MEETING AGENDA
Estimating Greenspace Exposure and Benefits
for Cumulative Risk Assessment Applications
4-5 May 2015
Room AG-30, U.S. Environmental Protection Agency
26 Martin Luther King Drive West, Cincinnati, OH 45220
Meeting Purpose
The role of ecosystem services, including access and exposure to greenspace, may have
beneficial effects on population health. There is some uncertainty as to which mechanisms (e.g.,
social connectedness, psychological well-being from exposure to nature) associations between
greenspace and health outcomes are acting through. Given that greenspace may be a marker of
non-chemical stressors or an exposure modifier, it is a good candidate to examine in a
cumulative risk context, which could help determine its use and effectiveness as an ecosystem
service and potential risk management practice. To this end, EPA's National Center for
Environmental Assessment in Cincinnati is hosting a technical meeting to evaluate various
measures and roles of greenspace from a cumulative risk assessment (CRA) perspective. The
technical group will review existing greenspace exposure measures and methods used across
different fields of study, with a focus on which measures are useful for different health outcomes
and cumulative risk applications. The meeting discussion and outputs will inform methods for
evaluating environmental health risks and benefits associated with greenspace (GS).
Driving Questions
• How can existing cumulative risk assessment frameworks consider greenspace as it relates to
exposure assessment for human health?
• How is greenspace conceptualized across disciplines?
• What health outcomes are relevant to greenspace prevalence and access?
• Which evidence-based measures of greenspace provide the most applicable, reliable, and
replicable estimates for greenspace exposure in urban settings?
• What are the specific mechanisms for certain health benefits and can these be used to inform
biologic plausibility of reported associations with greenspace?
Key Objective
Identify and qualify approaches and appropriate data sources for measuring greenspace and
evaluating the distribution of health benefits (i.e., across socioeconomic status, sensitive
populations), including risk reductions, from a cumulative risk assessment perspective, with
attention to bias and uncertainty in reporting and measurement.
1. Evaluate key pathways and methods for estimating greenspace exposure.
2. Evaluate key health outcomes and/or benefits and related methods and data sources for
quantifying health outcomes related to greenspace.
3. Determine appropriate applications for greenspace measures, outcomes, and benefits within
existing cumulative risk assessment frameworks.
Bl-2
-------
Day 2-Tues 5 May
Greenspace and Health
B2-1
-------
Day 2- Respiratory effects
Greenspace and Allergic / Respiratory
Disease
Background: Allergic Disease
Characterized by specific IgE production against
allergens
- HDM, pets cockroach, grass, trees, ragweed
Runny, stuffy nose, itchy eyes, red/watery eyes,
sneezing
Closely linked to respiratory disease / asthma
Food altera*
Skin allergy Respiratory allergy
INDOOR
CMtj
D°»<
R*.
Mmae i
i.! rtf m • x
¦3
Bermuda ST*" '
OA
Attentat u i
B«
i
) 5 II
Ht
> 15
rcrrt(SK)
INDOOR ¦
Call
rman toclnxJS I
Rat-
OUTDOOR.
B«ch ¦
a
-------
Day 2- Respiratory effects
Background: Asthma
• Chronic inflammatory disorder of the
airways associated with periods of
reversible airflow obstruction (i.e.
asthma attacks)
- Airflow obstruction caused by inflammation
and airway hyper responsiveness caused by
contraction of the airway smooth muscle
- Wheezing, shortness of breath, chest
tightness, and cough
- Triggers include: tobacco smoke, indoor
allergens (e.g dust mites, cockroaches,
pets), infections, exercise, weather, outdoor
air pollution, outdoor allergens
• Prevalence (US: 2008-2010)
- 0-17:9.5%
• MaIe-11%, Female-8%
• White-8%. Black-16%
- 18+: 7.7%
• MaIe-6%, Female-10%
Moorman JE. et a I. National Center for Health Statistics. Vital Health Stat 3(35)2012.
Greenspace and Asthma
(Overly Simplified)
Asthma
Pathogenesis
Air Pollution
Physical Activity
Exercise
Genetics /
Epigenetics
Stress I
Neighborhood I
Community
Weather
Outdoor Allergens
Crime I Violence
Respiratory
Infections
Vit D / Microbiome
Indoor Allergens
Asthma
Exacerbation
B2-3
-------
Day 2- Respiratory effects
Greenspace: Potential Beneficial Pathways
for Allergic / Respiratory Disease
Greenspace
Pollutant
reduction
Crime
reduction
Noise
reduction
Physical
activity
Heat
reduction
Stress
Environmental
Benefits
Socio-behavioral
Benefits
J. Allergy
/Asthma
Greenspace, Crime, and Allergic I
Respiratory Disease
The association between community crime and
childhood asthma prevalence in Chicago
Ruchi S. Gupta. MD. MPH*t; Xingyou Zhang. PhD?: Elizabeth E. Springsion. AB ::
Lisa K. Sharp, PhD§: Laura M. Curtis. MS*; Madeline Shalowitz, MD. MBA1): John J. Shannon. MD||;
Ann Allergy Asthma Immunol. 2010;104:299-306.
Greenspace
and Kevin B. Weiss. MD. MPH #
Table 3. Odds of Chicago Schoolchildren Betng
Likelihood of Asthma. OR (95% CI)
Adjusted without
Including race/ethniclty*
Adjusted
Including race/ethniclty*
Property crimes'
High vs low
Drug abuse viotations'
Crime
Reduction
Socio-behavioral Benefits
, Allergy / Asthma
1.16(0.96-1.37)
1.08(0.96-120)
Abbreviations: CI. confidence Interval: OR. odds ratio.
• Adjusted for age. sex. household member with asthma, and socioeconomic status.
• Adjusted tor age. sex. household member with asthma, socioeconomic status, and race/ethnicity
c Annual incidence per population of 100.000: high, >6352: moderate, --6352 and -3077; and low. <3077.
•P<.001.
• Annual incidence per population of 100.000 high. >1772: moderate, --1772 and -452: and tow. -452.
'P< 05.
» Annual incidence per population of 100.000: high. -4766: moderate. --4766 and -2440: and low. -;2440.
h Annual incidence per population of 100.000 high. >2707. moderate. *-2707 and >344; and to*. - 344.
B2-4
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Day 2- Respiratory effects
Greenspace, Stress, and Allergic I
Respiratory Disease
Parental psychological distress during pregnancy and
wheezing in preschool children: The Generation R Study
Monica Guxens. MD. MPH. PhD.*bcd Agnes M. M. Sonnenschein-van der Voort, MSc,*-*'1 Henning Tiemeier. MD. PhD.'-9
Albert Hofman. MD. PhD.' Jordi Sunyer, MD. PhD.bc> Johan C.de Jongste, MD. PhD.e Vincent W. V. Jaddoe. MD. PhD.* u
and Liesbeth Duijts. MD. PhD*'' Rotterdam. The NetherlauLx. and Banelona. Spam Nile no Clin Immunol 2III4:I.U:5'-67,|
Greenspace
Mental Health /
Stress Reduction
Socio-behavioral Benefits
I Allergy / Asthma
Al. Overall psychological distress
i;
A 2. Depression syroploim
A3. Anxiety symptom*
i:
]:
0174 00*3 OOOt <3001
Greenspace, Physical Activity, and
Allergic I Respiratory Disease
Physical Activity and Asthma: A Systematic Review and
Meta-Analysis
Marianne Eijkemans1'2*, Monique Mommers2, Jos M. Th. Draaisma', Carel Thijs2, Martin H. Prins*
Greenspace
Physical
Activity
Socio-behavioral Benefits
„ Allergy / Asthma
Odds Ratio
M H. Random, 95% CI
Odds Ratio
M H. Random. 95% CI
1.11 |0.88,M0]
0.95 (0 79.1.14]
0.5510 30. 0.99]
0 7210 42,1 25]
0 86 10 68.1.09]
0.77 [0.64, 0 92]
0 89 [0 65,1.22]
1.31 10 81,2.13]
0 46 |0 20.1 07]
0.88 [0.77,1.01]
0.01 01
favors high physical activity
jsalor
1 10 100
favors low physical activity
B2-5
-------
Day 2- Respiratory effects
Greenspace: Potential Beneficial Pathways
for Allergic I Respiratory Disease
Environmental
Benefits
Socio-behavioral
Benefits
Heat
reduction
Noise
reduction
f
Physical
activity
Pollutant
reduction
Crime
reduction
Stress
reduction
I Allergy
/Asthma
Greenspace, Noise, Heat, and Allergic I
Respiratory Disease
Greenspace
. Allergy/Asthma
Noise and asthma
- Greenspace (trees and shrubs) may
reduce noise by 5-10 db / 30m
- Lack of studies designed to examine noise
associated with asthma
• Activation of stress pathway?
Heat and asthma
- Greenspace I temperatures
- Heat-asthma link less clear
• Indirect pathway through ozone production
B2-6
-------
Day 2- Respiratory effects
Greenspace, Air Pollutants, and Allergic I
Respiratory Disease
Traffic-Related Air Pollution (TRAP)
- PM, NOx, PAHs, EC, Metals
- Significantly elevated near roadways
Traffic-related air pollutants causally associated with asthma exacerbation
- Hospitalization, medication use, symptoms, lung function
TRAP 'usually'associated with new-onset asthma
Rapid >50% drop by 150 m
Less rapid or gradual decay
No trend
CO (32)
EC (49)
NO (67)
L NO* (30)
V UF1 Particle no. (76)
UF2 Particle no. (93)
•ivV VOC1 (80)
\* \\
Benzene (33)
NO? (125)
PM25(61)
V:; ..
" -"s - _
*
Fine particle no. (19)
PM,0(57)
VOC2 (32)
- 1.2 -
~o
a>
J 1.0-
m
0 0.8 -
c
.2 0 6 ~
1
0.4 -
0.2
Distance from edge (m)
Karneret al. 2010
Greenspace and Air Pollutants
Greenspace
Environmental Benefits
••
Pollutant
reduction
¦-
f
J Allergy / Asthma
Surrounding Greenness and Exposure to Air Pollution During Pregnancy
An Analysis of Personal Monitoring Data
Payam Dadvand,h23 Audrey de Nazelle,1J-3 Margarita Triguero-Mas,' Anna Schembari,,-2 3-4 Marta Cirach,'
Elmira Amoly,4 Francesc Figueras* Xavier Basagana,,J-3 Bart Ostro,16 and Mark Nieuwenhuijsen}2-3
voiuut 1201 number 91 September 2012 • Environmental Health Perspectives 1 i-—. e v...:— a. 1 d
Table Z Regression coefficients 195% CIs) of change in personal exposure and microemnronmental pollutant levels associated wttli an IQR' Increase m
tie average NDVj wihm the butters ot 100 m, 2S0 m. aid 500 in around maternal residential addresses
Surrounding yeeoness
100-m buffer
250-m butter
500-m bu«er
Regression
Regression
Regression
Measurements
coetteient |95% 0)
/~value
coefficient |95% 0)
p-Vate
coefficient (95% cri
p-Value
Petsonai (unadjusted)
PM,S
-521-94.-091
002
-24 (-50. Oil
OX
-281-58.031
008
NO.
—2-6 f-15-3.101|
068
-23 (-9 7.511
054
-32 (-12 4.6 Ol
0 49
Personal (adjusted)*
PM,S
-59I-100.-I8)
<001
-2 4 M 8.0.01
006
-231-61.051
0.11
NO.
-511-186.84)
045
-3 OHO 7.4 61
043
-36H29.57I
044
Home-indoor'
PMq
-611-106. -16)
<001
-19 (-4 6,08)
017
-2 3 [—5 5.0 91
015
NO.
-951-244.531
020
-45 (-13.3.42)
031
-6 7 (-17 3.3 91
021
Home-outdoor1
PM;,
-441-95.0 71
008
-3 2 (-6 6.021
007
-5 5 (-10.5. -041
004
NO.
-581-176.60)
033
-53 (-14.0.3.4]
023
-561-195.831
043
and pass**). uss of gavcookmg appfcancas. lima spam m tramlsr. and MEDEA inda* ol neighborhood deprivation. 'Adjusted for tha ismperatura at home-indoors on the first day ot
sampling round, the uta ol gas-cooking appliances. smofcng (active and passive), lit* number at mhataamv and ME0EA index ol neighborhood deprivation ^Adjusted lor the traffic
mtensity n the buflw o» 100 m around mammal residential admass. tft« Might ot the monitor, and ME0EA mda* ot wngbboihood dapmahon
Unadluttcd -8.K-I10 -20) 001 -1X91-1114. -8.4) -001
A4justr001
MpiHrtt' -0301-044.-016) -0.01 -046f-080 -OJ2) <001
Traffic-teLtfed fMu (jc-nr*) SO (481
Unadjusted -U(-2J.0D) 005 -2.4( - lfi,-U) -001
MUMmS1 —15t—IS, -04) -O0t -2.7C-19.-10) <001
n (temperature. humaliry. and pvapiuuan >. m
and xhoo) cFuraoeihoo i nt Uni biaidwK *tx and vennUiscn
' AdiiRi«l tor weekly image of background level ot iIvk ptf kaant. metroroloicica) indKaton innxrjiuir. hum«5«y. jnd precvxietuiii. mcwicir placemen! ((low and orientation),
andttaflk Iwftcaon uiuared distance u> ihr noieeu major roadl product oOi^ftt Memrtyontheneamtrtud *Hlnvenerfdivuinelolhene*nii«l in a 50 mbutlei ar mad ihe Ktiooi)
B2-7
-------
Day 2- Respiratory effects
Land Cover
¦ Trees
~ Grass/Brush
~ Impervious
¦ Water
Kilometers
PYRENE
- 6.5
- 6 0
- 5.5
- 5.0
- 4.5
- 4.0
- 3.5
Kilometers
B2-8
-------
Day 2- Respiratory effects
PYRENE
PYRENE
Roads
B2-9
-------
Day 2- Respiratory effects
PYRENE
PYRENE
B2-10
-------
Day 2- Respiratory effects
PYRENE
PYRENE
Grass/Shrubs
B2-11
-------
Day 2- Respiratory effects
Potential Deleterious Effects of
Greenspace
Greenspace
Allergens
Pesticides I
Fertilizers
VOCs
Time spent
outdoors
Environmental Risk
Factors
t Allergy / Asthma
Urban Tree Canopy and Asthma, Wheeze, Rhinitis, and Allergic Sensitization
to Tree Pollen in a New York City Birth Cohort
Gina S. Lovasi,1 Jarlath P.M. O'Neil-Dunne.2 Jacqueline W.T. Lu, 3 Daniel Sheehan.14 Matthew S. Perzanowski,s
Sean W. MacFaden,2 Kristen L. Kinq,3 Thomas Matte,6 Rachel L. Miller,5 Lori A. Hoepner,5 Frederica P. Perera,s and
Andrew Rundle1 voujui121i*um»»4 April 2013 • trivlronmental Health Perspective*
• Birth cohort (n = 288 - 427)
• Tree canopy characterized by LiDAR and multispectral imagery < 0.25 prenatal
address
AJ
0 25 km around ago S address -
025 km around ago 7 address
1.0 km around prenatal address
10 km around ago 5 address -
1 0 km around ago 7 address -
Muhvlo imputation ot missing
Imrorso probaMtfy weighting .
