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To investigate the strength of the relation between the amount of green space in people's living environment and their perceived general health. This relation is analysed for different age and socioeconomic groups. Furthermore, it is analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. The study includes 250 782 people registered with 104 general practices who filled in a self administered form on sociodemographic background and perceived general health. The percentage of green space (urban green space, agricultural space, natural green space) within a one kilometre and three kilometre radius around the postal code coordinates was calculated for each household. Multilevel logistic regression analyses were performed at three levels-that is, individual level, family level, and practice level-controlled for sociodemographic characteristics. The percentage of green space inside a one kilometre and a three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity. The overall relation is somewhat stronger for lower socioeconomic groups. Elderly, youth, and secondary educated people in large cities seem to benefit more from presence of green areas in their living environment than other groups in large cities. This research shows that the percentage of green space in people's living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.
Green space, urbanity, and health: how strong is the
Jolanda Maas
J Maas*, RA Verheij, S Vries de, P Spreeuwenberg, PP Groenewegen
NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Neth-
*Contact details:
Many European cities have experienced a recent decline in the
quality and quantity of green space. Economic considerations
often prevail in spatial planning at the expense of green space.
However, we do not know much about the possible health
consequences of this development.
The aim of the present study is to investigate the strength of
the relationship between the amount of green space in people’s
living environment and the perceived general health. This rela-
tionship is analysed for urban and more rural areas separately,
because it was expected that the strength of this relationship
would vary according to urbanity.
The study includes a representative sample of 274 000 individu-
als aged 24 or older who filled in a one page self-administered
form on socio-demographic background and perceived general
health. For each individual, the percentage of green space (urban
green space, agricultural space, and real nature) in a 1 and 3 km
radius was calculated. Subjective health was dichotomised
with ‘less than good’ as the cut-off point. Multilevel logistic
regression analyses were performed, controlling for socio-
demographic characteristics.
The percentage of green space in a 1 and 3 km radius had a
significant positive effect on perceived general health. The
effects are equally strong for 1 and 3 km radius. The effect
was generally present in all degrees of urbanity, not only in
the most urban areas. The strongest effect was found for the
percentage of agricultural space. The percentage of built-up
space negatively affects people’s health in generally all degrees
of urbanity.
This research shows that the amount of green space in the living
environment has a positive effect on people’s health. Green
space appears to be more than a luxury good. Therefore, the
development of green space should get a more central position
in planning policy. Healthy planning should include a place for
green space.
Track 4: Workshop: Linking health promotion and
health care
Chairpersons: Alf Trojan, Heiko Waller*
Organiser: EUPHA Section on Health Promotion
*Contact details:
The topic of the workshop is related to the main topic of
the conference: the workshop aims to present and discuss dif-
ferent aspects of the link between health promotion and health
care: health promotion within health care institutions, health
promotion related to people with chronic diseases and disabil-
ities, health promotion related to health professionals and fin-
ancing of health promotion. This broad range of aspects will be
presented by colleagues from five different European countries.
Delivery at a WHO-/UNICEF-certified baby-friendly
hospital: effects on breastfeeding duration
and support seeking behaviour—the
Annette Seibt
A Seibt, C Deneke
School of Life Sciences, University of Applied Sciences, Hamburg, Germany and
Institute of Health Sciences (InGe), Hamburg, Germany
In comparison to other European mothers, German mothers
nurse their newborns less and shorter than the WHO recom-
mends. Since most women deliver in hospitals, the hospital
setting might have a potentially high influence on breastfeeding
attitudes and behaviours.
The certification ‘Baby-Friendly Hospital’ is a distinct award
on the basis of pre-defined WHO- and UNICEF-criteria. It
honors the institution for its quality of promoting breastfeeding
and its support of new mothers during their hospital stay. Since
the certification is to be renewed every 5 years, hospitals are
motivated to both prove and improve their support practices.
The study evaluates the quality of an already certified baby-
friendly hospital in Hamburg, Germany. 500 mothers, who
have given birth in this hospital between February and June
2005, are interviewed 3 months after delivery. The new mothers
are asked about their child feeding habits and the kind of
support they were able to get for coping with difficulties.
Data on the prevalence of breastfeeding, the attitudes towards
and the self-efficacy with breastfeeding are collected. Addition-
ally, the mothers’ perceptions of the actual helpfulness of com-
munity support services and personal support networks are
Results will be used to give feedback to the hospital about
its quality in informing and supporting the women during this
phase; of interest is, also, what kind of community services and
personal support systems are invoked after discharge from the
The retrospective study is conducted in cooperation with the
baby-friendly hospital Klinikum Nord/Heidberg, the Institute
of Health Sciences (InGe) and the Faculty of Life Sciences at
the University of Applied Sciences, all located in Hamburg,
Germany. The study will provide new data on the prevalence
of breastfeeding and the effects of the WHO-/UNICEF-
campaign ‘Baby-Friendly Hospital’.
