Abstract
There is growing evidence that urban natural outdoor environments (NOE) may positively impact health by reducing stress and stress-related symptoms. However, there is limited research investigating this link across a range of NOE indicators. This cross-sectional study investigated the association between neighbourhood NOE (availability, use, and satisfaction with NOE) and common somatic symptoms and the role of potential mediators. Data were analysed from 3481 adults from Barcelona (Spain), Doetinchem (Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (United Kingdom). NOE data were obtained through self-reported data and environmental measurements. Common somatic symptom data were self-reported. Mixed effects regression models were used for analysis, with models adjusted for potential sociodemographic confounders. Higher satisfaction with neighbourhood NOE was associated with lower prevalence of common somatic symptoms (exp(β) 0.97; 95% CI 0.96, 0.98); an association partially mediated by mental health, social cohesion and air quality concern. A longer time spent in NOE was associated with lower prevalence of common somatic symptoms in low socioeconomic status neighbourhoods (exp(β) 0.98; 95% CI 0.96, 1.00). A higher number of neighbourhood green spaces (300m buffer) was associated with higher prevalence of common somatic symptoms (exp(β) 1.03; 95% CI 1.00, 1.05). No statistically significant associations were found for other NOE indicators. Study findings suggest that higher satisfaction with NOE may be associated with lower prevalence of common somatic symptoms, with mental health, social cohesion and concern about air quality playing partial mediating roles. Little evidence was found of an association between objective NOE measurements and common somatic symptoms, underlining the importance of perceptions of NOE for conferring health benefits.
| Original language | English |
|---|---|
| Article number | 102381 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | Health and Place |
| Volume | 64 |
| DOIs | |
| Publication status | Published - Jul 2020 |
Funding
Previous studies investigating the link between neighbourhood NOE and common somatic symptoms have often reported a small but statistically significant negative association (Groenewegen et al., 2018; Korpela and Ylen, 2007; Maas et al., 2009a, b; Triguero-Mas et al., 2017; van den Berg et al., 2010). For example, a Dutch study using electronic GP records found a lower prevalence of common somatic symptoms among those living in areas with a higher percentage of green space ( Maas et al., 2009a, b). A recent study by Triguero-Mas et al., which used smartphones to collect data on time spent in NOE, reported a statistically significant negative association between time spent in surrounding greenness and common somatic symptoms (Triguero-Mas et al., 2017). Other studies have found no statistically significant association between NOE exposure and common somatic symptoms (Piccininni et al., 2018; Zock et al., 2018). Several of the studies that reported a statistically significant relationship between NOE and common somatic symptoms found that this relationship varied according to sociodemographic characteristics. For instance, stratified analysis undertaken by Groenewegen et al. revealed a statistically significant association between green space and somatic symptoms for the lowest quintile of socioeconomic status (SES) only, with more green space associated with fewer somatic symptoms; a finding also supported by Maas et al. (Groenewegen et al., 2018; Maas et al., 2009a, b). Triguero Mas et al. found stronger relationships between somatisation and contact with surrounding greenness among men, younger participants and those with a low-medium education level, as well as some differences between participants from different cities (Triguero-Mas et al., 2017). To date, few studies have investigated the potential mechanisms through which NOE and common somatic symptoms may be associated. Those that have indicate that stress-reduction and social cohesion may play particularly important roles (de Vries et al., 2013; Triguero-Mas et al., 2017). Triguero-Mas et al. (2017) found that perceived stress completely mediated the relationship between contact with NOE and the lack of somatisation. Since they could not establish mediation by physical activity, they argued that it might not be the intensity of activity undertaken in a NOE that is of importance to health, but the stress reduction that visiting the NOE provokes (Triguero-Mas et al., 2017). This was also concluded by de Vries et al. (2013), that found that especially stress reduction and social cohesion were important mediators of the association between NOE and perceived general health and acute health complaints (de Vries et al., 2013).While this study found little evidence of a statistically significant association between objective NOE exposure and common somatic symptoms, the significant association between satisfaction with NOE and common somatic symptoms suggests that individual perceptions of NOE and features of NOE beyond quantity are important to consider when designing urban areas that promote health. Furthermore, the differences in findings between socioeconomic groups provides further support for the potential benefits of introducing NOE in low SES neighbourhoods. While the associations found in the study are small, interventions with this level of health benefit can make an important contribution to health at a population level.The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007?2013) under grant agreement no 282996. W.L. Zijlema is supported by a Sara Borrell grant from the Instituto de Salud Carlos III (CD17/00195). We acknowledge support from the Spanish Ministry of Science and Innovation through the ?Centro de Excelencia Severo Ochoa 2019?2023? Program (CEX 2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program (ISGlobal). The research leading to these results has received funding from the European Community's Seventh Framework Programme ( FP7/2007–2013 ) under grant agreement no 282996. W.L. Zijlema is supported by a Sara Borrell grant from the Instituto de Salud Carlos III ( CD17/00195 ). We acknowledge support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019–2023” Program ( CEX 2018-000806-S ), and support from the Generalitat de Catalunya through the CERCA Program (ISGlobal).
| Funders | Funder number |
|---|---|
| Ministerio de Ciencia e Innovación | |
| Generalitat de Catalunya | |
| European Commission | |
| NOE exposure and common somatic symptoms | |
| Seventh Framework Programme | 282996 |
| Sara Borrell | |
| Instituto de Salud Carlos III | CD17/00195 |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 11 Sustainable Cities and Communities
Keywords
- Common somatic symptoms
- Green space
- Natural outdoor environments
- Nature perception
- Stress
- Stress-related symptoms
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