations varied among subgroups of respondents living alone. Analyses showed that visiting green space was associated with greater mental well-being and marginally lower odds of using anxiety/depression medication use indirectly, mediated via both relationship and community satisfaction. These indirect associations were equally strong among respondents living alone and those living with a partner. Neighbourhood green space was, additionally, associated with more visits among respondents living with a partner, whereas among those living alone, this was sensitive to the green space metric. Within subgroups of people living alone, few overall differences were found. Some indirect pathways were, nevertheless, stronger in males, under 60-year-olds, those with no financial strain, and residents in warmer climates. In conclusion, supporting those living alone, as well as those living with a partner, to more frequently access their local greenspaces could help improve mental health via promoting relational and collective restoration.

[Health and well-being from forests - experience from Finnish research]. / Effets bénéfiques de la forêt sur la santé et le bien-être. L'expérience de la recherche finlandaise.

The role of forests in enhancing human health and well-being has been studied in Finland for more than a decade, and these benefits are increasingly recognized by the Finnish society. The national research has studied the associations of use and availability of nature with health using different research methods such as population surveys, on-site field experiments, and combining GIS-based data describing the provision of nature areas with use of the areas and health status of people. This article sums up research results from multidisciplinary research work in Finland. One of the main study areas has been restorative effects of nature areas using various psychological measures. These studies demonstrate that forests and other nature areas are important in reducing stress and add recovery from work. Moreover, field experiments have confirmed that visiting forests have beneficial psychological and physiological effects on human health. These effects can be explained by psychological stress relief with contribution from reduced air pollution and noise exposure during the visits. In addition, studies looking at long-term effects of nature exposure suggest that physical activity has a mediating role in perceived health benefits, particularly among suburban residents. Recent efforts include national policy-science discussions on how the research knowledge can be implemented within various sectors such as public health and land-use planning and forest management. This work has resulted a suggestion for a national program called Nature for Health and Well-Being in Finland consisting of an action plan and a multidisciplinary research program. More comprehensive research knowledge has contributed to and triggered series of practical experiments and pilots that are briefly discussed in the article.

Acute effects of visits to urban green environments on cardiovascular physiology in women: A field experiment.

BACKGROUND: Epidemiological studies have reported positive associations between the amount of green space in the living environment and mental and cardiovascular human health. In a search for effect mechanisms, field studies have found short-term visits to green environments to be associated with psychological stress relief. Less evidence is available on the effect of visits on cardiovascular physiology. OBJECTIVES: To evaluate whether visits to urban green environments, in comparison to visits to a built-up environment, lead to beneficial short-term changes in indicators of cardiovascular health. METHODS: Thirty-six adult female volunteers visited three different types of urban environments: an urban forest, an urban park, and a built-up city centre, in Helsinki, Finland. The visits consisted of 15min of sedentary viewing, and 30min of walking. During the visits, blood pressure and heart rate were measured, and electrocardiogram recorded for the determination of indicators of heart rate variability. In addition, levels of respirable ambient particles and environmental noise were monitored. RESULTS: Visits to the green environments were associated with lower blood pressure (viewing period only), lower heart rate, and higher indices of heart rate variability [standard deviation of normal-to-normal intervals (SDNN), high frequency power] than visits to the city centre. In the green environments, heart rate decreased and SDNN increased during the visit. Associations between environment and indicators of cardiovascular health weakened slightly after inclusion of particulate air pollution and noise in the models. CONCLUSIONS: Visits to urban green environments are associated with beneficial short-term changes in cardiovascular risk factors. This can be explained by psychological stress relief with contribution from reduced air pollution and noise exposure during the visits. Future research should evaluate the amount of exposure to green environments needed for longer-term benefits for cardiovascular health.

Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries.

The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults. Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics. Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities. The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention.

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries.

The effects of 'nature' on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

The Perceived Restorativeness of Differently Managed Forests and Its Association with Forest Qualities and Individual Variables: A Field Experiment.

Despite increasing research knowledge about the positive well-being effects forests have on citizens, it is still unclear how the quality of forests and individual variables effect the well-being. This research investigated (1) the differences in restorative experiences (components being away, fascination, compatibility and extent, measured by perceived restorativeness (PRS)), and (2) how people evaluate forest qualities in four differently managed forests. Furthermore, this research studied (3) which individual variables (4) as well as forest qualities, explain the overall restorative experience (PRS-score from all components). Altogether, 66 volunteers were taken in small groups to each of the four forest sites once, after their day at work. The participants viewed the forests for 15 min and then walked inside the forests for 30 min. Their perceived restorativeness and perceptions about forest qualities were measured on-site after each visit. Most of the components of PRS differed between the three older forests compared to the young forest. The three older forests also had more preferred qualities, compared to the young commercial forest. From the individual variables, the nature relatedness positively explained the restorative experiences (PRS-score) in old-growth forest and in mature commercial forest. Beauty was the most important quality that explained PRS-score in all forests. Biodiversity positively explained the PRS-score, except in urban recreation forest. However, not all forest qualities need to be present in order to reach high perceived restorativeness and both a pristine or managed old forest can have high restorative values. Also, decaying wood does not seem to diminish forests' restorative values, but there may be individual differences in its acceptance. Therefore, a greater attention to the overall versatility is needed when managing the forest used for outdooring.

