Association of residential air pollution and green space with all-cause and cause-specific mortality in individuals with diabetes: an 11-year prospective cohort study.

BACKGROUND: To assess the long-term impact of residential air pollution and green space exposure on cause-specific mortality in individuals with type 2 diabetes mellitus (T2DM). METHODS: This study includes 174,063 participants newly diagnosed with T2DM from a prospective cohort in Shanghai, China, enrolled between 2011 and 2013. Residential annual levels of air pollutants, including fine (PM2.5) and coarse (PM2.5-10) particulate matter, nitrogen dioxide (NO2), along with the normalized difference vegetation index (NDVI), were derived from satellite-based exposure models. FINDINGS: During a median follow-up of 7.9 years (equivalent to 1,333,343 person-years), this study recorded 22,205 deaths. Higher exposure to PM2.5 was significantly associated with increased risks for all mortality outcomes, whilst PM2.5-10 showed no significant impacts. The strongest associations of PM2.5 were observed for diabetes with peripheral vascular diseases [hazard ratio (HR): 2.70; per 10 µg/m3 increase] and gastrointestinal cancer (2.44). Effects of NO2 became significant at concentrations exceeding approximately 45 µg/m³, with the highest associations for lung cancer (1.20) and gastrointestinal cancer (1.19). Conversely, each interquartile range increase in NDVI (0.10) was linked to reduced mortality risks across different causes, with HRs ranging from 0.76 to 1.00. The association between greenness and mortality was partly and significantly mediated by reduced PM2.5 (23.80%) and NO2 (26.60%). There was a significant and negative interaction between NO2 and greenness, but no interaction was found between PM2.5 and greenness. INTERPRETATION: Our findings highlight the vulnerability of individuals with T2DM to the adverse health effects of air pollution and emphasise the potential protective effects of greenness infrastructure. FUNDING: The 6th Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System (GWVI-11.1-22), the National Key Research and Development Program (2022YFC3702701), and the National Natural Science Foundation of China (82030103, 82373532).

Contact with nature may be a remedy for loneliness: A nationally representative longitudinal cohort study.

BACKGROUND: Nature prescribing - a written recommendation by a health professional for a person to spend more time in nature for health reasons - is being heralded by some as a potential solution to loneliness, defined as a felt deprivation of meaningful connection, companionship, and camaraderie. However, such recommendations currently lack evidence on how much time in natural environments is needed to tackle loneliness and over what timescale. METHODS: General, emotional, and social loneliness were measured using De Jong Gierveld's 6-item scale in a nationally representative sample of 3043 Australian participants at baseline (October 2020), with 2421 and 2123 completing follow-ups at 4 months (February 2021) and 16 months (February 2022), respectively. Multilevel logistic regressions examined the odds of change in loneliness status between baseline and follow-up in relation to hours spent in nature in the 7 days prior to the baseline survey, adjusting for confounding factors that influence time spent in nature and the risk of feeling lonely. FINDINGS: Relief from general loneliness in those experiencing it at baseline was 22.4% at month 4 and 29.4% at month 16. The equivalent findings for relief from social loneliness and emotional loneliness were 21.2% and 24.6%, and 34.2% and 41.2% at months 4 and 16, respectively. Incidence of loneliness at 4 months was 21.8% (general), 26.1% (social), and 11.8% (emotional), and at 16 months was 22.7% (general), 25.6% (social), and 12% (emotional). At each time point, the prevalence of loneliness was lower among participants with more time in nature. Just 1-2 h per week in nature (versus <1) was associated with relief from social loneliness at 4 months (Odds Ratio [OR] 1.69, 95%CI 1.10, 2.65) and at 16 months (OR 2.10, 95%CI 1.34, 3.30). Higher odds of relief from emotional loneliness were observed at 3-4 h spent in nature at 4 months (OR 1.84, 95%CI 1.11, 3.06) and at 16 months (OR 1.82, 95%CI 1.09, 3.07). Incidence of loneliness was not associated with nature contact. INTERPRETATION: Increasing time in nature may an effective non-medical prescription for people who are lonely to find durable relief within a relatively short space of time. Findings from this longitudinal study can inform further investigation through randomised trials of co-designed nature prescriptions targeting relief from loneliness in vulnerable populations.

Nurturing attention through nature.

