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A Review of Epidemiologic Studies on Greenness and Health: Updated Literature Through 2017

  • Susceptibility Factors in Environmental Health (B Ritz and Z Liew, Section Editors)
  • Published:
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Abstract

Purpose of Review

Many studies suggest that exposure to natural vegetation, or greenness, may be beneficial for a variety of health outcomes. We summarize the recent research in this area.

Recent Findings

We observed consistent and strong evidence of associations for higher greenness with improvements in birth weights and physical activity, as well as lower mortality rates. Recent studies also suggested that exposure to greenness may lower levels of depression and depressive symptoms. The evidence on greenness and cardiovascular health remains mixed. Findings are also inconsistent for greenness measures and asthma and allergies.

Summary

Our knowledge of the impacts of greenness on a wide variety of health outcomes continues to evolve. Future research should incorporate information on specific species and some qualities of natural greenness that might drive health outcomes, integrate exposure assessments that incorporate personal mobility into analyses, and include prospective designs to add to the growing evidence that nature exposure positively affects health.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. James P, Banay RF, Hart JE, Laden F. A review of the health benefits of greenness. Curr Epidemiol Rep. 2015;2(2):131–42. https://doi.org/10.1007/s40471-015-0043-7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Frumkin H, Bratman GN, Breslow SJ, Cochran B, Kahn PH, Lawler JJ, et al. Nature contact and human health: a research agenda. Environ Health Perspect. 2017;125(7):075001. https://doi.org/10.1289/EHP1663.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Markevych I, Schoierer J, Hartig T, Chudnovsky A, Hystad P, Dzhambov AM, et al. Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ Res. 2017;158:301–17. https://doi.org/10.1016/j.envres.2017.06.028.

    Article  CAS  PubMed  Google Scholar 

  4. Wilson EO. Biophilia. Cambridge: Harvard University Press; 1984.

    Google Scholar 

  5. Hansen MM, Jones R, Tocchini K. Shinrin-Yoku (forest bathing) and nature therapy: a state-of-the-art review. Int J Environ Res Public Health. 2017;14(8) https://doi.org/10.3390/ijerph14080851.

  6. Weier J, Herring D. Measuring vegetation (NDVI & EVI) [Internet]. 2000 [cited 2016 May 20]. Available from: http://earthobservatory.nasa.gov/Features/MeasuringVegetation/measuring_vegetation_2.php.

  7. USGS. Remote sensing phenology [Internet]. [cited 2017 Sep 9]. Available from: https://phenology.cr.usgs.gov/ndvi_avhrr.php.

  8. • Dadvand P, Nieuwenhuijsen MJ, Esnaola M, Forns J, Basagaña X, Alvarez-Pedrerol M, et al. Green spaces and cognitive development in primary schoolchildren. Proc Natl Acad Sci U S A. 2015;112(26):7937–42. This study had prospective design and investigated cognitive ability, a relatively less often researched outcome. https://doi.org/10.1073/pnas.1503402112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Sarkar C. Residential greenness and adiposity: findings from the UK Biobank. Environ Int. 2017;106:1–10. https://doi.org/10.1016/j.envint.2017.05.016.

    Article  PubMed  Google Scholar 

  10. Abelt K, McLafferty S. Green streets: urban green and birth outcomes. Int J Environ Res Public Health. 2017;14(7):771. https://doi.org/10.3390/ijerph14070771.

    Article  PubMed Central  Google Scholar 

  11. Casey JA, James P, Rudolph KE, Wu C-D, Schwartz BS. Greenness and birth outcomes in a range of Pennsylvania communities. Int J Environ Res Public Health. 2016;13(3) https://doi.org/10.3390/ijerph13030311.

  12. • Cusack L, Larkin A, Carozza SE, Hystad P. Associations between multiple green space measures and birth weight across two US cities. Health Place. 2017;47:36–43. This study demonstrates that in two cities, the association between greenness and birth weight was different. https://doi.org/10.1016/j.healthplace.2017.07.002.

    Article  PubMed  Google Scholar 

  13. Ebisu K, Holford TR, Bell ML. Association between greenness, urbanicity, and birth weight. Sci Total Environ. 2016;542(Pt A):750–6. https://doi.org/10.1016/j.scitotenv.2015.10.111.

