Margarita Triguero-Mas1, David Donaire-Gonzalez2, Edmund Seto3, Antònia Valentín4, David Martínez5, Graham Smith6, Gemma Hurst7, Glòria Carrasco-Turigas8, Daniel Masterson9, Magdalena van den Berg10, Albert Ambròs11, Tania Martínez-Íñiguez12, Audrius Dedele13, Naomi Ellis14, Tomas Grazulevicius15, Martin Voorsmit16, Marta Cirach17, Judith Cirac-Claveras18, Wim Swart19, Eddy Clasquin20, Annemarie Ruijsbroek21, Jolanda Maas22, Michael Jerret23, Regina Gražulevičienė24, Hanneke Kruize25, Christopher J Gidlow26, Mark J Nieuwenhuijsen27. 1. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: mtrigueromas@gmail.com. 2. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Physical Activity and Sports Sciences Department, Fundació Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain. Electronic address: david.donaire@isglobal.org. 3. Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, USA. Electronic address: eseto@uw.edu. 4. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: antonia.valentin@isglobal.org. 5. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: david.martinez@isglobal.org. 6. Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom. Electronic address: G.R.Smith@staffs.ac.uk. 7. Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom. Electronic address: G.L.Hurst@staffs.ac.uk. 8. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: gloria.carrasco@isglobal.org. 9. Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom. Electronic address: Daniel.Masterson@stoke.gov.uk. 10. Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands. Electronic address: mm.vandenberg@vumc.nl. 11. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: albert.ambros@isglobal.org. 12. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: tania.martinez@isglobal.org. 13. Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania. Electronic address: adedele@gmf.vdu.lt. 14. Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom. Electronic address: n.j.ellis@staffs.ac.uk. 15. Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania. Electronic address: t.grazulevicius@gmail.com. 16. Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands. Electronic address: martin.voorsmit@gmail.com. 17. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: marta.cirach@isglobal.org. 18. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: txerms0@hotmail.com. 19. Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: wim.swart@rivm.nl. 20. Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands. Electronic address: e.clasquin@gmail.com. 21. Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: annemarie.ruijsbroek@rivm.nl. 22. Department of Public and Occupational Health, Institute for Health and Care Research, VU University Medical Centre (VUMC), Amsterdam, The Netherlands. Electronic address: jolandamaas@hotmail.com. 23. Department of Environmental Health Sciences and Center for Occupational and Environmental Health, University of California, Los Angeles, USA. Electronic address: mjerrett@ucla.edu. 24. Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania. Electronic address: r.grazuleviciene@gmf.vdu.lt. 25. Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: hanneke.kruize@rivm.nl. 26. Centre for Sport Health and Exercise Research, Staffordshire University, Stoke-on-Trent, United Kingdom; Centre for Health and Development, Staffordshire University, Stoke-on-Trent, United Kingdom. Electronic address: C.Gidlow@staffs.ac.uk. 27. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: mark.nieuwenhuijsen@isglobal.org.
Abstract
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.
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.
Authors: Daniel W Riggs; Ray Yeager; Daniel J Conklin; Natasha DeJarnett; Rachel J Keith; Andrew P DeFilippis; Shesh N Rai; Aruni Bhatnagar Journal: Am J Physiol Heart Circ Physiol Date: 2021-01-08 Impact factor: 5.125