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Contact with green space in the environment has been associated with mental health benefits, but the mechanism underpinning this association is not clear. This study extends an earlier exploratory study showing that more green space in deprived urban neighbourhoods in Scotland is linked to lower levels of perceived stress and improved physiological stress as measured by diurnal patterns of cortisol secretion. Salivary cortisol concentrations were measured at 3, 6 and 9 h post awakening over two consecutive weekdays, together with measures of perceived stress. Participants (n = 106) were men and women not in work aged between 35-55 years, resident in socially disadvantaged districts from the same Scottish, UK, urban context as the earlier study. Results from linear regression analyses showed a significant and negative relationship between higher green space levels and stress levels, indicating living in areas with a higher percentage of green space is associated with lower stress, confirming the earlier study findings. This study further extends the findings by showing significant gender differences in stress patterns by levels of green space, with women in lower green space areas showing higher levels of stress. A significant interaction effect between gender and percentage green space on mean cortisol concentrations showed a positive effect of higher green space in relation to cortisol measures in women, but not in men. Higher levels of neighbourhood green space were associated with healthier mean cortisol levels in women whilst also attenuating higher cortisol levels in men. We conclude that higher levels of green space in residential neighbourhoods, for this deprived urban population of middle-aged men and women not in work, are linked with lower perceived stress and a steeper (healthier) diurnal cortisol decline. However, overall patterns and levels of cortisol secretion in men and women were differentially related to neighbourhood green space and warrant further investigation.
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Int. J. Environ. Res. Public Health 2013, 10, 4086-4103; doi:10.3390/ijerph10094086
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
Green Space and Stress: Evidence from Cortisol Measures in
Deprived Urban Communities
Jenny J. Roe 1,*, Catharine Ward Thompson 2,, Peter A. Aspinall 1,†, Mark J. Brewer 3,†,
Elizabeth I. Duff 3,†, David Miller 4,†, Richard Mitchell 5,† and Angela Clow 6,†
1 School of the Built Environment, Heriot-Watt University, Edinburgh EH14 4AS, UK;
2 OPENspace Research Centre, University of Edinburgh, Edinburgh EH3 9DF, UK;
3 Biomathematics and Statistics Scotland, Aberdeen AB15 8QH, UK;
E-Mails: (M.J.B.); (E.I.D.)
4 James Hutton Institute, Aberdeen AB15 8QH, UK; E-Mail:
5 Centre for Research on Environment, Society and Health, Institute of Health and Wellbeing,
University of Glasgow, Glasgow G12 0XH, UK; E-Mail:
6 Department of Psychology, University of Westminster, London W1B 2UW, UK;
These authors contributed equally to this work.
* Author to whom correspondence should be addressed; E-Mail:;
Tel.: +44-(0)1904-32-3480; +44-(0)1904-32-2898.
Received: 2 August 2013; in revised form: 14 August 2013 / Accepted: 15 August 2013 /
Published: 2 September 2013
Abstract: Contact with green space in the environment has been associated with mental
health benefits, but the mechanism underpinning this association is not clear. This study
extends an earlier exploratory study showing that more green space in deprived urban
neighbourhoods in Scotland is linked to lower levels of perceived stress and improved
physiological stress as measured by diurnal patterns of cortisol secretion. Salivary cortisol
concentrations were measured at 3, 6 and 9 h post awakening over two consecutive
weekdays, together with measures of perceived stress. Participants (n = 106) were men and
women not in work aged between 3555 years, resident in socially disadvantaged districts
from the same Scottish, UK, urban context as the earlier study. Results from linear
Int. J. Environ. Res. Public Health 2013, 10 4087
regression analyses showed a significant and negative relationship between higher green
space levels and stress levels, indicating living in areas with a higher percentage of green
space is associated with lower stress, confirming the earlier study findings. This study
further extends the findings by showing significant gender differences in stress patterns by
levels of green space, with women in lower green space areas showing higher levels of
stress. A significant interaction effect between gender and percentage green space on mean
cortisol concentrations showed a positive effect of higher green space in relation to cortisol
measures in women, but not in men. Higher levels of neighbourhood green space were
associated with healthier mean cortisol levels in women whilst also attenuating higher
cortisol levels in men. We conclude that higher levels of green space in residential
neighbourhoods, for this deprived urban population of middle-aged men and women not in
work, are linked with lower perceived stress and a steeper (healthier) diurnal cortisol
decline. However, overall patterns and levels of cortisol secretion in men and women were
differentially related to neighbourhood green space and warrant further investigation.
Keywords: green space; stress; diurnal; saliva; cortisol; neighbourhood; urban;
deprivation; gender; mental health
1. Introduction
Contact with green space has been associated with benefits to mental health, particularly levels of
stress [1]. These effects are thought to operate through one or more of three mechanisms: increased
physical activity (see [2] for a systematic review) which, in turn, improves mood [3]; increased social
contact and sense of belonging within a community [4]; and psychological restoration related to
attention processes and attenuation of stress and fatigue [5,6]. Two theoretical models of psychological
restoration have been proposed. The first is related to the Kaplans’ Attention Restoration Theory [6]
which posits that natural settings, inherently rich in stimuli, invoke involuntary attention which
supports restoration from mental fatigue. The second is Ulrich’s psychoevolutionary model [7] which
posits that stress reduction arises from an immediate, affective response to the visual stimulus array of
a natural setting, impacting the brain and neuroendocrine system. However, evidence of an impact
from contact with natural environments on the neuroendocrine system is currently limited to a small
number of studies.
Contact with nature has been shown to have positive effects on blood pressure [5,7], heart rate [7],
skin conductance and muscle tension [7]. However, most studies which have used salivary cortisol as a
measure of stress in relation to contact with nature have not measured diurnal patterns, focussing
instead on measuring levels immediately before and after exposure to different environmental settings.
For example, Park and colleagues [8] have shown visiting a Japanese forest can reduce cortisol
concentrations, compared to city environments. Lee et al. [9] reported that visiting a forest had greater
benefits for stress levels than visiting an urban environment, using cortisol and pulse rates as
biomarkers of stress. Similarly, van den Berg and Custer [10] found that a period of allotment
gardening led to greater levels of stress reduction than a restful indoor task (i.e., reading),
Int. J. Environ. Res. Public Health 2013, 10 4088
using salivary cortisol as a measure. Although these studies found that contact with natural
environments reduced stress, their external validity is limited because they either had very small
numbers of participants or limited categories of participant (e.g., university students, allotment
gardeners) or used very controlled, specific settings (possibly both). Very little research has examined
the stress neuroendocrine system in relation to the long-term effects of familiar, everyday
environments, set within the context of people’s normal patterns of activity and experience. One
exception is the study by Do et al. [11] which explored the relationship between a series of
neighbourhood characteristics (deprivation, violence, disorder and social cohesion) and changes in
diurnal cortisol rhythms. In that study, higher perceived levels of neighbourhood violence were
significantly associated with lower cortisol values on awakening and with a less steep decline in
cortisol concentrations from the morning to the evening.