    Article  CAS  PubMed  Google Scholar 

  14. Andrusaityte S, Grazuleviciene R, Kudzyte J, Bernotiene A, Dedele A, Nieuwenhuijsen MJ. Associations between neighbourhood greenness and asthma in preschool children in Kaunas, Lithuania: a case-control study. BMJ Open. 2016;6(4):e010341. https://doi.org/10.1136/bmjopen-2015-010341.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bijnens EM, Nawrot TS, Loos RJ, Gielen M, Vlietinck R, Derom C, et al. Blood pressure in young adulthood and residential greenness in the early-life environment of twins. Environ Health Glob Access Sci Source. 2017;16:53.

    Google Scholar 

  16. Dadvand P, Bartoll X, Basagaña X, Dalmau-Bueno A, Martinez D, Ambros A, et al. Green spaces and general health: roles of mental health status, social support, and physical activity. Environ Int. 2016;91:161–7. https://doi.org/10.1016/j.envint.2016.02.029.

    Article  PubMed  Google Scholar 

  17. Demoury C, Thierry B, Richard H, Sigler B, Kestens Y, Parent M-E. Residential greenness and risk of prostate cancer: a case-control study in Montreal, Canada. Environ Int. 2017;98:129–36. https://doi.org/10.1016/j.envint.2016.10.024.

    Article  PubMed  Google Scholar 

  18. Kim J, Kim H. Demographic and environmental factors associated with mental health: a cross-sectional study. Int J Environ Res Public Health. 2017;14(4):431. https://doi.org/10.3390/ijerph14040431.

    Article  PubMed Central  Google Scholar 

  19. Dewulf B, Neutens T, Van Dyck D, De Bourdeaudhuij I, Broekx S, Beckx C, et al. Associations between time spent in green areas and physical activity among late middle-aged adults. Geospat Health. 2016;11:411.

    Article  PubMed  Google Scholar 

  20. Bijnens E, Zeegers MP, Gielen M, Kicinski M, Hageman GJ, Pachen D, et al. Lower placental telomere length may be attributed to maternal residential traffic exposure; a twin study. Environ Int. 2015;79:1–7. https://doi.org/10.1016/j.envint.2015.02.008.

    Article  PubMed  Google Scholar 

  21. Markevych I, Standl M, Sugiri D, Harris C, Maier W, Berdel D, et al. Residential greenness and blood lipids in children: a longitudinal analysis in GINIplus and LISAplus. Environ Res. 2016;151:168–73. https://doi.org/10.1016/j.envres.2016.07.037.

    Article  CAS  PubMed  Google Scholar 

  22. Zijlema WL, Triguero-Mas M, Smith G, Cirach M, Martinez D, Dadvand P, et al. The relationship between natural outdoor environments and cognitive functioning and its mediators. Environ Res. 2017;155:268–75. https://doi.org/10.1016/j.envres.2017.02.017.

    Article  CAS  PubMed  Google Scholar 

  23. •• Vienneau D, de Hoogh K, Faeh D, Kaufmann M, Wunderli JM, Röösli M, et al. More than clean air and tranquillity: residential green is independently associated with decreasing mortality. Environ Int. 2017;108:176–84. This was a very large cohort study covering a close-to-complete population of an entire country, allowing it to investigate how the associations vary by region. https://doi.org/10.1016/j.envint.2017.08.012.

    Article  PubMed  Google Scholar 

  24. Wu J, Jackson L. Inverse relationship between urban green space and childhood autism in California elementary school districts. Environ Int. 2017;107:140–6. https://doi.org/10.1016/j.envint.2017.07.010.

    Article  PubMed  Google Scholar 

  25. Grazuleviciene R, Danileviciute A, Dedele A, Vencloviene J, Andrusaityte S, Uždanaviciute I, et al. Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study. Int J Hyg Environ Health. 2015;218(3):358–65. https://doi.org/10.1016/j.ijheh.2015.02.004.

    Article  PubMed  PubMed Central  Google Scholar 

  26. • Tischer C, Gascon M, Fernández-Somoano A, Tardón A, Lertxundi Materola A, Ibarluzea J, et al. Urban green and grey space in relation to respiratory health in children. Eur Respir J. 2017;49. This was a prospective cohort covering multiple asthma and allergy outcomes(6):1502112. https://doi.org/10.1183/13993003.02112-2015.

    Article  PubMed  Google Scholar 

  27. McEachan RRC, Prady SL, Smith G, Fairley L, Cabieses B, Gidlow C, et al. The association between green space and depressive symptoms in pregnant women: moderating roles of socioeconomic status and physical activity. J Epidemiol Community Health. 2016;70(3):253–9. https://doi.org/10.1136/jech-2015-205954.