BACKGROUND: Previous research suggests an association between exposure to nature and improved attention. However, no observational studies explored the underlying mechanisms or considered bluespace, and none used Polish data. We investigated the association between exposure to nature and attention, and whether it was mediated by nature perception, physical activity and sleep duration. METHODS: Data derived from the case-control NeuroSmog study comprised 195 participants with attention deficit hyperactivity disorder (ADHD) and 457 participants without ADHD, all aged 10 to 13. Attention was evaluated using the computerized attention network test and the continuous performance test. Lifelong and current exposure to nature, determined by percentage of grass and tree cover and water presence within 500m buffer around residences, as well as domestic garden, were examined through linear, log-linear and negative binomial regressions. Potential pathways were explored using structural equation modelling. RESULTS: Participants with ADHD with higher exposure to tree cover tended to have improved orienting ability, shorter reaction time and fewer correct rejections, while participants without ADHD tended to show decreased alertness and improved orienting ability. Participants with ADHD with higher exposure to grass cover tended to have longer reaction time, decreased alertness, improved orienting ability, reduced target discrimination ability, fewer correct rejections and less risky response style, while participants without ADHD tended to show decreased orienting ability, more mistakes, longer reaction time, better hit rate and more risky response style. Participants without ADHD with water in their neighbourhood tended to have improved orienting ability, fewer mistakes and better hit rate. Participants without ADHD with a garden tended to show improved target discrimination ability, better hit rate and more risky response style. No mediating pathways were revealed. CONCLUSION: Tree cover and presence of garden and water tended to be associated with improved attention in Polish adolescents while grass tended to have negative impact.

Longitudinal Impacts of High Versus Low Greenness on Cardiovascular Disease Conditions.

BACKGROUND: Greenness-or vegetative presence-has been identified as a factor in chronic disease. The present study examines the longitudinal relationship between objective measures of greenness at the residential block level and incidence of 6 cardiovascular disease conditions. METHODS AND RESULTS: Analyses examined the impact of consistently high versus consistently low "precision" greenness at the Census block level on the 5-year incidence of cardiovascular disease conditions, including acute myocardial infarction, atrial fibrillation, heart failure, ischemic heart disease, stroke/transient ischemic attack, and hypertension, among 229 034 US Medicare beneficiaries in Miami-Dade County, Florida, USA. Zero-inflated Poisson regression was used to model the odds of developing any new cardiovascular disease and number of new cardiovascular disease conditions based on greenness tertiles computed across 2011 and 2016 Normalized Difference Vegetation Index values, adjusting for individual age, sex, race, ethnicity, baseline cardiovascular disease conditions, neighborhood income, and walkability in 2011 and 2016. When compared with individuals consistently in the low greenness tertile in 2011 and 2016, those consistently in the high greenness tertile in 2011 and 2016 had a 9% lower odds of having any new cardiovascular conditions (odds ratio [OR], 0.91 [95% CI, 0.84-0.99]; P=0.021). CONCLUSIONS: Over a 5-year period, consistently high greenness, when compared with consistently low greenness, was associated with lower odds of any new cardiovascular disease conditions. Identifying the role of greenness exposure in such a small geographic area, the Census block on which the older adult resides, allows for more precise, strategic decisions on where additional trees can be added-by selecting at-risk blocks rather than entire neighborhoods for tree-planting interventions.

Sleep problems mediate the association between outdoor nighttime light and symptoms of depression and anxiety: A cross-sectional, multi-city study in Bulgaria.

BACKGROUND: Nighttime light is a growing anthropogenic health threat, particularly in urban areas. Limited evidence suggests that exposure to outdoor artificial light at night (ALAN) may be associated with people's mental health by disrupting sleep-wake cycles. AIMS: We assessed 1) the association between ALAN exposure and adults' symptoms of depression and anxiety, 2) whether the association was modified by sex, age, and income, and 3) the mediating role of sleep problems. METHODS: We obtained cross-sectional data from 4,068 adults from the five largest Bulgarian cities. Depression and anxiety symptoms were measured using the 4-item Patient Health Questionnaire (PHQ-4). Sleep problems were self-reported based on three items. Outdoor ALAN at residential addresses was assessed using annual radiance levels obtained from satellite imagery. Regression models were adjusted for person-level characteristics, green space, and nitrogen dioxide (NO2). We also assessed effect modification by sex, age, and income. Using mediation analyses, we tested sleep problems as a mediator of the ALAN-PHQ-4 association. RESULTS: Greater ALAN exposure in the fully adjusted model was marginally associated with higher PHQ-4 scores. We observed no effect modification. The mediator, sleep problems, was also positively associated with ALAN. The mediation of sleep problems was significantly positive. While the direct association was null, the total ALAN association was marginally and positively associated with PHQ-4 scores. CONCLUSIONS: Our findings suggest a positive association between outdoor nighttime light pollution and mental health. Poor sleep quality is a possible pathway relating ALAN exposure to mental health. Considering the increasing ubiquity and intensity of urban nighttime illumination, light pollution-reducing policies may provide significant health benefits for urban populations.