Some evidence points to demographic and socio-economic differences in the relationship between
green space and health. An inverse association between green space and all-cause mortality rate
appears stronger for more deprived populations than for more advantaged populations in England and
Wales [12]. Greater beneficial effects of local green space have been found in people spending more
time in their local neighbourhood (e.g., young people, older people, people not in work), perhaps due
to greater exposure to this green space [13]. Gender differences in the relationship between
environmental factors and health outcomes are beginning to emerge but remain under-explored.
For example, a population-level study in the UK has shown gender differences in the relationship of
urban green space to cause-specific mortality rates [14]. The authors suggested this difference was due
to gender differences in perceptions and usage of urban green space. Fear for safety is a common
barrier experienced by women in accessing urban green space [15] and a dimension that reduces the
likelihood of women walking in their local neighbourhoods, as compared to men [16]. A wider general
literature that has explored gender differences in the impact of general neighbourhood context on
health has generally found stronger effects on women than men [14].
Gender differences in the relationship between stress and the diurnal pattern of cortisol secretion
have also been reported. In middle-aged men, stress has been associated with higher cortisol
concentrations and a reduction in the diurnal cortisol decline (henceforth referred to as cortisol slope):
a high and flat pattern. In contrast, stressed middle-aged women presented with low cortisol
concentration and a lower and flatter cortisol slope [17]. Consistent with this finding, in older women
depression has been associated with hypocortisolemia whilst, in older men, depression was associated
with hypercortisolemia [18]. Lower cortisol levels have also been linked with negative life events,
associated with significantly lower cortisol levels in females [19]. There is increasing evidence for a
life-course influence on the cortisol cycle. For example, early life adversity has been shown to be
associated with lower cortisol profiles [20,21]. In summary, there appear to be gender differences in
the impact of neighbourhood characteristics on health as well as gender differences in the
neuroendocrine response to negative life events and stress.
This study builds on an earlier, exploratory study [22] of a socially deprived urban population that
found significant relationships between measures of neighbourhood green space, perceived stress and
the diurnal pattern of cortisol secretion. Higher levels of neighbourhood green space were linked with
lower levels of perceived stress and a steeper diurnal decline in cortisol secretion. In that study, as in
this one, neighbourhood was defined using Census Area Statistics (CAS) Ward. This is a small areal
Int. J. Environ. Res. Public Health 2013, 10 4089
unit used in the administration of the UK decennial census. It has previously been used as a definition
of neighbourhood in other research on green space and health [14,23]. Based upon this earlier study,
we generated two hypotheses for the current study:
1. Hypothesis 1: greater availability of neighbourhood green space in deprived urban communities
is linked to lower perceived stress;
2. Hypothesis 2: greater availability of neighbourhood green space in deprived urban communities
is linked to lower levels of physiological stress, as measured by the diurnal patterns of cortisol
Based upon the accumulating evidence cited above indicating gender differences in stress responses
we expanded the present study to include a third hypothesis:
3. Hypothesis 3: patterns of cortisol secretion in this socially deprived urban population will be
differentially expressed in men and women. We did not predict what pattern these would
follow by levels of neighbourhood green space.
2. Experimental Section
2.1. Study Design
The study repeats the earlier study [22] in outcome measures, demographics, geographic location
and cross-sectional design. As before, it included a survey of participant demographics, perceived
stress, well-being and self-reported exercise levels. Repeated salivary cortisol sampling took place
over two consecutive weekdays. The study employed secondary data analysis of participants’ local
environments in order to determine percentage of green space in each participant’s neighbourhood.
The study was set in the city of Dundee, United Kingdom, selected because it contains a number of
highly deprived urban neighbourhoods with varying levels of green space. The study was carried out in
accordance with the British Psychological Society Ethical Principles for Conducting the Research
with Human Participation and with full ethical approval granted by the lead researchers’ institutional
ethics board.
2.2. Participants
To reduce age-related effects on patterns of cortisol secretion our participants were men and women
aged 3355 years of age. They were not in work for any reason (e.g., job-seeking unemployed,
on invalidity benefit, carers) and were living in socio-economically deprived areas of Dundee as
measured by the Carstairs Index of deprivation [24]. The Carstairs Index is a widely used and
well-validated indicator of area-level socio-economic deprivation based on prevalence of household
overcrowding, unemployment among men, low social class, and not having a car; the higher the
Carstairs score, the greater the deprivation. Participants were recruited from areas with a Carstairs
score of 57 (the average Carstairs score for Dundee is 3.93).
Int. J. Environ. Res. Public Health 2013, 10 4090
2.3. Recruitment
Recruitment was through a two-stage process. Firstly, specified postcode areas in the city of
Dundee were selected on the basis of Carstairs indices of 57. Within these areas a campaign of
door-to-door recruitment was undertaken over a period of five weeks, from May to June 2010.
Interested participants that fulfilled the inclusion criteria were provided with information sheets and,
following an indication that they were willing to take part, their details were recorded by the
recruitment company and followed-up by the by the research team. Potential participants were invited
to a group briefing session in the city-centre. People were excluded if they were taking oral steroids,
but more stringent exclusion criteria (e.g., use of anti-depressants, smoking) although recorded, were
waived owing to the high likelihood of finding such behaviour patterns in the target sample population.
People who had lived for less than 12 months in their neighbourhood were also excluded.
At the group briefing session, following informed consent, participants completed a short,
paper-based questionnaire and were instructed on the protocol for taking cortisol samples. Of the
158 potential participates that attended the briefing session 81 participants successfully completed the
study. As statistical analyses established no effects of season or demographic differences between this
sample and the exploratory study sample (gathered in January 2010), the databases were merged to
achieve greater statistical power with a total sample size of 106 participants, 50% male and female.
2.4. Measures
The primary outcome measures were perceived stress (the Perceived Stress Scale (PSS) [25],
the cortisol slope and average cortisol levels, derived from multiple saliva sampling across two
consecutive days. The PSS comprises 10 items measured on a 5-point response from never to very
often. The final score assesses perceived stress over the preceding month and can range from 0
(minimum level of stress) to 40 (maximum level of stress). The detailed procedure for the cortisol
sampling is described below.
Other measures included positive well-being and self-reported levels of physical activity, captured
as potential explanatory variables. Well-being was measured using a shortened version of the Warwick
and Edinburgh Mental Well-being Scale (SWEMWBS) [26]. SWEMWBS asks participants how they
had felt over the previous four weeks in relation to seven items used to measure aspects of mental
well-being (e.g., feeling relaxed, feeling useful), with responses rated on a 5-point scale from none of
the time to all of the time. Final scores can range from 7 (low well-being) to 35 (high well-being).