Disease Avoidance Model Explains the Acceptance of Cohabitation With Bats During the COVID-19 Pandemic.

Bats and humans have a close relationship based on cohabitation, with bats taking roost in buildings. It has been suggested that bats function as a reservoir of the SARS-CoV-2 virus that causes the COVID-19 disease in humans. A misconception that bats can spread SARS-CoV-2 to humans may have increased negative emotions toward bats and reduced individuals' acceptance of cohabitation with bats during the COVID-19 pandemic. By applying the disease avoidance model, we tested whether knowledge about bats would be associated with reduced negative emotions toward bats, which in turn would be associated with increased acceptance of cohabitation with bats. Moreover, we tested whether previous experiences of bats, perceived COVID-19 risk, age, gender and level of education would be associated with negative emotions and acceptance of bats. A quantitative survey (N = 577) collected during the COVID-19 pandemic in Finland was analyzed with multiple linear regression. The results supported the disease avoidance model. Negative emotions toward bats reduced the acceptance of cohabitation with bats. However, knowledge about bats was associated with increased acceptance of bats both directly, as well as indirectly, via reduced negative emotions. Moreover, perceived COVID-19 risk was associated with increased negative emotions toward bats, and reduced acceptance of bats. Females were more likely than other respondents to report negative emotions, and reduced acceptance of cohabitation with bats. Prior experience of bats was associated with increased acceptance of bats as neighbors. These findings suggest that COVID-19 pandemic may threaten the existence of bats if no action is taken. The findings highlight the importance of correcting misunderstandings about non-human species as transmitters of diseases to humans.

Parental Mental Well-Being and Frequency of Adult-Child Nature Visits: The Mediating Roles of Parents' Perceived Barriers.

Regular access to green space has been shown to provide several health benefits for children. However, children today spend less time outdoors. Thus, it has become important to understand what drives and limits children's activities in nature. Based on a Finnish online survey of 1463 parents of children aged 2-7 conducted in 2019, the current study examined parents' perceived barriers to visiting nature with their children. It also examined how parental mental well-being is related to families' frequency of nature visits, and whether this association is mediated by different categories of parents' perceived barriers. Eleven out of 12 barriers were largely perceived by parents as reasons that did not prevent them from visiting nature with their children. Next, factor analysis indicated a three-factor solution to the barriers. The results of a multiple mediation analysis showed that better parental mental well-being was associated with more frequent adult-child nature visits, and this relationship was partially mediated by a "lack of competence and logistics" and a "lack of time and interest", but not by "insecurity and fear". The results indicated that parents with poor mental well-being were more likely to perceive barriers to visiting nature, which in turn appeared to be related to a higher likelihood of having children who visited nature less frequently.

Associations between green/blue spaces and mental health across 18 countries.

Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.

Results from an 18 country cross-sectional study examining experiences of nature for people with common mental health disorders.

Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but 'green prescription' programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.

Restorative effects of urban green environments and the role of urban-nature orientedness and noise sensitivity: A field experiment.

In this experiment we investigated how individual differences in orientation towards built vs. nature environment as well as noise sensitivity affect psychological and physiological restoration in a constructed urban park, urban woodland and city centre of Helsinki, Finland. The participants, 30-61-year-old healthy women (N = 83), visited each study site once. The experiment consisted of a 15-min viewing session, followed by a 30-min walking session in each environment. We measured restorative effects: perceived restorative outcomes, vitality, and blood pressure in these three environments. The data were analysed in SAS with a linear mixed model. We found significant differences between environments in psychological restorative effects, but not in blood pressure. The urban-nature orientedness, and to a lesser extent noise sensitivity, modified the effect of environment on restoration. In conclusion, individual characteristics affect psychological restoration provided by various urban environments. Varying needs of individuals should be taken into account in city planning.

Individual and environmental factors associated with green exercise in urban and suburban areas.

In this study, we mainly aimed to explore the associations of personal and socio-demographic factors, and the supply of green areas and built sports facilities with green exercise (GE). We also compared the residents of the core urban area and suburban areas according to the level of leisure time physical activity (LTPA) they had. A population-based sample of 3730 adults (aged 25-101 y) from Finland, filled out a questionnaire in 2015. Variables describing the supply of green areas and built sports facilities were objectively calculated. The green areas were classified into small (<25 ha), middle-sized (25-150 ha) and large (>150 ha) areas to reflect their qualities for GE. The data analysis methods included multinomial logistic regression, t-, and Chi Square tests. Our results indicate that having a short distance to at least a middle-sized green area and high nature relatedness are important for participation in GE, both in core urban and suburban areas. More factors were found to be related to GE in the suburban areas compared to core urban areas and among the low LTPA compared to the high LTPA group.