In neMptato fofcww up
Scale and ttnmg
o
-------
Day 2- Respiratory effects
A modeling study of the impact of urban trees on ozone
David J. Nowak"*, Kevin L. Civerolo\ S. Trivikrama Raob, Gopal Sistlah,
Christopher J. Lnleyc, Daniel E. Crane" Almospbcrlc Environmcn, w,20oq, l60,-l6,3
• Trees produce VOCs, which can in turn
increase ozone.
-Varies by species (sweet gums are bad, for
example) but minor compared to anthropogenic
sources
Greenspace and Allergic I Respiratory
Disease in the CCAAPS Cohort
• Cincinnati Childhood Allergy and Air Pollution
Study (CCAAPS)
- Objective: Determine if children exposed to traffic-
related air pollution, specifically diesel exhaust
particles, are at increased risk for developing
allergic diseases, asthma, and impaired
neurobehavioral development
- Longitudinal birth cohort study of infants born 2001-
2003 in greater Cincinnati region
• Eligibility: Birth record address < 400 m major road or >
1500 m from major road
• Enrolled - 762; Age 7-617; Currently ongoing Age 12 -
-500
B2-13
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Day 2- Respiratory effects
CCAAPS Methods
• Clinical evaluations
- 1-4: Questionnaire, SPT, physical exam, hair, saliva, blood,
eNO, spirometry
- 7: All above + behavior
- 12: All above + intelligence, reading ability, attention/inhibition,
memory, executive function, neuromotor function, behavior,
anxiety/depression, MRI (structure, organization, and function)
• Indoor exposure (1,7)
- Walk-through, dust (allergens, mold, endotoxin)
• Outdoor exposure
- PM2.5, EC
- Land-use regression model
Greenspace and Parks and Lung
Function in the CCAAPS Cohort
Dist.to.Park_Age7 - i
Dist.to.Park_Agel
NDVI_Age7 -J
NDVI_Age1 -I i
percentFEVI
Dist.to.Park_Age7 -
Dist.to.Park_Age1 -
NDVI_Age7 -
NDVI_Age1 -
'—I 1 1 1
0.00 0.01 0.02 0.03 0.04
percentFVC
—I 1 1 1 r
0.00 0.01 0.02 0.03 0.04
Dist.to.Park_Age7 •
Dist.to.Park_Age1 ¦
NDVI_Age7
NDVI_Age1 ¦
FEF2575
Dist.to.Park_Age7 -
Dist.to.Park_Age1
NDVI_Age7 -
NDVI_Age1 -
peakFlow
0.00 0.04 0.08
regression .coefficient
H 1 1 1 n
0.0 2.5 5.0 7.5 10.0
B2-14
-------
Day 2- Respiratory effects
CCAAPS Preliminary Data: Greenspace,
Traffic, and Lung Function
Low TRAP
Ov.toPjrt_Aa«7
Dwi.lo -
NOVI/mI
p^rcwitFEVI
&SttoP*1i_Ag*7
D«sS to.P«rk_Ag* 1"
NCWI_Ag«7
NWI.Afl»l
-0 02 0 00 0 02 0 04
Diftto P»it_Ag«7 -
D*tlaP*it_A««1 -
NOVI_A«*7
NOVI_A«#V
Dtstto PaA_Afle7
Di« to P»r*_Ae» 1 ¦
NDVI_A©«7
N£V1_A0*1 -
p*fO*ntFVC
-0.05 0 00 0 06 OtO
D»!tO.P»rt_Ag«7 -
OlSt to. Park_Ag« 1 -
ND\'I_A9«7-
NDVI_A9#1 - K
High TRAP
0 00 0 01 0.02 0.03 0.04 0 05
FEF2575
Dtslto Part; _Ag«7-
D(*ltoP«rt_Ag«1 -
NDVI_*9«7 -
NOVI_A®#1 -
Dtstto.Park_Age7
^isl !o ParV_Ag«1 -
NDVI_A9«7
NDVI_Aja1
D«tto.Park_Aga7
Df*ttoP#rk_A9#i
NOVi_Aga7
N0VI_A9«1
0 00 0 02 0 04
regression coefficient
000 0 05 0.10 0 15
regression coefficient
CCAAPS Preliminary Data: Greenspace,
and Allergic I Respiratory Disease
Dist.to.Park_Age7 -
Dist.to.Park_Age1 -[j
NDVI_Age7 -
NDVI_Age1 H
Dist.to.Park_Age7
Dist.to.Park_Age1 -
NDVI_Age7 -
NDVI_Age1 -
spl7
odds.ratio
B2-15
-------
Day 2- Respiratory effects
CCAAPS Preliminary Data: Greenspace,
Traffic, and Allergic/Respiratory Disease
Ost to Parfc_Age7 •
D«t to P*l(_Ag« 1 ¦
NO/l_Ag«7
N0VI_Ag«1
Ok to P*k_Ag#7 ¦
OsttoParti_Age1
NDVI_Ao«7
NCVI_A«*1
Low TRAP
astfma
!
¦
i
•
BM.7
i
i
i
i
1
1
Olit.to.Park_Ag«? -
Dlstlo.Park_Ag«1 -jT
NDVI_Ag»7 -
NDVI_Ag#1 -
-I
D(st.to.Pari<_Ag«7 -
Dl*t to.Parl<_Ag*1 -
NDVI_Ag«7 -
N0VI_Ag«1 -
High TRAP
13 2-0
0 0 0.5 1.0
0.5 1.0 1.5 2.0
CCAAPS Preliminary Data: TRAP and
Park Distance
TRAP
> Median
< Median
Distance to Park (500 m)
B2-16
-------
Day 2- Respiratory effects
Susceptible Populations
• Children
- More time spent outdoors
- More active -> f ventilation rates
- Respiratory / immune system development begins prenatally and
continues through adolescence
• Prenatal - ~1-2 years especially important
• Elderly
- Pre-existing conditions
• Socioeconomically disadvantaged
• Black / Puerto Rican
- t asthma prevalence and morbidity / mortality
Summary
Greenspace
Physical
Pollutant
Crime
Stress
t Time
spent
Allergens
• Pesticides
I Fertilizers
Potential
Deleterious
Effects
Potential
Benefits
Environmental
Socio-behavioral
Environmental
Individual Susceptibility
:
Allergy / Asthma
B2-17
-------
Day 2- Respiratory effects
Driving Questions
- How should cumulative risk assessment frameworks consider
greenspace as it relates to respiratory health?
- What greenspace elements and metrics are relevant to respiratory
health?
- What are the specific known or presumed mechanisms of respiratory
health, and can this be used to inform biologic plausibility of reported
associations with greenspace?
- Consideration of "active" vs. "passive" exposure pathways and health
impacts—e.g. outdoor exercise (active) vs. visible greenspace around
residence (passive)
- Considerations of community and individual level outcomes and
specific populations
B2-18
-------
Day 2- Reproductive effects
Reproductive Health
Reproductive Health
• Birth weight a major cause of neonatal and infant
morality and influences health across the life course.
• Birth weight (and preterm birth and SGA) have been
associated with several social and environmental
exposures that may be related to greenspace.
— Air pollution
— Noise
— Heat
— Stress/depression
— Social capital,
— Etc...
B2-19
-------
Day 2- Reproductive effects
Psychosocial pathway as
= biologic plausible pathway
Green space
o
Maternal stress
3 possibles mechanisms
Physiological pathway as
= hypothetical pathway
Green space
Maternal health
Biological pktuiibhr
PiychoneyrOTPjjiKMne mKhjn'SHI
Direct impact on an individual's brain and body
Activation HPA regulate Cortisol secretion
- Promotes psychological restoration
- Improves attention
-Reduces stress and anxiety
Phy$loioQlGol
Mental disorders
• Poor mental health
~ Depression
•Cognitive fonctlon
Cardiovascular disease
stroke, heart, blood
pressure
ggifealis jimiatlan
- Diabetes
- Obesity
Reduction of maternal stress and associated
neuroendocrine and immune mechanism
Smoking,
Self-medication
Environmental pathway as
= Indirect plausible pathway
Green space
Environmental
risk factors
)
5
Reduced air
pollution:
N02, PM
Reduced noise i Improved
level j microclimates
¦ kHthMiflKll
1
J 7
| Maternal exposure
1 |
Unhealthy behaviors
Reduced adverse pregnancy
outcomes related with these
environmental factors
Low birth weight
Preterm birth
Intrauterine growth retardation
Beneficial impact on pregnancy outcome
Figure 3 A conceptual model of mediating variables and their hypothesized association with pregnancy outcomes.
Green space, social inequalities and neonatal mortality in France http://wvAM.biomedcantral.com/conKnt/odf/1471-2393-13-191-odf
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Research Children's Health
Residential Greenness and Birth Outcomes: Evaluating the Influence
of Spatially Correlated Built-Environment Factors
Perry Hystad,1 Hugh W. Davies,2 Lawrence Frank,2-3 Josh Van Loon2 Ulrike Gehring.4 Lillian Tamburic2 and
Michael Brauer2
'College of Public Hearth and Human Sciences. Oregon Stale University. Corvallls. Oregon. USA; 'School of Population and Public Health,
and 3School of Community and Regional Planning. University of British Columbia. Vancouver, British Columbia. Canada; 'institute for
Risk Assessment Sciences. Utrecht University, Utrecht, the Netherlands
Perinatal
Physician Billing,
Database &
Hospital Discharge,
Canada Census
Vital Statistics
Databases
Residential
history
Geographic
linkage
Greenness, Air, noise
and built environment
data
Covariates
Outcomes
Built Environment
Exposure Measures
Birth cohort identified 92,158 children born in the Vancouver
metropolitan area from 1999-2002.
B2-20
-------
Day 2- Reproductive effects
Greenness Air Pollution (NO, N02, PM2 5, BC)
Noise (Traffic and all Soi
Adjusted ~ Built
Environment Variables
Adjusted
NDVI
B2-21
-------
Day 2- Reproductive effects
Urban trees and the risk of poor birth outcomes
Table 2
Multiple logistic regression of small for gestational age births (Portland. Oregon, 2006 and 2007, n=5295).
Variable
Odds ratio
95% CI
p-value
Marginal effect per
1000 births
Total births
0.8466
0.7611-0.9418
0.0022
-10.3
Mother has no college education
1.4424
1.1267 1.8465
0.0037
25.3
Mother non-Hispanic white
0.6941
0.5580-0.8633
0.0010
-24.4
Percent canopy cover within 50 m
0.9902
0.98It-0.9993
0.0343
-1.42*
Distance to private open space (m)
1.0001
1.0000-1.0001
0.0178
- 1.85~
McFadden R- squared
0.01853
• For a 10% increase in canopy cover.
"" For a 500 m reduction in distance (private open space consists of cemeteries, golf courses, private-school grounds, and community gardens).
Systematic Review and Meta-Analysis
n = 0
Studies identified
during the peer-review
n- 3
Excluded: did not assess
birth weight
n = 2
Grey literature/
unpubKslied data/experts
n = 0
Included in systematic teview and meta-analysis after full-text screening
(KrippcndorfTs alpha = 1.00)
Titles and abstracts screening
(KrippendorfTs alpha = 0.67)
n«7
Fig. 1. Row diagram of study selection and screening process.
Dzhambov A, Dimitrova D, Dimitrakova E. (2014). Association between residential greenness and birth weight:
Systematic review and meta-analysis. Urban Forestry & Urban Greening 13 (2014) 621-629
B2-22
-------
Day 2- Reproductive effects
Table 3
Meta-analysis results for 100-m buffer (standardized regression coefficients, quality
effects model).
Study
P
LCI
UCI
Weight (%)
Dadvand etal. (2014)
0.004
0.0003
0.007
1.766
Dadvand etal. (2012a)
-0.001
-0.004
0.002
2.372
Dadvand et al. (2012b)
0.007
0.001
0.013
1.494
Markevych et al. (2014)
0.004
-0.001
0.008
1.591
Laurent etal. (2013)
0.0004
0.0001
0.001
58.728
Donovan etal. (2011)
0.005
0.0003
0.010
1.887
Agay-Shay et al. (2014)
0.002
0.001
0.002
16.872
Hystad et al. (2014)
0.003
0.003
0.004
15.790
Pooled fi
0.001
-0.001
0.003
100.000
Heterogeneity statistics
/2
91.051
84.775
94.740
Cochran's Q
78.221
x2.p
0.0001
Q-Index
10.812
Note. LCI- Lower95%CI; UCI- Upper95%CI; fi-standardized regression coefficient.
