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1. Spending at least 120 minutes a week in nature is associated with good health and wellbeing.

Author

White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, Bone A, Depledge MH, and Fleming LE

Subjects
Adolescent, Adult, Environment, Female, Humans, Male, Middle Aged, Residence Characteristics, Self Report, Young Adult, Exercise, Health, Walking physiology
Abstract

Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15-2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120-179 mins: ORs [95%CIs]: Health = 1.59 [1.31-1.92]; Well-being = 1.23 [1.08-1.40]). Positive associations peaked between 200-300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly nature exposure guidelines comparable to those for physical activity.

Published
2019
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2. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces.

Author

Grellier J, White MP, Albin M, Bell S, Elliott LR, Gascón M, Gualdi S, Mancini L, Nieuwenhuijsen MJ, Sarigiannis DA, van den Bosch M, Wolf T, Wuijts S, and Fleming LE

Subjects
Europe, Humans, Research Design, Fresh Water, Health, Public Health, Recreation, Social Planning
Abstract

Introduction: Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe's coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with 'blue space' (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood., Aims and Methods: The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas., Ethics and Dissemination: Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind., Competing Interests: Competing interests: All authors report grants from European Union Horizon 2020 programme (grant number 666773), during the conduct of the study., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2017
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3. Data mashups: potential contribution to decision support on climate change and health.

Author

Fleming LE, Haines A, Golding B, Kessel A, Cichowska A, Sabel CE, Depledge MH, Sarran C, Osborne NJ, Whitmore C, Cocksedge N, and Bloomfield D

Subjects
Humans, Climate Change, Data Collection, Data Mining, Decision Support Techniques, Health
Abstract

Linking environmental, socioeconomic and health datasets provides new insights into the potential associations between climate change and human health and wellbeing, and underpins the development of decision support tools that will promote resilience to climate change, and thus enable more effective adaptation. This paper outlines the challenges and opportunities presented by advances in data collection, storage, analysis, and access, particularly focusing on "data mashups". These data mashups are integrations of different types and sources of data, frequently using open application programming interfaces and data sources, to produce enriched results that were not necessarily the original reason for assembling the raw source data. As an illustration of this potential, this paper describes a recently funded initiative to create such a facility in the UK for use in decision support around climate change and health, and provides examples of suitable sources of data and the purposes to which they can be directed, particularly for policy makers and public health decision makers.

Published
2014
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4. The Blue Climate Initiative Healthy Blue Communities Network - Safeguarding Human Health & Well-Being Against Climate Change: An Ocean-Based, Community-Centered Proposal

Author

Landrigan, Philip, Depledge, Michael, Fleming, Lora E, and Stegeman, John

Subjects
well-being, health, ocean, climate
Abstract

This publication was commissioned by the Blue Climate Initiative (BCI), which accelerates ocean-related strategies, collaborating across a multidisciplinary global community towards a restored and healthy climate; an understood and protected ocean; and resilient, thriving, and equitable communities. In 2020, the BCI initiated a holistic process to identify transformational opportunities at the intersection of people, ocean, and planet, engaging over sixty world-class scientists and academics. These contributors compiled recommendations across six thematic areas: Health & Well-Being, Food & Nutrition, Marine Energy & Transportation, Mineral & Genetic Resources, Biodiversity & Nature-Based Solutions, and Sustainable Tourism. This publication is part of that series., A compendium synthesizing messages across the six Transformational Opportunities papers is available: Fries, L., Everett, J., and Davies, N. (eds.) 2021. Transformational Opportunities for People, Ocean, and Planet. French Polynesia: Blue Climate Initiative, Tetiaroa Society. https://doi.org/10.5281/zenodo.4540323.

Published
2021
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5. Employment and occupation effects on depressive symptoms in older Americans: does working past age 65 protect against depression?

Author

Christ, Sharon L., Lee, David J., Fleming, Lora E., LeBlanc, William G., Arheart, Kristopher L., Chung-Bridges, Katherine, Caban, Alberto J., and McCollister, Kathryn E.

