Natural outdoor environments and mental health: Stress as a possible mechanism.

INTRODUCTION: Better mental health has been associated with exposure to natural outdoor environments (NOE). However, comprehensive studies including several indicators of exposure and outcomes, potential effect modifiers and mediators are scarce. OBJECTIVES: We used novel, objective measures to explore the relationships between exposure to NOE (i.e. residential availability and contact) and different indicators of mental health, and possible modifiers and mediators. METHODS: A nested cross-sectional study was conducted in: Barcelona, Spain; Stoke-on-Trent, United Kingdom; Doetinchem, Netherlands; Kaunas, Lithuania. Participants' exposure to NOE (including both surrounding greenness and green and/or blue spaces) was measured in terms of (a) amount in their residential environment (using Geographical Information Systems) and (b) their contact with NOE (using smartphone data collected over seven days). Self-reported information was collected for mental health (psychological wellbeing, sleep quality, vitality, and somatisation), and potential effect modifiers (gender, age, education level, and city) and mediators (perceived stress and social contacts), with additional objective NOE physical activity (potential mediator) derived from smartphone accelerometers. RESULTS: Analysis of data from 406 participants showed no statistically significant associations linking mental health and residential NOE exposure. However, NOE contact, especially surrounding greenness, was statistically significantly tied to better mental health. There were indications that these relationships were stronger for males, younger people, low-medium educated, and Doetinchem residents. Perceived stress was a mediator of most associations, and physical activity and social contacts were not. CONCLUSIONS: Our findings indicate that contact with NOE benefits mental health. Our results also suggest that having contact with NOE that can facilitate stress reduction could be particularly beneficial.

The association between greenness and traffic-related air pollution at schools.

Greenness has been reported to improve mental and physical health. Reduction in exposure to air pollution has been suggested to underlie the health benefits of greenness; however, the available evidence on the mitigating effect of greenness on air pollution remains limited and inconsistent. We investigated the association between greenness within and surrounding school boundaries and monitored indoor and outdoor levels of traffic-related air pollutants (TRAPs) including NO2, ultrafine particles, black carbon, and traffic-related PM2.5 at 39 schools across Barcelona, Spain, in 2012. TRAP levels at schools were measured twice during two one-week campaigns separated by 6months. Greenness within and surrounding school boundaries was measured as the average of satellite-derived normalized difference vegetation index (NDVI) within boundaries of school and a 50m buffer around the school, respectively. Mixed effects models were used to quantify the associations between school greenness and TRAP levels, adjusted for relevant covariates. Higher greenness within and surrounding school boundaries was consistently associated with lower indoor and outdoor TRAP levels. Reduction in indoor TRAP levels was partly mediated by the reduction in outdoor TRAP levels. We also observed some suggestions for stronger associations between school surrounding greenness and outdoor TRAP levels for schools with higher number of trees around them. Our observed reduction of TRAP levels at schools associated with school greenness can be of public importance, considering the burden of health effects of exposure to TRAPs in schoolchildren.

Asthma and allergic disease prevalence in a diverse sample of Toronto school children: results from the Toronto Child Health Evaluation Questionnaire (T-CHEQ) Study.

BACKGROUND: Asthma is the most common chronic disease in children. OBJECTIVES: To describe the prevalence of asthma and allergic disease in a multiethnic, population-based sample of Toronto (Ontario) school children attending grades 1 and 2. METHODS: In 2006, the Toronto Child Health Evaluation Questionnaire (T-CHEQ) used the International Study of Asthma and Allergies in Childhood survey methodology to administer questionnaires to 23,379 Toronto school children attending grades 1 and 2. Modifications were made to the methodology to conform with current privacy legislation and capture the ethnic diversity of the population. Lifetime asthma, wheeze, hay fever and eczema prevalence were defined by parental report. Asthma was considered to be current if the child also reported wheeze or asthma medication use in the previous 12 months. RESULTS: A total of 5619 children from 283 randomly sampled public schools participated. Children were five to nine years of age, with a mean age of 6.7 years. The overall prevalence of lifetime asthma was 16.1%, while only 11.3% had current asthma. The reported prevalence of lifetime wheeze was 29.2%, while 14.2% reported wheeze in the past 12 months. Sociodemographic and major health determinant characteristics of the T-CHEQ population were similar to 2001 census data, suggesting a diverse sample that was representative of the urban childhood population. CONCLUSIONS: Asthma continues to be a highly prevalent chronic disease in Canadian children. A large proportion of children with reported lifetime asthma, who were five to nine years of age, did not report current asthma symptomatology or medication use.