Systematic Review and Meta-Analysis
Conclusions
• The pooled correlation coefficient was 0.049 (95% CI: 0.039,0.059)
and the pooled standardized regression coefficient was 0.001
(95%CI: -0.001, 0.003).
• "exposure-response" approach towards urban greenness is an
oversimplification.
• Need for more theory-driven studies focusing prospectively on a
smaller population of pregnant women (rather than extracting data
from large populations).
• Additional studies published since meta-analysis demonstrating
association with birth weight.
• Mixed evidence for greenspace and gestational age, PTB and VPTB.
B2-23
-------
Day 2- Reproductive effects
FaMr I Strength ol evidence Icr greenna* aid health otOcc
Oufccmc
Study dewgrw
Settmg
Finding*
Strogth of evidence
Phywcal activity
IS oraMtctnul ttulo
4 «nkn mi the USA. 6 at the UK. 2 n 1 ranee. 1
(trmwert evidence of poatne aaooaton between
in
I26*. 27.28. 33-43.45J
each n Auwralia. Vtherlandv New Zealand, and Spi
an greenne** and pby-acal activity Few pnwpectnc »tudic*
1 fwmpectrve **>dy |44|
tKcrw eight
10 croui-«ectKiul nul»
3 «ud>c* m the USA. 2 M the I V. 2 in Canada. 1
Some o aknee of neginc auuctatusi between
II
oticwry
||U. 43,46-W. 5I-54J
each m Australia. Denmark. Fgypt and Spaai
grecnocftt overweight, ohculy, though folding*
1 pn»«pa;tr\« Uidy (SO)
iespecially among chtllieni »cie mixed iVmiNc
dlcet imdilkatMi by gender. Few pampcctrve uuk>
Mental health
11 cmw-tecaoml tttkn
4 Umbo m the UK. 2 m \cthcr Umh. 2 at the 1 SA,
SuBOtne pMctmc died ol gmmnc%» on *ell-
II
I20.22-.2X 56.
1 each m Aiaunha. link Ifcnmarl. \ cm-
rtpr>Kd mental health More pnwpective uudic* needed
5fU6l. 63-65]
Zealand. Span and Sweden
3 pnxpectiYT
t57.66.67J
Hath and
A birth cohort ktutho
2 tfuihe* in Spam. 2 tfmfact n (lanuny 1 each in
C raunacM evidence of a puMtne rditomhip hetwuen
111
developmental
(31*. 6i.6¥, 71-73)
C'autla. France, UrrcL and die UK
residential groctme** exptmmr and bath weight
nlcana
2 cimvMKtEtml »tuhc«
I\>«mHc dlcv t nukliatui by Sl-S Fmtfcng* kit
of allergies and auhma
i«her birth and developmental nikuim requrr
and hvperactvity (21. *2.43).
fiithcrmdawr
1 anhovsKulaf
2 expetwartal «uihe* pit. R4|
4 rudK* n the UK. 1 arch m the USA, Nethertnlv
( onviacnt evidence of higher gnrmcu and lower
lllll
nuKMim
3 ecological audio (16, 7*. 79)
(iermany. Auvtaha. and Canada
card** atcular dacaK. hnwrotr. mow tfutfco arc
1 cntMectntal Muki J62. HQ. SI |
ecological and ovn»-wtn*ial One prospective
1 piDfatnt cohort Mudy [*>)
v*idv could not arcount for mdnidual-levd umkmg
Sfcvuhty
3 protpatne vtnbc* |*>. 85, 87]
3 uud»e» m the I K. 2 ttMhe* in the l-'SA. 1 each m
Faah ciawMtent evidence of higher gremrxx* and lowet
II
5 ecological tludio
Japan. New Zealand, and (. audi
rtviriality. however, mtjonty of *tud» air eeobfKal
i 7*. 7V, *6. > • |
Two protective tfuki were in ^Metfic vubpopubun*
(eiderly and «vb nn nw) (htpmpcctm vtuly
could not accumrt i»r individual-level unolong.
Secrigth of evidence defmtiom
I High evidence •• onMart. ptauilile, and prce««K qurbfkd ad thoe n low proMwIity of hai
II1 Iracrmedute ev tderxe curtv hoi not entirely oimKcrt. a not quillkd preendy. <* my he vulnerable to hut
III Low evidence n mcomMcnt. unpiautihtc. and«* nay he vulnerable to hu* aevnely limiting the value of the effect hemg dewrnhed
James P, Banay R, Hart J, Laden F. (2015). A Review of the Health Benefits of Greenness. Curr Epidemiol Rep (2015)
2:131-142
Driving Questions
• How should cumulative risk assessmentframeworks consider
greenspace as it relates to reproductive health?
• What greenspace elements and metrics are relevant to
reproductive health?
• What are the specific known or presumed mechanisms of
reproductive health, and can this be used to inform biologic
plausibility of reported associations with greenspace?
• Consideration of potential cumulative effect of greenness on
reproductive health -- "active" + "passive" exposure
pathways—e.g. outdoor exercise (active) and visible
greenspace around residence (passive)
• Considerations of community and individual level outcomes
and specific populations
B2-24
-------
Day 2- Obesity and physical activity
Obesity & Physical Activity
Matilda Annerstedt van
den Bosch
Aaron Hipp
May 5, 2015
Estimating Greenspace Exposure & Benefits for
Cumulative Risk Assessment Applications
Technical Working Group Meeting
May 4-5, 2015
U.S. Environmental Protection Agency
26 Martin Luther King Drive West, Cincinnati, OH 45220
Physical Activity (PA) & health outcomes
General effects
1. Antiinflammatory
Low grade inflammation causes/accelerates long term
conditions (increased cytokines)
Exercise:
> muscles release antiinflammatory myokines
> loss of pro-inflammatory visceral fat rather than
subcutaneous fat
2. Mitochondrial
Sedentary - mitochondria charges, free radicals -
inflammation & aging
Exercise:
>Muscles need energy - reduced charging
^Stimulates autophagy - cleaning of cell cytoplasma
3. Weight loss
Obesity - metabolic syndrome -
cardiovascular & chronic kidney
diseases
Exercise:
>250 minutes/week-weight loss
> Lowered BMI - 10% of the health
effects of physical activity
Source: BMJ Learning
B2-25
-------
Day 2- Obesity and physical activity
Physical Activity (PA) & health outcomes
Organ and disease specific effects
•SCardiovascular: reduce fibrinogen and inflammatory response, increase HDL, reduce
blood pressure and pulse rate, increase stroke volume
^Musculoskeletal: stabilize joints, increase stability and balance, prevents osteoarthiritis,
builds up cartilage
SBrain: reduce anxiety, depression and dementia, increase memory and learning, induce
neuron growth
^Immune system: increased number of Natural Killer (NK) cells - tumor suppression
•SCancer: Positive hormonal effects (delays menarche, reduced oestrogen & progestersone,
increased insulin resistance), decreased cell proliferation, increased cellular antioxidants,
increased NK-cells
^Diabetes: increased insulin sensitivity, increased number of mitochondria- manufacture
antioxidants ,
Source: BMJ Learning
Physical inactivity
Disease
Risk reduction
Strength of
evidence
Death
20-35%
Strong
CHD and Stroke
20-35%
Strong
The fourth leading risk factor
Type 2 Diabetes
35-40%
Strong
for premature death globally
Colon Cancer
30-50%
Strong
Causes more deaths than
Breast Cancer
20%
Strong
smoking
Hip Fracture
36-68%
Moderate
Depression
20-30%
Strong
Hypertension
33%
Strong
Alzheimer's Disease
20-30%
Moderate
World Health Organization. 2010
Functional limitation, elderly
30%
Strong
B2-26
-------
Day 2- Obesity and physical activity
Cost of additional healthcare
due to inactivity.
inactive
active
Years of life: 20
Source: CDC I National Centre for Chronic Disease Prevention
At least UK is worse....
Lazybones
EUROPE
BO M
THE
AMERICAS
ASIA
PACIFIC
EQ
VMIDDLE
EAST
BH
AFRICA
WORLD: 31.1%
Physical inactivity*
in adults
Aged IS years or more,
latest available year
(2009 or earlier).*
| >50.0
j 40.0-49.9
j 30.0-39.9
~ 20.0-29.9
~ <19.9
i I Nodoto
EH Bvfegion
Source: The Loixet
•Physical activity is defined as 30 minutes of moderate-intensity
activity five times a week. 20 minutes of vigorous-intensity
activity three times a week. or some combination of both
B2-27
-------
Day 2- Obesity and physical activity
Choose your place
• PA (with increased breathing rate) in urbanised areas may be
hazardous due to environmental stressors (e.g. air pollution,
noise)
• Inside a car you're protected from those stressors...
• Biking along a frequent road depletes the positive cognitive
effects of PA
• Makes the case for parks, but not street trees
Ref: Vlachokostas et al. 2014; McNabola et al. 2007; de Nazelle et al. 2012
7
GS and PA
• Proximity to urban parks is correlated to higher levels of PA
• Some studies have shown a correlation between larger size (> 5 ha) of
GS and PA
• But different features attract different user groups (e.g. life course
perspective)
• Shape of association may be more important than magnitude
• No thresholds or benchmarking exist
Ref: Gomez et al. 2010; Sugiyama et al. 2010; Giles-Corti et al. 2005, 2013; Koohsari et al. 2013, Schipperijen et al. 2013;
Konijendijk et al. 2013
8
B2-28
-------
Day 2- Obesity and physical activity
What is the evidence for health benefits
from urban parks?
PA, obesity
Stress
Self-reported health, longevity,
noise
HIGH
MODERATE
Konijnendijk, Annerstedt et al. 2013.
Benefits of Urban Parks - A Systematic Review, IFPRA.
Social
support
~
LOW
6£Ifpra
Suggested mechanisms
Distraction
Sustained effect
Play and sports
Shade encourages walking and active transport
10
B2-29
-------
Day 2- Obesity and physical activity
GPS, accelerometer, NDVI
Community design
(Smart Growth)
34-39% increased OR of MVPAfor NDVI increase of 0.11 (10th to 90th percentile increase in GS exposure)
Stronger association in Smart Growth communities
> 20 min GS exposure - 5 times the rate of MVPA of children with 0 exposure
Contant* lias avorlabla M SciVwwi ScwncoOiroct
Health & Place
journal homapaga: www altavlar.com/tocata/haalthplaca
A study of community design, greenness, and physical activity in children
using satellite. CPS and accelerometer data
Estela Almanza**, Michael Jcrrctt*. Genevieve Dunton b. Edmund Seto*. Mary Ann Pentzb
(rrclivmj pbyttul jiimty
Nomulurd Olffnmcr
InJa 'NUVI) rnrd lo quantify daliiimt («-20*: inrnnni jt JO » cpxli
iatlmmilB jnd CPS dju point* A xnwr jlirvd I in Mr mual model with * krtnt "
Mm for Jddmtwit HMttil JuKKorrrljIion n« fit lo jndyur mtdniul neighborhood
lulbftfli jcfiuty ii hoinr jnd rtutms idiaol haun. in epoch-level jnilyw fix**
vi£KtHJt phyircjl .activity (MWAX Thn imxuliwi nu *ionjrr lor uiijn tiimlh r
e«pertm Benwi ip«i Kt O J09-7.J0).
n
Physical Activity Level W< I
Fig. 1. Geovisualization of a child* personal monitoring points show MVl'A
occurring within green areas and dunng active transport (* home points shifted
for confidentiality).
Limited Intervention Research
FLSFVIFR
Social Science ft Medicine 124 (2015) 246-256
Contents lists available at ScienceOirect
Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Review
The impact of interventions to promote physical activity in urban
green space: A systematic review and recommendations for future
research
Ruth F. Hunter 1 \ Hayley Christian b, Jenny Veitch \ Thomas Astell-Buitd e.
J.Aaron Hipp Jasper Schipperijn 8
(Dc
12
B2-30
-------
Day 2- Obesity and physical activity
Measuring Physical Activity
Doubly Label led Water
Direct calorimetry
Indirect calorimetry
Criterion measures
Objective measures
Subjective measures
"Tactometers
^Questionnaires
Ease of Assessment
Publicly Available Data
fas
PUBUC HEALTH
ORIGINAL RESEARCH ARTICLE
Use of emerging technologies to assess differences
in outdoor physical activity in St. Louis, Missouri
Deepti Adlakha Elizabeth L. Budd, Rebecca Gemes, Sonia Sequeira and James A. Hipp
Bam Sfftnl tVufngun unvmtym St Lc
Run-, Walks
K
287
71
Tool Distance (m miJes)
172201
-56 84
Distance (in miles) m parks
519 60
10100
S m or taagennal to parks
80 80S
7040*.
S m parks m low-SES neighborhoods
691U
15.5 OS
• running and walking routes downloaded from MapMyRm.com
ud pmrtT rat* ta Si Lnc. MO. CSA
B2-31
-------
Day 2- Obesity and physical activity
Fri Sep 07 2012 11:58:00 GMT-0500 (Central Daylight Time)
St Louis Arch
B2-32
-------
Day 2- Obesity and physical activity
USACE Field
Research
Facility
Kitty Hawk, NC
B2-33
-------
Day 2- Obesity and physical activity
-------
Day 2- Obesity and physical activity
B2-35
-------
Day 2- Obesity and physical activity
2007 2008
Hipp, J.A. etal. EmergingTechnologies: Webcams and Crowd-sourcingto Identify ActiveTransportation. American Journal of PreventiveMedicine. 44(1) 96-97.
Human IntelligenceTask
HIT:
1 FWCPEOPIX
2 ()NOBIK£S
3 RMJCABS
•» Step 1: Find all the people in this scene
There ore no people
-------
Day 2- Obesity and physical activity
Weekly PedestrianTrends
• Camera ID = 919. n =
20.075
_ .050
00 0.025
Camera ID = 942.
fill!
