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Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries

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dc.contributor.author Elliott, Lewis R.
dc.contributor.author Pasanen, Tytti P.
dc.contributor.author White, Mathew P.
dc.contributor.author Wheeler, Benedict W.
dc.contributor.author Grellier, James
dc.contributor.author Cirach, Marta
dc.contributor.author Bratman, Gregory N.
dc.contributor.author van den Bosch, Matilda A.
dc.contributor.author Roiko, Anne
dc.contributor.author Ojala, Ann
dc.contributor.author Nieuwenhuijsen, Mark J.
dc.contributor.author Fleming, Lora E.
dc.date.accessioned 2023-11-07T07:28:13Z
dc.date.available 2023-11-07T07:28:13Z
dc.date.issued 2023
dc.identifier.citation Elliott LR, Pasanen T, White MP, Wheeler BW, Grellier J, Cirach M, Bratman GN, van den Bosch M, Roiko A, Ojala A, Nieuwenhuijsen M, Fleming LE. Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries. Environ Int. 2023 Aug;178:108077. DOI: 10.1016/j.envint.2023.108077
dc.identifier.issn 0160-4120
dc.identifier.uri http://hdl.handle.net/10230/58220
dc.description.abstract The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults. Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics. Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities. The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention.
dc.description.sponsorship This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 666773 (BlueHealth). Data collection in California was supported by the Center for Conservation Biology, Stanford University. Data collection in Canada was supported by the Faculty of Forestry, University of British Columbia. Data collection in Finland was supported by the Natural Resources Institute Finland (Luke). Data collection in Australia was supported by Griffith University and the University of the Sunshine Coast. Data collection in Portugal was supported by ISCTE—University Institute of Lisbon. Data collection in Ireland was supported by the Environmental Protection Agency, Ireland. Data collection in Hong Kong was supported by an internal University of Exeter—Chinese University of Hong Kong international collaboration fund. The funders had no role in the conceptualisation, design, analysis, decision to publish or preparation of the manuscript. A subset of the data used in this study can be downloaded from the UK Data Service (Elliott, LR, White, MP. 2022. BlueHealth International Survey Dataset, 2017-2018. [data collection]. UK Data Service. SN: 8874, doi: 10.5255/UKDA-SN-8874-2).
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof Environ Int. 2023 Aug;178:108077
dc.rights © 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
dc.rights.uri http://creativecommons.org/licenses/bync-nd/4.0/
dc.subject.other Salut urbana
dc.subject.other Salut ambiental
dc.title Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1016/j.envint.2023.108077
dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/666773
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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