Objectives - Determine whether patients who live in greener and more walkable neighbourhoods live longer, and take fewer opioids, following hip or knee arthroplasty. Design - Retrospective cohort study. Setting - Residential environment following surgery at one of 54 New Zealand hospitals. Participants - All people who received a total hip or knee arthroplasty at a publicly-funded hospital in New Zealand in 2006 and 2007 (7449 hip arthroplasties and 6558 knee arthroplasties). Primary and secondary outcome measure - Time to all-cause mortality and number of postsurgical opioid prescriptions. Results - Patients who lived in greener neighbourhoods, as measured by the Normalised Difference Vegetation Index, lived longer following hip or knee arthroplasty (standardised OR: 0.95, 95% CI 0.92 to 0.99). However, when we estimated separate hip-arthroplasty-only and knee-arthroplasty-only models, greenness was only significantly associated with greater longevity following hip arthroplasty. Similarly, patients who lived in greener neighbourhoods took fewer opioids in the 12 months following hip or knee arthroplasty (standardised OR: 0.97, 95% CI 0.95 to 0.99), but in separate hip-arthroplasty-only and knee-arthroplasty-only models, greenness was only significantly associated with lower opioid use following hip arthroplasty. Walkability was not significantly associated with postsurgical opioid use or postsurgical longevity. All ORs were adjusted for sex, ethnicity, age, presurgical chronic health conditions, presurgical opioid use, social deprivation and length of hospital stay. Conclusions - Consistent with the literature on enhanced recovery programme, people who lived in greener neighbourhoods took fewer opioids, and lived longer, following hip arthroplasty. Improving access to the natural environment may therefore be an effective component of postsurgical recovery programme.
Despite reported health benefits of urban greenspace (gs), the epidemiological evidence is less clear for allergic disease. To address a limitation of previous research, we examined the associations of medium- and high-resolution residential gs measures and tree and/or grass canopies with allergic outcomes for children enrolled in the longitudinal cincinnati childhood allergy and air pollution study (ccaaps). We estimated residential gs based on 400 m radial buffers around participant addresses (n=478) using the normalized differential vegetation index (ndvi) and land cover-derived urban greenspace (ugs) (tree and grass coverage, combined and separate) at 30 m and 1.5–2.5 m resolution, respectively. Associations between outdoor aeroallergen sensitization and allergic rhinitis at age 7 and residential gs measures at different exposure windows were examined using multivariable logistic regression models. A 10% increase in ugs-derived grass coverage was associated with an increased risk of sensitization to grass pollens (adjusted odds ratio [aor]: 1.27; 95% confidence interval = 1.02–1.58). For each 10% increase in ugs-derived tree canopy coverage, nonstatistically significant decreased odds were found for grass pollen sensitization, tree pollen sensitization, and sensitization to either (aor range= 0.87–0.94). Results similar in magnitude to ugs-tree canopy coverage were detected for ndvi and allergic sensitizations. High-resolution (down to 1.5 m) gs measures of grass- and tree-covered areas showed associations in opposite directions for different allergy outcomes. These data suggest that measures strongly correlated with tree canopy (e.g., ndvi) may be insufficient to detect health effects associated with proximity to different types of vegetation or help elucidate mechanisms related to specific gs exposure pathways.
Background: Several small experimental studies and cross-sectional observational studies have shown that exposure to the natural environment might protect against attention-deficit hyperactivity disorder (ADHD) or moderate the symptoms of ADHD in children. We aimed to assess whether exposure to the natural environment protects against ADHD and whether this hypothesised protective effect varies across a child’s life course.
Methods: We did a longitudinal study with data collected from all children born in New Zealand in 1998, excluding those without an address history, those who were not singleton births, and those who died or emigrated before 18 years of age. We used Statistics New Zealand’s Integrated Data Infrastructure to identify children with ADHD and to define covariates. ADHD was defined according to hospital diagnosis or pharmacy records (two or more prescriptions for ADHD drugs). Exposure to green space for each year of a child’s life (from gestation to 18 years of age) was estimated at the meshblock level (the smallest geographical unit for which the New Zealand Census reports data) using normalised difference vegetation index (NDVI), and land-use data from Landcare Research New Zealand. We used logit models to assess the associations between ADHD prevalence and minimum, maximum, and mean lifetime NDVI, as well as rural living, controlling for sex, ethnicity, mother’s educational level, mother’s smoking status, mother’s age at parturition, birth order, antibiotic use, and low birthweight.
Findings: Of the 57450 children born in New Zealand in 1998, 49923 were eligible and had available data, and were included in the analysis. Children who had always lived in a rural area after 2 years of age were less likely to develop ADHD (odds ratio [OR] 0.670 [95% CI 0.461–0.974), as were those with increased minimum NDVI exposure after age 2 years (standardised OR for exposure vs first quartile: second quartile 0.841 [0.707–0.999]; third quartile 0.809 [0.680–0.963]; fourth quartile 0.664 [0.548–0.805]). In early life (prenatal to age 2 years), neither rural living nor NDVI were protective against ADHD. Neither mean nor maximum greenness was significantly protective against ADHD.
