Xiaoqi Feng

• PhD, MLitt, BA Hons
• Professor (Associate) at UNSW Sydney

Introduction: There are few studies on the potential benefits of green space quantity and quality for child well-being. The authors hypothesized that more and better quality residential green space would be favorable for well-being and that these associations could be subject to effect modification across childhood. Method: Multilevel linear reg...

Several recent studies have suggested that people in socioeconomically disadvantaged circumstances may benefit more from local green space (‘equigenesis’). This study provides a test of this hypothesis in children aged 0–13 years old. Results from multilevel models suggest the odds of sub-optimal general health were 14% lower among children in area...

In China, rising obesity has coincided with increasing affluence. Few studies have properly accounted for geographic variation, however, which may influence prior results. Using large data with biomarkers in China, we show body mass index (BMI) to be positively correlated with higher person-level education if estimated using ordinary least squares....

Do socioeconomic inequities in body mass index (BMI) widen across the adult lifecourse? BMI data for 29,104 male and 32,454 female person-years aged 15 years and older (21,403 persons in total) were extracted from the Household, Income and Labour Dynamics in Australia between 2006 and 2012. Multilevel linear regression was used to examine age and g...

Recent reviews of the rapidly growing scientific literature on neighbourhood green space and health show strong evidence for protective and restorative effects on mental wellbeing. However, multiple informants are common when reporting mental wellbeing in studies of children. Do different informants lead to different results? This study utilised na...

Objective: To determine the extent of inequitable distributions in green space qualities in urban areas of Australia. Method: Existing data from the cities of Sydney (n approximately 5M), Newcastle (n approximately 500k), and Wollongong (n approximately 300k) in Australia was used to define green space qualities relating to accessibility, amenities...

Cities, states, and countries across the globe are recognizing the interconnections of human and planetary health, and are investing in greening. Nevertheless, environmental improvements may not bring adequate changes in exposure needed to reduce chronic disease and improve mental health. Nature prescription, in which a health provider refers a pat...

Background: With growing interest in nature-based interventions for health, establishing implementation frameworks for prescribing nature in diverse settings is crucial. This study aims to develop and validate a nature prescribing framework tailored for the Australian healthcare context, employing a Delphi methodology to harness expert consensus. M...

There has been a rapid increase in the delivery of social prescribing globally in recent years. However, a lack of theoretical framework, the diversity of social prescribing interventions and outcome measures, a lack of ongoing resources to provide services equitably and a lack of coordinated research agenda make it challenging for practitioners to...

Green social prescriptions (GSPs) are interventions designed to combat sedentary behavior and preventable diseases by leveraging the benefits of nature-based physical activity. As these programs are still evolving, there is limited data regarding the likelihood of participation from an international perspective. This study examined factors influenc...

Urban greening is threatened by the concern that street trees increase traffic-related injury/death. Associations between all serious and fatal traffic crashes and street tree percentages were examined in Sydney, Australia. Associations were adjusted for confounding factors relating to driver behavior (speeding, fatigue, and use of alcohol) and roa...

Numerous studies set in high-income countries document the potential benefits of urban green spaces for mental health, and a growing number of related studies have been conducted in mainland China. In this chapter, we summarized the current studies examining associations between green space and mental illness, sleep or cognition-related outcomes se...

Increasing evidence indicates contact with nature supports mental, physical and social health. However, beyond a widely reported number of barriers to nature contact, the constellation of motivations for human contact with nature is under‐theorised and under‐studied. We begin to develop indicators of autonomous and controlled motivations for nature...

Increasing evidence demonstrates the psychological benefits of nature contact. However, the evidence is often established at the population level, and the individual differences in the psychological benefits gained from nature are considered negligible variations. In this study, we performed a cross-sectional online survey in Brisbane and Sydney, A...

There is a significant amount of evidence highlighting the health, wellbeing and social benefits of gardening during previous periods of crises. These benefits were also evident during the COVID-19 pandemic. This paper presents a narrative review exploring gardening during the early stages of the COVID-19 pandemic to understand the different forms...