    Article  CAS  PubMed  Google Scholar 

  28. Triguero-Mas M, Dadvand P, Cirach M, Martínez D, Medina A, Mompart A, et al. Natural outdoor environments and mental and physical health: relationships and mechanisms. Environ Int. 2015;77:35–41. https://doi.org/10.1016/j.envint.2015.01.012.

    Article  PubMed  Google Scholar 

  29. Weimann H, Rylander L, Albin M, Skärbäck E, Grahn P, Östergren P-O, et al. Effects of changing exposure to neighbourhood greenness on general and mental health: a longitudinal study. Health Place. 2015;33:48–56. https://doi.org/10.1016/j.healthplace.2015.02.003.

    Article  PubMed  Google Scholar 

  30. Markevych I, Smith MP, Jochner S, Standl M, Brüske I, von Berg A, et al. Neighbourhood and physical activity in German adolescents: GINIplus and LISAplus. Environ Res. 2016;147:284–93. https://doi.org/10.1016/j.envres.2016.02.023.

    Article  CAS  PubMed  Google Scholar 

  31. Almanza E, Jerrett M, Dunton G, Seto E, Pentz MA. A study of community design, greenness, and physical activity in children using satellite, GPS and accelerometer data. Health Place. 2012;18(1):46–54. https://doi.org/10.1016/j.healthplace.2011.09.003.

    Article  PubMed  Google Scholar 

  32. Dadvand P, Sunyer J, Alvarez-Pedrerol M, Dalmau-Bueno A, Esnaola M, Gascon M, et al. Green spaces and spectacles use in schoolchildren in Barcelona. Environ Res. 2017;152:256–62. https://doi.org/10.1016/j.envres.2016.10.026.

    Article  CAS  PubMed  Google Scholar 

  33. •• James P, Hart JE, Hipp JA, Mitchell JA, Kerr J, Hurvitz PM, et al. GPS-based exposure to greenness and walkability and accelerometry-based physical activity. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2017;26(4):525–32. This study used GPS devices and accelerometers to track the location and physical activity levels of study subjects, allowing it to minimize exposure misclassification. It also investigated non-linearity. https://doi.org/10.1158/1055-9965.EPI-16-0925.

    Article  Google Scholar 

  34. Younan D, Tuvblad C, Li L, Wu J, Lurmann F, Franklin M, et al. Environmental determinants of aggression in adolescents: role of urban neighborhood greenspace. J Am Acad Child Adolesc Psychiatry. 2016;55(7):591–601. https://doi.org/10.1016/j.jaac.2016.05.002.

    Article  PubMed  PubMed Central  Google Scholar 

  35. •• Cusack L, Larkin A, Carozza S, Hystad P. Associations between residential greenness and birth outcomes across Texas. Environ Res. 2017;152:88–95. This study had a very large sample size, and it looked at multiple birth outcomes. https://doi.org/10.1016/j.envres.2016.10.003.

    Article  CAS  PubMed  Google Scholar 

  36. McMorris O, Villeneuve PJ, Su J, Jerrett M. Urban greenness and physical activity in a national survey of Canadians. Environ Res. 2015;137:94–100. https://doi.org/10.1016/j.envres.2014.11.010.

    Article  CAS  PubMed  Google Scholar 

  37. van Heeswijck T, Paquet C, Kestens Y, Thierry B, Morency C, Daniel M. Differences in associations between active transportation and built environmental exposures when expressed using different components of individual activity spaces. Health Place. 2015;33:195–202. https://doi.org/10.1016/j.healthplace.2015.03.003.

    Article  PubMed  Google Scholar 

  38. Chaix B, Kestens Y, Perchoux C, Karusisi N, Merlo J, Labadi K. An interactive mapping tool to assess individual mobility patterns in neighborhood studies. Am J Prev Med. 2012;43(4):440–50. https://doi.org/10.1016/j.amepre.2012.06.026.

    Article  PubMed  Google Scholar 

  39. •• Gariepy G, Kaufman JS, Blair A, Kestens Y, Schmitz N. Place and health in diabetes: the neighbourhood environment and risk of depression in adults with type 2 diabetes. Diabet Med J Br Diabet Assoc. 2015;32(7):944–50. This was a prospective study on depression that adjusted for many potential confounders. https://doi.org/10.1111/dme.12650.

    Article  CAS  Google Scholar 

  40. Banay RF, Bezold CP, James P, Hart JE, Laden F. Residential greenness: current perspectives on its impact on maternal health and pregnancy outcomes. Int J Womens Health. 2017;9:133–44. https://doi.org/10.2147/IJWH.S125358.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Fuertes E, Markevych I, Bowatte G, Gruzieva O, Gehring U, Becker A, et al. Residential greenness is differentially associated with childhood allergic rhinitis and aeroallergen sensitization in seven birth cohorts. Allergy. 2016;71(10):1461–71. https://doi.org/10.1111/all.12915.