Interpretation: Rurality and increased minimum greenness were strongly and independently associated with a reduced risk of ADHD. Increasing a child’s minimum lifetime greenness exposure, as opposed to maximum or mean exposure, might provide the greatest increment of protection against the disorder.
Most studies of the health benefits of the natural environment use coarse 2D exposure metrics based on the normalized difference vegetation index (NDVI). We compare the performance of these 2D NDVI metrics to finer-resolution 3D metrics derived from Light Detection and Ranging imagery (LiDAR). In logit models of small-for-gestational-age births, both NDVI and LiDAR metrics were associated with a reduced probability of an adverse birth outcome. However, models using LiDAR metrics had higher explanatory power than equivalent NDVI models, and LiDAR models also revealed that vegetation height (as well as variation in vegetation height) were protective of small-for-gestational age births.
We examined the relationship between urban trees and the sales price of single-family homes in Tampa, Florida. We chose Tampa, because the city is facing major redevelopment pressure that may impact the association between trees and house price. In particular, a frequently voiced view in Tampa’s development community is that trees adversely affect the value of houses that are being sold for redevelopment. We estimated hedonic models of sales price controlling for house and neighborhood characteristics and correcting for spatial autocorrelation (n = 1,924). We found that trees within 152m (500 feet) of a house’s lot were significantly associated with higher sales prices. Specifically, a 1-percentage point increase in tree-canopy cover was associated with a total increase in sales price of $9,271 to $9,836 (results were largely insensitive to correction for spatial autocorrelation). Our results demonstrate that, even in a city facing major redevelopment pressure, trees are associated with higher sales prices.
The magazine article is an informal review of a wide range of research, spanning multiple decades, concerning human health benefits derived from experiences of nearby nature in urbanized places. The actionable information is aimed at professional, manager, and concerned citizen audiences who may have an interest in urban design and planning, as well as urban forestry. A framework of benefits is presented, including Active Living, Stress Reduction, Mental Health and Function, Healing and Therapy, and Social Cohesion. In addition, the article offers suggestions for integrating the research findings into evidence-based urban planning and design, including topics of Neighborhood Walkability, Plant Selection and Placement, Welcoming Spaces, Making Sense of it All, and Co-Design for Co-Benefits. The article content was derived from the Green Cities: Good Health web site, a cooperative project of the USDA Forest Service (Research and S&P deputy areas) and University of Washington (Seattle), and is a research synthesis, science delivery product intended for professional and manager audiences.
This magazine article is an informal review of a wide range of research, spanning multiple decades, concerning human health benefits derived from experiences of nearby nature in urbanized places. The actionable information is aimed at professional and manager audiences who may have an interest in urban design and planning, as well as urban forestry. Urban parks range in scale from large regional parks that are destinations for recreation, to local parks that contain natural areas and sports facilities, to small parks that serve a specific community or neighborhood, including pocket parks. Acquiring large parcels for new parks is difficult or expensive in many cities. Innovative strategies can be used in a sites-to-systems approach that optimizes the use of small parcels, green infrastructure, and green streets to provide nature-based human health benefits. A framework of mental health benefits is presented, including Improved Mood and Attitude, Stress Reduction, Better Mental Functioning, Improved Mindfulness and Creativity, and Building Social Capital. In addition, the article offers suggestions for integrating the research findings into evidence-based urban planning and design. The article content was derived from the Green Cities: Good Health web site, a cooperative project of the USDA Forest Service (Research and S&P deputy areas) and University of Washington (Seattle), and is a research synthesis, science delivery product intended for professional and manager audiences.
This magazine article is an informal review of a wide range of research concerning environmental equity, specifically regarding human health benefits derived from experiences of nearby nature in urbanized places. The article recounts key issues of environmental equity, including green jobs and training programs. The primary purpose of the article is to share current knowledge about equitable access to trees, parks and gardens. The actionable information is aimed at professional and manager audiences who may have an interest in urban design and planning, as well as urban forestry. A framework of health benefits is described, including active living, stress reduction, mental health benefit, and social cohesion. Specific research findings are provided about the proven disparities of distribution of trees, parks and gardens in many cities, while noting that small-scale, inexpensive improvements in urban forestry and urban greening can generate remarkable benefit. The article ends with suggestions for how to encourage broader community participation in creating and managing nearby nature in cities. The article content was derived from the Green Cities: Good Health web site, a cooperative project of the USDA Forest Service (Research and S&P deputy areas) and University of Washington (Seattle), and is a research synthesis, science delivery product intended for professional and manager audiences.