Oral health promotion and dental health
care among children with disabilities
in Belgrade
Irena Dzeletovic- Milosevic
I Dzeletovic-Milosevic
Institute for Public Health Belgrade, Serbia and Montenegro
Oral health promotion and dental health care has to be in close
The purpose of the study is to present oral health promotion
among schoolchildren with disabilities in Belgrade and dental
health care provided for them.
It is a social medicine evaluation study cross-sectional type,
based on routine statistical reports analyzed by statistical
routine methods. Indicator used in the study is average DMF
at 12-year-old pupils with special needs.
14 European Journal of Public Health, Vol. 15, Supplement 1, 2005
All children with disabilities registered in Belgrade’s primary
schools for children with special needs in the year 2004.
In Belgrade there are few schools for children with disabilities.
Average DMF for children with special needs in the year 2004 was
3.50 comparing with average DMF among other school children
in Belgrade being 2.77. The number of paediatric dentists—
providers of oral health care to those children—is more deficient
than in other European countries. There are no specially
educated paediatric dentists for children with disabilities in
primary health care. The standard would be 1:800 children.
The oral health status among children with disabilities is in poor
state. According to the previous results it is considered that the
National Preventive Dental Health Program (NPDHP) had not
integrated the children with disabilities as equal part of society
and the promotion of oral health among these children was
neglected such as dental health care for them.
Measures suggestions
The children with disabilities have to be covered by all measures
and activities of NPDHP even more than the others. Oral health
promotion and total accomplishment of dental health care in
Belgrade is closely linked.
Osteoporosis—The ‘silent thief’—a major public
health issue
Laura Andronache
L Andronache
University Hospital Bucharest, Romania
Osteoporosis is responsible for >1.5 million fractures annually,
including 300 000 hip fractures, 700 000 vertebral fractures,
250 000 wrist fractures, and >300 000 fractures at other sites. In
the presence of osteoporosis, fractures can occur from normal
lifting and bending, as well as from falls. Furthermore, osteo-
porotic fractures, particularly vertebral ones, can be associated
with disabling pain. Although it is thought as an old person’s
disease, it can affect younger people who have hormonal diffi-
culties, anorexia, bleeding, or menstrual abnormalities in their
20s. Early prevention intervention can prevent devastating frac-
tures. Changing attitudes and brightening the outlook of people
with osteoporosis lead to improving the quality of life and is an
important health care goal. Because there is a lack of sufficient
evidence regarding the cost effectiveness of routine screening
or concerning the efficacy of early initiation of preventive
treatment, we decided to analyze and evaluate the efficacy of
preventing measures in osteoporosis treatment, paying atten-
tion to the correct information of the patient concerning diet,
posture weight bearing exercises (walking, the therapeutic
band), improving balance, muscle strength, agility, measures
which involve low costs and clear improvement of the health
We had the following objectives:
—expanding awareness and enhancing knowledge, under-
standing of the prevention, early detection and treatment
of osteoporosis
—improving the clinical diagnosis of this condition
—nutrition optimization
—reducing the fracture risk through education
—developing strategies for coping with all these issues.
—comprehensive education and changing the lifestyle make
people less susceptible to osteoporosis
—the balance ‘costs efficiency’ of the treatment is improved
through these measures.
Multicentric survey of smoking habits of health
professionals in Italy
Guiseppe La Torre
MG Ficarra
, R Bucci
, G La Torre
, M von Pinoci
, F Trani
, G Chiaradia
M Marchetti
, A Fiore
, F Mormile
, W Ricciardi
Institute of Hygiene, Catholic University Rome, Italy
Health Direction Teaching Hospital ‘A. Gemelli’ Rome, Italy
Respiratory Phisiopathology Unit, Catholic University Rome, Italy
In Italy the prevalence of smokers among health professionals is
high (35%), much higher than in the general adult population.
With the aim of better understanding the problem, an epidemi-
ological multicentric survey was conducted among health pro-
fessionals in Italy as concerns tobacco smoking. The study is part
of the multidisciplinary project ‘Hospitals Smoking Free’, which
foresees three phases—education, implementation of no smok-
ing directives, and initiatives for helping those wishing to quit
A pilot study was conducted in 2004 using an anonymous ques-
tionnaire involving a sample of 89 health professionals at various
hospitals in Italy. The questionnaire provides for the following
research areas: personal data; knowledge of the subject (smoke);
work environment; clinical activities for quitting smoking; and
personal smoking habits. A larger survey is foreseen in 2005,
involving at least 750 individuals.