Exploring the quality of urban green spaces and their association with health: An epidemiological study on obesity using Street View technology.

OBJECTIVES: Evidence suggests that access to urban green spaces (UGS) may encourage physical exercise and impact nutritional status and health. Nevertheless, the quality of UGS is an understudied area. Novel digital tools allow the analysis of urban environments. This study aims to explore the quality of UGS and its association with obesity in Córdoba, Argentina, using Google Street View (GSV) images. STUDY DESIGN: Population-based cross-sectional study. METHODS: Lifestyle and sociodemographic data were collected in Córdoba, Argentina (n = 1322 adults) during 2020-2022. Anthropometric measurements were obtained. Buffers of 500m were established around dwellings to identify the presence of large-area UGS (≥1ha). The quality of 226 UGS was evaluated across specific dimensions using a multi-dimensional assessment tool adapted for remote monitoring through GSV. Two-level logistic regression models for obesity outcome (yes/no) were fitted using a random intercept to account for spatial variability. Odds ratios (OR) and their 95 % confidence intervals (95 % CI) were estimated as measures of association. RESULTS: Obesity was present in 25.9 % of participants. The UGS quality dimensions that showed an inverse association with obesity were safety (OR = 0.33; 95 % CI 0.32-0.82), potential usage (OR = 0.42; 95 % CI 0.21-0.81), surroundings (OR = 0.54; 95 % CI 0.31-0.93), access (OR = 0.55; 95 % CI 0.31-0.97), aesthetics (OR = 0.55; 95 % CI 0.34-0.87) and amenities (OR = 0.62; 95 % CI 0.42-0.91). Proximity to UGS was not significantly associated with obesity. CONCLUSIONS: Rather than their proximity, the quality of the UGS might play a key role as a determinant of obesity. In urban areas, digital tools such as GSV are useful to explore these topics.

Long-term exposure to green and blue space and incidence of cardiovascular disease: A Danish Nurse Cohort study.

BACKGROUND: Few cohort studies have examined the associations of natural surroundings (green and blue space) with cardiovascular disease (CVD) and show mixed findings. We aimed to investigate the associations between long-term exposure to green and blue space and incidence of CVD in the Danish Nurse Cohort. METHODS: We followed 19,070 female nurses living in Denmark from 1993/1999 to 2018. The shortest Euclidian distance from a residence to three types of green space (park, woodland, and heathland) and four types of blue space (lake, river, coast, and wetland), along with total count of all types of natural surroundings within a 500 meter (m), 1000 m, and 5000 m radius from a residence, were calculated using GeoDanmark data from 2005. Distance was log-transformed to correct for a right-skewed data distribution. Residential air pollution and road traffic noise data for 2005 were estimated by the Danish air pollution modeling system ('DEHM/UBM/AirGIS') and Nord2000 model, respectively. Cox proportional hazards models were used to estimate associations between green and blue space and the first-ever incidence of total CVD and certain CVD subtypes after adjusting for individual factors, air pollution, and noise. We examined effect modification by age, smoking status, occupational status, household income, and urbanicity level. Hazard ratio (HR) and 95% confidence interval (95% CI) were presented per e unit (equivalent to ∼2.72 fold) increase in distance. RESULTS: 8179 new cases of CVD were observed over 344,084 person-years. Living further from woodland was associated with higher stroke incidence (HR: 1.153; 95% CI: 1.029-1.293), while living further from heathland was associated with reduced total CVD incidence (HR: 0.975; 95% CI: 0.955-0.996). No associations were found between distance to park, woodland, lake, river, coast, or wetland and total CVD incidence. Total count of all types of green and blue spaces within a 5000 m radius was linked to a reduced risk of CVD incidence. Adjusting for air pollution or road traffic noise did not alter observed associations. Younger individuals (<50 years old) were observed to have lower HRs when living closer to all types of natural surroundings. CONCLUSION: We found that proximity to woodland was associated with a reduced risk of stroke, whilst no significant or even inverse associations were observed between proximity to other types of natural surroundings and CVD incidence. Total count of all types of natural surroundings within a 5000 m radius was negatively associated with CVD incidence, suggesting cumulative benefits of these areas.