Physical activity was measured using one item asking for the number of days on which physical
activity (of sufficient exertion to raise breathing rate) reached or exceeded 30 min, recalled over the
past four weeks. This item is recommended by the British Heart Foundation National Centre [27].
Socio-economic deprivation was based on the Carstairs Index for population data in 2001 [24],
obtained via each participant’s postcode. Participants’ age and gender were also recorded.
Exposure to green space was measured by the percentage of the area in the Census Area Statistics
(CAS) Ward of the participant’s residence which was identified as green space. The green space
measure includes parks, woodlands, scrub and other natural environments, but not private gardens
(although participants indicated yes/no as to whether they had access to a garden). Dundee contains
Int. J. Environ. Res. Public Health 2013, 10 4091
31 CAS Wards with a mean population of 4942 at the 2001 census, and a mean proportion of green
space of 33.89%. These data were created by the Centre for Research on Environment Society and
Health (CRESH) [14, 23] and are freely available at the CRESH website [28].
2.5. Cortisol Sampling Procedure
Participants were instructed to take three samples of saliva per day on two consecutive weekdays
(Monday and Tuesday) using salivette saliva sampling devices (Starstedt, Leicester, UK). Requested
sampling times were 3, 6, and 9 h after awakening. They were instructed not to smoke, eat or drink
anything but water 30 min before taking each sample and to keep a log of sample times. Wake up time
was defined as the moment a participant was first conscious of being awake. To maximize adherence,
participants were sent individualised SMS text prompts, based upon self-report predicted awakening
times, 3 times on each day to remind them to take their samples. At the end of the day, participants
were asked to freeze their samples (or place in a fridge) in a sealed bag provided. They were then
collected and shipped to the laboratory for assay analysis within five days of collection. Cortisol assays
were carried out by Salimetrics Europe using Enzyme Linked Immuno-Sorbent Assay. The lower limit
of sensitivity is 0.01638 nmol/L. The standard range in assay is 0.5138.468 nmol/L; correlation of
assay with serum: r (47) = 0.91, p < 0.0001; intra and inter-assay variations were both below 10%.
Average daily cortisol concentrations were determined by calculating the average cortisol
concentration across all sampling points on both sampling days. The cortisol slope was derived from
the change in cortisol concentration from 39 h post awakening, averaged across both sampling days.
The use of start and end data points to determine the linear slope follows methods by Thorn et al., [29]
and Power et al., [30].
2.6. Data Cleaning
When computing cortisol regression analyses, a total of 13 participants were initially removed for
data quality issues (i.e., a cortisol sample outside the required time threshold of plus or minus 45 min
from target sampling time, and/or missing data). Any single measurement greater than two standard
deviations from the mean was retained with that measure winsorised. This resulted in a sample size of
93 for mean cortisol; for cortisol slope (requiring means extant for: sample times 3, 6 and 9 h),
five further participants were removed owing to doubts about the timing of the sampling (less likely to
affect the mean cortisol), giving a sample size of 88. For the perceived stress regression, three
participants were removed for data quality issues, resulting in sample size of 103. When computing
descriptive statistics, a total of two participants were removed owing to missing data, resulting in a
sample size of 104. In summary, data were cleaned or participants removed in preparation for four
different analyses: cortisol slope, cortisol mean; perceived stress; and descriptive statistics.
2.7. Statistical Analysis
Bivariate relationships between variables were explored using Pearson correlations. Gender
differences in socio-demographic characteristics and outcome variables were assessed via
Mann-Whitney tests, as the data were not normally distributed. Multiple linear regressions examined
Int. J. Environ. Res. Public Health 2013, 10 4092
main effects and interaction effects in relationships with the primary outcome variables of perceived
stress, cortisol slope and average cortisol concentrations, and the predictors of age, gender, deprivation
level, physical activity level and the amount of neighbourhood green space; this selection of
covariates is justified by the findings of our earlier study. Since model diagnostics found the
average cortisol concentration to violate the assumption of normality, a log-transformed variable was
used to remove this. Variance inflation factors confirmed there were no collinearity issues in all final
models presented.
In initial regressions, perceived income coping was found to be a very high correlate of perceived
stress (i.e., the two share a very strong relationship with each other, in suggesting that coping with low
income levels is likely to be a main cause of stress in people living with unemployment). As a
consequence, in this particular data set, income coping can be regarded as a surrogate for stress, and
was therefore removed from the analysis. Physical activity was not significantly associated with
outcome measures in exploratory analyses, and was removed from the models for this reason. It is
possible that the number of missing values with respect to physical activity (giving a smaller resultant
sample of 88) may account for this. We found a similar pattern with the life events scale, i.e., it was
not a significant predictor of stress in exploratory regression analyses, but 25% of participants did not
answer this question. We note that removing variables from models in this manner can lead to “omitted
variable bias”, so in each case we checked that the coefficients of remaining variables were not altered
greatly as a result.
Relationships between outcome measures and green space were examined carefully; while a linear
relationship seemed appropriate for two of the measures (perceived stress and mean cortisol), there did
seem to be evidence of a step-change with respect to cortisol slope, suggesting that a binary indicator
might be more suitable than a straight line. We required an objective, scientific method for determining
where on the continuous scale to make the split into two (or more); for this purpose we used SPSS
AnswerTree to establish an optimal split of 43% green space using a CHAID (CHI squared Automatic
Interaction Detector) analysis. Note further: the algorithm used had the potential to make single or
multiple splits, but in the event, only one was found to be significant (at 43%). The term low green
space henceforth refers to areas with less than (or equal to) 43% green space; the term high green
space to areas with more than 43% green space. While associations between stress levels and access
to private or semi-private gardens are not a focus of this paper, we felt it important to ensure any
effects of a household having access to a garden were accounted for prior to assessing any effects of
access to publicly accessible green space. Reported access to a garden (yes/no) was therefore included
as a co-variate in the regression analyses.
Int. J. Environ. Res. Public Health 2013, 10 4093
3. Results and Discussion
3.1. Results
A repeated measures ANOVA factoring day (sampling days 1 and 2), and sample (cortisol
concentrations at 3, 6, 9 h post-awakening) revealed no significant main effect for day. As expected,
there was a highly significant main effect of sampling time (F = 26.62, df = (1,54), p < 0.001),
indicating that cortisol means varied across the day. Both results suggested participant adherence to the
required sampling protocol and legitimised the strategy of averaging both cortisol measures (average
concentration and cortisol slope) across the two sampling days to give the most reliable measures.
