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124 P H R / 2011 S 1 / V 126
Healthy Workplaces: The Effects
of Nature Contact at Work
on Employee Stress and Health
E L-W, PDa
W. W C, PD, CHESb
V D, PD, MPHb
R W, PD, MPHb
aUniversity of North Florida, Brooks College of Health, Department of Public Health, Jacksonville, FL
bUniversity of Florida, College of Health and Human Performance, Department of Health Education and Behavior, Gainesville, FL
Address correspondence to: Erin Largo-Wight, PhD, University of North Florida, Brooks College of Health, Department of Public Health,
1 UNF Drive, Jacksonville, FL 32224; tel. 904-620-2037; fax 904-620-1035; e-mail <firstname.lastname@example.org>.
©2011 Association of Schools of Public Health
Objectives. Cultivating healthy workplaces is a critical aspect of comprehensive
worksite health promotion. The inﬂuence of healthy workplace exposures on
employee health outcomes warrants research attention. To date, it is unknown
if nature contact in the workplace is related to employee stress and health. This
study was designed to examine the effects of nature contact experienced at
work on employee stress and health.
Methods. Ofﬁce staff at a southeastern university (n5503, 30% response
rate) participated in the cross-sectional study. We used a 16-item workplace
environment questionnaire, the Nature Contact Questionnaire, to comprehen-
sively measure, for the ﬁrst time, nature contact at work. The Perceived Stress
Questionnaire and 13 established health and behavioral items assessed the
dependent variables, general perceived stress, stress-related health behaviors,
and stress-related health outcomes.
Results. There was a signiﬁcant, negative association between nature contact
and stress and nature contact and general health complaints. The results
indicate that as workday nature contact increased, perceived stress and gener-
alized health complaints decreased.
Conclusions. The ﬁndings suggest that nature contact is a healthy workplace
exposure. Increasing nature contact at work may offer a simple population-
based approach to enhance workplace health promotion efforts. Future
researchers should test the efﬁcacy of nature-contact workplace stress
E N C E S H 125
P H R / 2011 S 1 / V 126
The work environment contributes to employee health.
A sick environment can threaten health through
biological and psychological pathways. Biologically,
indoor air pollutants and toxins may cause illness,
such as the Sick Building Syndrome.1 Psychologically,
ofce environments typied with crowding and noise
contribute to chronic stress.2,3 Conversely, ofce envi-
ronments can be created to enhance employee health.
Healthy exposures include the following: availability of
healthy behavioral options (e.g., healthy food choices),
enhanced and optimized safety, environmental sustain-
ability and stewardship, and the opportunity for nature
contact at work.4–8 The healthy workplace consists of
these healthful exposures and is free of the negative
Effective, comprehensive worksite health promo-
tion programs (WHPPs) aim to foster a healthy work-
place. It is now widely believed that worksite health
promotion should go beyond education and focus on
individual behavior change and also include environ-
mental modications. Environmental modications
are physical changes or interventions to the workplace
environment. Engbers et al. conducted a systematic
review of 13 randomized controlled trials (RCTs) with
environmental interventions at work entitled “Work-
site Health Promotion Programs with Environmental
Changes.”4 The Working Healthy Project, for example,
was a study of more than 2,000 employees that showed
how environmental modications, such as food label-
ing on vending machines and at restaurants and a
red-line route to promote lunchtime walking, resulted
in a signicant increase in fruit and vegetable con-
sumption and physical activity at 2.5 years follow-up.9
Environmental modications are especially important
components of WHPPs because they support and
enable health and behavioral outcomes.
One way that the workplace may be modied to
promote health is through the purposeful use of
nature contact.10 Nature contact is a component of all
healthy places and the focus of this workplace study.
Everyday nature contact is exposure to the outdoors or
outdoor-like elements in the places people live, work,
and play.5 At work, nature contact may be achieved by
adding an indoor ofce plant or taking a work break
outdoors. To date, a handful of workplace studies have
suggested that nature contact experienced at work
or in an ofce setting may be health promoting. For
example, previous work or ofce ndings suggest that
relaxing outdoors,11 indoor ofce plants,12 and ofce
window views7 were related to less stress. Although
these ndings support the notion that nature contact
is a component of a healthy workplace, studies are
few and limited.