Subjects
Aged -- Psychological aspects, Aged -- Health aspects, Aged -- Analysis, Aged -- Social aspects, Depression, Mental -- Risk factors, Depression, Mental -- Analysis, Job stress -- Risk factors, Job stress -- Analysis, Health, Psychology and mental health, Seniors
Abstract

Objectives. This 'article examines the effects of work status, occupational sector, and occupation type on depressive symptoms in older Americans. We partially controlled for the healthy worker selection effect by including disability as a predictor of both work status and depressive symptoms. Methods. We analyzed a nationally representative sample of 23,247 respondents aged 65 to 88 from the National Health Interview Survey pooled over 1997 to 2000. We used structural equation models with latent variables to assess relationships between work/occupation and depressive symptoms. Results. Older Americans who work bad lower levels of depressive symptoms as compared to older nonworkers. Membership in several worker groups, generally higher status occupations, protected against depressive symptoms. After controlling for disability, the difference in level of depressive symptoms for workers versus nonworkers did not persist. However, workers in specific occupational sectors and types reported different levels of depressive symptoms even when we controlled for disability. Discussion. The mental health benefit of working, among persons aged 65 and older, may be due to the healthy worker effect. However, the particular job sector in which older workers are employed matters. Socioeconomic status and financial versus personal motivations for working are potentially important explanations for differences.

Published
2007

6. Prevalence of the metabolic syndrome among U.S. workers

Author

Davila, Evelyn P., Florez, Hermes, Fleming, Lora E., Lee, David J., Goodman, Elizabeth, LeBlanc, William G., Caban-Martinez, Alberto J., Arheart, Kristopher L., McCollister, Kathryn E., Christ, Sharon L., Clark, John C., III, and Clarke, Tainya

Subjects
United States. National Center for Health Statistics, Workers -- Surveys, Medical research, Medicine, Experimental, Health surveys, Prevalence studies (Epidemiology), Cardiovascular diseases, Health
Abstract

OBJECTIVE--Differences in the prevalence of cardiovascular disease (CVD) and its risk factors among occupational groups have been found in several studies. Certain types of workers (such as shift workers) may [...]

Published
2010
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8. Young adults, mortality, and employment

Author

Davila, Evelyn P., Christ, Sharon L., Caban-Martinez, Alberto J., Lee, David J., Arheart, Kristopher L., LeBlanc, William G., McCollister, Kathryn E., Clarke, Tainya, Zimmerman, Frederick, Goodman, Elizabeth, Muntaner, Carles, and Fleming, Lora E.

Subjects
Employment -- Research, Employment -- Influence, Employment -- Health aspects, Teenagers -- Research, Teenagers -- Behavior, Teenagers -- Employment, Youth -- Research, Youth -- Behavior, Youth -- Employment, Suicidal behavior -- Risk factors, Environmental issues, Health
Published
2010

9. Food label use and awareness of nutritional information and recommendations among persons with chronic disease

Author

Lewis, John E., Arheart, Kristopher L., LeBlanc, William G., Fleming, Lora E., Lee, David J., Davila, Evelyn P., Caban-Martinez, Alberto J., Dietz, Noella A., McCollister, Kathryn E., Bandiera, Frank C., and Clark, John, D., Jr.

Subjects
Chronic diseases -- Care and treatment, Food labeling -- Usage, Food/cooking/nutrition, Health
Abstract

Background: Because of the relation between chronic disease and poor nutritional habits, the use of food labels and adherence to dietary recommendations are important for chronic disease populations. We explored whether persons with chronic disease read nutrient information on food labels and whether they were aware of dietary guidelines. Objective: This study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population. Design: A total of 5603 respondents aged [greater than or equal to] 17 y from the 2005-2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease. Results: Subjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance. Conclusions: People with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease. doi: 10.3945/ajcn.2009.27684.

