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.

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.