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      Nature Contact and Human Health: A Research Agenda

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          At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding.


          We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions.


          We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science.


          Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights.

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          Most cited references 365

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          The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants.

          Because human activities impact the timing, location, and degree of pollutant exposure, they play a key role in explaining exposure variation. This fact has motivated the collection of activity pattern data for their specific use in exposure assessments. The largest of these recent efforts is the National Human Activity Pattern Survey (NHAPS), a 2-year probability-based telephone survey (n=9386) of exposure-related human activities in the United States (U.S.) sponsored by the U.S. Environmental Protection Agency (EPA). The primary purpose of NHAPS was to provide comprehensive and current exposure information over broad geographical and temporal scales, particularly for use in probabilistic population exposure models. NHAPS was conducted on a virtually daily basis from late September 1992 through September 1994 by the University of Maryland's Survey Research Center using a computer-assisted telephone interview instrument (CATI) to collect 24-h retrospective diaries and answers to a number of personal and exposure-related questions from each respondent. The resulting diary records contain beginning and ending times for each distinct combination of location and activity occurring on the diary day (i.e., each microenvironment). Between 340 and 1713 respondents of all ages were interviewed in each of the 10 EPA regions across the 48 contiguous states. Interviews were completed in 63% of the households contacted. NHAPS respondents reported spending an average of 87% of their time in enclosed buildings and about 6% of their time in enclosed vehicles. These proportions are fairly constant across the various regions of the U.S. and Canada and for the California population between the late 1980s, when the California Air Resources Board (CARB) sponsored a state-wide activity pattern study, and the mid-1990s, when NHAPS was conducted. However, the number of people exposed to environmental tobacco smoke (ETS) in California seems to have decreased over the same time period, where exposure is determined by the reported time spent with a smoker. In both California and the entire nation, the most time spent exposed to ETS was reported to take place in residential locations.
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            Green space, urbanity, and health: how strong is the relation?

            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.
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              Is Open Access

              A systematic review of evidence for the added benefits to health of exposure to natural environments

              Background There is increasing interest in the potential role of the natural environment in human health and well-being. However, the evidence-base for specific and direct health or well-being benefits of activity within natural compared to more synthetic environments has not been systematically assessed. Methods We conducted a systematic review to collate and synthesise the findings of studies that compare measurements of health or well-being in natural and synthetic environments. Effect sizes of the differences between environments were calculated and meta-analysis used to synthesise data from studies measuring similar outcomes. Results Twenty-five studies met the review inclusion criteria. Most of these studies were crossover or controlled trials that investigated the effects of short-term exposure to each environment during a walk or run. This included 'natural' environments, such as public parks and green university campuses, and synthetic environments, such as indoor and outdoor built environments. The most common outcome measures were scores of different self-reported emotions. Based on these data, a meta-analysis provided some evidence of a positive benefit of a walk or run in a natural environment in comparison to a synthetic environment. There was also some support for greater attention after exposure to a natural environment but not after adjusting effect sizes for pretest differences. Meta-analysis of data on blood pressure and cortisol concentrations found less evidence of a consistent difference between environments across studies. Conclusions Overall, the studies are suggestive that natural environments may have direct and positive impacts on well-being, but support the need for investment in further research on this question to understand the general significance for public health.

                Author and article information

                Environ Health Perspect
                Environ. Health Perspect
                Environmental Health Perspectives
                Environmental Health Perspectives
                31 July 2017
                July 2017
                : 125
                : 7
                [ 1 ]Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington , Seattle, Washington, USA
                [ 2 ]Center for Conservation Biology, Stanford University , Stanford, California, USA
                [ 3 ]Center for Creative Conservation, University of Washington , Seattle, Washington, USA
                [ 4 ]School of Environmental and Forest Sciences, University of Washington , Seattle, Washington, USA
                [ 5 ]Willamette Partnership , Portland, Oregon, USA
                [ 6 ]Department of Psychology, University of Washington , Seattle, Washington, USA
                [ 7 ]The Nature Conservancy , Seattle, Washington, USA
                [ 8 ]Department of Pediatrics, University of Washington School of Medicine , Seattle, Washington, USA
                [ 9 ]Seattle Children’s Hospital , Seattle, Washington, USA
                [ 10 ]School of Aquatic and Fishery Sciences, University of Washington , Seattle, Washington, USA
                [ 11 ]Department of Chemistry, University of Washington , Seattle, Washington, USA
                [ 12 ] Pacific Northwest Research Station, USDA Forest Service , Seattle, Washington, USA
                [ 13 ]The Natural Capital Project, Stanford University , Stanford, California, USA
                Author notes
                Address correspondence to H. Frumkin, Dept. of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Box 354695, Seattle, WA 98195-4695 USA; Telephone: 206-897-1723; Email: frumkin@

                EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.


                Public health


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