We developed and validated a composite healthy ageing score (HAS) to address the absence of a definitive composite score comprising multiple health domains that measure healthy ageing in epidemiology. The HAS is developed from 13 health domains reported to influence healthy ageing. Data to measure these domains was extracted from the 45 and Up Stud...

Urban tree canopy is associated with lower dementia risk, but no mediation analysis has been attempted to reveal potential mechanisms. We examined 3,639 dementia diagnoses in 109,688 participants of the Sax Institute's 45 and Up Study. Adjusted models indicated ≥20% tree canopy lowered the odds of developing dementia by 14% over 11 years (Odds Rati...

Nature prescriptions are gaining popularity as a form of social prescribing in support of sustainable health care. This systematic review and meta-analysis aims to synthesise evidence on the effectiveness of nature prescriptions and determine the factors important for their success. We searched five databases from inception up to July 25, 2021. Ran...

There is increasing awareness for beneficial health effects of green space surrounding the home, but the underlying mechanisms are not yet fully understood and challenging to study given the correlation with other exposures. Here, the association of residential greenness and vitamin D including a gene-environment interaction is investigated. 25-hyd...

This chapter provides an overview of the empirical evidence regarding the association between green space in general, and forests and trees in particular, and health outcomes. The evidence is organised by life stage, and within the three life stages – early life (Section 3.2.), adulthood (Section 3.3.) and the elderly (Section 3.4.) – by type of he...

Background In China, road traffic injury (RTI) is the seventh-leading cause of death More than 1.5 million adults in China live with permanent disabilities due to road traffic accidents. In 2011, the Chinese government implemented a more severe law that increased the penalty points and fines for persons charged with drink-driving as a criminal offe...

Urban parks provide a multitude of health benefits for citizens navigating the challenges of 21st-century living. And while this is well known by both scholars and practitioners, there is less understanding about the differential impacts of park size, type of facilities, community accessibility, and management. This is the central concern of the re...

Introduction Associations between green space type and social loneliness (a scarcity of people one feels they can depend on) were investigated in city-living participants in the Sax Institute’s 45 and Up Study. Methods Availability of green space, tree canopy and open grass were measured as a percentage of land-use within 1.6 km road−network dista...

Objective: Green space reduces cardiovascular disease (CVD) risk, but few studies examine what types of green space matter, which is an important consideration as cities densify and apartments become more common. Method: Participants were 86,727 in houses and 17,998 in apartments from the 45 and Up Study (Sax Institute) baseline survey with 10 y...

This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates C...

Introduction Momentum for urban densification is increasing opportunities for apartment-living, but can result in reduced green space availability that negatively influences mental health. However, in contexts where apartment-living is atypical and commonly viewed as secondary to house-ownership, it may be a stressful antecedent condition (or marke...

Growing number of evidence have reported that exposure to air pollution was associated with unfavourable birth outcomes while increased exposure to green spaces was associated with better birth outcomes. However, the effect of interactions between air pollution and green spaces on pregnancy outcomes remain unclear. Using the data on all the live bi...

Background No studies appear to examine potential associations between changes in built environments across childhood and the developmental trajectories of child weight status. Objective Examine the developmental trajectories of child weight status with respect to changes in childhood exposure to the built environments. Methods This study used da...

Persistent loneliness troubles people across the life span, with prevalence as high as 61 % in some groups. Urban greening may help to reduce the population health impacts of loneliness and its concomitants, such as hopelessness and despair. However, the literature lacks both a critical appraisal of extant evidence and a conceptual model to explain...

We investigated how the perceived quality of natural spaces influenced levels of visitation and felt benefits during the COVID-19 pandemic in Australia via a nationally representative online and telephone survey conducted on 12–26 October (Social Research Centre’s Life in AustraliaTM panel aged > 18 years, 78.8% response, n = 3043). Our sample was...

Urban greening may help to reduce the population health impacts of loneliness and its concomitants, such as hopelessness and despair. However, the literature lacks both a critical appraisal of extant evidence and a conceptual model to explain how green space would work as a structural intervention. Both are needed to guide decision making and furth...