The demographic profile of participants is provided in Table 1. Women reported higher perceived
stress, lower well-being and lower levels of physical activity and their average cortisol concentrations
were significantly lower than men’s.
Table 1. Characteristics of the study population (n = 104).
Mean (SD)
Mean (SD)
Mean (SD)
Percentage sample
Mean age (years)
44.75 (6.91)
44.21 (6.65)
45.28 (7.20)
Level of deprivation (mean Carstairs score)
6.64 (2.21)
6.28 (2.36)
7.0 (2.02)
Work status %
Working part-time (less than 30 h/week)
In education
Not in work owing to sickness, disability
Not in work owing to caring for family
Percentage of green space in residential environment
Low green space < 43%
High green space 43%
Perceived Stress (PSS)
14.28 (5.8)
18.66 (5.9) *
21.87 (5.40) *
Perceived well-being (SWEMWBS)
22.35 (4.94)
23.55 (4.92) *
21.10 (4.67) *
Reported physical activity (days/month)
8.20 (8.71)
9.70 (8.9) *
6.67 (8.29) *
Cortisol mean concentration (over 2 days)
6.00 (2.85)
6.54 (2.54)
5.58 (3.08)
Cortisol slope (mean slope over 2 days)
4.00 (5.00)
4.09 (4.74) *
3.91 (5.27) *
* statistically significant gender difference between male and females p < 0.05 (Mann-Whitney U Test).
Bivariate correlations revealed that, within the total population, higher mean cortisol concentrations
were positively associated with a higher cortisol slope (Table 2). This atypical relationship indicates
that, in this socially disadvantaged sample, low cortisol levels were associated with flat diurnal cortisol
profiles, i.e., low cortisol levels were associated with less healthy cortisol profiles. The cortisol slope
was negatively associated with perceived stress and positively associated with physical activity and
more green space (measured on the binary variable). Higher percentage neighbourhood green space
was associated with lower perceived stress and higher mean cortisol secretion.
Int. J. Environ. Res. Public Health 2013, 10 4094
Gender differences in stress levels were found when taking account different levels of green space
in the residential environment (Table 3). In both men and women, perceived stress was higher in low
green space areas, but women’s perceived stress was significantly higher in low green space areas than
men’s (p < 0.05). Also, women had significantly lower mean cortisol concentrations in lower green
space areas compared to men (p < 0.05), indicative of greater hypocortisolemia (low flat cycle). It is
notable that the differences in stress levels between men and women were only significant in low green
space areas, with evidence of greater comparability in stress levels in high green space areas.
Table 2. Relationships between cortisol patterns, health measures and percentage green space.
% GS
1. Cortisol Mean
2. Cortisol Slope
0.458 ***
3. Stress (PSS)
0.173 *
4. Well-being (SWEMWBS)
0.616 ***
5. PA (Physical Activity)
0.207 *
6. Percentage Green Space (% GS)
0.311 ***
0.286 **
7. Binary green space (BinGS)
0.174 *
0.812 ***
* p < 0.10; ** p < 0.05; *** p < 0.01. The reported correlation coefficients are Pearson’s (relatively similar
Spearman rank correlations were found). Log transformed data was used for cortisol mean analysis.
Table 3. Gender differences in stress levels by level of green space.
Male mean (SD)
Female mean (SD)
Low Green
High Green
Low Green
High Green
Perceived Stress (PSS)
13.24 * (5.80)
10.92 (5.83)
16.49 * (5.94)
14.38 (3.38)
Cortisol mean concentration
(nmol/L) (over 2 days)
7.62 * (10.22)
4.61 (1.14)
4.24 * (2.03)
6.43 (3.50)
Cortisol slope (nmol/L)
(mean slope over 2 days)
3.87 (4.89)
4.98 (4.16)
3.25 (4.49)
5.67 (6.85)
* statistically significant difference between males and females p < 0.05 (Mann-Whitney U Test).
Regression analyses were performed to predict perceived stress, the cortisol slope and average
cortisol secretion over the day (see Table 4).
Int. J. Environ. Res. Public Health 2013, 10 4095
Table 4. Linear regression model analyses predicting perceived stress, cortisol slope and
cortisol mean over 2 days.
Main Effects
Model 1
Perceived stress (n = 103)
Model 2
Cortisol Slope (n = 88)
Model 3
Cortisol mean (n = 93)
95% CI
95% CI
95% CI
Gender (female)
5.47 ***
1.98, 8.95
1.79, 1.72
0.62 ***
0.14 *
0.29, 0.02
0.13 **
0.00, 0.26
0.01 **
0.00, 0.03
Deprivation level
0.19, 0.78
0.39, 0.38
0.03, 0.04
% green space
0.08 **
0.01, 0.01
binary green space
3.00 ***
0.86, 5.14
No Garden
3.48 **
0.13, 6.82
Interaction Effects
No Garden
with gender (female)
4.31 *
8.75, 0.13
% green space
(continuous) with
gender (female)
0.01 **
0.00, 0.02
Note cells with “- denotes terms removed from the model for that particular response variable. * p < 0.10;
** p < 0.05; *** p < 0.01.
Model 1
Perceived Stress: being female and living with lower neighbourhood green space was associated
with higher perceived stress. Not having a garden was associated with higher stress levels but,
as the interaction term shows, only for males (to clarify: the main effect of “no garden” for males
corresponds to the main effect for “no garden”, and total effect for females is 3.48−4.31 = 0.83,
t = 0.71, p = 0.683, hence not significant). The overall model was significant at p = 0.003 with
adjusted r2 value of 13%.
Model 2
Cortisol Slope: Increasing age and living with high rather than low levels of green space (binary
variable) was associated with a greater diurnal cortisol decline. This pattern is illustrated in Figure 1
which shows that participants living in areas of higher green space had a steeper cortisol slope profile
whilst those participants living with lower neighbourhood green space have a flatter slope profile.
There was no evidence of gender or interaction effects of gender with green space in the models,
suggesting the positive association between green space and cortisol slope was consistent in both men
and women. The overall model was marginally significant at p = 0.052 with adjusted r2 of 6.3%.
Int. J. Environ. Res. Public Health 2013, 10 4096
Figure 1. Difference in cortisol slope between participants living in high versus low green
space areas.
Model 3
Cortisol Mean Concentration: Being female and of younger age was associated with lower average
cortisol concentrations (Table 4). There was no significant overall association between neighbourhood
green space and average cortisol concentrations. There was a significant interaction between
percentage green space and gender such that higher neighbourhood green space was associated with
higher average cortisol levels among females, with no effect for males. The overall model was
significant at p = 0.004 with adjusted r2 value of 13%. The interaction effect between gender and green
space (F = 7.03, df = (1,94), p = 0.009) was confirmed in a repeated measures (multilevel) analysis
(using the original separate cortisol readings within individuals), although we prefer to present the
separate, simpler analyses here, as there are fewer problems caused by missing values. In low green
space, women showed a low and flat slope, illustrated in Figure 2(a). For men, lower green space
was associated with a high flat cortisol slope associated as illustrated in Figure 2(b).