The response rate was 79%. The prevalence of smokers was
33.3%. Knowledge on health risks attributable to smoking
differed significantly between smokers and non-smokers (P <
0.001), with an underestimation of them among smokers. As far
as concerns to attitude of the participants, 56.5% of them believe
that the lifestyle of health professionals could be considered a
model for the whole population (no significant difference
between smokers and no-smokers). Eighty percent of non-
smokers and 47.8% of smokers agree to forbid smoking in
hospitals (P < 0.01). The hospital areas where smoking is
most frequently observed are halls, dinning facilities, baths, and
The results of the survey confirm the national trend of smoking
habits among health professionals and suggest the activation of
health promotion campaign tailored to this kind of workers.
Moreover, the authors will provide updated results concerning
the larger survey.
Needs of health promotion and the ways of
financing through mutual societies in Hungary
Arpad Skrabski
A Skrabski, M Kopp
Hungarian Federation of Mutual Societies, Institute of Behavioural Sciences in
Semmelweis University, Budapest, Hungary
Constitutional right of every Hungarian citizens is ‘the highest
possible level of mental and physical health’ which is guaranteed
through compulsory (social security) and complementary
systems. After the law on ‘Voluntary Mutual Insurance Funds’
passed in 1993 the complementary system is financed by
voluntary mutual health societies (mutualite
) (VMHSs). The
members are the owners of the VHMSs, they are solidarity-
based not-for-profit organizations.
The aims of two UNDP and two Hungarian Government
projects were (i) implementation of preventive methods,
13th Annual EUPHA Meeting: Parallel Session 1, Thursday 10 November, 14:00–15:30 15
(ii) investment for health promotion, (iii) sustainability of the
results. In the framework of these projects we organised two
surveys, Hungarostudy1995 (n ¼ 12 640), Hungarostudy2002
(n ¼ 12 570), which represented the Hungarian population by
age, sex, counties, and sub-regions. Market research was exe-
cuted on the basis of the surveys, concerning the needs for health
promotion and the satisfaction with the ways of financing.
The level of highest (maximum points) trust in health financing
by social security increased from 55 to 68% during the last seven
years. The members in VMHSs increased with 50% of every year
and in 2005 there are 500 000 members. Around 50–80% of
the interviewed persons are willing to pay for one or more of
different health promotion services. There are successful pilot
projects to increase the number of health promotion services
recommended by the VMHSs to their members.
The majority of the Hungarian population is satisfied with social
security financed healthcare and by VMHSs. There are unique
roles of VMHS in financing health promotion. The member’s
‘co-operative entrepreneur’ attitude might be a good basis
of self-management, which is a health promoting factor. The
VMHS as a friendly society could be a community as provider.
VMHS can reach out to those high risk individuals who have not
turned to physicians and could strengthen the social capital of
the communities.
Track 5: Workshop: Wellness, past, present, and future
Chairperson: Eva Adamer-Ko
Organiser: James Miller
FH-Joanneum University for Applied Sciences, Department of Health
Management in Tourism, Bad Gleichenberg, Austria
Contact details:
This workshop will examine the wellness movement from a cross-
cultural perspective, tracing its roots in the US and Europe and
examining future trends connected with it. The workshop will
begin with a historical overview of the concept by James Miller,
followed by the keynote address on the future of wellness by one
of the movement’s founders, John Munson. It will close with an
examination of wellness within a European context by Kai Illing.
A historical approach to defining wellness
James Miller
J Miller
FH-Joanneum University for Applied Sciences, Department of Health
Management in Tourism, Bad Gleichenberg, Austria
Both the term and the concept of wellness have a complex past.
Some of the ideas that are packed into the term have their
origins in nineteenth-century American religious and cultural
movements. A definition focussed on active health promotion
through lifestyle change emerged in the 1950s and spawned
the wellness movement in the 1970s. The term then took on
additional meanings as a marketing tool, and it has since become
linked to certain esoteric ideas. This paper traces the develop-
ment of the concept of wellness as it moved through these
various transformations.
The paper takes a historical approach, describing the develop-
ment of the concept of wellness, based on the writings of
some of the seminal thinkers behind it. Beginning with such
nineteenth-century health gurus as Mary Baker Eddy and John
Harvey Kellogg, the paper then explores the development of
wellness in the writings of mid-twentieth-century writers and
activists such as Halbert Dunn, John Travis, Donald Ardelt, John
Munson, and Bill Hettler. The paper will conclude with
an examination of the growing esoteric aspects of the concept,
which have discredited it somewhat in some parts of the
academic community.