* ' i I
Day of week
Residential Intersection
Day of week
Commercial Intersection
Hourly PedestrianTrends
Camera ID = 919. n = 14090
I
Camera ID = 942, n = 14893
Time of day
Residential Intersection
Time of day
Commercial Intersection
B2-37
-------
Day 2- Obesity and physical activity
Hourly Transportation Trends
Camera ID = 919. n = 14090
S3
Camera ID = 942. n = 14893
I
Time of day
Residential Intersection
Time of day
Commercial Intersection
Weather and Active Transportation
i l
¦o
£
| 0.8
I
59-65 66-72 73-79
Temperature Range (F)
B2-38
-------
Day 2- Obesity and physical activity
29
Mobile devices for collecting data
• Hardware sensors: accelerometers, GPS, barometer, luminance,
microphone, temperature, heart rate, etc.
• Behaviour inference sensors: calendar availability, communication
patterns, social interactions
• Qualitative sensors: on-screen questionnaires, diaries, experience
sampling
• Necessary to have power-efficient sensing architecture
• Real-time analysis
• Existing platforms: e.g. AWARE
30
B2-39
-------
Day 2- Obesity and physical activity
www.awareframework.com
AWARE
AWARE Documentation Forum Contact ui
(»? ¥*> \A
' '' ¦
AWARE AWA«
piupns UW«U»
d*>* S3
Pocket-sized intelligence ... ,1
;!
1 Read more
~ "
— 1
J
For smartphones and Android Wear (automatically
installed): Android 2.3.3 or higher
Vetston; 3,3.4 (MsvenCentral» Android Studio library) Last update: April 29th. 2015
Scalable
Easy to u*e. plugln-baio
Open
Opcn-MMiree and community
Science
Wktdy adopted and supported by
University of Oulu, Finland.
V Kostakos, D Ferreira
Standards in policies
• Area-percentage (percentage reserved for GS)
• Catchment areas (size and distance)
• Often based on "common-sense approaches", rarely empirical
evidence
• Internationally little or no evidence-based approach for developing
planning standards for GS
• Quality of GS often ignored
• Consider needs-based approaches
• Lack of cost-efficiency analyses
Ref.: Veal, 2012; Kellettand Rofe, 2009)
B2-40
-------
Day 2-Cardiovascular disease and mortality
GREEN SPACE AND HEALTH:
Mortality and Cardiovascular
Mark J Nieuwenhuijsen PhD
Perry Hystad
5-6 May 2015/ EPA Cincinatti
Generalitat
de Catalunya
Mortality
• Generally large population size needed
• Not many studies
• Recent systematic review
• Exposure:
-generally % in census area unit (CAU)
-NDVI at CAU or buffer
B2-41
-------
Day 2-Cardiovascular disease and mortality
Table 1. Main estimations of the association between surrounding greenness or access to green spaces and mortality
Author (year)
N
Exposure type
Exposure description
Mortality outcome
Outcome
description
Estimate type
Estimate provided
bv the study
Harlan et al. 2013. The
USA
2081 CAUs
Surrounding
greenness at CAU
(Factor calculated
from NDVI)
IQR=1.16*
Extreme heat
11.4% of
CAUs with at
least one
death
OR (95%CI)
1.19(1.02. 1.39)*"*
Hu et al. 2008. The USA Not reported
"Amount" of GS at
CAU (LCM)
Min. Max= -52.4 to 7.1
Stroke SMR
Min, mean,
max (average
of all
CAU)=4.22.
8.06. 34.42
P(SD)
•0.161 (0.067)'
Lachowycz et al. 2014.
The UK
Not reported
% GS at CAU and
5 and 10km buffer
(LCM)
Quintiles (highest vs lowest)
Circulatory causes
SMR
Not reported
Rate Ratio
(95%CT)
0.95 (0.92.0.98)*
Mitchell et al. 200S. The
UK
40813236
individuals
% GS at CAU
(LCM)
Five equal interv al groups
(every 20% - highest vs
lowest)
All-cause
Circulatory diseases
Lung cancer
Intentional self-harm
366348 cases
90433 cases
25742 cases
12308 cases
IRR (95%CI)
0.94 (0.93.0.96)
0.96 (0.93. 0.99)
0.96(0.91. 1.02)
1.00(0.92. 1.09)
Mitchell etal. 2011. The
UK
1625495
individuals
% GS at CAU
(LCM)
Five equal interval groups
(every 20% - highest vs
lowest)
All-cause
Not reported
IRR (95%CI)
0.63 (0.54. 0.73)
Richardson et al. 2010.
The UK
28.6 million
individuals
% GS at CAU
(LCM)
Four equal interval groups
(every 25%- highest vs
lowest)
Cardiovascular
disease
103711 cases
IRR (95%CI) by
gender
Men
Women
0.95 (0.91.0.98)
1.00 (0.95. 1.06)
www.creal.cat
Gascon et al (under review)
Author (year)
N
Exposure type
Exposure description
Mortality outcome
Outcome
description
Estimate type
Estimate provided
bv the studv
Rcspiratoiy disease
26591 cases
Men
0.89 (0.83.0.96)
Women
0.96 (0.88. 1.05)
Lung cancer
30110 cases
Men
0.96(0.90.1.02)
Women
1.02(0.94. 1.11)
Richardson et al. 2010.
1546405
% GS at CAU
Quartiles (highest vs lowest) -
Cardiovascular
9484 cases
IRR (95%CI)
1.01 (0.91. 1.11)
New Zealand
individuals
(LCM)
mean (range) for all CAU=
disease
42% (0-100%)
Lung cancer
2603 cases
1.12 (0.94. 1.32)
Richardson et al. 2012.
43 million
% GS at CAU
Three categories (highest
Average (all
P (95%CI) by
The USA
individuals
(LCM)
(59® o-72%) vs lowest (20%-
citics)=27000
gender
45%))
All-cause
cases
Men
132.9(18.3.247.5)
Women
94.2(21.8.. 166.7)
Heart disease
Men
6.5 (-62.5. 75.5)
Women
1.9 (-42.0.45.8)
Diabetis
Men
4.3 (-3.06. 11.73)
Women
4.2 (-0.8. 9.2)
Lung cancer
Men
7.9 (-8.8. 24.6)
Women
2.5 (8.8.13.7)
Motor vehicle
Men
0.6 (-8.1.9.2)
fatalities
Women
-3.4 (-8.5. 1.7)
Tamosiunas et al. 2014.
5112 individuals
Distance to the
Tertiles (<347.8m. 347.81-
Cardiovascular
83 cases
HR (95%CI)
1.15 (0.64.2.07)**
Lithuania nearest green space 629.6m. >629.61) disease
(LCM)
www.creal.cat
Gascon et al (under review)
B2-42
-------
Day 2-Cardiovascular disease and mortality
Author (year)
N
Exposure type
Exposure description
Mortality outcome
Outcome
description
Estimate type
Estimate provided
bv the studv
Ucjio ct al. 2011, The
USA
1741 CAUs
Surrounding
greenness at CAU
(NDVT)
IQR=0.047*
Extreme heat
3.6% of
CAUs with at
least one
death'
OR (95%CI)
0.64 (0.01, 40.4)°
Viileneuve et al. 2012.
Canada
574840
individuals
Surrounding
greenness in 50
and 300m buffers
(NDVT)
IQR=0.24
All-nou accidental
cause
Cardiovascular
disease
Respiratory disease
181110
66530
13730
Rate Ratio
(95%CI)
0.95 (0.94.0.97)
0.95 (0.93.0.97)
0.92 (0.88.0.96)
Wilkeretal. 2014. The
USA
1645 individuals
Surrounding
Kreciuicss in 250m
buffer (NDVD
Quartiles (highest vs lowest)
Post-stroke all-cause
929
HR (95%CI)
0.80 (0.65.0.99)
www.creal.cat
Gascon et al (under review)
Study RR (95% CI)
Harlan et al 2013. The USA 1^2 (1 05. 1 43)
Mitchell etal 2008
0 96)
Mitchell etal 2011
(0 02.62 21) ^1
Uepo et al 2011 Tlie USA
Viileneuve et al 2012 0 95(0 94
Wilkeretal 2014 0 80(0 65
Overall
l-squared=88 0% p<0 001) 0 92 (0 87, 0 97)
Meta-analysis All cause mortality
02 05 1.0 20
Risk Ratio (95%CI)
www.creal.cat
Gascon et al (under review)
B2-43
-------
Day 2-Cardiovascular disease and mortality
Meta-analysis Lung cancer mortality
Study RR (95% CO
Mitchell et al 2008 0 % <0 94 0 98)
Richardson et al 2010a (M) 0 96 (0 93.0 99)
Richardson el al 2010a _
s
ViBeneuve et al 2012 0 95 (0 93 0 97)
Overall
(l-squared=21 3% p=0 261) 0 96 <0 94 0 97)
3
0 7 0 8 0 9 10 11 12
Risk Ratio (95%CI)
Gascon et al (under review)
B2-44
-------
Day 2-Cardiovascular disease and mortality
TREES AND MORTALITY IN THE USA
The Relationship Between Trees and
Human Health
Evidence from the Spread of the Emerald Ash Borer
Geoffrey H. Donovan, PhD, David T. Butry, PhD, Yvonne L. Michael, ScD,
Jeffrey P. Prestemon, PhD, Andrew M. Liebhold, PhD,
Demetrios Gatziolis, PhD, Megan Y. Mao
Purpose: A natural experiment, which provides stronger evidence of causality, was used to test
whether a major change to the natural environment—the loss of 100 million trees to the emerald ash
borer, an invasive forest pest—has influenced mortality related to cardiovascular and lower-
respiratory diseases.
Am I Prev Med 2013;44(2):139-145
www.creal.cat
Gascon et al (under review)
Extent of
infestation
2002
2007
I ¦ 1 1 1 1 1 1 1 2010
0 125 250 500 750 1000 km
Figure 1. Counties where the emerald ash borer had been detected in 2002, 2007, and 2010
B2-45
-------
Day 2-Cardiovascular disease and mortality
TREES AND MORTALITY IN THE USA
Results: There was an increase in mortality related to cardiovascular and lower-respiratory-tract
illness in counties infested with the emerald ash borer. The magnitude of this effect was greater as
infestation progressed and in counties with above-average median household income. Across the 15
states in the study area, the borer was associated with anadditional6113 deaths related to illness of the
lower respiratory system, and 15,080 cardiovascular-related deaths.
Table 1. Longitudinal regression mode* of adult lowet'
respirotory-trnct disease-related mortality, acfcusting for
emanates. U.S.. 1990-2007
nm# trend
1-year mortality.mo laf
-2.96(-3.23. -2.72) <0.001
0.3110 JOX 0.3101 <0.001
9.40(6.40.12.401 <0.001
2.1410.32. 3.97 > 0.022
13£516.50. 21.391
1.22(0.92.1.521
Emerald ash Bow
Income
Yean of Infestation
WltNn counties
Between counties
Overall
2.24 <1.89. 2.58)
-5.22(-7.79. -2.64)
4.241-8.10. -0.39)
6.23(2.23.10.22)
1.44(0-96.1.92)
-0.85 (-1.30.-0.41)
0.609
0.187
0.352
<0.001
<0.001
0.077
<0.001
<0.001
The presence
of the borer in
a county is
associated
with 6.8
additional
deaths per
year per
100,000
adults (95%
CI4.8, 8.7).
Table 3. Longitudinal regression model of adult
caidiovascul(»i r*Hate"2
1.003
1.002-1.003
Race
White
RER
Asian
0.729
0.649-0,819
Black
0.653
0.6t8-0.692
Hispanic
0.855
0.773-0.946
Native
0.973
0.767-1.24
Other
0.962
0.835-1.11
Income
<$35,000
REF
S35.000-S49.399
0.911
0.875-0.948
S50.000-S74.999
0.S54
0.817-0.893
S75.000-S100.000
0.759
0.709-0.814
S100.000-S150.000
0 743
: til-::
>$150,000
0.720
0.637-0,814
Smoking Status
Never Smoked
REF
Smoker
1.755
166-188
Former Smoker
1.131
1.1-1.17
Intervention Received
HRT
1.097
1.04-1.16
Dietary Modification
0.S69
0.922-1.02
Calcium and Vitamin D
0.962
0.917-1.01
Observational Study
1.513
1.45-1.57
BMI
1.018
1.002-1.036
(B»)»2
0.9997
0.999-1.000
Alcohol Servings Per Week
0.9877
0.384-0.992
(Alcohol Servings Per Week)-2
Recreational Energy Expenditure IIET-Hours Per
Week
1.0001
0.9972
1.0001-1 .M02
0.936-0.998
MeanfEmotional Wellness)
0.9951
0.994-0.996
Diabetes
1.9470
186-2.04
Hypertension
2.4696
2.39-2.55
www.creal.cat
B2-46
-------
Day 2-Cardiovascular disease and mortality
Life expectancy
Jonkers etal. (2014)
- An increase of 1 SD in the percentage of urban green space
was associated with a 0.1 -year higher LE, and, in the case of
quality of green, with an approximately 0.3-year higher LE and
HLE
• Takano et al. (2002)
- The probability of five year survival of the senior citizens studied
increased in accordance with the space for taking a stroll near the
residence (p<0.01), parks and tree lined streets near the
residence (p<0.05), and their preference to continue to live in
their current community (p<0.01).
Gascon et al (under review)
A Alt-cause mortality
2-2-i
5 16
I
•o
•o 14
12
10-
rih
ri
i
i
rt
ri
rih
~ Income group 2
~ Income group 3
~ Income group 4
rt
T
-x-
£
-i-
rh
r
B Deaths from circulatory disease
2 6 -i
2 4-
2-2-
o
B
2 2-0
&>
5 18-
^ 16"
c
14
1-2-
10-
i
it
:
T
ft
i
£
J3
L
Group 1 (least)
Group 2 Group 3 Group 4
Exposure to green space
Group 5 (most)
Mitchell
and
Popham
2008
Figure 2: Incidence rate ratios for all-cause mortality (A) and deaths from circulatory disease (B) in
income-deprivation quartiles 2-4, relative to income deprivation quartile 1 (least deprived), stratified by
exposure to green space
B2-47
-------
Day 2-Cardiovascular disease and mortality
CVD Incidence
• Generally large population size needed
•Very few studies available looking at long-term
greenspace and CVD incidence
•Most examine mortality of short-term
influences on risk factors (e.g. Blood
pressure, HRV, etc.)