Published
2009

10. Disparities in survival among women with invasive cervical cancer: a problem of access to care

Author

Brookfield, Kathleen F., Cheung, Michael C., Lucci, Joseph, Fleming, Lora E., and Koniaris, Leonidas G.

Subjects
Cervical cancer -- Demographic aspects, Cervical cancer -- Patient outcomes, Cervical cancer -- Research, Social classes -- Health aspects, Social classes -- Influence, Social classes -- Research, Women -- Health aspects, Women -- Reports, Health
Published
2009

11. Accuracy of self-reported smoking and secondhand smoke exposure in the US workforce: the National Health and Nutrition Examination Surveys

Author

Arheart, Kristopher L., Lee, David J., Fleming, Lora E., LeBlanc, William G., Dietz, Noella A., McColliser, Kathryn E., Wilkinson, James D., Lewis, John E., Clark, John D., III, Davila, Evelyn P., Bandiera, Frank C., and Erard, Michael J.

Subjects
Passive smoking -- Surveys, Occupational health and safety -- Surveys, Surveys, Environmental issues, Health
Published
2008

12. Declining trends in serum cotinine levels in US worker groups: the power of policy

Author

Arheart, Kristopher L., Lee, David J., Dietz, Noella A., Wilkinson, James D., LeBlanc, William G., Serdar, Berrin, and Fleming, Lora E.

Subjects
Cotinine -- Measurement, Cotinine -- Forecasts and trends, Passive smoking -- Prevention, Antismoking movement -- Influence, Work environment -- Health aspects, Market trend/market analysis, Environmental issues, Health
Published
2008

13. Healthcare provider smoking cessation advice among US worker groups

Author

Lee, David J., Fleming, Lora E., McCollister, Kathryn E., Caban, Alberto J., Arheart, Kristopher L., LeBlanc, William G., Chung-Bridges, Katherine, Christ, Sharon L., Dietz, Noella, and Clark, John D. III

Subjects
Physicians -- Influence, Physicians -- Practice, Smoking cessation programs -- Health aspects, Smoking cessation programs -- Methods, Occupational health and safety -- Health aspects, Workers -- Health aspects, Health, Sociology and social work
Published
2007

14. Aerosolized red-tide toxins (Brevetoxins) and asthma

Author

Fleming, Lora E., Kirkpatrick, Barbara, Backer, Lorraine C., Bean, Judy A., Wanner, Adam, Reich, Andrew, Zaias, Julia, Cheng, Yung Sung, Pierce, Richard, Naar, Jerome, Abraham, William M., and Baden, Daniel G.

Subjects
Red tide -- Health aspects, Red tide -- Research, Asthma -- Development and progression, Asthma -- Research, Asthma -- Environmental aspects, Health
Published
2007

15. Smoking rate trends in U.S. occupational groups: the 1987 to 2004 National Health Interview Survey

Author

Lee, David J., Fleming, Lora E., Arheart, Kristopher L., LeBlanc, William G., Caban, Alberto J., Chung-Bridges, Katherine, Christ, Sharon L., McCollister, Kathryn E., and Pitman, Terry

Subjects
White collar workers -- Health aspects, Blue collar workers -- Health aspects, Workplace smoking -- Risk factors, Workplace smoking -- Surveys, Environmental issues, Health
Published
2007

23. Influence of structured encounter forms on documentation by community pediatricians

Author

Grant, Penny, Skinner, Halcyon G., Fleming, Lora E., and Bean, Judy A.

Subjects
Medical research -- Analysis -- Health aspects, Medicine, Experimental -- Analysis -- Health aspects, Physical diagnosis -- Analysis -- Health aspects, Periodic health examinations -- Analysis -- Health aspects, Medical records -- Standards -- Management -- Health aspects -- Analysis, Pediatricians -- Practice -- Analysis -- Health aspects, Sick children -- Care and treatment -- Medical examination -- Health aspects -- Analysis, Company business management, Health
Abstract

ABSTRACT Background. Age-specific structured encounter forms for well-child examinations have been shown to improve thoroughness of documentation among pediatric house staff. This study evaluated the influence of such forms on [...]