In all three models, age was a significant predictor of stress: with increasing age perceived stress
decreased and mean cortisol concentrations were higher with a healthierand steeperdiurnal slope.
We found no evidence of omitted variable bias in any of our three models.
3.2. Discussion
As hypothesised, the study found that higher levels of neighbourhood green space were associated
both with lower levels of perceived stress (Hypothesis 1) and a steeper diurnal decline in cortisol
secretion, for men and women (Hypothesis 2). Green space was found to be an independent predictor
of the circadian cortisol cycle. This confirms the earlier study [22] and establishes further evidence of
an association between levels of neighbourhood green space and neuroendocrine function, which may
point to better understanding of any link between the observed beneficial effects of green space
and health.
12 High green space
Low green space
Hours post awakening
Cortisol (nmol/l)
Int. J. Environ. Res. Public Health 2013, 10 4097
Figure 2. (a) Differences in mean cortisol slope in women living in high versus low green
space areas. (b) Differences in mean cortisol slope in men living in high versus low green
space areas.
A new findingand atypical of a more socially advantaged middle-aged populationwas that
lower cortisol levels were associated with flat diurnal cortisol profiles, suggestive of a prevalence of
hypocortisolemia and chronic stress. Dysregulation of the diurnal pattern of cortisol secretion is
associated with an array of negative health outcomes [31].
In addition, we found different levels of perceived stress and different cortisol secretion patterns
in men and women (Hypothesis 3) that also varied by amount of green space in the local area.
Firstly, women in low green space areas had significantly higher levels of perceived stress. Secondly,
the diurnal cortisol pattern between men and women was different in areas of low green space but not
in high green space areas. Women showed evidence of greater hypocortisolemia (i.e., a low flat
slope cycle) and men a high flat slope cycle in low green space areas. A low flat cycle is associated
with exhaustion and chronic stress [19,3234], whereas a high flat cyclewhilst also indicative of
severe stresssuggests better overall stress regulation [35,36]. This finding is consistent with reports
of hypocortisolemia in middle-aged females exposed to stress, depression and negative life events [1719].
3 6 9
Women low green space
Women high green space
Hours post awakening
Cortisol (nmol/l)
3 6 9
Men low green space
Men high green space
Hours post awakening
Cortisol (nmol/l)
Int. J. Environ. Res. Public Health 2013, 10 4098
It suggests that high green space may contribute to lessening the differential effect of stress on women
compared with men. Whilst associations between stress levels and access to gardens were not the focus
of this study, it is interesting to note that perceived stress was higher for those with no garden, but that
this effect was significantly weaker for females. This suggests further research should explore types of
green space, including access to gardens, and gender effects on stress levels.
We found a positive relationship between higher green space levels and mean cortisol levels in
women, but not in men. It seems that higher neighbourhood green space may contribute in some
way to higher but healthier cortisol levels in this female population and, conversely, to moderating
unhealthily high cortisol levels in men (i.e., cortisol concentrations in men come down in higher
green space areas to a healthier level). This finding provides further evidence of gender differences
in neuroendocrine associations with psychosocial factors and points to gender differences in the
neuroendocrine response to the environment. However it is interesting that in males and females,
irrespective of overall cortisol levels, a greater diurnal decline in cortisol was associated with more
neighbourhood green space. High green space levels therefore appear to offer some degree of stress
buffering in this socially disadvantaged population, reducing or moderating the differences in stress
levels perceived in men and women compared with those living with low green space.
The participants in this study were mostly middle-aged and long-term residents in urban, deprived
neighbourhoods. It is plausible that the impact of unemployment and long-term socio-economic
adversity in the participants resulted in long-term HPA axis dysregulation and the cortisol profiles
presented here. Recently it has been shown that adult only city living is associated with greater
stress-related activity in the amygdala, which activates the HPA axis [37], Unfortunately, the impact of
lifetime exposure to city dwelling was not directly explored in this study although, in the
neighbourhoods surveyed, it is typical for residents to have been life-long inhabitants of the same city.
For the purpose of this current study, what is of most interest is that those residing in city areas with
higher levels of green space report less perceived stress and appear to have been more resilient to the
negative effects of urban deprivation as evidenced by a steeper cortisol slope profile.
These results are potentially important in understanding how neighbourhood green space might
contribute to public health improvement. Stress is known to impact on cardiovascular disease via
interaction with a variety of risk factors that include genetics, early experience, age, race, diet and
physical activity [38], with women at greater risk [39,40] but little is known about the environmental
factors that might also contribute. At a population level, higher levels of green space are associated
with reduced cardio-vascular mortality in England and Wales [12]. Our data indicate that
neighbourhood green space is associated with perceptions of stress as well as the stress neuroendocrine
system and this may be a pathway by which the environment can impact health. Whilst more research
is needed to understand these mechanisms, including a better understanding of how use of nearby
green space may affect the pattern of stress associated with higher neighbourhood green space,
our study represents a valuable step in establishing a biological pathway linking green space with
stress levels in deprived urban environments.
Int. J. Environ. Res. Public Health 2013, 10 4099
3.3. Limitations
Our study was cross-sectional in design and therefore cannot demonstrate causality.
Whilst demographic and socio-economic factors were accounted for, it is possible that other individual
and environmental factors, for example smoking status, or social contact, may have influenced
outcomes. The percentage of smokers in our sample wasbased on pilot screeningknown to be
high, with smoking levels in deprived areas of Dundee over 50% [41]. It was not realistic, therefore, in
this population, to exclude smokers from our study. Whilst smoking increases levels of salivary
cortisol it has a short-term effect on the neuroendocrine system. We controlled for this with text
promptsissued to participants at timed intervals during the day advising them to refrain from
smoking (and other stimulants) half an hour prior to sampling procedures. We have no reason to
believe participants did not comply with this instruction: the linear decline data suggests they did not
smokeas requestedotherwise we would have seen a spike in cortisol. All spikes detected were
managed in the data set as described in Section 2.6.
We were unable to confirm the significant relationship found in the earlier study between cortisol
slope and physical activity, although we found a positive correlation between these two variables,
showing a positive effect of increased physical activity on cortisol slope patterns. We suspect this is
owing to a high proportion of missing data in answering the physical activity question (12% of our
sample did not provide data for this variable). In future, more objective measures might usefully be
used to establish daily physical activity levels in participants e.g., accelerometers. We would also
recommend the inclusion of a social connectedness scale to further explore relationships between
stress and levels of green space butin the current studythis was outwith our agenda.
