Max Jordan Nguemeni Tiako1, Eugenia South2, Megan M Shannon3, Clare McCarthy4, Zachary F Meisel5, Michal A Elovitz6, Heather H Burris7. 1. Department of Emergency Medicine, Center for Emergency Care and Policy Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: Max.tiako@yale.edu. 2. Department of Emergency Medicine, Center for Emergency Care and Policy Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, Wharton School of the University of Pennsylvania, PA, USA. 3. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 4. Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 5. Department of Emergency Medicine, Center for Emergency Care and Policy Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, Wharton School of the University of Pennsylvania, PA, USA. 6. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 7. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Abstract
OBJECTIVE: To examine the association of urban residential tree canopy cover with perceived stress in a cohort of pregnant women in Philadelphia, PA, and explore whether this association differed among participants with a history of anxiety and depression. STUDY DESIGN: We performed a secondary analysis of 1294 participants of the Motherhood & Microbiome (M&M) pregnancy cohort who lived in Philadelphia, with first visit perceived stress (Cohen's Perceived Stress Scale, PSS-14), and key covariate data. Tree canopy cover was calculated as percent cover within 100 and 500 m radii buffers around participants' homes. We performed multilevel mixed effects linear regression models, with perceived stress as the dependent variable. The main independent variable was tree canopy coverage. Individual-level covariates included season of last menstrual period, history of depression or anxiety, race/ethnicity, insurance, parity, and age. Census tract neighborhood deprivation index was used to account for area-level socioeconomic confounding variables. We also examined whether a history of anxiety or depression, modified the association between tree canopy coverage and perceived stress. RESULTS: Most participants were non-Hispanic Black (70.6%, n = 913), on Medicaid or uninsured (60.4%, n = 781), and 15.8% (n = 204) of participants had a prior history of depression or anxiety. We did not detect associations between tree canopy coverage and perceived stress overall. However, we detected effect modification; among participants with a history of depression or anxiety, each standard deviation increase in tree canopy cover was associated with lower PSS-14 in 100 m buffers (β -1.0, 95% CI -1.8, -0.2), but not among participants with no histories of depression or anxiety (β 0.2, 95% CI -0.3, 0.7) (interaction P = 0.007). Results were similar in directionality but not statistically significant within 500 m buffers. CONCLUSION: Residential tree canopy coverage was associated with reduced perceived stress among urban-dwelling pregnant women with history of anxiety or depression. Future studies of the effects of greenness and other stress-reducing efforts should consider underlying mental health conditions as effect modifiers.
OBJECTIVE: To examine the association of urban residential tree canopy cover with perceived stress in a cohort of pregnant women in Philadelphia, PA, and explore whether this association differed among participants with a history of anxiety and depression. STUDY DESIGN: We performed a secondary analysis of 1294 participants of the Motherhood & Microbiome (M&M) pregnancy cohort who lived in Philadelphia, with first visit perceived stress (Cohen's Perceived Stress Scale, PSS-14), and key covariate data. Tree canopy cover was calculated as percent cover within 100 and 500 m radii buffers around participants' homes. We performed multilevel mixed effects linear regression models, with perceived stress as the dependent variable. The main independent variable was tree canopy coverage. Individual-level covariates included season of last menstrual period, history of depression or anxiety, race/ethnicity, insurance, parity, and age. Census tract neighborhood deprivation index was used to account for area-level socioeconomic confounding variables. We also examined whether a history of anxiety or depression, modified the association between tree canopy coverage and perceived stress. RESULTS: Most participants were non-Hispanic Black (70.6%, n = 913), on Medicaid or uninsured (60.4%, n = 781), and 15.8% (n = 204) of participants had a prior history of depression or anxiety. We did not detect associations between tree canopy coverage and perceived stress overall. However, we detected effect modification; among participants with a history of depression or anxiety, each standard deviation increase in tree canopy cover was associated with lower PSS-14 in 100 m buffers (β -1.0, 95% CI -1.8, -0.2), but not among participants with no histories of depression or anxiety (β 0.2, 95% CI -0.3, 0.7) (interaction P = 0.007). Results were similar in directionality but not statistically significant within 500 m buffers. CONCLUSION: Residential tree canopy coverage was associated with reduced perceived stress among urban-dwelling pregnant women with history of anxiety or depression. Future studies of the effects of greenness and other stress-reducing efforts should consider underlying mental health conditions as effect modifiers.
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Ann Intern Med Date: 2007-10-16 Impact factor: 25.391
Authors: William A Grobman; Corette Parker; Pathik D Wadhwa; Marian Willinger; Hyagriv Simhan; Bob Silver; Ron J Wapner; Samuel Parry; Brian Mercer; David Haas; Alan M Peaceman; Shannon Hunter; Deborah Wing; Steve Caritis; Sean Esplin; Matt Hoffman; Jack Ludmir; Jay Iams; Emily Long; George Saade; Uma M Reddy Journal: Am J Perinatol Date: 2016-08-08 Impact factor: 1.862
Authors: Heather H Burris; Valerie M Riis; Isabel Schmidt; Kristin D Gerson; Amy Brown; Michal A Elovitz Journal: Am J Obstet Gynecol MFM Date: 2020-02-10