Published
2002

24. Cancer trends among Hispanic men in South Florida, 1981-1998

Author

Wilkinson, James D., Wohler-Torres, Brad, Trapido, Edward, Fleming, Lora E., MacKinnon, Jill, Voti, Lydia, and Peace, Steven

Subjects
Hispanic American men -- Health aspects, Cancer -- Demographic aspects, Prevalence studies (Epidemiology) -- Analysis, Health and race -- Research, Health
Published
2002

28. Dental care access and unmet dental care needs among U.S. workers

Author

Caban-Martinez, Alberto J., Lee, David J., Fleming, Lora E., Arheart, Kristopher L., LeBlanc, William G., Chung-Bridges, Katherine, Christ, Sharon, and Pitman, Terry

Subjects
Employee benefits -- Surveys, Dental care -- Management, Dental care -- Surveys, Dental hygiene -- Management, Dental hygiene -- Surveys, Workers -- Health aspects, Workers -- Surveys, Mouth -- Care and treatment, Mouth -- Management, Mouth -- Surveys, Employee benefits, Company business management, Health
Abstract

The results of the National Health Interview Survey (1997 to 2003) which suggests the need of dental care access among workers are discussed.

Published
2007

29. Fostering human health through ocean sustainability in the 21st century.

Author

Fleming, Lora E., Maycock, Bruce, White, Mathew P., Depledge, Michael H., and Hails, Rosemary

Abstract

The approach of the Decade of the Ocean for Sustainable Development (2021–2030) provides a time to reflect on what we know about the complex interactions between the seas, oceans, and human health and well‐being. In the past, these interactions have been seen primarily within a risk framework, for example, adverse impacts of extreme weather, chemical pollution and increasingly, climate change.However, new research is expanding our concept of the 'health' of the 'Global Ocean', with a broader recognition of its essential and beneficial contribution to the current and future health and well‐being of humans. The seas and coasts not only provide an essential source of food, opportunities for trade and access to sustainable energy, but also the chance for people to interact with high‐quality marine environments which can lead to improvements in mental and physical health and well‐being, particularly of socio‐economically deprived individuals.By going beyond this risk framework and a purely extractive anthropocentric point of view, we can capture the true benefits, value and importance of these resources. Articulating a vision of how humans might better interact with marine ecosystems in the future, is a key first step in identifying a range of policy and management actions that can deliver our goals of fostering health and well‐being through the establishment of more sustainable interconnections with the Global Ocean. A free Plain Language Summary can be found within the Supporting Information of this article. A free Plain Language Summary can be found within the Supporting Information of this article. [ABSTRACT FROM AUTHOR]

Published
2019
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30. Formation and Current Results of a Patient-Organized Registry for [[Alpha].sub.1]-Antitrypsin Deficiency(*)

Author

Stoller, James K., Brantly, Mark, Fleming, Lora E., Bean, Judy A., and Walsh, John

Subjects
Registries (in medicine) -- Innovations -- Physiological aspects, Alpha 1-antitrypsin -- Physiological aspects, Health, Physiological aspects, Innovations
Abstract

Background: Significant challenges exist to investigating uncommon illnesses because too few patients are seen at any single clinical center to permit appropriate research studies. Recognizing this impediment to clinical research [...]

Published
2000

31. Understanding How Healthy Workplaces Are Created: Implications for Developing a National Health Service Healthy Workplace Program.

Author

Wyatt, Katrina M., Brand, Sarah, Ashby-Pepper, Julie, Abraham, Jane, and Fleming, Lora E.