We chose to examine the diurnal decline in cortisol secretion (3, 6 and 9 h post awakening) as
opposed to the cortisol awakening response (CAR). It was not practical in this deprived population to
impose the intensive post awakening saliva sampling regime required for determination of the CAR.
In addition we did not have objective means of verifying adherence with the required regime which is
essential for accurate determination of this measure (recently it has been shown that post awakening
non-adherence of just 515 min can lead to misleading CAR estimates) [42]. Diurnal cortisol patterns
have been established using as few as two post-awakening samples (at 3 and 6 h); establishing the
slope pattern over the day between 39 h post awakening was therefore felt to be an appropriately
rigorous measurement in this context.
Owing to limitations in UK land use classifications systems our objective measure of percentage
green space was unable to pick up the finer grain detail of front gardens and street trees. Improving the
measurement of different types of green space is therefore one important area to develop in future
research to test hypotheses in relation to gender differences in relation to associations between access
to private/semi-private gardens, other types of green space and health.
4. Conclusions
Higher levels of neighbourhood green space in deprived urban communities are linked with lower
perceived stress and a steeper diurnal decline in cortisol secretion, confirming the earlier study [22].
This new study extends the evidence for a biological pathway which may explain the link between
Int. J. Environ. Res. Public Health 2013, 10 4100
neighbourhood green space and health outcomes, for which stress has an aetiological role. In addition,
we found evidence of hypocortisolemia (i.e., lower daytime levels of cortisol) in this socially deprived
urban population, an atypical pattern and indicative of chronic stress, with greater hypocortisolemia
evident in women living in low green space. Furthermore, we have shown that higher levels of green
space are associated with a lower level of this pattern in women, with a positive association of
increased green space with mean cortisol concentrations, warranting further investigation. Through
successful replication of earlier methodology, we have demonstrated that this experimental approach is
an ecologically valid and reliable method for furthering evidence of salutogenic environment-body
interactions within a real-world context.
We thank Sue Morris, Keith Marshall, Jane Morrice and Paula Horne from the James Hutton
Institute, for assisting with recruitment protocol; Lisa Thorn, University of Westminster, for
exploratory statistical analysis. This study is part of the Green Health project funded by the
Scottish Government project No. MLU/ECA/UGW/847/08, with the James Hutton Institute in
collaboration with the Universities of Edinburgh, Glasgow and Heriot-Watt, and with Biomathematics
and Statistics Scotland.
Conflicts of Interest
The authors declare no conflict of interest.
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... The available literature on this association is also inconsistent, while some studies have found a beneficial association for greenspace (Demoury et al., 2017;James et al., 2016;Lee et al., 2020), others have reported an increased risk of cancers associated with this exposure (Astell-Burt et al., 2014;Carles et al., 2017), or have not observed any associations (Kim et al., 2019;Klompmaker et al., 2020). Stress reduction (Roe et al., 2013), mitigation of urban-related pollutants (e.g. air pollution and noise) (Baldauf, 2020;Margaritis and Kang, 2017), and improved social interaction and physical activity (Dzhambov et al., 2020a;Markevych et al., 2017) have been suggested to underlie the reported beneficial associations observed between greenspace and cancer. ...
We conducted a systematic review and meta-analysis of the available literature on the association between greenspace exposure and all-sites and site-specific cancer incidence, prevalence, and mortality in adults. We searched PubMed, Scopus, and Web of Science for original articles published, without language restriction until September 2021. We assessed the risk of bias in each study and the overall quality of evidence for exposure-outcome pairs that were reported in two or more studies. Out of the 18 included studies, cross-sectional studies were the most common study design (n = 8), and most of the studies were conducted in Europe (n = 8). In terms of risk of bias, the majority of cohorts (four out of six) and case-control studies (three out of four) were of good or very good quality, and cross-sectional studies were mostly (five out of eight) of poor quality. Outcomes (incidence, prevalence, mortality) on different cancer sites were reported: lung cancer (n = 9), prostate cancer (n = 4), breast cancer (n = 4), skin cancer (n = 3), colorectal cancer (n = 2), all-sites cancer (n = 2), brain cancer (n = 1), mouth and throat cancer (n = 1), and esophageal cancer (n = 1). The meta-analyses for the breast, lung, and prostate cancer incidence did not show statistically significant associations (for example for breast cancer: hazard ratio = 0.83; 95% confidence interval: 0.47–1.48). For skin cancer, the available evidence suggests that greenspace could be a potential risk factor. For the other cancers, the evidence was non-conclusive. The overall quality of evidence of all of the exposure-outcome pairs was very low. Given the wide confidence interval of the pooled estimates and very low quality of evidence, the findings should be interpreted with caution. Future large and longitudinal studies are needed to assess the potential association of greenspace exposure with cancers, considering types and quality of greenspace, evaluation of cancer sub-types, and adjustment for a sufficient set of covariates.
... Physical settings can play a role in coping with stress. A rapidly growing amount of research from many different areas (e.g., environmental/consumer/health/sport/organizational/occupational psychology, environmental epidemiology, and public health) indicates that nature has a multiplicity of beneficial qualities for mental health [40,41], including stress reduction [42][43][44][45]. With the term "Nature", we refer to spaces (outdoor and indoor) and views that incorporate natural elements (e.g., trees, rivers, and beaches), material (e.g., wooden and water), sound (e.g., birds and water), or odors (e.g., essential oils). ...
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In recent years, work-related stress has grown exponentially and the negative impact that this condition has on people’s health is considerable. The effects of work-related stress can be distinguished in those that affect workers (e.g., depression and anxiety) and those that affect the company (e.g., absenteeism and productivity). It is possible to distinguish two types of prevention interventions. Individual interventions aim at promoting coping and individual resilience strategies with the aim of modifying cognitive assessments of the potential stressor, thus reducing its negative impact on health. Mindfulness techniques have been found to be effective stress management tools that are also useful in dealing with stressful events in the workplace. Organizational interventions modify the risk factors connected to the context and content of the work. It was found that a restorative workplace (i.e., with natural elements) reduces stress and fatigue, improving work performance. Furthermore, practicing mindfulness in nature helps to improve the feeling of wellbeing and to relieve stress. In this paper, we review the role of mindfulness-based practices and of contact with nature in coping with stressful situations at work, and we propose a model of coping with work-related stress by using mindfulness in nature-based practices.
... Contact with nature 1 reduces stress (e.g. Roe et al. 2013;Ward Thompson et al. 2012) and negative emotions and increases positive emotions (e.g. McMahan and Estes 2015). ...