There are important nature-contact and health nd-
ings in other populations and other settings. These
ndings, although not directly related to work, may
inform future worksite studies and practice. These nd-
ings help point to possible forms of nature contact that
may represent healthy exposures at work and warrant
future research. For example, a nature-contact inter-
vention of gardening reduced stress in a study of breast
cancer patients.13 Other less active forms of outdoor
exposure, such as spending passive time in an urban
park, have also been associated with less stress among
random samples of city dwellers.14 Indoor exposure to
plants, natural lighting, sh tanks, and a view from the
window have been previously associated with less stress
among many populations.15–19 In addition, exposure to
abstract representations of nature experienced indoors,
such as recorded nature sounds or photographed
images, has been associated with decreased stress and
stress-related outcomes.20 A study demonstrated that a
“nature therapy” intervention consisting of two forms of
nature contact—a nature mural printed on a hospital
bedside curtain and a nature CD playing—resulted
in signicantly less perceived pain and stress during
a bronchoscopy procedure.21 In summary, these stud-
ies suggest that the following forms of nature contact
were health-promoting among a variety of populations
and settings: window view, natural light, sh tanks,
live or articial plants, listening to recorded nature
sounds on a CD, nature photography or art, and out-
door breaks or lunch.5 These nature-contact ndings
may inform future work studies by pointing to these
forms of nature contact that may be healthful in the
workplace as well.
The theoretical question “How does nature contact
promote health?” has previously been explored. In
a nutshell, nature contact reduces stress. Biological
researchers point to an evolutionary explanation for
this phenomenon. The biophilia hypothesis contends
that natural elements are calming for people today
because of the linkage to survival in the past (just as
common fears—such as snakes, spiders, and heights—
are rooted in the past and related to survival):22,23
“Throughout human existence, human biology has
been embedded in the natural environment. Those
who could smell the water, nd the plants, follow the
animals, and recognize the safe havens must have
enjoyed survival advantages.”23 Psychological research-
ers have studied the brain and stress response after
exposure to nature contact. This work has led to two
potential mechanisms to explain how natural ele-
ments reduce stress in people today. Environments
with natural elements either (1) restore stress-fatigued
cognitive resources to enhance coping abilities24 or (2)
126 R A
P H R / 2011 S 1 / V 126
stimulate underutilized portions of the “old” brain,
which balance the concentrated stimulation and relieve
exhausted portions of the brain25 to reduce stress.
Stress-reducing work environments represent an impor-
tant focus of research and practice. Stress not only inu-
ences mental health and quality of life, it also increases
the likelihood of chronic diseases, such as heart disease
and cancer.26–28 Stress and related health consequences
are more prevalent in the U.S. today than in the past,
and work is attributed as a major cause.29 According
to the demand-control model and previous ndings,
occupational positions with low decision latitude and
high psychological demands, such as ofce staff, suffer
most from stress.30,31 In addition to having high-stress
jobs, ofce staff are a priority public health population
because they represent 70% of the U.S. workforce.32
In this study, we examine workplace environments and
stress among ofce staff.
This study was designed to (1) describe the inu-
ence of nature contact at work on perceived stress and
stress-related health and behavioral outcomes and (2)
inform public health promotion. Although there is
evidence that nature contact is health-promoting in
many populations and varied settings, there are few
ndings on nature contact at work and health among
ofce staff, a priority public health population.7 To
date, it is unknown if regular contact with nature in
the workplace is associated with perceived stress levels
of ofce staff. Understanding and designing healthy
workplaces is important and offers a promising and
population-based approach to reduce stress and related
health outcomes among working Americans.5,7
We invited a census of ofce staff at a southeastern
university (n51,622) to participate in the study. The
group included 13 job codes of full-time, mostly desk-
bound ofce staff, such as secretaries and ofce clerks.
Electronic informed consent was obtained from all par-
ticipants; participation was anonymous and voluntary.
We used a cross-sectional, Web-based survey design to
collect data. We sent an e-mail invitation along with
the Web link to access the online survey to the census.