Subjects
INDUSTRIAL hygiene standards, ATTITUDE (Psychology), AWARDS, GROUP identity, HEALTH, HEALTH facility employees, HEALTH promotion, INDUSTRIAL relations, INTERVIEWING, LEADERSHIP, RESEARCH methodology, CASE studies, MEDICAL cooperation, NATIONAL health services, RESEARCH, RESEARCH funding, STRESS management, TRUST, WORK environment, EMPLOYEES' workload, QUALITATIVE research, THEMATIC analysis, HUMAN services programs, DESCRIPTIVE statistics
Abstract

The workplace is an important setting for promoting health and well-being. We sought to understand how successful workplace health and well-being programs were developed and implemented to inform the development of a program for a National Health Service (NHS) hospital. Case studies of successful healthy workplace programs with 34 semi-structured employee interviews informed 12 interviews with NHS staff. Interviews were thematically analyzed using Nvivo. Themes were fed back to participants for further clarification and validation. Healthy workplace programs were characterized by senior management endorsement; collective sense of ownership; presence of visible “quick wins”; and a sense that participation was easy and fun, not mandated. Programs evolved organically, allowing trust to be built and activities to be developed with employees. Interviews with NHS staff suggested a lack of belief in the possibility of change in their workplace due to time and workload pressures, and a sense of an “us and them” relationship with management, as well as environmental barriers. A consistent pattern of how the conditions for a healthy workplace can be created, which map onto the results from the NHS ward staff, suggest that without creating an enabling environment for health-promoting behaviors, workplace programs will have poor uptake and retention. [ABSTRACT FROM AUTHOR]

Published
2015
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32. Environmental and human health impacts of cruise tourism: A review.

Author

Lloret, Josep, Carreño, Arnau, Carić, Hrvoje, San, Joan, and Fleming, Lora E.

Subjects
ENVIRONMENTAL health, TOURISM impact, CRUISE ships, MARINE pollution, CRUISE industry, INFORMATION resources, HABITATS
Abstract

The intensive growth of cruise tourism worldwide during recent decades is leading to growing concerns over the sector's global environmental and health impacts. This review combines for the first time various sources of information to estimate the magnitude of the cruise industry's environmental and public health footprints. This research shows that cruising, despite technical advances and some surveillance programmes, remains a major source of air, water (fresh and marine) and land pollution affecting fragile habitats, areas and species, and a potential source of physical and mental human health risks. Health risks impact both the people on board (crew and passengers) and on land (workers of shipyards where cruise ships are dismantled and citizens inhabiting cities with cruise ports and shipyards). In this context, we argue that the cruise industry should be held accountable with more monitoring and regulation to prevent or minimize the growing negative environmental and human health impacts. [Display omitted] • Environmental and human health impacts of cruise tourism are increasing. • Air, water, soil, fragile habitats and areas and wildlife are affected by cruises. • The health of passengers, crew, residents living near cruise ports and workers of shipyards is compromised. • The cruise industry's impacts provide an example of interconnections between human and environmental health. • Cruises should be more closely monitored and regulated to prevent or minimize all impacts. [ABSTRACT FROM AUTHOR]

Published
2021
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33. Indicators of Ocean Health and Human Health: Developing Research and Monitoring Framework.

Author

Knap, Anthony, Dewailly, Èric, Furgal, Chris, Galvin, Jennifer, Baden, Dan, Bowen, Robert E., Depledge, Michael, Duguay, Linda, Fleming, Lora E., Ford, Tim, Moser, Fredricka, Owen, Richard, Suk, William A., and Unluata, Umit

Subjects
MARINE ecology, HEALTH
Abstract

Examines the quality of marine ecosystem in relation to ecosystem change and human health. Indicators for marine organism; Interaction between human and oceans; Definition of ocean health.