Objective To systematically review the literature on the impact of the COVID-19 pandemic on deaths of despair (suicide, overdoses and drug-related liver diseases). Methods Five electronic databases were searched using search terms on deaths of despair and COVID-19. Results The review of 70 publications included indicates that there is no change o...

Background This study aimed to investigate prosocial behaviour—those behaviours that benefit others or enhance relationships with others—as a mediator of the associations between green space quality and child health-related outcomes (physical activity, mental health, and health-related quality of life (HRQOL)). Methods This study involved data fro...

Background Studies from high income ‘western’ countries indicate that green space visit duration is associated with better health. However, scant comparable research has been done in developing countries with rapid urbanization and on the potential health impacts of specific green infrastructure. Objective Associations between green space visit du...

Background "Nature prescriptions" are gaining popularity as a form of social prescribing and in response to calls for sustainable healthcare. Our review and meta-analysis appraised evidence of effectiveness of nature prescriptions on various health outcomes. In doing so, we sought to determine the factors that are critical for the success of nature...

Background A large multicentre European study reported later onset of menopause among women residing in greener areas. This influence on the timing of a reproductive event like menopause, raises the question whether similar associations can be observed with timing of menarche. We investigated whether exposure to residential green space was related...

Background This study assessed the associations between changes in exposure to green space quality, heavy traffic conditions, and asthma symptoms among children. Methods 10-year cohort data of 9589 children, retrieved from the Longitudinal Study of Australian Children, were analysed. Caregiver-reported neighbourhood green space quality, heavy traf...

The WHO recommends front-of-package labeling (FOPL) to help parents make healthier food choices for their children. But which type of FOPL resonates with parents in China? We performed a cross-sectional study to investigate parental preferences for five widely used formats of FOPL. A multi-stage cluster sampling method was applied to selected paren...

Accumulating exposure to quality green space over time is posited to influence child health, yet longitudinal studies are scarce. This study aimed to examine the associations between trajectories of perceived green space quality and child health-related outcomes. We used data of 1874 children from the B-cohort of the Longitudinal Study of Australia...

Evidence indicates under-perception of overweight is associated with lower levels of weight loss. This might be due to ‘visual normalisation’ of overweight through comparisons made in communities where average body mass index (BMI) is high, which in turn, may protect against weight stigma and psychological distress. Evidence in support of this hypo...

On nature and health “The supreme reality of our time is our indivisibility as children of [nature] and the common vulnerability of this planet.”¹ Our earnest, some might say borderline sacrilegious, amendment to President John F. Kennedy’s vivid oration at the Irish Parliament in 1963 is a call to arms. Cooperative international relations within a...

Introduction Adolescents, especially females, tend to experience poorer mental health if they are higher in introversion and neuroticism. As a result, they also may have more to gain from having quality green space (e.g. parks) nearby to enable restoration, but this remains tested. Method Cross-sectional data on 2946 adolescents aged 16-17y were e...

(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health ou...

Introduction While the evidence of mental health benefits from investing in green space accumulates, claims of reduced healthcare expenditure are rarely supported by evidence from analyses of actual healthcare data. Additionally, the question of ‘who pays?’ has been ignored. We addressed these gaps using person-level data in three Australian cities...

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resi...

Association between green space and physical activity has ignored housing type, despite people in houses often having access to private green space, whereas their counterparts in apartments do not. Thus, access to green space may have contrasting influences on outdoor leisure time and how much of it is spent in the types of physical activity known...

Potential pathways linking green space quality to prosocial behaviour have not been investigated so far. This study aimed to examine 15 candidate mediators of the association between green space quality and prosocial behaviour across physical activity, social interaction, health-related quality of life (HRQOL), child and caregiver mental health. Th...

Evidence affirms green space has health benefits, but ethnic inequities in green space availability are under-researched. Percentages of parkland, tree canopy, and open grass within 1.6 km road network distance from home were linked to 110,233 participants in the Sax Institute’s 45 and Up Study baseline survey living in the cities of Sydney, Newcas...