... As shown in a series of randomized controlled trials (RCTs) using integrative body-mind training (IBMT) [6,8,39,42], effortless training is often accompanied by enhanced parasympathetic activity indexed by lower heart rate and skin-conductance response (SCR), greater belly respiratory amplitude, or/and high-frequency heart-rate variability (HRV). Similarly, nature exposure, a form of effortless training or experience, is associated with increasing parasympathetic regulation that supports reduced stress and anxiety, improved attention restoration, and cognitive function [36,[43][44][45]. Moreover, flow experience is also related to greater parasympathetic activity such as greater high-frequency HRV [34,46]. ...
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For the past 50 years, cognitive scientists have assumed that training attention and self-control must be effortful. However, growing evidence suggests promising effects of effortless training approaches such as nature exposure, flow experience, and effortless practice on attention and self-control. This opinion article focuses on effortless training of attention and self-control. We begin by introducing our definitions of effortful and effortless training and reviewing the growing literature on these two different forms of training. We then discuss the similarities and differences in their respective behavioral outcomes and neural correlates. Finally, we propose a putative neural mechanism of effortless training. We conclude by highlighting promising directions for research, development, and application of effortless training.
[Free PDF:🌐 🌐] Every windowed room has a view, which reflects the visibility of nature and landscape and has a strong influence on the health, living satisfaction, and housing value of inhabitants. Thus, automatic accurate window view assessment is vital in examining neighborhood landscape and optimizing the social and physical settings for sustainable urban development. However, existing methods are labor-intensive, inaccurate, and non-scalable to assess window views in high-rise, high-density cities. This study aims to assess Window View Indices (WVIs) quantitatively and automatically by using a photo-realistic City Information Model (CIM). First, we define four WVIs to represent the outside (i) greenery, (ii) water-body, (iii) sky, and (iv) construction views quantitatively. Then, we propose a deep transfer learning method to estimate the WVIs for the window views captured in the CIM. Preliminary experimental tests in Wan Chai District, Hong Kong confirmed that our method was highly satisfactory (R2 > 0.95) and fast (3.08 s per view), and the WVIs were accurate (RMSE < 0.042). The proposed approach can be used in computing city-scale window views for landscape management, sustainable urban planning and design, and real estate valuation.
To increase physical activity levels in children, knowledge on how school playgrounds can be optimally designed is important. Until now, the contribution of playground variety and greening to children’s physical activity level during recess remains unclear. This study examined the associations of school playground variety and greening with energy expenditure (EE) in elementary school children in Ecuador and Belgium. Additionally, moderating effects of study site and gender were studied. Observational data were collected using SOPLAY in ten schools in East Flanders (Belgium) and Cuenca (Ecuador). Data were analysed with linear mixed-effects model analyses. Results showed that independent of study site, EE was higher in playground areas with less green elements, and a higher level of total variety. Primary surface was only associated with EE in boys, they were more active when an artificial surface was present. Implementation of loose equipment was somewhat more strongly positively associated with EE in Ecuadorian than in Belgian children. Because of the well-known restorative effects of green elements, we do not wish to suggest that less greening should be implemented at schools. However, ideally green spaces should be designed in a way that active play is stimulated by combining green elements with other improvements.
Background Telomeres are vulnerable to various environmental exposures and lifestyle factors, encompassed in the exposome. Recent research shows that telomere length is substantially determined early in life and that exposures in childhood may have important consequences in setting later life telomere length. Objectives We explore in a child population the associations of 17 exposures with telomere length and longitudinal telomere change. Methods Children (2.8–10.3y at baseline, 51.3% boys) were followed-up for five to seven years. Relative telomere length was measured at baseline and follow-up using quantitative real-time PCR. Exposures and lifestyle factors included: body composition (body mass index and waist circumference), dietary habits (sugar- and fat-rich food intake, vegetables and fruit intake), psychosocial stress (events, emotions, behaviour), sleep duration, physical activity, and residential environmental quality (longterm black carbon, particulate matter exposure, and residential green space). Cross-sectional (n = 182) and longitudinal (n = 150) analyses were assessed using linear regression models, adjusting for age, sex, socioeconomic status and multiple testing. Results Our longitudinal analyses showed that higher residential green space at baseline was associated with (β = 0.261, p = 0.002) lower telomere attrition and that children with a higher waist circumference at baseline showed a higher telomere attrition (β = −0.287, p = 0.001). These two predictors were confirmed via LASSO variable selection and correction for multiple testing. In addition, children with more unhealthy exposures at baseline had a significantly higher telomere attrition over the follow-up period compared to children with more healthy exposures (β = −0.200, p = 0.017). Discussion Waist circumference and residential green space were identified as predictors associated with telomere attrition in childhood. These results further support the advantages of a healthy lifestyle from early age onwards and the importance of a green environment to promote molecular longevity from childhood onwards.
For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.
Background Community-based research inclusive of self-assessment and objective environmental metrics can be enhanced by the collection of biomarker data in unity toward assessing the health impacts of the totality of environmental stress driven by structural racism. Cortisol dynamic range (CDR), a measure of chronic stress burden, may underpin place-based connections to health, but a gap remains in elucidating community-based CDR methodology. Purpose To 1) assess the feasibility of cortisol collection and CDR measurement in a community-based study with home-based, participant-directed specimen collection, and 2) explore the association between CDR and other individual and environmental measures in a sample of predominantly Black participants. Methods: In this cross-sectional, observational study in predominantly Black urban neighborhoods, participants (n = 73) completed health assessments and in-home, self-collected salivary cortisol. For feasibility, CDR (peak-nadir) was compared to cortisol awakening response (CAR) slope over time. Comparisons of CDR quartile by person and place variables were explored (ANOVA). Results The cohort (77% Black, 39.7% <$15 k/year income, high perceived stress) completed 98.6% of cortisol collection timepoints. CDR was calculated in all participants without interruptions to sleep-wake cycle as seen with CAR collection. Participants in the lowest quartile of CDR were the oldest (p = 0.03) with lowest reported mental health (p = 0.048) with no associations seen for CAR. Conclusion Participant-collected CDR is more feasible than cortisol measures dependent on slopes over time in a community-based, predominately Black cohort with exploratory findings supporting relevance to outcomes of interest to future work. Future community-based studies should integrate CDR with environment and psychosocial measures.