Urbanization alters the relative importance of local and landscape factors affecting plant communities in the Tokyo megacity.

Plant communities are impacted by local factors (related to environmental filtering) and landscape factors (related to dispersal limitation). While many studies have shown that the relative importance of these factors in understanding plant community dynamics due to urbanization, little is known about how they are altered by urbanization-a significant threat to biodiversity. This study evaluates the relative importance of local environmental (local factors), landscape, and spatial (landscape factors) variables that influence plant communities in 34 urban green spaces comprising two different habitats (forests and grasslands) along the urban-rural gradients in the Tokyo megacity, Japan. To continuously assess the relative importance of each factor along the urban-rural gradients, we extracted 1000 landscapes within a certain range that contained several sites. Subsequently, the relative importance of each factor and urbanization rate (proportion of artificial built-up area) were estimated for each landscape. Our study found that the relative importance of both local and landscape factors decreased, while that of local factor for native species in forest habitats and that of landscape factors for native species in grassland habitats increased. Collectively, these findings suggest that city size and habitat characteristics must be considered when predicting changes in plant communities caused by urbanization.

The heat-mortality association in Jordan: Effect modification by greenness, population density and urbanization level.

BACKGROUND: The Middle East is one of the most vulnerable regions to the impacts of climate change, yet evidence of the heat-related mortality remains limited in this area. Our present study investigated the heat-mortality association in Jordan and the potential modifying effect of greenness, population density and urbanization level on the association. METHODS: For each of the 42 included districts, daily meteorological and mortality data from 2000 to 2020 were obtained for the warmest months (May to September). First, a distributed lag non-linear model was applied to estimate the district level heat-mortality association, then the district specific estimates were pooled using multivariate meta-regression models to obtain an overall estimate. Last, the modifying effect of district level greenness, population density and urbanization level was examined through subgroup analysis. RESULTS: When compared to the minimum mortality temperature (MMT, percentile 0th, 22.20 °C), the 99th temperature percentile exhibited a relative risk (RR) of 1.34 (95 % CI 1.23, 1.45). Districts with low greenness had a higher heat-mortality risk (RR 1.39, 95 % CI 1.22, 1.58) when compared to the high greenness (RR 1.28, 95 % CI 1.13, 1.45). While heat-mortality risk did not significantly differ between population density subgroups, highly urbanized districts had a greater heat-mortality risk (RR 1.41, 95 % CI 1.23, 1.62) as compared to ones with low levels of urbanization (RR 1.32, 95 % CI 1.13, 1.55). Districts with high urbanization level had the highest heat-mortality risk if they were further categorized as having low greenness (RR 1.63, 95 % CI 1.30, 2.04). CONCLUSION: Exposure to heat was associated with increased mortality risk in Jordan. This risk was higher in districts with low greenness and high urbanization level. As climate change-related heat mortality will be on the rise, early warning systems in highly vulnerable communities in Jordan are required and greening initiatives should be pursued.

Relationship between urban green space and mental health in older adults: mediating role of relative deprivation, physical activity, and social trust.

Introduction: The importance of improving older adults' mental health is increasing worldwide with the rapid development of the aging process. Green space is an important part of the urban built environment, demonstrates a deep connection with the mental health of older adults, and its internal mechanisms have been widely studied. This study analyzed the influence of urban green spaces on the mental health of older adults via three factors: relative deprivation, physical activity, and social trust. Methods: Based on the 2018 China Labor Dynamics Survey, a multi-level structural equation model was used to explore the mediating roles of relative deprivation, physical activity, social trust in urban green spaces, and the mental health of older adults. Results: Urban green space was positively correlated with the mental health of older adults. Relative deprivation and physical activities played a mediating role between urban green space and the mental health of older adults. Discussion: An increase in urban green spaces can help increase the number of older adults obtaining green space resources, and help them maintain good mental health. Secondly, older adults with a relatively homogeneous environment have more equal opportunities to obtain urban green space resources, which helps to reduce the comparison of older adults in access to green space resources and reduce the adverse impact of relative deprivation on their mental health. Additionally, increasing urban green spaces can encourage older adults to engage in physical activities and improve their mental health. Finally, we suggest improving the accessibility, fairness, and quality of green spaces, paying attention to the psychological needs of older adults, encouraging older adults to engage in physical activities in green spaces, and taking various measures to enhance the positive role of green space on the mental health of older adults.