The very malleability of the term wellness presents the scholar
with a problem: if you do not have a precise definition of the
term, it is extremely difficult to adequately trace its origins. It is
really only possible to do so within a specific context. Therefore a
multi-contextual approach is necessary.
Wellness, as defined by academics such as Bill Hettler and John
Munson, continues to be an important concept in health pro-
motion, despite the various other ways in which it has been used.
Ultimately, the holistic approach to health that it entails should
be the guiding principle of health promotion.
Building healthy people for healthy futures through
wellness lifestyles
John Munson
J Munson
University of Wisconsin-Stevens Point, School of Health Promotion and Human
Development, United States
What will the next 10 years of wellness bring? How will we
influence the future and mould it? How will demand from
the masses for self-directed behavioural change alter the way
health educators, wellness managers, community health
agencies, and governments deliver health-improving choices
and programs? This presentation will reflect on the changes
in health care delivery services and project how wellness entre-
preneurs can lead the charge for breaking old habits and bad
choices. In the process it will provide a ‘Futurist’s Look’ at the
wellness movement.
The presentation will begin with a review of the concept of
wellness as used at the University of Wisconsin-Stevens Point,
one of the earliest and most influential centres of the wellness
movement in the United States. It will then move into predicting
what opportunities will present themselves for educators, gov-
ernment leaders, health club managers, and entrepreneurs in
the wellness movement in the next 10 years. These predictions
will be based on a series of interviews conducted with leaders in
the wellness movement in the United States, both inside and
outside of academia.
Traditionally, the medical profession has viewed medical prob-
lems as fundamentally either physical or mental in nature and
has treated them separately. Holistic medical treatments that
recognize the need to consider a person’s total environment
(Family, Work, Stress, and Play) will result in the introduction
of a whole range of programs coming out of many different
healing traditions.
Learning to mould the subtle choices that often guide individual
behaviours offers a host of possibilities for new businesses and
educational programs.
16 European Journal of Public Health, Vol. 15, Supplement 1, 2005
... Green spaces refer to those land uses that are covered with natural or man-made vegetation in the built-up areas and planning areas (Wu, 1999). The green spaces usually include community parks, woodlands, nature reserves and agricultural lands (Maas et al., 2006). With the population increase and expansion of cities, more and more open space, woodland and cultivated land have been converted into construction land due to the increasing demands for transportation land, commercial land and residential land. ...
Full-text available
Urban green spaces are open spaces in urban areas that are primarily covered by vegetation which can be public or private. This study was an attempt to dynamically map out and monitor green spaces in Pabna Municipality of Bangladesh in last 20 years. Both primary and secondary data were acquired to document the spatial–temporal dynamics of green spaces in the study area. Focus group discussion (FGD) as primary and the secondary data are collected from Landsat 5 TM images for 1997, 2007, and 2017 were used and supervised classification is used in the study. The analysis exposed that green spaces of Pabna Municipality are rapidly decrease and last twenty years about 187 ha (total area 3087. 27 ha) urban green space is lost and annually 9.36 ha. Population, urban growth rate and build up area is significant factor to lose the green spaces. For the validation of land classification, the kappa statistics is about 75% which indicate the considerable arrangement of this procedure. To promote and inspire a better relationship with the environment and sustainable planned development of a municipality, proper monitoring of the municipal green space should be ensured.
... As seen above, green spaces are important places for both individual and social health. In other words, they are important for the physical and mental renewal of individuals and society (Burgess et al., 1988;Orsega-Smith et al., 2004 as cited in Byrne & Wolch, 2009;Giles-Corti et al., 2005 as cited in Ceylan, 2007;Ulrich, 1979;Kaplan et al., 2004 as cited in Byrne & Wolch, 2009;Maas et al., 2006;Mitchell & Popham, 2007;Sugiyama et al., 2008). Consequently, green spaces have a direct effect on the sustainability and inhabitability of the city and the society. ...
Full-text available
Turkish women use cities as service areas where they practice their social gender roles. Parks are one of these service areas. This study aims to propose ways to analyze and assess green areas as public places regarding the women-friendly city concept as a way of promoting gender equality. The study claims that planning and constructing a green area is insufficient to create a public place, and the existence of a green area does not mean that it can be used. Furthermore, green areas should be approached in a context where their existence is not merely limited to their square meter ratios per person. Thus, green areas should be planned with a women-friendly perspective which meets the needs and demands of all users and with an approach that overcomes the intersectionality-blindness of planning.This study analyzes green areas based on the following three categories: accessibility, safety, and usability. The findings revealed that no parks met these criteria, especially in the densely used areas. Furthermore, problems related to all the three criteria were observed in the central area, and as people moved away from this area, issues related to accessibility and security came to the fore.