• Exposure:
-Generally NDVI
fV-ncal activity 15 cn»*-*cc«aaial «tudic»
27.2*. 33-43.45)
I pimpcittu- rt»dy |*4]
(*cr*» eight 10 ttudio
obeaty 119. 43. 46-W. 51-54)
t prospective »**dy |50|
4 «iAc»»the ISA.* m the UK. 2 at Fmoc. I
? «kk< n the USA, 2 mi the IX. 2 «n C*ak I
cacti in Autfralu. Drmui. Igypt and Spaoi
4 4uki m the L'K. 2 in Nctalmk. 2 m chc USA.
t each m Autaaha. C anada. Doniwi Sow
/alaid Span, and Sweden
! authe* a) Span 2 Okbo m Germany. I each n
( aiak Fiaxc. Itrael. and the I K
Vkntil health 11 cim-Mckml »aufcev
120. 22-. 23. 56.
SMI. 6345]
3 pnipcctnt viKbc*
C57.66.67)
ttirth and 6 bath cohort vtucfco
dcvdnpMUil IJl'.M.M.TI-T))
2 CRHMCctiMal «lokc«
of allergic* and avthna
and hyperactvay (21. 32.43).
2 eipcnmriaal «i«hc« [K3. IU|
3 ecological Mud*. 116. 7*. TV)
3 cn>w*cct»»nal ttu&e* (62. HQ. XI |
I pto^xxtiw cohort ttudy |S>)
3 puivpcx trvc tlnkt p>. *5. K7) 3 tlutbe* a the Ik. 2 rtuthc* m the USA. I each in
Jecutoftcal «tud»
(16, 7*. 79. W>. ffl)
I audirt as the UK. I cacti ai the USA.
(¦crown, Amtala. aid Canada
(onuacra evidence <4 povttve ivocunw between
pretax™ and phyacal activity Fern prospective audio
Some evafcnee of negaive nttatlna Iwwcd
(mmot overweight ohc»ity. though finding*
(opeculX an»r^; ttukJitnl we* mixed K**ibJc
cflal mndtfkatKei K gendct Few pn>«pxtne uufce*
Suggestive pntettn c died of (icnaru on *clf-
reportcd menu I health Mote procpective itudie* needed
C unuaeta cadence of a pmMive tciaBomhip between
IWiNc eflcvt nattfelkatkai by SI S Indaigv far
i«hcx Nrth and developmental iwtcomcv mjure
CVntMcM evalrac c4 higher peemu and Iww
canfcovskcular doeme. however, n»a nudm ate
ccoiopcai and aotv«cctional One prospective
%a*S could not accotiii for mdrnduaMoel ui*»kjng
faah cccwntent cvidawe of higher panncu and lower
mortality, hfflirwt, mi^ntv of main ate nnbpcjl
Two pnfatnr Uuk< were ai «pecilW kwg
Strength of evaknee defindom
I - High evidence n coiwknt. plaafotc. and pcccncly quantified and there n low probability of hat
II • Iracrmedute cvaiencc cum. but not entirety conttacnt. a ant tfuanaficd precwdy. or may be vulnerable ID hia*
III Lear oxkrvc a atcoaurtcn. impiuivible. anior nay he vulnerable m htav *\ea:b limiting the value of the effect heay described
www.creal.cat
James P. Banay R Hart J. Laden F (2015). A Review of the Health Benefits of Greenness. Curr Epidemiol Rep (2015) 2:131-142
B2-48
-------
Day 2-Cardiovascular disease and mortality
Neighborhood greenness and cardiovascular disease
• Pereira et al. (2012). The association between neighborhood greenness and
cardiovascular disease: an observational study
• Cross-sectional study of 11,404 adults obtained from a population representative
sample for the period 2003-2009 in Perth, Western Australia.
• Neighborhood greenness was ascertained for a 1600 m service area surrounding
the residential address using NDVI.
•Measured average greenness and
•variation of greenness levels in service area
• Assessed associations with medically diagnosed and
hospitalization for coronary heart disease or stroke
Table 2 Odds ratios (OR) and 95% confidence intervals (CI) of coronary heart disease or stroke for differences in
neighborhood greenness for the 11,404 adults in the study population. Adjustment was made by cumulative inclusion
of risk factors
Modd A
Model B
Model C
Model D
Model E
Model F
No adjustment Sociodemographics Sociodemographics Sociodemographics
Biological factors Biological factors
Behavioral factors
Self-reported medical diagnosis with coronary heart disease or stroke
Sample size (N) >1.374 9.216 7.216
Mean greenness (NDI/1) In 1600 m service area
Low 1 1 1
Moderate 0.91(079,105) 0.81 (0.69, 0.96) 0.83(0.69,1.00)
High 1.09 (055.124) 098 (084.1.15) 1.01 (085.122)
Linear increase 0.98 (093.1XM) 097(0.90 103) 098(0.91.105)
Standard deviation (SO) of greenness (NOW In 1600 m service area
Low 1 1 1
Moderate 0.84 (074.0.97) 0.71 (0.60, 0.83) 0.70 (0.58, 0.84)
High 091 (080 104) 0.83 (0.70, 0.97) 0.83 (0.69, 0.99)
Linear increase 094 (08a 101) 089(082.0.97) 0.90 (0.82.0.99)
Hospital admission with coronary heart disease or stroke
Sample size (N) 11.198 8901
Mean greenness (NOVO in 1600 m service area
Low 1 1
Moderate 1.16 (090 150) 088 (065.1.17)
High 1.11(086.1.44) 095(071.128)
Linear Increase 098 (088 108) 094 (0.83,1.06)
Standard deviation (SD) of greenness (NDVI) In 1600 m sennce area
Low 1 1 1
Moderate 1.01 (079.130) 092(0.69,123)
High 0.90 (069.1.16) 081 (OGO. 109)
Linear Increase 094 (082.107) 092 (0,79.107)
6941
1
0,87 (064, 1.19)
082(059. 1.13)
0.89(077.102)
0.92 (0.68. 124)
0.71 (0.51, 0.99)
0.89(0.74. 105)
083 (0.68. 102)
092(075. 1.13)
098 (093. 104)
1
0.76 (0.62, 0.93)
0.84 (068. 102)
091 (082. 101)
1
092(065. 130)
085 (058, 124)
090 (077, 105)
1
0.87 (061. 122)
0.66 (0.45, 0.96)
0.84 (0.70 102)
Sociodemographics Sociodemographics
Biological factors Biological factors
Behavioral factors
Air quality
1
083 (0.68. 102)
092 (0.75. 1.13)
093 (0.85. 101)
1
0.76 (0.62. 0.93)
084 (0.68, 103)
091 (0.82 101)
1
092 (065. 130)
08S (0.5a 124)
0.90(0,77. 105)
Behavioral factors
Air quality
All greenness
1
084 (069, 1.02)
0,94 (0.76, 1.15)
0.93 (085. 1.01)
1
0.76 (0.62, 0.94)
0.84 (068. 103)
0.91 (0.82.1.02)
1
0.90 (063.1.27)
087 (060. 127)
090 (077, 1.0S)
1
0.85 (0.60 120)
0.63 (0.43,
0.82 (0.68, 1.00)
B2-49
-------
Day 2-Cardiovascular disease and mortality
Preliminary Results from Nurses Health Study (Peter James)
• Urban greenness exposures and CVD
incidence in the Nurses' Health Study
prospective cohort.
• 92,053 women followed from 2000-
2010.
• Time-varying MODIS satellite NDVI
(absolute and relative to urban area)
linked to addresses.
• 1,715,019 person-years and 3,503
CVD events identified.
• Adjusted for wide-range of individual
and contextual variables.
www.creal.cat
Preliminary Results
• No association between NDVI
and CVD.
• One unit increase in long-term
average Z-score of relative NDVI
was associated with a 6%
reduction in CVD incidence
(95%CI: 0.90, 0.99).
• No associations between short-
term relative greenness and
CVD.
Greenness and Cardiovascular Disease Incidence in the Nurses'Health Study
Authors: Peter James. Jaime E. Hart, Perry Hystad, Rachel F. Banay Fran cine Laden
www.creal.cat
B2-50
-------
Day 2-Cardiovascular disease and mortality
Greenspace and CVD Incidence: Conclusions
• Very little research has examined greenspace and CVD
incidence
• Little evidence of an association in observational studies
• Some evidence of short-term impacts on CVD risk factors
(e.g. blood pressure, hypertension, HRV, etc)
B2-51
-------
Day 2-Neurological/neurodevelopmental effects
Greenspace and Neurological /
Neurodevelopmental Effects
Background: Mental Health
Leading causes of disability-adjusted life years (DALYs), in all ages
• Mental and behavioral disorders
- Clinically significant conditions
characterized by alterations in
thinking, mood (emotions), and
behavior associated with personal
distress and/or impaired
functioning - who 2001 report
• Prevalence of mental and
behavioral disorders rising
globally
- Affect > 25%
• Point prevalence - 10% adults
B2-52
Both sexes, all ages % total
1 Lower respiratory infections 6.4
2 Perinatal conditions 6.2
3 HIV/AIDS 6.1
4 Unipolar depressive disorders 4.4
5 Diarrhoeal diseases 4.2
6 Ischaemic heart disease 3.8
7 Cerebrovascular disease 3.1
8 Road traffic accidents 2.8
9 Malaria 2.7
10 Tuberculosis 2.4
11 Chronic obstructive pulmonary disease 2.3
12 Congenital abnormalities 2.2
13 Measles 1.9
14 Iron-deficiency anaemia 1.8
15 Hearing loss, adult onset 1.7
16 Falls 1.3
17 Self-inflicted injuries 1.3
18 Alcohol use disorders 1.3
19 Protein-energy malnutrition 1.1
20 Osteoarthritis 1.1
WHO The World Health Report: 2001: Mental
Health: New Understanding. New Hope.
-------
Day 2-Neurological/neurodevelopmental effects
Background: Neurodevelopment
Learning disabilities and activity disorders T ~3% annually
- ~12 million children in the U.S. have at least one neurobehavioral disability impacting cognitive function,
language, emotion, motor function, or behavior
Prenatal and early childhood are particularly important as this is the time of rapid growth and
cellular differentiation, unprotected barriers
- Brain growth continues throughout childhood and prolonged period of myelination -»brain is not mature
until young adulthood
t
Multiple factors including genetics, social, nutritional, and environment
- Environmental neurotoxicants are associated with -25% of neurobehavioral disabilities
- Lead, pesticides, tobacco smoke, traffic
¥
yj
ii
!•" W MS
i i I,' SHi i
<11
OPEN ANO SHUT
Tl># rumun tnn't t» "ww* **mi to cm) « i«vm tmwl»
Kg**™ to
-------
Day 2-Neurological/neurodevelopmental effects
Greenspace and Neurobehavior I Mental
Health
Greenspace
Psychosocial
benefits
Physical
activity
Social
activity
Pollutant
reduction
Noise
reduction
Heat
reduction
Environmental
Benefits
Socio-behavioral
Benefits
Neurobehavioral I Mental Health
Mental Health Benefits of Long-Term Exposure to Residential
Green and Blue Spaces: A Systematic Review
Mircia Gascon ,-2-V4-*, Margarita Triguero-MasJJ, David Martinez2J, Payam Dadvand2-\
Joan FornsAntoni Plasencia 1 and Mark J. Nieuwenhuijsen 2vJ Int. J. Em-iron. Res. Public Health 2015. 12.4354-4379; doi: 10.3390 ijerph 120404354
• Four studies of children identified
- All evaluated emotional and behavioral problems using SDQ and/or ADHD symptoms
- No studies of cognitive or psychomotor development
Table 1. Main characteristics and results of the studies on surrounding greenness and mental health.
Author (War.
Country)
Study Design
Ap of thr Study Population
(Mt.Hiflratioas Interactions)
X
Tools to Mraiirt
Mrnlal Health
Mental Health
Item
Greenness
Data Source
Greenness Indicator
Risk of Mental Health Problems
Exclusively children
Increasing greenness 100 m buffer 1 total
SDQ difficulties. SDQ
hyperactivity inattention & ADHD
Awoly 2014 <*ai..
Spain (30]
Cross.
Children 7-10 >•
2111
SDQ
ADHDDSM-IV
Emotional &
behavioural
problems'
NDV1
tOOm. 250 m. 500 m
buffers
(inattention)
250 m buffer: 1 total SDQ difficulties.
SDQ hyperoctmty inattention
500 ni buffer . 1 total SDQ difficulties.
SDQ hyperactivity inattention. SDQ
emotional symptoms
Balsevicienc etal
20>I4.
Lithuania [2S]
SCCtlOUIll
4-6 y (maternal education)
1468
SDQ
Emotional A
behavioural
problems *
NDV1
300 m buffer
Higher maternal education group;
increasing greenness T conditional
ptoblcms & , ptosocial behaviour
Floim etal. 2014.
The UK (I9J
Lougirudm.il
i.fti'y
(socioeconomic status)
6384
SDQ
Emotional &
behavioural
problems'
Land-cover map
•.OS at CAU
Poor children of age 3y to Sy: increasing
greenness I emotional problems
Moiicvych
-------
Day 2-Neurological/neurodevelopmental effects
Mental Health Benefits of Long-Term Exposure to Residential
Green and Blue Spaces: A Systematic Review
Mircia Gascon Margarita Triguero-Mas2-\ David Martinez "\ Payam Dadvand 2J,
Joan Forns 1-iA, Antoni Plasencia 1 and Mark J. NieuwenhuijsenJ Emiron. Res. Public Health 2015. 12.4354-4379; doi: 10.3390 ijerph 120404354
• Twenty-four studies of adults
- 6 longitudinal, 1 ecological, 17 cross-sectional
- Most conducted in Europe, none in Asia or Africa
Table 1. Com.