The wellbeing benefits of engaging in a nature-based programme, delivered by the Voluntary, Community and Social Enterprise sector, were examined in this study. Prior to attending The Conservation Volunteers’ Green Gym™, attendees (n = 892) completed demographics, health characteristics and the Warwick Edinburgh Mental Wellbeing Short-Form Scale. Attendees (n = 253, 28.4%) provided a measure on average 4.5 months later. There were significant increases in wellbeing after engaging in Green Gym, with the greatest increases in those who had the lowest starting levels of wellbeing. Wellbeing increases were sustained on average 8.5 months and 13 months later in those providing a follow up measure (n = 92, n = 40, respectively). Attendees who continued to engage in Green Gym but not provide follow up data (n = 318, 35.7%) tended to be more deprived, female and self-report a health condition. Attendees who did not continue to engage in Green Gym (n = 321, 36.0%) tended to be less deprived and younger. These findings provide evidence of the wellbeing benefits of community nature-based activities and social (‘green’) prescribing initiatives and indicate that Green Gym targets some groups most in need.
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Green space has been associated with a wide range of health benefits, including stress reduction, but much pertinent evidence has relied on self-reported health indicators or experiments in artificially controlled environmental conditions. Little research has been reported using ecologically valid objective measures with participants in their everyday, residential settings. This paper describes the results of an exploratory study (n = 25) to establish whether salivary cortisol can act as a biomarker for variation in stress levels which may be associated with varying levels of exposure to green spaces, and whether recruitment and adherence to the required, unsupervised, salivary cortisol sampling protocol within the domestic setting could be achieved in a highly deprived urban population. Self-reported measures of stress and general wellbeing were also captured, allowing exploration of relationships between cortisol, wellbeing and exposure to green space close to home. Results indicate significant relationships between self-reported stress (P < 0.01), diurnal patterns of cortisol secretion (P < 0.05), and quantity of green space in the living environment. Regression analysis indicates percentage of green space in the living environment is a significant (P < 0.05) and independent predictor of the circadian cortisol cycle, in addition to self-reported physical activity (P < 0.02). Results also show that compliance with the study protocol was good. We conclude that salivary cortisol measurement offers considerable potential for exploring relationships between wellbeing and green space and discuss how this ecologically valid methodology can be developed to confirm and extend findings in deprived city areas to illuminate why provision of green space close to home might enhance health.
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Cortisol levels may be altered in childhood in association with maltreatment (neglect, abuse and witnessing abuse) and other adversities, yet little is known about whether effects on cortisol persist into later life. To establish whether childhood psychosocial adversities predict cortisol levels in mid-adulthood. Childhood psychosocial adversities were ascertained in the 1958 British birth cohort and cortisol was measured in two saliva samples, one 45 min after awaking (T(1)) and the other 3 h later the same day (T(2)), from 6524 participants aged 45 years. No association was seen for abuse or household dysfunction in childhood and adult cortisol levels. In women but not men, T(1) cortisol was lowered by 7.9% per unit increase in childhood neglect score (range 0-3); T(1) to T(2) cortisol decline was less steep. High levels of maltreatment (abuse, neglect, witnessed abuse) were associated with >25% lower T(1) cortisol in both men and women, and 24% higher T(2) cortisol for men after adjustment for concurrent depressive/anxiety symptoms. In a non-clinical population, cumulative maltreatments in childhood were associated with flattened morning cortisol secretion in mid-adult life.
This chapter is structured around a conceptual framework based on a research on emotion and environment-person interactions in relation to cardiovascular function and disease. It summarizes what is known about gender differences in the cardiovascular effects of specific behavioral stresses presumed to elicit emotional states. The chapter also describes gender differences in basal cardiovascular function and the effects of conditions that activate the sympathetic nervous system, including personality and social factors. There is discussion on the role of emotional experience in cardiovascular disease and survey on the putative roles of anger and hostility, depression, hopelessness, and anxiety in hypertension as well as CVD. The chapter also discusses the gender differences in the role of macro-environmental factors such as social class, employment, job strain, and social support in CVD pathogenesis and progression. Complex interactions and social systems of humans are seen to provide the conditions for eliciting or avoiding the experiential and physiologic components of emotional mechanisms that can mediate cardiovascular disease.
This paper explores who uses woodlands near their homes, why they visit, what benefits they believe they obtain and what makes the difference between them choosing to visit or not. In the research, supported by the Forestry Commission, a multi-method, user-led approach was used, based on focus groups, questionnaire surveys and on-site observation in relation to five different communities in the central belt of Scotland. The conclusions demonstrate the overriding importance of childhood woodland visits as predictors of adult patterns of use. Proximity of woodlands is important for regular woodland users and freedom from rubbish is the physical quality people care most about. The physical qualities that make a difference as to whether people visit woodlands or not include directional signs, good information boards, variety of trees and tidiness of appearance. Perceptions of woodlands differ according to age and sex but are predominantly positive across all groups sampled: most people feel at peace in a woodland.
We compared psychophysiological stress recovery and directed attention restoration in natural and urban field settings using repeated measures of ambulatory blood pressure, emotion, and attention collected from 112 randomly assigned young adults. To vary restoration needs, we had half of the subjects begin the environmental treatment directly after driving to the field site. The other half completed attentionally demanding tasks just before the treatment. After the drive or the tasks, sitting in a room with tree views promoted more rapid decline in diastolic blood pressure than sitting in a viewless room. Subsequently walking in a nature reserve initially fostered blood pressure change that indicated greater stress reduction than afforded by walking in the urban surroundings. Performance on an attentional test improved slightly from the pretest to the midpoint of the walk in the nature reserve, while it declined in the urban setting. This opened a performance gap that persisted after the walk. Positive affect increased and anger decreased in the nature reserve by the end of the walk; the opposite pattern emerged in the urban environment. The task manipulation affected emotional self-reports. We discuss implications of the results for theories about restorative environments and environmental health promotion measures.
There is compelling evidence for feedback disturbances in the hypothalamus-pituitary-adrenal system associated with human aging as assessed by challenge tests. However, reports about age-related changes in human basal activity are ambiguous and to date little is known about changes in the pulsatile features of the HPA system. To investigate these changes we studied twenty-two healthy male and eleven healthy female subjects ranging from 23 to 85 and 24 to 81 years respectively. 24-hour blood sampling with 30 minute sampling intervals was performed. From 18.00 to 24.00 hours blood was sampled every 10 minutes for analysis of pulsatile features of HPA activity. Statistical analysis revealed that age in particular had major effects upon basal HPA-system activity: there was a significant age-associated increase in minimal (p < 0.0001) and mean (p < 0.0002) cortisol plasma concentrations, but no alteration in pulsatile features. We found no age-cortisol correlation during daytime, but were able to demonstrate a strong impact of age upon cortisol plasma levels from 20.00 to 1.30 hours. The diurnal amplitude of cortisol (p < 0.0005) and ACTH (p < 0.0006), relative to the 24-hour mean of the hormones, showed an age-associated decline. Additionally, the evening cortisol quiescent period (p < 0.0001) was shortened in the elderly, suggesting increasingly impaired circadian function in aging. Our results suggest an increased basal activity and a flattened diurnal amplitude of the HPA system in the elderly.