    Article  CAS  PubMed  Google Scholar 

  42. Notas G, Bariotakis M, Kalogrias V, Andrianaki M, Azariadis K, Kampouri E, et al. Accurate prediction of severe allergic reactions by a small set of environmental parameters (NDVI, temperature). PLoS One. 2015;10(3):e0121475. https://doi.org/10.1371/journal.pone.0121475.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Yitshak-Sade M, Kloog I, Novack V. Do air pollution and neighborhood greenness exposures improve the predicted cardiovascular risk? Environ Int. 2017;107:147–53. https://doi.org/10.1016/j.envint.2017.07.011.

    Article  CAS  PubMed  Google Scholar 

  44. • Crouse DL, Pinault L, Balram A, Hystad P, Peters PA, Chen H, et al. Urban greenness and mortality in Canada’s largest cities: a national cohort study. Lancet Planet Health. 2017;1(7):e289–97. This was a large cohort investigating greenness and its associations with mortality in mostly urban environments. https://doi.org/10.1016/S2542-5196(17)30118-3.

    Article  Google Scholar 

  45. James P, Hart JE, Banay RF, Laden F. Exposure to greenness and mortality in a nationwide prospective cohort study of women. Environ Health Perspect. 2016;124(9):1344–52. https://doi.org/10.1289/ehp.1510363.

    Article  PubMed  PubMed Central  Google Scholar 

  46. de Keijzer C, Agis D, Ambrós A, Arévalo G, Baldasano JM, Bande S, et al. The association of air pollution and greenness with mortality and life expectancy in Spain: a small-area study. Environ Int. 2017;99:170–6. https://doi.org/10.1016/j.envint.2016.11.009.

    Article  PubMed  Google Scholar 

  47. Son J-Y, Lane KJ, Lee J-T, Bell ML. Urban vegetation and heat-related mortality in Seoul, Korea. Environ Res. 2016;151:728–33. https://doi.org/10.1016/j.envres.2016.09.001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, et al. Modification of heat-related mortality in an elderly urban population by vegetation (urban green) and proximity to water (urban blue): evidence from Lisbon, Portugal. Environ Health Perspect. 2016;124(7):927–34. https://doi.org/10.1289/ehp.1409529.

    PubMed  Google Scholar 

  49. Thiering E, Markevych I, Brüske I, Fuertes E, Kratzsch J, Sugiri D, et al. Associations of residential long-term air pollution exposures and satellite-derived greenness with insulin resistance in German adolescents. Environ Health Perspect. 2016;124(8):1291–8. https://doi.org/10.1289/ehp.1509967.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Orban E, Sutcliffe R, Dragano N, Jöckel K-H, Moebus S. Residential surrounding greenness, self-rated health and interrelations with aspects of neighborhood environment and social relations. J Urban Health Bull N Y Acad Med. 2017;94(2):158–69. https://doi.org/10.1007/s11524-016-0112-3.

    Article  Google Scholar 

  51. Kondo MC, South EC, Branas CC, Richmond TS, Wiebe DJ. The association between urban tree cover and gun assault: a case-control and case-crossover study. Am J Epidemiol. 2017;186(3):289–96. https://doi.org/10.1093/aje/kwx096.

    Article  PubMed  PubMed Central  Google Scholar 

  52. MacNaughton P, Eitland E, Kloog I, Schwartz J, Allen J. Impact of particulate matter exposure and surrounding “greenness” on chronic absenteeism in Massachusetts public schools. Int J Environ Res Public Health. 2017;14(3) https://doi.org/10.3390/ijerph14020207.

  53. Kigozi SP, Pindolia DK, Smith DL, Arinaitwe E, Katureebe A, Kilama M, et al. Associations between urbanicity and malaria at local scales in Uganda. Malar J. 2015;14(1):374. https://doi.org/10.1186/s12936-015-0865-2.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Entringer S, Buss C, Wadhwa PD. Prenatal stress, telomere biology, and fetal programming of health and disease risk. Sci Signal. 2012;5:pt12.

    Article  PubMed  Google Scholar 

  55. Zhao Z, Pan X, Liu L, Liu N. Telomere length maintenance, shortening, and lengthening. J Cell Physiol. 2014;229(10):1323–9. https://doi.org/10.1002/jcp.24537.