Aalbor (V«r.
Ceaatrr)
Stady Dntp
Aft of the Srndv Popalatiea
(Sliatlftiatlon* Inletaction*)
X
Tool wo Mmwk
Menial Health
Menial Health
Item
Data Soetce
Sni founding
bmunt Indkalot
Rlvk of Mental Health Problem*
Adult* (or populai
too inevpectn e of age)
Alcockef al
2014. Tbe UK [22J
Loagoudmal
Adult*
1064
GHQ-12
Mental health
Uwl<«n) map
•• GSalCAL"
((evidence change in
1 omul health m people
moving to gieeno area*
Arava tl al 2007
Cfcric(M)
XflHMUl
Adult* l«-$4 y
3870
CIS-R
ICO-IO
PtythaMnc
anxiety and
depcetuve
dlWrlllei*
BEAT (audit)
Ptetence of public green
aiea* and it> 45y
iphvxicji activity)
200001
KI0
Pvrebological
dmtrn
Laad-cotti map
• • GS in 1 km buffo
lacteaung gtrenoew i nik in all
population (afto »ti«if>cuicm only ta
phvucally acme adult*)
Atietl-Burt a a!
2014. Tbe IK [IS]
»l$y
(age. gewlo)
6M07
GHQ-J2
Mux* pqtiumc
Laud -coier map
•• GS at CAU
bxieatiog gieennett J mk a male* -30
rear* and in female* 41 year* A living in
modetaie gteeimew
Bryttttol
2014. The USA
("1
21-74y
2479
DASS
Dfffnws
Anxiety Sue**
NDVI
Latid
-------
Day 2-Neurological/neurodevelopmental effects
Potential Pathways: Environmental Benefits
of Greenspace
Greenspace
Pollutant
reduction
Noise
reduction
Heat
reduction
Environmental
Benefits
Neurobehavioral / Mental Health
Greenspace, heat, air quality, and health
Green space
Heat and air
pollution
Figure 1. The data gap: understanding the evidence base on green space, heat, air quality and health
(a) Strong evidence base on the relationship between heat and health and air pollution and health; (b) Large and
growing evidence base on the relationship between green space and health in general; (c) Growing evidence
base on the relationship between green space heat and air quality but gaps regarding the specific settings and
greening characteristics to maximize benefits; (d) Data gap: documented health impacts as a result of greening
strategies that reduce urban heat and air pollution.
ZupancicT. WestmacottC, BulthuisM. The Impact of Green Space on Heat and Air Pollution in Urban Communiies: A Meta-Narrative Systematic Review. March 2015.
David Suzuki Foundation.
B2-56
-------
Day 2-Neurological/neurodevelopmental effects
Greenspace: Heat and noise reduction
Greenspace
Heat
Noise
reduction
reduction
Neurobehavioral I Mental Health
Heat
- Greenspace reduces urban heat islands,
particularly in hottest months / times of day
• Bowler et al. 2010: air temp of parks ~1°C
(or more) less than non-green urban areas
- Max cooling distance ~200 - 500 m depending
on park size, temperature, vegetation density
(Feyisa et al 2014; Cao et al. 2010)
- Effect of heat reduction on neurobehavior/
mental health?
Noise
- Greenspace (trees and shrubs) may
reduce noise by 5-10 db / 30m
- Exposure to noise associated with
cognition and neurobehavior in children
Greenspace: Pollutant reduction
Greenspace
.
f
Pollutant
reduction
\
f
Neurobehavioral / Mental
Health
i ozone?
- Dependent on vegetation type
Gaseous pollutants
- Uptake via leaf stomata
PM
- Trees may serve as a barrier to PM
• Maher et al (2013): ~50%J, in measured
PM inside houses
- Dependent on PM size
- Large urban forests J, PM2.5
B2-57
-------
Day 2-Neurological/neurodevelopmental effects
Air Pollution and the Central Nervous System
A + Neurointlammatfon
(iNOS, TNF.i, 11-1 p, COX?. & NFkB)
+ Neuron damage/loss
+ Microglia activation (HLA-DR & CD14)
(ROS & cytokine production)
+ Blood Oram barrier damage/dysfunction
(Changes in inflammatory, tight junction, & transport proteins)
+ A|t42 accumulation
(Neuronal, vascular. & diffuse plaques)
+ A|i and u-Synuclein aggregation
+ Lipid peroxidation + Astrogliosis(GFAP)
+ DNA damage
Direct mechanisms Peripheral mechanisms
Soluble compounds
reach the brain
CNS pathology
Cardiovascular system
Adsorbed compounds
reach the brain
t
Particulate matter
reaches the brain
Circulating
rrx ocyw
Circulating
cytokines
L.ve-
Block and Calderon-Garciduenas Trends in Neurosciences 2009:32:506-516
Air Pollution and the Central Nervous System
• Experimental Studies
- f microglia
- t neuroinflammation (TNFa, IL1p, IL-6)
• Epidemiologic Studies
- Estimated life-time exposure to BC associated with [ vocabulary, IQ, memory and
learning at age 10(Sugliaetal Am J Epidemiol 2008)
- Prenatal exposure to polycyclic aromatic hydrocarbons associated with J.
cognition (age 3), 1 IQ (age 5), and t anxiety and attention (age 6-7)
-------
Day 2-Neurological/neurodevelopmental effects
Potential Pathways: Socio-behavioral Benefits
of Greenspace
Greenspace
Social
activity
Physical
activity
Psychosocial
benefits
Socio-behavioral
Benefits
Neurobehavioral / Mental Health
Greenspace: Physical Activity
Greenspace
Physical
activity
Neurobehavioral/
Mental Health
Socio-behavioral
Benefits
Inconsistent / weak evidence for
greenspace -> physical activity -> mental
health link
- Maas et al. 2008: No association between
greenspace and meeting physical activity
recommendations
- Ord, Mitchell, et al. 2013: Availability of
greenspace in the neighborhood not
associated with physical activity
- Lee and Maheswaran 2010: Physical activity
-> health, but weak evidence for greenspace
-> physical activity
B2-59
-------
Day 2-Neurological/neurodevelopmental effects
Greenspace: Social activity and psychosocial
benefits
Provide a meeting place for users to
develop and maintain neighborhood
social ties
- Increased social support (Maas et al.
2009)
- Increased sense of community
Mechanism not well studied
Greenspace
Neurobehavioral/
Mental Health
Social activity /
psychosocial
benefits
Socio-behavioral
Benefits
Potential Deleterious Effects of Greenspace
on Pollutant Concentrations
• Increase ground-level ozone
precursors
• Vegetation that emits biogenic
VOCs
• f N02 concentrations in street
canyons?
• Increased exposure for
pedestrians in canyon
• Change in airflow may J,
ventilation resulting in reduction
in TRAP dilution
• t CO
- Exposure to pesticides /
herbicides associated with
behavior and cognition
Greenspace
Neurobehavioral / Mental
Health
Increase
pesticides I
herbicides
Increase
VOCs
Increase
pollutants
within street
canyons
Change
airflow/
ventilation
B2-60
-------
Day 2-Neurological/neurodevelopmental effects
Greenspace and Behavioral Outcomes in the
CCAAPS Cohort
• Cincinnati Childhood Allergy and Air Pollution Study
(CCAAPS)
- Objective: Determine if children exposed to traffic-related
air pollution, specifically diesel exhaust particles, are at
increased risk for developing allergic diseases, asthma,
and impaired neurobehavioral development
- Longitudinal birth cohort study of infants born 2001-2003
in greater Cincinnati region
• Eligibility: Birth record address < 400 m major road or > 1500
m from major road
• Enrolled - 762; Age 7-617; Currently ongoing Age 12 - -500
CCAAPS Methods
• Clinical evaluations
- 1-4: Questionnaire, SPT, physical exam, hair, saliva, blood, eNO,
spirometry
- 7: All above + behavior
- 12: All above + intelligence, reading ability, attention/inhibition,
memory, executive function, neuromotor function, behavior,
anxiety/depression, MRI (structure, organization, and function)
• Indoor exposure (1,7)
- Walk-through, dust (allergens, mold, endotoxin)
• Outdoor exposure
- PM2.5, EC
- Land-use regression model
B2-61
-------
Day 2-Neurological/neurodevelopmental effects
Neurobehavioral Assessment Battery
Child Direct Assessments
Outcome / Assessment
Wechsler Intelligence Scale for Children (WISC-IV)
Verbal comprehension, perceptual reasoning, working memory, processing
speed, and full scale IQ
Conner's Continuous Performance Test (Conner's CPT)
Inattentiveness, impulsivity, sustained attention, and vigilance
Children's Depression Inventory (CDI-II)
Cognitive, affective, and behavioral signs of depression in children
Spence Children's Anxiety Scale (SCAS)
Generalized anxiety, panic/agoraphobia, social phobia, separation anxiety,
obsessive compulsive disorder, and physical injury fears
Grooved Pegboard Test
Eye-hand coordination and motor speed
Wide Range Achievement Test (WRAT-4)
Word reading and sentence comprehension
Children's Sleep Habits Questionnaire (CSHQ)
Behaviorally and medically-based sleep problems in school-aged children
Caregiver Survey about Child
Outcome / Assessment
Behavior Assessment System for Children (BASC-2)
Child's behavioral and emotional function including internalizing,
externalizing, and adaptive behaviors
Behavior Rating Inventory of Executive Function (BRIEF)
Assessment of executive function in children
Children's Sleep Habits Questionnaire (CSHQ)
Behaviorally and medically-based sleep problems in school-aged children
Parenting Relationship Questionnaire (PRQ)
Parent perspective on the parent-child relationship and rearing environment
Social Responsiveness Scale (SRS)
Social impairment and behaviors associated with autism spectrum disorders
Caregiver Direct Assessment
Outcome / Assessment
Wechsler Abbreviated Scale of Intelligence (WASI-2)
Brief measure of cognitive ability that provides a full scale IQ
Beck Depression Inventory - 2nd Ed. (BDI-II)
Measure of depression in adults
Neuroimaging
• Nested substudy of children exposed to high (n = 100)
and low (n = 100) TRAP during early childhood
- 3T MRI Scanner
Sequences Acquired
Imaging Outcome
Three dimensional T1 weighted
imaging
Whole brain and substructure
volumes
Standard T2 weighted
Inflammatory changes noted
with hyperintense signals
T2 map for quantitative T2
measurements
T2 rates for brain tissues
Diffusion Tensor Imaging of White
Matter
White matter integrity metrics
Magnetic Resonance
Spectroscopy
Metabolite concentrations
Functional Magnetic Resonance
Imaging
Verb generation task
Neural activation levels
B2-62
-------
Day 2-Neurological/neurodevelopmental effects
TRAP Exposure Prior to Age 1 and Behavioral
Scores at Age 7
BASC-2 Subscale
% "at
risk"
(>59)
TRAP (High/Low)-
Unadjusted OR
OR 95% CI
TRAP (High/Low)-
Adjusted** OR
OR 95% CI
Hyperactivity
18%
1.9
(1.2-2.9)
1.7
(1.0-2.7)
Attention problems
19%
1.4
(0.9-2.2)
1.1
CO
Aggression
16%
1.5
(0.9-2.4)
1.2
(0.7-2.0)
Conduct problems
14%
2.1
(1.3-3.3)
1.5
(0.9-2.6)
Atypicality
14%
2.0
(1.3-3.2)
1.5
(0.9-2.6)
'Adjusted for gender, tobacco smoke exposure prior to age one, maternal education
Newman et al. Environmental Health Perspectives. 2013
B2-63
-------
Day 2-Neurological/neurodevelopmental effects
CCAAPS Preliminary Data: Greenspace and
Behavior
Dist.to.Park_Age7 -
Dist.to.Park_Agel -
NDVI_Age7 -
NDVI_Age1 -|
Dist.to.Park_Age7
Dist.to.Park_Age1 -
NDVI_Age7 -
NDVI_Age1 -|
3
Dist.to.Park_Age7
Dist.to.Park_Agel
NDVI_Age7
NDVI_Agel
Dist.to.Park_Age7-
Dist.to.Park_Agel
NDVI_Age7
NDVI_Age1
Hyperactivity_risk
Attention_risk
Conduct risk
Depression_risk
Anxiety_risk
CCAAPS Preliminary Data: Greenspace,
Traffic, and Behavior
D®t »Part(_Aoe7
Distto Part_A»el
NCVI_Ao«7
NCWI_Ag*1-
DtSS to P*f*_Ag«7
Dist.tO P*V_A^«1 -
NCVI_A««7
NCWI_Ao«1
|
OsUoPjrt_A©«7
Dt« to. P*fc_Ag« 1 -
NDt/l_A««7
NCVI_Aa«1
0«.toPjrt_A©»7
D*t !o P*k_A®«1
NEVI_A0«7-
NWI_A®«1 '
Low TRAP
Hyp*rAcOvCy_n»k
AH*«t»on_nsk
Ej1*rnalizlng_risK
1
"J
1
i
CorvJoct_mk
Atyp^.r**
!"
|.