The participants took approximately 10–15 minutes to
complete the online survey. We utilized a Web-based
survey because it was cost-efcient, environmentally
sound, practical, and had the potential to reach the
study’s population.33 Five previously identied strate-
gies34 were used to minimize potential disadvantages
of Web-based surveys, such as non-response error and
low response rate: (1) e-mails were personalized by
addressing each participant by name; (2) informed
consent to participate in the study was obtained by
clicking “next” on the online survey; (3) personal
questions about income, age, and marital status were
located at the end of the survey; (4) two follow-up,
reminder e-mails were sent three and ve days after
the initial e-mail invitation to ofce staff who had not
yet participated; and (5) participants in the study were
eligible for a nominal incentive.
We measured nature contact at work using a 16-item
scale, the Nature Contact Questionnaire (NCQ). We
measured total score and three subscales—outdoor,
indoor, and indirect nature contact. The outdoor-na-
ture-contact subscale measured the employees’ outdoor
exposure at work—for example, “the weekly frequency
of work breaks outdoors.” The indoor-nature-contact
subscale measured employees’ exposure to natural
elements within the ofce space, such as view from a
window, natural light, and live plants. An example was
“the number of live plants in the ofce.” The indirect-
nature-contact subscale measured employees’ exposure
to abstract representations of natural elements in the
ofce, such as photographs of natural landscapes and
recorded nature sounds. An example was “percentage
of time per week listening to recorded nature sounds
on CD.” The range of possible total scores was 16
to 96. We used a continuous Likert scale to quantify
the response options and included percentage of
time exposed to the item (0%, 1%–20%, 21%–40%,
41%–60%, 61%–80%, and 81%–100%), frequency of
contact with the item (N/A, 0, 1, 2, 3, 4, and 5 or more),
and number of contact items (0, 1, 2, 3, 4, and 5 or
more). We established content validity (expert panel),
construct validity (Kaiser-Meyer-Olkin 5 0.68), internal
consistency (alpha 5 0.63), and test-retest reliability
(r50.84). The NCQ and psychometric properties were
reported in detail elsewhere.35
We measured stress using the Perceived Stress Ques-
tionnaire (PSQ). The PSQ consists of 30 items, such
as “you have too many things to do,” “you feel lonely
or isolated,” and “you nd yourself in situations of
conict.” The range of possible total scores was 30 to
120. The reported test-retest reliability of the PSQ was
r50.82 and the internal reliability was alpha 5 0.92.
The PSQ psychometric properties also were reported
in detail elsewhere.36
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P H R / 2011 S 1 / V 126
We measured health and health behaviors using 13
items drawn from the Behavioral Risk Factor Surveil-
lance System (BRFSS),37 National Quality Institute,38
Centers for Disease Control and Prevention,39 and
previous studies.40,41 We measured self-reported health,
the number of days in the past month inuenced by
poor health, and behavioral items—including ciga-
rette smoking and preventive behaviors—using BRFSS
historical questions.37 Alcohol and coffee consump-
tion were measured with items similar to the BRFSS
historical questions but modied based on previous
research.40 We measured frequency of moderate and
vigorous physical activity using items from a national
healthy workplace questionnaire.38 Lastly, we measured
diet with two items related to fruit and vegetable con-
sumption based on previous research41 and dened a
serving using governmental guidelines from the 5 A
Day for Better Health Program.39
We used SPSS® version 1642 to analyze the data. All sur-
vey responses were numerically coded, and totals and
subtotals were calculated for both survey instruments
(PSQ and NCQ). We used multiple regression analysis
to determine which of the health and behavioral items
were stress related. To explore the relationship between
nature contact and health and the relationships among
forms of nature contact, we conducted bivariate cor-
relation analyses and independent t-test analyses.
The majority of the participants were women (92.9%)
and white (82.5%). The mean age of the participants
was 42 years, with a standard deviation of 12 years.
Approximately half of the participants attended some
college or technical school (47.5%), reported earn-
ing $25,001–$35,000 per year (49.5%), and reported
being married (54.4%). The response rate was about
Nature contact at work and employee health
First, we determined which of the health and behav-
ioral survey items were stress related. To determine
the stress-related variables, we employed a multiple
regression analysis with the PSQ stress total as the
dependent variable and the 13 health and behavior
survey items as independent variables. Data analysis
revealed that “general health” self-rating (poor to
excellent) and “number of days in the past 30 days
that health prevented from doing usual activities” were
signicant predictors of stress and, thus, represented
the stress-related variables in this study. None of the
health behavior items, such as smoking and physical
activity, was a statistically signicant predictor of stress.