... Residential areas should feature a mix of housing types such as apartments and townhouses and should be surrounded by a broad mix of stores, parks, schools, and civic spaces. Green spaces, in particular, are vital to the health of urban residents (Maas et al. 2006, Smith et al. 2017) as they are natural and healthy spaces for community gathering and health promoting activities. By connecting these communities with diversity in transit options (i.e. ...
Full-text available
Transit-oriented developments are increasingly important as they address many modern urban environment problems such as urban sprawl, pollution, and rising rates of non-communicable diseases. However, their implementation is difficult as cities are complex systems. Urban health improvements is a labyrinthian process as enhancements in one area often leads to several unintended side effects, such as transit-induced gentrification or injustice. The Purple Line Impact on Neighborhood, Health and Transit (PLIGHT) study examines the community impact of a forthcoming light rail train line in Prince George’s County, Maryland, a predominantly Black and Hispanic community. Results show that despite mindful planning the Purple light rail train is subject to ‘Transit Orientated Development’ idealism, which can propagate transit injustices. This qualitative study highlights the disconnect between this idealism and practice. It explicitly identifies the most vulnerable of transit users and highlights how neoliberal urbanism contributes to health inequities in Transit Orientated Development practice.
... Numerous studies have demonstrated that cities with more green space can offer greater health advantages and enhance the standard of living for their citizens [4,5] . Examples include minimizing the urban heat island effect, lowering blood pressure, cortisol levels, and anxiety, and boosting emotions and self-esteem [6][7][8][9] . ...
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Urban parks play a distinctive and important role in satisfying residents’ demands on leisure and recreation, and thus have become the focus of research in the field of urban planning and sustainable development. The measurement of the equity of the spatial pattern of urban park plays an important role in optimizing the construction of urban parks. In this paper, the administrative streets of Shinan District of Qingdao City were taken as the spatial unit. Three aspects of urban park (supply quantity, landscape quality, and accessibility measures) were analyzed by the principal component analysis, two-step moving search method, and coupled coordination analysis. Results show that (1) Administrative streets have the most significant differences in accessibility measures and the least differences in landscape quality. Badaguan Street has the highest indexes in the number of urban parks supply and accessibility measures, and Zhuhai Road Street has the highest indexes in landscape quality. (2) On the whole, the coupling coordination of the spatial pattern of urban parks in Shinan District is poor, among which the coordination level of Badaguan Street is the highest and has moderately coordinated. Our results provide a valuable reference for sustainable urban design and planning.
... Following the Common International Classification of Ecosystem Services (CICES, Haines-Young and Potschin, 2018), CESs are "characteristics of elements of nature that provide opportunities for people to derive cultural goods or benefits". Nature is indeed experienced as an environment for resting and recovering from the daily stress, providing a source of relaxation and recreation, and the percentage of green space in people's living environment has shown a positive association with their wellbeing (Maas et al., 2006;Meuwese at al., 2021;Beckmann-Wübbelt et al., 2021). In recent years, Ecosystem Services (ESs) have become an essential tool for decision-making on ecological and social issues (Cheng et al., 2019); the assessment of ESs can be a support tool for urban and landscape planning and to define policy strategies aimed at improving life quality (Egoh et al., 2008;Willemen et al., 2008, Lautenbach et al., 2011Manes et al., 2016). ...
Green areas provide Cultural Ecosystem Services (CESs), that is, the ecosystem outputs that enable a range of experiential and intellectual activities. These include health promotion, recreation, enjoyment of the cultural heritage, and aesthetic experiences. The demand for CESs has grown during the first half of 2020, when most of the EU Member States had to face a stringent lockdown to contain the spread of the Covid-19, and people have undergone considerable psychophysical distress. In this framework, the Garden of Ninfa, one of the most visited Gardens of Italy, with its natural, historical, and architectural beauties delivers precious CESs, which have however been poorly studied. In this research, through a survey, we investigated the CESs delivered by the Garden of Ninfa in the immediate post-lockdown period, providing at the same time a monetary evaluation. The results show that people mostly visit the Garden of Ninfa for the aesthetic experience, followed by the resonance in terms of culture or heritage and health promotion; the combination of water bodies and fauna is highly effective in delivering CESs. The monetary evaluation, ranging between 1.0 and 2.7 Million EUR per year, may stimulate the replication of similar initiatives, especially in highly altered areas. The safety measures put in place by the governance of the Garden of Ninfa have safeguarded the tour experience from the Covid-19 fear of infection.