Ocpr«sion_nsfc
A*,** .risk
1
1
Dts! to Park_Afl«7
Oi« toP*rk_Afl«1
NOVI_A©«7
NOVI_Ag*l
0« toP>ft _A
-------
Day 2-Neurological/neurodevelopmental effects
Greenspace Function: Environmental and Socio-Behavioral
Pollutant
Removal
Characteristics
Access and
Opportunities for
Social Activities
Access and
Opportunities for
Physical Activity
Heat Buffering
Characteristics
Noise Reduction
Characteristics
Noise
Levels
Reduced
Social
Activity
Greenness
Environmen
re
Atmospheric
Pollutant
Concentrations
Ambient Noise
Levels
Perceived Social
Support
Physical Fitness
Changes to
Stress Level
Individual
exposure to
heat
Individual
exposure to
pollutants
Individual
Exposure to
Noise
Exposure Response
Relationship: Stress
nd Receptor for Mental
health
Exposure-
Response: Heat
and Receptor
for Mental
health
Exposure-Response:
Pollutant and Receptor for
Mental health
Receptor Response:
Mental health
Exposure Response
Relationship: Noise and
Receptor for Mental health
Driving Questions
• How should cumulative risk assessment framework consider
greenspace as it relates to neurodevelopment?
• What greenspace elements and metrics are relevant to
neurodevelopment?
• What are the specific known or presumed mechanisms of
neurodevelopment, and can this be used to inform biologic plausibility
of reported associations with greenspace?
• Consideration of potential cumulative effect of greenness on
neurodevelopment - "active" + "passive" exposure pathways - e.g.
outdoor exercise (activie) and visible greenspace around residence
(passive)
• Considerations of community and individual level outcomes and
specific populations
B2-65
-------
Day 2-Neurological/neurodevelopmental effects
Contribution of Greenspace to Neurobehavior
I Mental Health
• Greenspace widely viewed as beneficial to mental health
- Recovery from fatigue
- Reduction in stress
- Reduction in crime
- Improved self-reported general health
• Greenspace linked to reduction in biomarkers of stress
- jcortisol
• Potential mechanisms
- | physical activity -> improved mental health
- Exposure to nature
- t social interaction
- Decreased exposure to pollutants, noise, and heat
B2-66
-------
Day 2-Psychosocial effects
"...in every walk with Nature one receives far more than he seeks"
John Muir 1992, p. 918
Psychosocial effects
Michelle Kondo
Julia Africa
Matilda Annerstedt van
den Bosch
May 5, 2015
Estimating Greenspace Exposure & Benefits for
Cumulative Risk Assessment Applications
Technical Working Group Meeting
May 4-5, 2015
U.S. Environmental Protection Agency
26 Martin Luther King Drive West, Cincinnati, OH 45220
Psychosocial health
Determinants:
• Stress
• Social capital
• Genetics
• Environment
It's been a rough week but
I made it - how about you?
B2-67
-------
Day 2-Psychosocial effects
Stress biology: Autonomic nervous system (ANS)
Parasympathetic
Sympathetic ganglia
Sympathetic
Constncts pupi
Stimulates sanation
Inhftts heart
Corwtnrrs broncN
5"x*iates Agestive
*fav#y -OlJL
Stmulates
gsfctadder
Contracts
bladder
Relaxes rectum
Thoracic
Lumbar
Dilates pupd
Inhibits
salivation
Relaxes bronchi
Accelerates
heart
~m Inhibits digestive activity
Stimulates glucose
release by kver
Secretion of epinephrine ard
norepnephrne from kidney
Relaxes bladder
Contracts recturi
Biomarkers:
• Pulse rate
• Blood pressure
• HRV, TWA (ECG)
• Hormones (e.g. Cortisol)
• Brain electricity signals
(EEC)
• Skin conductance
Adaptation & pathophysiology
(.McEwen 1998,
McEwen & Stellar 1993,
McEwen 2000)
Stress mediators:
Glucocorticoids (e.g. Cortisol)
Cathecolamines
Tim*
Allostatic load
Allostasis
(homeostasis)
Maintaining stability through change
(acute stress responses and recovery)
Repeated stressful events -
chronic stress (e.g. multiple
periods of poverty, child abuse)
Effects: early aging, depression,
decline of physical and mental
Functioning
Failure to turn off
Repealed "hits"
Lack of adaptation
Time
Prolonged response
Inadequate response
Failure to adapt (e.g. if lack of
self-confidence & self-esteem)
Inadequatestress response (genotype)
Low Cortisol and high inflammatory
Cytokines
e.g. fibromyalgia, chronic fatigue
syndrome 4
B2-68
-------
Day 2-Psychosocial effects
Mobile measurement
Autonomic, endocrine, and immune
system activity as well as affective
state (mood) and cognitive acuity in
natural vs. urban settings
Biomarkers of stress:
Salivary or urinary Cortisol, blood
pressure, heart rate variability, skin
conductance, and temperature can
help reveal autonomic arousal
patterns
Photos courtesy Bum Jin Park
http://bit.ly/aDBgvZr; http://bit.ly/ZtW9Qg; http://bit.ly/10uwNNe; http://bit.ly/asPT8U7
Devices can be implanted belowthe skin, onthe skin, or worn as accessories(bands,
belts, vests, or even clothes). ^
Research firms predict significant growth for the wearable market, potentially
reaching $50 billion by 2018.
Breakdown of VC funding by segement, 2000-2011
INFOTAINMENT($109 mil)
MILITARY & INDUSTRIAL ($159 mil)
¦ FITNESS & WELLNESS ($405 mil)
¦ MEDICAL & HEALTHCARE ($341 mil)
Medical + Fitness = -75% of total or $746 million
http://nyti.ms/auAoZDj Rock Health, the future of biosensingwearables,June2014
B2-69
-------
Day 2-Psychosocial effects
Stress and the brain
• Deactivates neo-cortex
• Activates amygdala in limbic system (including interactions with
hippocampus and prefrontal cortex)
• Paleocortex
• Unreasonable, agitated,
thoughtless behaviour
• Chronic stress - chronic changes in brain
(incl. epigenetic changes)
• Impaired coping/adaptation (allostasis)
Ref: Gray et at. 2013, McEwen 2012, Davidson & McEwen 2012,
McEwen & Gianaros, 2011)
The reptilian brain
primitive functions
The mammalian
brain
nurturing functions
Neocortex
cognitive functions
The brain: stress & environment
Urbanisation
Rural Town City
Current urbanicity
Rural Town City
Current urbanicity
Lederbogen eta 1.2011.
City living and urban upbringing affect
neural social stress processing in humans.
Nature.
B2-70
-------
Day 2-Psychosocial effects
Stress and mental illness
• Persons with major depression or schizophrenia have a 40 - 60% higher risk of dying
prematurely as compared to a general population.
• Mental illness represents three of the ten leading causes of disease burden in low- and
middle-income countries, and four of the leading ten in high-income countries.
• More than 800 000 persons die from suicide each year.
• Globally only 2.8% of the health budget is allocated to mental health.
• Depression affects one of five people over the age of 65
• Prevention programmes are often the most efficient
• Unequal distribution
• High level of co-morbidity (somatic diseases, e.g. cancer, cardiovascular)
• Costs: US$ 16.3 million 2011 - 2030
(Source: WHO; Bloom et al. 2012)
GS - stress - mental disorders
NATURE
Decreased
levels of
STRESS
Prevention
Reduced prevalence of
mental disorders
4
Significant impact on
GBD
-> Reduced public health
issues and costs
Ref: Annerstedt et al. 2012, 2013, 2015; Ward Thompson et al. 2012; Roe et al. 2013; Ulrich et al. 1991; van den Berg et al. 2010;
Grahn & Stigsdotter, 2003 10
B2-71
-------
Day 2-Psychosocial effects
Context: etiology and pathology of stress
Social context Personality
Design benefits
would likely be
seen in the
appraisal of
demands and
adaptive
capacities
Environmental Demai^s (stressors/1 ife events)
Appraisal of Demands and of Adaptive Capacities
4 4
Perceived Stress Benign Appraisal
Negative f^riotional Responses
Physiological or Behavioral Responses
*
Increased Risk of Physical disease
Mr
Increased risk of Psychiatric Disease
(feedback)
Cohen et a I 1995
Vacant Spaces and Stress
Zoom in for details
Cheltej
Riverside
Radnor
Mar pie
ic^nce
• public
# private
in use
Conshohocken
Leaflet | Map data O OpenStreetMap contributors. Imagery C Mapbox
Upper
Cherry t29S
Hill
Narberth
12
B2-72
-------
Day 2-Psychosocial effects
Vacant Lot Greening & Stress
A mobile biosensing project with residents living near vacant lots
Control Site Pre-lntervention
I Greening Site Post-Intervention
Control Site Post-Intervention
Vacant Lot Greening & Stress
Results: heart rate decreases when in view of vacant lots
• 12 participants (yTrx: 5 Ctrl)
• DDD estimates forTrx & Ctrl sites based on:
• pre-post greening
• within- vs. out-of-view
• preceeding vs. succeeding greened lots
• -15.6 bpm (Trxsite) vs. -1.7 bpm (Ctrl site)
USDA
Urban Health Lab
Science. Making. Cities Better
wwv».urbanhcalthl4b.org
South, Kondo, Cheney, Branas (2015) Neighborhood blight, stress, and health: A walking trial of urban greening and
V7 L^lli 1 ambulatory heart rate. American Journal of Public Health 105(5): 909-913.
B2-73
-------
Day 2-Psychosocial effects
|L n!/
«<¦ ;
V j
v* + „ 1
*v.* 1.
Mood, Mobility and Place
¦¦¦
Direct relation between nature and mental health
TO: Move to a less green area
TO: Move to a greener area
o 04
T-1 T+1 T+2
Year relative to move
T+3
T-1 T+1 T+2
Year relative to move
Alcock et al. 2014. Longitudinal effects on mental health of moving to
greener and less green urban areas. Environmental Scienceand
Technology
B2-74
-------
Day 2-Psychosocial effects
Social cohesion
• Interaction with neighbors
• Sense of community
Barriers:
- Illness
- Lack of supportive
community/environment
- Lack of social opportunities
- Fear
- Lack of self confidence
Ref: Goll et al. 2015, Bergh et al. 2009, Aslund et al. 2010
Social cohesion and disease
• Social cohesion, both personally and in the environment prevents
chronic illness
• Loneliness among main risk factors for disease, at same level as
smoking
• Loneliness significantly correlated to impaired cognitive function
• Social cohesion mitigates other risk factors (e.g. smoking, physical
inactivity, drug abuse)
• Elderly often affected
• Immigrants
• Biological causality between loneliness and disease is unclear
Ref. Boss et al. 2015, Waverijn et al. 2014, Samuel et al. 2015
B2-75
-------
Day 2-Psychosocial effects
Social cohesion and GS
Quality aspects of GS & social cohesion
Ref: Donovan & Prestemon, 2012; Maas et al. 2009;
Loftand 1998; Peters et al. 2010; Kuo et al. 1998;
Cohen et al. 2008; de Vries et al. 2013
• Safety perceptions
• High quality GS
• Well maintained
• Good, attractive recreational facilities
• Community gardens
Ref.: Francis et al. 2012; Hartig et al. 2014; Kazmierczak, 2013
Green spaces and crime reduction
Green Spaces increase social contact and the sense of belonging
within a community
• Encourage getting familiar with persons of different social and ethnic
backgrounds
B2-76
-------
Day 2-Psychosocial effects
GS and pro-social behaviour
• Share, care, cooperate, and assist
• Less rational behavior
• External/internal stimuli - automatic mind (10% of our decision are
rationally based)
• "Choice architecture" /"Nudging"
• Exposure and relation to nature promotes prosociality
"No one really knows why humans do what they do."
D.K Reynolds
Ref.: Mayer & Frantz, 2004; Zhang et al., 2014; Diessner et al. 2013; Piff et al. 2014;
GS and pro-environmental behaviour
Automatic processes - mirror neurons and mentalising system
Enriched environments (rat models)
Nature connectedness stimulates PEB
Nature exposure promotes PEB
GS - PEB - reduced climate change - reduced negative effects on
health
Public Health
Ref, Coricelli, 2005; Enget et al. 2008; Sale et al. 2009; Nisbet et at, 2009; Hartig et al. 2001; Zelenski et al. 2015
B2-77
-------
Day 2-Attention Restoration/cognition effects
Engagement with Nature—How Does that Affect Health?
Prevailing Mechanistic Theories
Stress Reduction
Attention Restoration
Ksolan arvi Kaplan 1369
Decreased Cortisol and blood
pressure
• Martig et al. 2003; Lee et al 2011. Part e< al 2008
ThtmipVTi Coon a* 2011 :jlan|Mll|.20U)
Improved attention and
cognitive function
• Hartig 2006; Koo and Taylor 2CC4 Pratt; at al
2005; Ta>lor and Kuo 2009
Nature Appreciation
Improved mood and mental
health
• Baden and Pretty 2010: van den Berg et al. 2010»
Social Interaction
Maasetat 2009
Bolton and Prefly 2010
Increased social cohesion
(Colayatal 1007 Kakj nl •! al
2009}
Public Health
Promotion of:
Feelings of
Wcll-Boing
Mental
Acuity
Healthy
Body Weight
Green Space
Catalyzes:
Social
interaction
fr
( ^1
Stress
Reduction
u
Engagement
with nature
(visual &
physical)
Stress
Reduction
Attention
Restoration
~0~
Physical
Exercise
Stress
Reduction
^ J
Attention
Restoration
Bio-
energetics
B2-78
-------
Day 2-Attention Restoration/cognition effects
Otettty
AstKmn
Amwy
Theories intersect;
uncertainties remain.
Social
Interaction
Engagement
with nature
(visual &
physical)
Public Health
Promotion of:
Feelings of
Well-Being
8
c
'5.
»
z
Stress
Reduction
from social
cohesion?
Stress
Reduction
for nature
lovers only?