As a result, we included the PSQ stress total and the two
stress-related health variables as dependent variables
in remaining analyses.
We used Pearson product bivariate correlations
to examine the relationship between nature contact
at work and the three study variables (stress, general
health, and number of days health prevented activi-
ties). Higher nature-contact scores represented more
nature contact at work, and lower perceived stress and
health scores represented less stress and fewer health
concerns (Table 1). The correlations were interpreted
based on the strength of the association.
We conducted t-test analyses to further examine
the patterns of association between nature contact
and health. High and low nature-contact scores were
dummy-coded as 1 and 2, respectively. The high-
nature-contact group was one standard deviation above
the mean and the low-nature-contact group was one
standard deviation below the mean. We ran analyses
to compare the highest and lowest nature-contact
groups. The high-total-nature-contact group and the
high-outdoor-nature-contact group had signicantly
less stress and better general health than the related
low groups. There was no statistically signicant dif-
ference between high and low nature contact for the
number of days one missed normal activities over the
last month for any measure of nature contact. Table 2
Table 1. Relationships between nature contact at
work and stress, general health, and number of days
health prevented activities among ofﬁce staff
Independent variables Dependent variables r
Nature contact total Stress total 20.14a
General health 20.14a
Days health poor 0.01
Outdoor nature contact
Days health poor 0.04
Indoor nature contact
Days health poor 20.03
Indirect nature contact
Days health poor 20.01
128 R A
P H R / 2011 S 1 / V 126
provides a summary of the inuence of high vs. low
nature contact on total stress score.
The purpose of this study was to examine the inuence
of nature contact at work on stress and health among
ofce staff, a priority public health population that
has not been well studied.11 The ndings from this
study were consistent with previous ndings in other
settings and the primary theoretical explanations.5,24–25
Employees with more nature contact at work reported
signicantly less perceived stress and stress-related
health complaints. These ndings suggest that nature
contact at work may constitute a healthy workplace
It is important to understand healthy workplace
exposures. It is now widely believed that cultivating
healthy workplaces is an important component of
comprehensive WHPPs.4 This study’s main ndings
suggest that nature contact at work, as in other settings,
is associated with stress reduction among employees.
These ndings, in the context of the larger body of
literature, suggest that the purposeful use of nature
contact at work may reduce employee stress.5 Creating,
enhancing, or promoting the use of outdoor break
areas, for example, may be one way for health promo-
tion practitioners to cultivate a healthy workplace with
nature-contact exposures.10 Future research should
build off of these cross-sectional ndings and assess if
environmental (nature-contact) interventions at work
result in stress reduction among employees.
Although the effect size was small to moderate, the
ndings were statistically signicant and important. The
ndings are particularly important because increasing
nature-contact exposure at work may be an inexpensive
and practical way to enhance worksite health promo-
Table 2. Relationships between perceived stress and high vs. low nature contact at work among ofﬁce staff
Independent variables NM SD t-score
Low nature contact—total 41 67.3 16.2 2.1a
High nature contact—total 60 60.5 16.2
Low nature contact—outdoor subscale 85 68.0 17.8 3.1b
High nature contact—outdoor subscale 58 59.2 15.7
Low nature contact—indoor subscale 131 65.4 16.1 0.8
High nature contact—indoor subscale 52 63.1 17.1
Low nature contact—indirect subscale 84 66.1 16.5 2.1a
High nature contact—indirect subscale 46 60.1 16.6
M 5 mean
SD 5 standard deviation
tion efforts. In contrast to other factors that inuence
perceived stress, such as social support, job demands,
and relaxation skills,28 enhancing nature contact at
work is a relatively simple approach. Adding indoor
plants, opening blinds, or going outside for a work
break instead of to the break room, for example, are
straightforward ways to increase healthy exposures at
work to combat stress and promote health. Enhancing
coping or social support, on the other hand, likely
involves more time, effort, and resources. Maller et al.