Background With rapid urbanization globally, people in cities tend to have fewer opportunities to interact with nature. Some health-promoting green infrastructure may support increased visitation. Objective To investigate associations between green space visitation and a range of health promoting green infrastructure. Methods From November 2019 t...

Background Urban greening may reduce loneliness by offering opportunities for solace, social reconnection and supporting processes such as stress relief. We (i) assessed associations between residential green space and cumulative incidence of, and relief from, loneliness over 4 years; and (ii) explored contingencies by age, sex, disability and coha...

Associations between green space type and 9-year risk of incident cardiovascular disease (CVD) hospitalisations and deaths were analysed in 4166 people with type 2 diabetes in the Sax Institute's 45 and Up Study. Incidence of all-cause mortality, cardiovascular mortality, fatal or non-fatal CVD events and acute myocardial infarctions (AMI) were 14....

The choice of a green space metric may affect what relationship is found with health outcomes. In this research, we investigated the relationship between percent green space area, a novel metric developed by us (based on the average contiguous green space area a spatial buffer has contact with), in three different types of buffers and type 2 diabet...

Aims The evidence on the pathways through which the built environment may influence type 2 diabetes (T2D) risk is limited. This study explored whether behavioural, physical and mental health factors mediate the associations between perceived built environment and T2D. Methods Longitudinal data on 36,224 participants aged ≥45 years (The Sax Institu...

We hypothesized that visits to green and blue spaces may have enabled respite, connection and exercise during the COVID-19 pandemic, but such benefits might have been inequitably distributed due to differences in financial difficulties, opportunities to work from home, and localized restrictions in spatial mobility generated by ‘lockdowns’. A natio...

Objective To test relatively simple and complex models for examining model fit, higher‐level variation in, and correlates of, GP consultations, where known nonhierarchical data structures are present. Setting New South Wales (NSW), Australia. Design Association between socioeconomic circumstances and geographic remoteness with GP consultation fre...

Growing body of research recognizes the importance of green spaces on the perinatal outcomes however, further evidence from different geographies are warranted. We aimed to investigate association between, and differential responses to, maternal exposure to green space and birthweight. Birth records (n=82,221) were extracted from the Perinatal Data...

Background Studies investigating the potential role of neighbourhood green space quality on the development of prosocial behaviour among children are sparse. This study aimed to investigate the longitudinal association between caregiver perceived green space quality and child prosocial behaviour, and identify potential effect modifiers of the assoc...

Background: Current evidence from studies on green space and child prosocial behaviour suggests a paucity of studies investigating the plausible role of green space quality in shaping the development of prosocial behaviour. This study aimed to examine longitudinal association between green space quality and prosocial behaviour among children. Meth...

Background: We examined to what extent perceived neighbourhood crime moderates, associations between type 2 diabetes mellitus (T2DM) and perceived local amenities, recreational facilities, footpaths and public transit, and potential mediation of environmental characteristics-T2DM association by physical activity, social contact, sleep and body mas...

Urban green space may help slow cognitive decline. We extend the investigation towards subjective memory and green space type using latent class analysis and multilevel models of 45,644 individuals in the Sax Institute's 45 and Up Study. Participants with more tree canopy relative to open grass within 1.6 km, compared to similar quantities of both...

Cardiometabolic risk factors (CMRFs) demonstrate significant geographic variation in their distribution. The study aims to quantify the general contextual effect of the areas on CMRFs; and the geographic variation explained by area-level socioeconomic disadvantage. A cross sectional design and multilevel logistic regression methods were adopted. Da...

Increasing evidence suggests adults living in greener areas tend to have more favourable sleep-related outcomes, but children and adolescents are under-researched. We hypothesised that children and adolescents living in greener areas would have better quality and more sufficient levels of sleep on average, especially within the context of high traf...

Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association betwee...