    Article  CAS  PubMed  Google Scholar 

  56. •• Fuertes E, Markevych I, von Berg A, Bauer C-P, Berdel D, Koletzko S, et al. Greenness and allergies: evidence of differential associations in two areas in Germany. J Epidemiol Community Health. 2014;68(8):787–90. This was a prospective analysis combining data of multiple cohorts and illustrates that different associations between greenness and specific outcomes can occur with data from varying geographic regions. https://doi.org/10.1136/jech-2014-203903.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Dadvand P, Villanueva CM, Font-Ribera L, Martinez D, Basagaña X, Belmonte J, et al. Risks and benefits of green spaces for children: a cross-sectional study of associations with sedentary behavior, obesity, asthma, and allergy. Environ Health Perspect. 2014;122(12):1329–35. https://doi.org/10.1289/ehp.1308038.

    PubMed  PubMed Central  Google Scholar 

  58. Blair SN, Morris JN. Healthy hearts—and the universal benefits of being physically active: physical activity and health. Ann Epidemiol. 2009;19(4):253–6. https://doi.org/10.1016/j.annepidem.2009.01.019.

    Article  PubMed  Google Scholar 

  59. Albus C. Psychological and social factors in coronary heart disease. Ann Med. 2010;42(7):487–94. https://doi.org/10.3109/07853890.2010.515605.

    Article  PubMed  Google Scholar 

  60. Gold DR, Mittleman MA. New insights into pollution and the cardiovascular system: 2010 to 2012. Circulation. 2013;127(18):1903–13. https://doi.org/10.1161/CIRCULATIONAHA.111.064337.

    Article  PubMed  Google Scholar 

  61. Villeneuve PJ, Jerrett M, Su JG, Burnett RT, Chen H, Wheeler AJ, et al. A cohort study relating urban green space with mortality in Ontario, Canada. Environ Res. 2012;115:51–8. https://doi.org/10.1016/j.envres.2012.03.003.

    Article  CAS  PubMed  Google Scholar 

  62. Pan C-W, Ramamurthy D, Saw S-M. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt. 2012;32(1):3–16. https://doi.org/10.1111/j.1475-1313.2011.00884.x.

    Article  PubMed  Google Scholar 

  63. Oliveira JC d, Epiphanio JCN. Noise reduction in MODIS NDVI time series data based on spatial-temporal analysis. 2012 I.E. Int. Geosci. Remote Sens. Symp. 2012. p. 2372–5.

  64. Gidlöf-Gunnarsson A, Öhrström E. Noise and well-being in urban residential environments: the potential role of perceived availability to nearby green areas. Landsc Urban Plan. 2007;83(2-3):115–26. https://doi.org/10.1016/j.landurbplan.2007.03.003.

    Article  Google Scholar 

  65. Nowak DJ, Crane DE, Stevens JC. Air pollution removal by urban trees and shrubs in the United States. Urban For Urban Green. 2006;4(3-4):115–23. https://doi.org/10.1016/j.ufug.2006.01.007.

    Article  Google Scholar 

  66. Hyam R. Automated image sampling and classification can be used to explore perceived naturalness of urban spaces. PLoS One. 2017;12(1):e0169357. https://doi.org/10.1371/journal.pone.0169357.

    Article  PubMed  PubMed Central  Google Scholar 

  67. James P, Jankowska M, Marx C, Hart JE, Berrigan D, Kerr J, et al. “Spatial energetics”: integrating data from GPS, accelerometry, and GIS to address obesity and inactivity. Am J Prev Med. 2016;51(5):792–800. https://doi.org/10.1016/j.amepre.2016.06.006.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Chaix B, Méline J, Duncan S, Merrien C, Karusisi N, Perchoux C, et al. GPS tracking in neighborhood and health studies: a step forward for environmental exposure assessment, a step backward for causal inference? Health Place. 2013;21:46–51. https://doi.org/10.1016/j.healthplace.2013.01.003.

    Article  PubMed  Google Scholar 

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Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the USEPA or the NIH. Further, USEPA and NIH do not endorse the purchase of any commercial products or services mentioned in the publication.

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This publication was made possible by USEPA (RD-834798, RD-835872, RD-83615601-0) and NIH (R00 CA201542, P50 MD010428).

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Correspondence to Kelvin C. Fong.

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Fong, K.C., Hart, J.E. & James, P. A Review of Epidemiologic Studies on Greenness and Health: Updated Literature Through 2017. Curr Envir Health Rpt 5, 77–87 (2018). https://doi.org/10.1007/s40572-018-0179-y

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