One of the most important political and economic challenges facing Europe and elsewhere is the ageing of societies. Must ageing populations create conflict between generations and crisis for health systems? Our answer is no. The problem is not so much demographic change as the political and policy challenge of creating fair, sustainable and effective policies for people of all ages. This book, based on a large European Observatory study, uses new evidence to challenge some of the myths surrounding ageing and its effects on economies and health systems. Cataclysmic views of population ageing are often based on stereotypes and anecdotes unsupported by evidence. How we address ageing societies is a choice. Societies can choose policies that benefit people of all ages, promoting equity both within and between generations, and political coalitions can be built to support such policies. This title is available as Open Access on Cambridge Core.
We present an overview of the evidence of how nature benefits mental health, popular theories used to explain the effects, and the development potential of these theories. A large body of evidence highlights the beneficial effects of nature on mental health, with observed outcomes ranging from alleviating the symptoms of psychiatric disorders to improvements in cognitive abilities. The theoretical backbone for these salutary effects of nature consists of a set of models, mainly the attention restoration theory (ART), the stress reduction theory (SRT), and the Biophilia hypothesis. However, these high-level models are only loosely related and lack a pronounced biopsychological basis. While biopsychological measurements have been used widely in recent years, these efforts have not sufficiently been reflected in theories aiming to explain the benefits of nature contact for mental health. This paper seeks to encourage interdisciplinary work and further theory development to guide both research and practice toward strategically green and healthy living conditions.
Background Previous studies have indicated that exposure to residential greenness may benefit the health status of pregnant women, and air pollution may exert a mediating effect. Gestational weight gain (GWG) is an important indicator of pregnant women and fetuses' health and nutrition status. However, evidence concerning the impact of residential greenness on excessive gestational weight gain (EGWG) is scarce, and to what extent air pollution in urban settings mediates this relationship remains unclear. Objective This study aims to explore the association of residential greenness with EGWG, consider the mediating effect of air pollution, and estimate the combined impact of residential greenness and air pollution exposures on EGWG. Method This population-based cross-sectional study involved 51,507 pregnant women with individual-level data on residential addresses in the Wuhan Maternal and Child Health Management Information System. Two spectral indexes, the normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI), were used to proxy residential greenness. The air pollution data included six indicators (PM2.5, PM10, SO2, CO, NO2, O3) and used the Ordinary Kriging interpolation method to estimate overall pregnancy exposure to air pollutants. Generalized linear mixed regression models were utilized to explore the relationship between residential greenness and EGWG. Restricted cubic spline (RCS) models were developed to examine the dose-response relationships. Mediation analyses explored the potential mediating role of air pollution in the residential greenness-EGWG associations. Finally, the weighted-quantile-sum (WQS) regression model was used to investigate the association between residential greenness-air pollutants co-exposure and EGWG. Result Among all participants, 26,442 had EGWG. In the adjusted model, the negative association was found significant for NDVI100-m, NDVI200-m, and NDVI500-m with EGWG. For example, each IQR increase in NDVI100-m was associated with 2.8% (95% CI: 0.6–5.0) lower odds for EGWG. The result of WQS regression showed that, when considering the six air pollutants and NDVI-100m together, both positive and negative WQS indices were significantly associated with EGWG, PM10, PM2.5, with SO2 having significant weights in the positive effect direction and CO, O3, NO2, and NDVI100-m having a negative effect. Our results also suggested that SO2, NO2, PM10, PM2.5, and CO significantly mediated the association between NDVI-100m and EGWG, and our estimates were generally robust in the sensitivity analysis. Conclusion Exposure to a higher level of residential greenness is associated with a reduced risk of EGWG, in which air pollution may exert a mediating effect. Pregnant women might benefit more in gaining healthy gestational weight when greenness levels increase from low to medium than from medium to high. Given the current cross-sectional study design, large-sale prospective cohort studies are needed to confirm our findings further.
Full-text available
We are now entering the third decade of the 21st Century, and, especially in the last years, the achievements made by scientists have been exceptional, leading to major advancements in the fast-growing field of Public Health Education and Promotion. Frontiers has organized a series of Research Topics to highlight the latest advancements in science in order to be at the forefront of science in different fields of research. This editorial initiative of particular relevance, led by Dr. Marcelo Demarzo, Associate Editor of the Public Health Education and Promotion section, is focused on new insights, novel developments, current challenges, latest discoveries, recent advances and future perspectives in the field of Public Health Education and Promotion. The Research Topic solicits brief, forward-looking contributions from the editorial board members that describe the state of the art, outlining, recent developments and major accomplishments that have been achieved and that need to occur to move the field forward. Authors are encouraged to identify the greatest challenges in the sub-disciplines, and how to address those challenges. The goal of this special edition Research Topic is to shed light on the progress made in the past decade in the Public Health Education and Promotion field and on its future challenges to provide a thorough overview of the status of the art of the Public Health Education and Promotion field. This article collection will inspire, inform and provide direction and guidance to researchers in the field.