and others recognized that “contact with nature may
provide an effective population-wide strategy.”43
These ndings are also important because this
was the rst known study to measure nature contact
comprehensively at work or in any setting. Other
studies have examined the inuence of one form of
nature contact (e.g., the number of indoor plants) on
stress or health. Researchers have previously pointed
to three forms of nature contact important for child
development that were similar to the forms measured
and analyzed in this study,44 but this is the rst known
study to measure all known health-promoting forms
of nature contact. The ndings from this study also
allowed the rst-ever quantitative comparisons between
forms of nature contact. Kuo emphasized the need to
study nature contact comprehensively to determine
“which forms or doses of nature enhance effectiveness
and which do not.”45
In this study, ndings suggest that the forms of
nature contact may matter. The most direct nature
contact—outdoor nature contact—had the strongest
association with stress reduction and health. The
frequency of employees’ outdoor exposure at work
had the strongest negative correlation to stress and
health complaints, whereas the least direct form of
nature contact—indirect nature contact—resulted
in the least health benets. Employees’ exposure to
E N C E S H 129
P H R / 2011 S 1 / V 126
nature photography or nature sounds in the ofce,
for example, had the weakest negative correlation to
stress and health complaints. These novel ndings will
help health promotion practitioners begin to prioritize
efforts. These ndings are important for shaping work-
place stress interventions and may suggest that taking
an outdoor “booster break,”46 for example, would be
more important than displaying nature photography
or a live plant in the ofce. Future research should
build off of these cross-sectional ndings and compare
environmental (nature-contact) interventions at work
to best inform practice.
Although the ndings from our study and other studies
suggest that nature contact may be helpful to reduce
employee stress, future research should be conducted.
An important limitation of our study was that partici-
pants consisted of ofce staff from one university. This
limits generalizability to larger populations. Future
research should examine other working populations.
Another limitation of our study was the lack of
causal relationships. Like all cross-sectional studies,
the ndings from this study cannot infer causation.
Nature contact did not cause stress reduction in this
study. Future studies should examine the efcacy of
workplace nature-contact interventions, such as the
outdoor booster break, on employee stress among vary-
ing populations of employees. Intervention research
could also be employed to better compare the forms
(outdoor, indoor, and indirect) of nature contact on
stress. Ideally, future intervention research should
employ a RCT design in an applied workplace setting
with several follow-ups to best inform recommenda-
tions for practice.
Creating environments with natural elements to reduce
stress is both intuitive and scientic. Ofce windows,
vacation destinations, and real-estate costs worldwide
suggest that people everywhere value nature contact
(and will pay more for it).5,17,47–50 This phenomenon
has also been well studied. The main theoretical per-
spectives suggest that natural elements are calming
for people today because of the linkage to survival in
A recent review entitled “Cultivating Healthy Places
and Communities: Evidenced-Based Nature Contact
Recommendations”10 summarized the nature-contact
literature as it related to human health. The article
points to 12 research-based health promotion recom-
mendations, with the assumption that “environments
can be protected, created, recongured, or regulated
to prevent, eliminate, or mitigate [stress].”51 The rec-
ommendations include the following: advocate for the
preservation of pristine wilderness; incorporate wooded
parks/green space in community design; maintain
healing gardens; cultivate and landscape grounds for
outdoor viewing; welcome animals inside; provide a
plethora of indoor potted plants within view; light
rooms with bright, natural sunlight; provide a clear
view of nature outside; allow outside air and sounds
in; display nature photography and realistic nature art;
watch nature on TV or videos; and listen to recorded
Our study’s ndings support the notion that many
of these recommendations may also apply to the
workplace environment. These ndings, together
with the previous studies and the evidenced-based
recommendations, suggest that nature contact may
be fostered through environmental modications to
reduce employee stress. The concept of “wellness by
design”15 in the workplace may be achieved, in part,
through the purposeful use of nature contact.
This study was supported by the Society for Public Health Educa-
tion (SOPHE)/Agency for Toxic Substances and Disease Registry
(ATSDR) student fellowship in environmental health promotion.
The contents of this article are solely the responsibility of the
authors and do not necessarily represent the ofcial views of
SOPHE or ATSDR.
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