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      Assessing the Impact of School-Based Greenness on Mental Health Among Adolescent Students in Ontario, Canada

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          Abstract

          Neighbourhood greenness has been frequently associated with improved mental health in adulthood, yet its impact among youth is less clear. Additionally, though youth spend large portions of time at school, no study has investigated associations between school-based measures of greenness and students’ mental health in Canada. We addressed this gap by linking participant responses from the 2016–2017 Ontario Student Drug Use and Health Survey to school-based features of the built environment. Our analyses included 6313 students, ages 11–20. Measures of greenness were the mean and max of the annual mean Normalized Difference Vegetation Index within 500 m and 1000 m from the centroid of the school postal code. Measures of mental health included: serious psychological distress (Kessler 6-item Psychological Distress Scale), self-rated mental health (using a five-point Likert scale), suicide ideation, and suicide attempt. In our study population, the prevalence of serious psychological distress and low self-rated mental health was 16.7% and 20.3%, respectively. Suicide ideation was reported by 13.5% of participants, while 3.7% reported a suicide attempt. Quantity of greenness was similar between schools in the lower and upper quartiles. In logistic regressions, we found no association between objective school-based greenness and mental health, as assessed by multiple measures, both before and after adjustment. Null findings held true after stratification by season, as well. Whether other characteristics of school greenness (such as type, quality, or access and use) are more impactful to students’ mental health should be a focus of future analyses.

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          Most cited references22

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          A Review of the Health Benefits of Greenness.

          Researchers are increasingly exploring how neighborhood greenness, or vegetation, may affect health behaviors and outcomes. Greenness may influence health by promoting physical activity and social contact; decreasing stress; and mitigating air pollution, noise, and heat exposure. Greenness is generally measured using satellite-based vegetation indices or land-use databases linked to participants' addresses. In this review, we found fairly strong evidence for a positive association between greenness and physical activity, and a less consistent negative association between greenness and body weight. Research suggests greenness is protective against adverse mental health outcomes, cardiovascular disease, and mortality, though most studies were limited by cross-sectional or ecological design. There is consistent evidence that greenness exposure during pregnancy is positively associated with birth weight, though findings for other birth outcomes are less conclusive. Future research should follow subjects prospectively, differentiate between greenness quantity and quality, and identify mediators and effect modifiers of greenness-health associations.
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            Life course outcomes of young people with anxiety disorders in adolescence.

            This study examined associations between the extent of anxiety disorder in adolescence (14-16 years) and young people's later risks of a range of mental health, educational, and social role outcomes (16-21 years). Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Measures collected included (1) an assessment of DSM-III-R anxiety disorders between the ages of 14 and 16 years; (2) assessments of mental health, educational achievement, and social functioning between the ages of 16 and 21 years; and (3) measures of potentially confounding social, family, and individual factors. Significant linear associations were found between the number of anxiety disorders reported in adolescence and later risks of anxiety disorder; major depression; nicotine, alcohol, and illicit drug dependence; suicidal behavior; educational underachievement; and early parenthood. Associations between the extent of adolescent anxiety disorder and later risks of anxiety disorder, depression, illicit drug dependence, and failure to attend university were shown to persist after statistical control for the confounding effects of sociofamilial and individual factors. Findings suggest that adolescents with anxiety disorders are at an increased risk of subsequent anxiety, depression, illicit drug dependence, and educational underachievement as young adults. Clinical and research implications are considered.
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              Green spaces and General Health: Roles of mental health status, social support, and physical activity.

              Green spaces are associated with improved health, but little is known about mechanisms underlying such association. We aimed to assess the association between greenness exposure and subjective general health (SGH) and to evaluate mental health status, social support, and physical activity as mediators of this association. This cross-sectional study was based on a population-based sample of 3461 adults residing in Barcelona, Spain (2011). We characterized outcome and mediators using the Health Survey of Barcelona. Objective and subjective residential proximity to green spaces and residential surrounding greenness were used to characterize greenness exposure. We followed Baron and Kenny's framework to establish the mediation roles and we further quantified the relative contribution of each mediator. Residential surrounding greenness and subjective residential proximity to green spaces were associated with better SGH. We found indications for mediation of these associations by mental health status, perceived social support, and to less extent, by physical activity. These mediators altogether could explain about half of the surrounding greenness association and one-third of the association for subjective proximity to green spaces. We observed indications that mental health and perceived social support might be more relevant for men and those younger than 65years. The results for objective residential proximity to green spaces were not conclusive. In conclusion, our observed association between SGH and greenness exposure was mediated, in part, by mental health status, enhanced social support, and physical activity. There might be age and sex variations in these mediation roles.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                08 November 2019
                November 2019
                : 16
                : 22
                : 4364
                Affiliations
                [1 ]Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada; sebastiansrugo@ 123456gmail.com (S.A.S.); margaret.degroh@ 123456canada.ca (M.d.G.); ying.jiang@ 123456canada.ca (Y.J.); howard.morrison@ 123456canada.ca (H.I.M.)
                [2 ]Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; hayley.hamilton@ 123456camh.ca
                [3 ]Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
                [4 ]School of Mathematics and Statistics, Carleton University, Ottawa, ON K1S 5B6, Canada
                Author notes
                [* ]Correspondence: Paul.Villeneuve@ 123456carleton.ca ; Tel.: +1-613-520-2600 (ext. 3359)
                Author information
                https://orcid.org/0000-0001-9117-103X
                https://orcid.org/0000-0001-7786-7997
                Article
                ijerph-16-04364
                10.3390/ijerph16224364
                6887786
                31717373
                211a56ef-e274-4ef0-af92-db845a17163f
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 09 October 2019
                : 06 November 2019
                Categories
                Article

                Public health
                built environment,schools,mental health,adolescent,survey
                Public health
                built environment, schools, mental health, adolescent, survey

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