Public housing aims to reduce social inequalities by providing affordable dwellings as a social policy. Anchored in an ecological perspective, the paper reports on a multicase photovoice study documenting public housing tenants' perceptions of how their residential environment influences their well-being. This design can provide a deeper understanding of the public housing environment to inform change at a programmatic level. To this end, 303 captioned photos were collected by 59 tenant-researchers at six sites in Québec (Canada). An in-depth cross-case analysis of the material led to two key themes with five subthemes each. In the Residential environment perceived as mostly positive theme, the subthemes were access to nature, community resources and services, positive relations among tenants, opportunities for participation, and specific aspects of their home. In the Negative aspects focused on life in public housing theme, the subthemes were strict regulations, lack of respect for tenants' needs, lack of intimacy, lack of proper maintenance, and conflicts between tenants. Findings highlight the dynamic interplay between the residential environment and public housing tenants' well-being. Two recurring programmatic issues are highlighted: problematic maintenance and limited opportunities for tenants' empowerment. Changes to address these concerns at the programmatic level of public housing could potentially increase tenants' well-being.
Full-text available
Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall.
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Urban-rural health differences are observed in many countries, even when socioeconomic and demographic characteristics are controlled for. People living in urban areas are often found to be less healthy. One of the possible causes for these differences is selective migration with respect to health or health risk factors. This hypothesis is hardly ever empirically tested. This paper tries to assess the existence of selective urban-rural migration. Health indicators and health risk factors were measured in a 1991 population sample. Moves were registered between 1991 and 1995. Using logistic regression analyses, comparisons were made between, firstly, urban to rural movers and rural to urban movers and secondly, between movers and stayers. Region surrounding the city of Eindhoven in south eastern part of the Netherlands. Data were used of 15,895 respondents aged 20-74 in 1991. By 1995 613 subjects had moved from urban to rural and 191 subjects from rural to urban. Bivariate nor multivariate analyses show hardly and differences between movers into urban and movers into rural areas. Bivariate analyses on movers and stayers show that movers are healthier than stayers. However, when socioeconomic and demographic variables are controlled for, movers appear to be less healthy, with the exception of the younger age groups. Areas that attract many migrants from and lose few migrants to other degrees of urbanicity will in the long run obtain healthier populations, because of demographic and socioeconomic characteristics. However, if these characteristics are accounted for, the opposite is true, with the exception of younger age groups. In extreme cases this may cause spurious findings in cross sectional research into the relation between urbanicity and health. Absolute numbers of migrants need to be very high, however, to make this noticeable at the aggregate level.
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Study objective: The focus of physical activity promotion is moving from methods for increasing health enhancing physical activity on the individual level to higher level strategies including environmental and policy approaches. Scientific inquiry, traditionally related to individual-based strategies, requires adaptation and refinement when environmental and policy changes become more relevant. The objective of this study is to investigate the significance for behaviour and health of community-based environments that encourage physical activity. Design and setting: The article presents data and results from a cross sectional comparative survey of the general population in six European countries (Belgium, Finland, Germany (East and West), Netherlands, Spain, Switzerland). Specifically, the relation between perceived community-based opportunities for physical activity, self reported physical activity, and self rated health status is investigated. Participants: Representative samples of general populations (adults 18 years or older). Overall response rate: 53.5%. Sample sizes realised: Belgium: n = 389; Finland: n = 400; Germany (East): n = 913; Germany (West): n = 489; Netherlands: n = 366; Spain: n = 380; Switzerland: n =406. Main results: Analyses show that best opportunities are reported by people who are lightly to moderately physically active. People's self rated health is moderately, but significantly associated with both perceived opportunities, and physical activity itself. These predictors interact in that especially for women, the health impact of physical activity is more pronounced in case of good opportunities. Conclusions: The paper shows the potential of opportunities within residential and community environments with regard to physical activity, both for behaviour and health. Opportunities may enable the population, especially women, to develop an active lifestyle, and thus improve their health. Future studies with objective indicators for physical activity related environments should test the findings that are based on perceptions.