Association between urban green space quality and older adult outdoor recreation may vary across contrasting community contexts, but few international comparisons have been made. Data on older adult outdoor recreation and the quality of thirty-two (32) green spaces were collected using established tools (Systematic Observation of Play and Recreatio...

Background: Management of diabetes and chronic disease is a challenge, making mHealth an increasingly attractive option. There is evidence that these apps may be effective, with systematic reviews demonstrating improvements in HbA1c and other measures of diabetes control. However, dropout can be a major issue in apps. Recent research has indicated...

Aim: The aim of this study was to examine the association between neighborhood characteristics and type 2 diabetes (T2D) comorbidity in serious mental illness (SMI). We investigated associations of neighborhood-level crime, accessibility to health care services, availability of green spaces, neighborhood obesity, and fast food availability with SMI...

BACKGROUND Chronic disease represents a large and growing burden to the healthcare system worldwide. One method of managing this burden is app-based interventions, however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have sig...

Background: Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that...

The plausible role of nearby green space in influencing prosocial behaviour among children and adolescents has been studied recently. However, no review has been conducted of the evidence testing the association between green space and prosocial behaviour. This systematic review addresses this gap among children and adolescents. Within this review,...

Previous studies suggest that green and blue spaces may promote several health outcomes including birth outcomes. However, no synthesis of previous work has specifically asked policy-relevant questions of how much and what type is needed in every neighborhood to elicit these benefits at the population level. A systematic review and meta-analyses we...

Studies from high income, mostly westernised countries tend to report health benefits from urban green spaces. Generalizability of this evidence for the 125 low and middle-income countries (LMICs) is debatable. This systematic review explored and synthesized the quality of green space-health studies reported from LMICs. Following PRISMA guidelines,...

Background Concerns about loss of greenspace with urbanisation motivate much research on nature and health; however, contingency of greenspace-health associations on the character of community change remains understudied. Methods With aggregate data from governmental sources for 1432 Swedish parishes, we used negative binomial regression to estima...

Background: The aim of this study was to enhance capability in research on social determinants of health in China by linking and analyzing routinely-collected death records over 5 years with national population health surveillance. Methods: Linkage of 98 058 participants in the 2010 China Chronic Disease and Risk Factor Surveillance (CCDRFS) to rec...

Objectives The primary aim of this study was to describe the geography of serious mental illness (SMI)–type 2 diabetes comorbidity (T2D) in the Illawarra-Shoalhaven region of NSW, Australia. The Secondary objective was to determine the geographic concordance if any, between the comorbidity and the single diagnosis of SMI and diabetes. Methods Spat...

Importance The self-perception of weight and weight loss attempts might promote weight loss and maintenance. Objective To examine trends in current measured body mass index (BMI) and weight, self-reported weight, self-perceived weight status, weight loss attempts, and weight loss strategies among adults in the United States. Design, Setting, and...

Background: Cross-sectional studies suggest that more green space may lower the odds of prevalent diabetes, hypertension and cardiovascular diseases (CVD) in cities. We assess if these results are replicable for tree canopy exposure and then extend the study longitudinally to examine incident cardiometabolic outcomes. Methods: The study was set...

Objectives To investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China. Design Multilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015. Setting All 31 provinces in China, not including Hong Kong, Macao or Taiwan. Pa...

This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)–type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis...

Importance The American Heart Association (AHA) introduced the Life’s Simple 7 (LS7) metrics to assess and promote cardiovascular health. However, several shortcomings of these metrics have been identified. Therefore, a revised set of LS7 metrics was developed. Objectives To evaluate national trends in the metrics addressed by the revised LS7 and...

Introduction Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypoth...

Importance Recent studies indicate that living near more green space may support mental and general health and may also prevent depression. However, most studies are cross-sectional, and few have considered whether some types of green space matter more for mental health. Objective To assess whether total green space or specific types of green spac...

Much of the existing studies on the built environment and type 2 diabetes are cross-sectional and prone to residential self-selection bias. Using multilevel logistic regression analysis of 36,224 participants from a longitudinal study, we examined whether perceived built environment characteristics are associated with type 2 diabetes. We found that...