Mental
Acuity
Attention
Restoration
I Examples of
measured outcomes)
B2-79
-------
Day 2-Attention Restoration/cognition effects
Public Health
Promotion ofr
Protection against:
Fee ings of
Well-Beng
Mental
Acuity
Healthy
Body Weight
Toxicity
Extreme
Events
Deprivation
Social
Interaction
Stress
Reduction
fn creased
Resilience
Increased
ftesrJience
Increased
Residence
Green Space
in
I
5
Engagement
with nature
(visual &
physical]
R®duct»on
Attention
Restoration
Physical
Exercise
Stress
Reduction
Attention
Restoration
Bio-
energetics
Provides:
Hazard
Suffers
Filtration
Modulation
Food
•A'atar
Raw
Materials
Increased
Resilience
Increased
Resilience
B2-80
-------
Day 2-Economic and community benefits
Community Benefits
Michelle Kondo (USFS)
Geoffrey Donovan (USFS)
Estimating Greenspace Exposure & Benefits for
Cumulative Risk Assessment Applications
Technical Working Group Meeting
May 4-5, 2015
U.S. Environmental Protection Agency
26 Martin Luther King Drive West, Cincinnati, OH 45220
1
Green Space and Safety Perception
1. Nasar JL, Fisher B, Grannis M. Proximate physical cues to fear of crime. Landsc Urban Plan. 1993;26(1).
2. Nasar JL, Jones KM. Landscapes of fear and stress. Environ Behav. 1997;29(3).
3. Fisher BS, Nasar JL. Fear of crime in relation to three exterior site features prospect, refuge, and escape. Environ Behav. 1992;24(1).
4. Chiang, Yen-Cheng, Jack L. Nasar, and Chia-Chun Ko. "Influence of visibility and situational threats on forest trail
evaluations." Landscape and Urban Planning 2014;125.
B2-81
-------
Day 2-Economic and community benefits
Green Space and Safety Perception
Before greening After greening
1. Kuo FE, Sullivan WC, Coley RL, Brunson L. Fertile ground for community: Inner-city neighborhood common spaces. Am J Commun
Psychol. 1998;26(6):823-851.
2. Garvin EC, Cannuscio CC, Branas CC. Greening vacant lots to reduce violent crime: a randomised controlled trial. Inj Prev.
2012;19(3):198-203.
Green Space and Crime
1. Kuo FE, Sullivan WC. Environment and crime in the inner city: Does vegetation reduce crime? Environ Behav. 2001;33(3).
2. Troy A, Morgan Grove J, O'Neil-Dunne J. The relationship between tree canopy and crime rates across an urban-rural gradient
in the greater Baltimore region. Landsc Urban Plann. 2012;106(3)
3. Donovan GH, Prestemon JP. The effect of trees on crime in Portland, Oregon. Environ Behav. 2012;44(1)
B2-82
-------
Day 2-Economic and community benefits
Vegetation Type or Scale
Location
1. Valley Green Space
2. Green Cities: Good Health. Kathleen Wolf, University of WA / USFS
3. Kuo FE, Bacaicoa M, Sullivan WC. Transforming inner-city landscapes trees, sense of safety, and preference. Environ Behav.
1998;30(1)
4. Donovan GH, Prestemon JP. The effect of trees on crime in Portland, Oregon. Environ Behav. 2012;44(1)
1. Kondo M, Low S, Henning J, Branas C. The impact of green stormwater infrastructure installation on surrounding health and
safety. Am J Public Health. 2015(105):3
2. Kondo, MC, Han, S, Donovan, G, MacDonald, JM. The Effect of Trees on Urban Crime: Evidence from the Spread of the Emerald
Ash Borer in Cincinnati. Under review.
3. Donovan GH, Prestemon JP. The effect of trees on crime in Portland, Oregon. Environ Behav. 2012;44(1)
EAB-Ash tree removals by block group
B2-83
-------
Day 2-Economic and community benefits
Maintenance
Before greening
1. youngphillypolitics.com
2. nakedphilly.com
3. Garvin EC, Cannuscio CC, Branas CC. Greening vacant lots to reduce violent crime: a randomised controlled trial. Inj Prev.
2012;19(3).
Community Involvement
Youngstown Vacant Lots
Stabilization-basic treatment lots (n=166)
• LOG 2.0 reuse lots (n=77)
• Control lots (ungreened: n=976)
Targetted neighborhoods
~ City sections
South
lor. or OrtHfn
Community
Kondo, MK, Hohl, BC, Han, S, Branas, C (under review) Effects of Greening and Community Reuse of Vacant Lots on Crime.
B2-84
-------
Day 2-Economic and community benefits
/ize/ d&JFSoutft
Mil Plain
Vancouver
I 7^
-Hllsboro-
Cedar Mil
ftiv&t-Syfr.aim £
keslianr
B2-85
-------
Day 2-Economic and community benefits
Temperature
B2-86
-------
Day 2-Specific populations, health considerations
Specific populations
(health)
Rich Mitchell
Pat Ryan
Estimating Greenspace Exposure & Benefits for
Cumulative Risk Assessment Applications
Technical Working Group Meeting
May 4-5, 2015
U.S. Environmental Protection Agency
26 Martin Luther King Drive West, Cincinnati, OH 45220
1
Introduction
«. Sunwarf of *tt,9 : te GSusicy cccwtuaf mate ttmpsras
• Why should we care that green space might have different health effects
for different groups?
• Inequalities
• Equigenesis
• What groups should we look at?
• Borrowing the groups from yesterday's talk - gender, sep/race and age
• What should we expect?
• Important to note that the experimental studies, particularly on physiological
benefits and psychological restoration, have generally not been stratified by
population sub-group
• We have no reason to think that the mechanisms will work in a different way for
different sub-groups, but they might be triggered differently, be more or less
important..
2
B2-87
-------
Day 2-Specific populations, health considerations
Gender
• Mixed evidence for differential 'effects' (observational studies!) by gender
• Richardson and Mitchell found significant negative associations between
amount of green space in the neighbourhood and risk of mortality from
CVD and respiratory diseases for men, but not for women.
• Ward Thompson et al found beneficial effects of residence in greener
neighbourhoods on diurnal Cortisol patterns for both men and women, but
they were of different kinds...
• Astell-Burt et al found some interesting differences between men and
women in association with GHQ score
• Of course, the pregnancy / green space literature applies only to women ©
Gender differences in 'effects' on
mental health, across the life course
Green space
120
115
110
105
100
95
9.0
8.5
0-33% 34-66%
Men
rC J> J? & J> J? ->P & -P a"» & a"
-v* -vto ^ ^ "\V
Age
Astell-Burt T, et al. J Epidemiol Community Health 2014;0:1-6. doi:10.1136/jech-2013-203767
B2-88
-------
Day 2-Specific populations, health considerations
Example of gender difference in
green space 'effects'
12n
9-
€ 6
o
o
3J
12
-• - Women low green space
Women high green space
3 6 9
Hours post awakening
(a)
1 6
o
3J
Men low green space
Men high green space
3 6 9
Hours post awakening
(b)
Roe etal Int. J. Environ. Res. Public Health 2013, 10,4086-4103; doi:10,3390/ijerphl0094086
Socio-economic position
• Differences in association with health by SEP is a key area of interest
in my team.
• Chronic medical conditions of the kinds that green space might
plausibly help - along with their associated signs/symptoms and
mortality risks - are far more common among vulnerable populations.
6
B2-89
-------
Day 2-Specific populations, health considerations
Income-related health inequality may be smaller in greener
neighbourhoods.
2.4
Least green areas
Most green areas
~ Income group 2
a Income group 3
l Income group 4 (poorest)
Mitchell R, PophamF. Effect of exposure to natural environment on health inequalities:an observational population study.The Lancet 372(9650):1655-1660.
Income-related health inequality may be smaller in greener
neighbourhoods.
2.4
In the most green areas,
the health gap is
dramatically smaller
Least green areas
Most green areas
~ Income group 2
o Income group 3
i Income group 4 (poorest)
Mitchell R, Popham F. Effect of exposure to natural environment on health inequalities: an observational population study.The Lancet 372(9650):1655-1660.
B2-90
-------
Day 2-Specific populations, health considerations
Income-related mental health inequality appears to be smaller among
those with better access to green space / recreational areas
c 20
Great difficulty with
access
Some difficulty with
access
Easy Access
Very easy access
Easily make ends meet ¦ Some difficulty in making ends meet ¦ Great difficulty in making ends meet
Mitchell RJ, Richardson EA., Shortt NK, Pearce JR. Neighborhood Environments and Socioeconomic Inequalities in Mental Weil-Being. Am J Prev; 2015;l-5.
Income-related mental health inequality appears to be smaller among
those with better access to green space / recreational areas
Great difficulty with
access
Some difficulty with
access
Easy Access
Very easy access
Easily make ends meet ¦ Some difficulty in making ends meet ¦ Great difficulty in making ends meet
Mitchell RJ, Richardson EA., Shortt NK, Pearce JR. Neighborhood Environments and Socioeconomic Inequalities in Mental Well-Being. Am J Prev; 2015;1—5.
B2-91
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Day 2-Specific populations, health considerations
Variation in mental wellbeing by reported access to green / recreational
areas and financial strain (reported difficulty in making ends meet)
75
70
65
x 60
55
50
45
-Great difficulty with access
-Some difficulty with access
Easy Access
-Very easy access
¦ Does not use
Easily make ends Some difficulty in Great difficulty in
meet making ends meet making ends meet
http://cresh.org.uk/2015/04/21/more-reasons-to-think-green-space-may-be-equigenic-a-new-study-of-34-european-nations/
li
Is escaping to nature related to life satisfaction? (all those who need to escape)
7.5
5
I 7
5.5
Doesn't escape to nature
Escapes to nature
Mitchell R. Paper in preparation. Data from the Scottish Social Attitudes Survey 2009 (n=949)
B2-92
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Day 2-Specific populations, health considerations
Does escape to nature hold more benefit for those under more stress / more
deprived? (NB equalised access)
a) Woods, beach or countryside
10
9
8
5 7
« 6
1 5
i
c 4
^ 3
2
1
0
Living very/fairly comfortably on Coping Finding it diff/v diff on present inccome
present income
¦ Doesn't escape to this environment ¦ Does escape to this environment
Mitchell R. Paper in preparation. Data from the Scottish Social Attitudes Survey 2009 (n=331) yBfl
What about escape to other environments?
Living very/fairly comfortably on Coping Finding it diff/v diff on present inccome
present income
¦ Doesn't escape to this environment ¦ Does escape to this environment
Mitchell R. Paper in preparation. Data from the Scottish Social Attitudes Survey 2009
B2-93
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Day 2-Specific populations, health considerations
Challenges to this work
• It's (so far) cross-sectional
• We don't know how the equigenic effect happens (if it's real)
• Differences in use of the spaces seem an unlikely explanation
• Perhaps the effects are more readily felt by those with a poorer health status
to begin with
• Perhaps our models (which assess variance after all), aren't well equipped to
see a similarly supportive effect of nature for a population that already has
good health
• Residual confounding is a big problem
15
Review: Greenspace and Health
Respiratory
Reproductive
Obesity
What is the nost relevant
developmental J
age) for gr senspace?
:ime period (I.e. -| j
Greenspace
CVD
Neurodevelopmental
Psychosocial
Attention / Cognition
B2-94
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Day 2-Specific populations, health considerations
Identifying Critical Windows of Exposure for Children's Health
Sherry G. Selevan,1 Carole A. Kimmel,1 and Pauline Mendola2
'National Center for Environmental Assessment, Office of Research and Development. U.S. Environmental Protection Agency. Washington.
OC, USA; 'National Health and Environmental Effects Research Laboratory. Office of Research and Development. U.S. Environmental
Protection Agency, Research Triangle Park, North Carolina, USA tnviionnwnui Heattti re>spectiv« - vol loe. supptonwm j - |„™- 1000
Window of susceptibility / exposure
• Specific developmental period during which an individual is especially vulnerable to
increased health risks associated with environmental exposures
• In utero
• Neonatal
• Pubertal
• Adolescence
• Elderly
Many health effects are unique to the stage of exposure
• E.g. prenatal miscarriage, low birth weight
• E.g. prenatal /early childhood -> neurodevelopment
Relevant time periods (age) is dependent on health outcome and the
mechanism
Exposure to Greenspace:
Prenatal
r1
c=
Neu r odevetopmentai
Attention I Cognition
' 1 1
3
4
tmbryonic period (wneksl
5 1 •
'
Fetal
12
seriod (vvsak
IB
*1
20-38
—— Full term
38
(35
^^1
» tm
L
V
©
' Ciir.ln.mJ
T|
iOt-
1
t*«*
0
n 1
——
—-1
1
1 1 )
Major morphologic obi
omulitiM
Physiologic Oofactt a
id minor morphologic nbn
otmolitioa
B2-95
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Day 2-Specific populations, health considerations
Exposure to Greenspace:
Early Childhood
'Children are not little adults'
• Developing organ systems
• CNS
• Respiratory
• Immune
• Behavior
• t time outdoors
• T respiratory rate
r<
c Greenspace >
c
Neuiodeveioomentai
Attention' Cognition
RitzB. andWilhelmM. UCLA Institute of the Environment and Sustainabiiity.
www.environment.ucla.edu/reportcard/article1700.htrrt.
T '¦ ';"vv ®
lip
i J 4 /
k;A .V "j
Adolescence, Adulthood, Elderly
Cj
Neurodeveiopmental
Attention I Cognition
Adolescence
• Relevant time period for greenspace in relationship
to obesity, attention, respiratory, psychosocial
• CVD?
Adulthood
• Mental health, obesity, CVD, psychosocial,
reproductive
Elderly
• CVD, respiratory, mental health,
B2-96
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Day 2-Specific populations, health considerations
Gender differences in 'effects' on
mental health, across the life course
Green space
0-33%
Women
Astell-BurtT, et al.J Epidemiol Community Health 2014;0:1-6. doi:10.1136/jech-2013-203767
Summary
• Potential role for greenspace on health throughout lifespan
• Similar to environmental exposures, the impact of greenspace is likely to vary
by age and health outcome
• Understanding the mechanism by which greenspace is associated with each
health outcome is critical to define window of susceptibility
• E.g. Potential mechanism: Greenspace -> J. air pollution
• Health outcomes: Respiratory, CVD, reproductive, neurodevelopmental
• Relevant time windows: Prenatal, early childhood, adolescence, elderly
B2-97
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