A new method of measuring the degree of urbanization of a given area, developed by the Dutch Central Bureau of Statistics, is introduced. "The measure classifies areas according to what is called address density of the surroundings: the average address density within a radius of 1 km of an address in the area." The advantages are discussed, and the measure is used to classify the 647 municipalities in the Netherlands into five groups according to urbanization level. (SUMMARY IN ENG) excerpt
In order to gain insight into the relation between health and people's environment, literature published between 1985 and 1994 was gathered from several international databases. An introduction into existing theory regarding geographic disparities is presented: geographical drift and breeder hypotheses are discussed. This is followed by a critical review focusing on interaction effects of urbanicity and individual characteristics on health. This leads to two major conclusions. First, emphasis in past research has been primarily on urban constraints rather than opportunities. Positive aspects of urban living are often insufficiently appreciated. Second, positive and negative environmental aspects have an effect on health that is often dependent on individual characteristics. The extent to which the environment exerts influence on a person's health is dependent on that person's individual characteristics. These conclusions are relevant only for further developing the breeder hypothesis, however. Large scale individual based longitudinal data should be studied in order to gain more insight into the relative importance of the geographical drift hypothesis.
Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults. Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed. Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries. PROPOSED MODEL: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary. Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.
Promoting physical activity is a public health priority, and changes in the environmental contexts of adults' activity choices are believed to be crucial. However, of the factors associated with physical activity, environmental influences are among the least understood. Using journal scans and computerized literature database searches, we identified 19 quantitative studies that assessed the relationships with physical activity behavior of perceived and objectively determined physical environment attributes. Findings were categorized into those examining five categories: accessibility of facilities, opportunities for activity, weather, safety, and aesthetic attributes. Accessibility, opportunities, and aesthetic attributes had significant associations with physical activity. Weather and safety showed less-strong relationships. Where studies pooled different categories to create composite variables, the associations were less likely to be statistically significant. Physical environment factors have consistent associations with physical activity behavior. Further development of ecologic and environmental models, together with behavior-specific and context-specific measurement strategies, should help in further understanding of these associations. Prospective studies are required to identify possible causal relationships.
Research in the physical activity promotion arena has focused on the application of theoretical perspectives aimed primarily at personal levels of understanding and analysis. The investigation of such theories has provided some insights related to potentially useful mediators of physical activity behavior. However, to continue to expand this field, new perspectives on personal-level theories, in addition to the exploration of more macro-level conceptual perspectives, are required. The purpose of this article is to: (1) briefly review the current strengths and limitations of the personal-level, physical activity-theory literature; and (2) introduce concepts and perspectives from other fields, including the social-ecology and urban-planning fields, of potential relevance to the physical activity arena. We provide an overview of potentially relevant theoretical perspectives aimed at different levels of understanding and analysis, from the personal level through the broader-scale meso- and macro-environmental perspectives. In addition, we suggest initial steps to take in developing a transdisciplinary paradigm encompassing all such levels of analysis and investigation. Given the scope of the physical inactivity epidemic facing the U.S. population currently and in the future, methods and approaches that integrate theory and concepts across a broader group of disciplines will be increasingly necessary.
A new method of measuring the degree of urbanization of a given area, developed by the Dutch Central Bureau of Statistics, is introduced. "The measure classifies areas according to what is called address density of the surroundings: the average address density within a radius of 1 km of an address in the area." The advantages are discussed, and the measure is used to classify the 647 municipalities in the Netherlands into five groups according to urbanization level. (SUMMARY IN ENG) excerpt
To study the association between greenery filled public areas that are nearby a residence and easy to walk in and the longevity of senior citizens in a densely populated, developed megacity. Cohort study. The authors analysed the five year survival of 3144 people born in 1903, 1908, 1913, or 1918 who consented to a follow up survey from the records of registered Tokyo citizens in relation to baseline residential environment characteristics in 1992. The survival of 2211 and the death of 897 (98.9% follow up) were confirmed. The probability of five year survival of the senior citizens studied increased in accordance with the space for taking a stroll near the residence (p<0.01), parks and tree lined streets near the residence (p<0.05), and their preference to continue to live in their current community (p<0.01). The principal component analysis from the baseline residential environment characteristics identified two environment related factors: the factor of walkable green streets and spaces near the residence and the factor of a positive attitude to a person's own community. After controlling the effects of the residents' age, sex, marital status, and socioeconomic status, the factor of walkable green streets and spaces near the residence showed significant predictive value for the survival of the urban senior citizens over the following five years (p<0.01). Living in areas with walkable green spaces positively influenced the longevity of urban senior citizens independent of their age, sex, marital status, baseline functional status, and socioeconomic status. Greenery filled public areas that are nearby and easy to walk in should be further emphasised in urban planning for the development and re-development of densely populated areas in a megacity. Close collaboration should be undertaken among the health, construction, civil engineering, planning, and other concerned sectors in the context of the healthy urban policy, so as to promote the health of senior citizens.