Published
2002
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35. Using urban blue spaces to benefit population health and wellbeing

Author

Hall, Kerri L, Garrett, Joanne K, White, Mathew P, Grellier, James, Wuijts, Susanne, and Fleming, Lora E

Subjects
bluespace, 13. Climate action, well-being, 11. Sustainability, evidence-based policy, health, environment, urban planning
Abstract

This report presents an overview of the key messages that came out of the research conducted within the BlueHealth project. In particular, it explains what is meant by "BlueHealth" research, what challenges society faces regarding urban "blue spaces", and how the urban environment can exploit blue infrastructure as a health and well-being resource. We show how an evidence base can be built up with primary studies, and then be implemented in practice with different kinds of interventions. This report is useful as a primer for a wide range of decision-makers, including those making policy, designing and planning our cities and towns, and working towards improved public health and environmental quality in the face of 21st century challenges.

36. The BlueHealth Toolbox – Guidance for urban planners and designers

Author

Grellier, James, Mishra, Himansu S, Elliott, Lewis R, Wuijts, Susanne, Braubach, Matthias F W, Hall, Kerri L, Bell, Simon, White, Mathew P, and Fleming, Lora E

Subjects
evidence-based design, blue space, 13. Climate action, 11. Sustainability, environmental assessment, health, tool, BlueHealth, environment, 6. Clean water, urban planning
Abstract

The BlueHealth Toolbox is for planners, designers and other decision-makers responsible for blue spaces. The tools provide the means to make comparable assessments of urban blue spaces before and after any proposed changes. Such changes can include a wide range of interventions, from physical alterations to the environment to advertising campaigns that influence how people interact with it. The tools provide evidence about the quality of blue environments, as well as information about how people and communities use, perceive and interact with blue spaces. They also assess the state of people’s health and wellbeing. Together, this evidence can enhance urban planning and design. This Guidance document presents an overview of the tools and explains how they can be used by decision makers and planners in the service of evidence-based design.

37. The BlueHealth Toolbox – Guidance for urban planners and designers

Author

Grellier, James, Mishra, Himansu S, Elliott, Lewis R, Wuijts, Susanne, Braubach, Matthias F W, Hall, Kerri L, Bell, Simon, White, Mathew P, and Fleming, Lora E

Subjects
evidence-based design, blue space, 13. Climate action, 11. Sustainability, environmental assessment, ComputerApplications_COMPUTERSINOTHERSYSTEMS, health, tool, BlueHealth, environment, 6. Clean water, urban planning
Abstract

The BlueHealth Toolbox is for planners, designers and other decision-makers responsible for blue spaces. The tools provide the means to make comparable assessments of urban blue spaces before and after any proposed changes. Such changes can include a wide range of interventions, from physical alterations to the environment to advertising campaigns that influence how people interact with it. The tools provide evidence about the quality of blue environments, as well as information about how people and communities use, perceive and interact with blue spaces. They also assess the state of people’s health and wellbeing. Together, this evidence can enhance urban planning and design. This Guidance document presents an overview of the tools and explains how they can be used by decision makers and planners in the service of evidence-based design., {"references":["Grellier J, White MP, Albin M, et al. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces. BMJ Open. 2017;7(e016188):1-10. doi:10.1136/bmjopen-2017-016188","Wheeler BW, White MP, Stahl-Timmins W, Depledge MH. Does living by the coast improve health and wellbeing. Heal Place. 2012;18(5):1198-1201. doi:10.1016/j. healthplace.2012.06.015","Wheeler BW, Lovell R, Higgins SL, et al. Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality. Int J Heal Geogr. 2015;14:17. doi:10.1186/s12942- 015-0009-5","Nutsford D, Pearson AL, Kingham S, Reitsma F. Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city. Heal Place. 2016;39:70-78. doi:10.1016/j. healthplace.2016.03.002","de Vries S, ten Have M, van Dorsselaer S, van Wezep M, Hermans T, de Graaf R. Local availability of green and blue space and prevalence of common mental disorders in the Netherlands. BJPsych Open. 2016;2(6):366-372. doi:10.1192/bjpo.bp.115.002469","Völker S, Kistemann T. The impact of blue space on human health and well-being - Salutogenetic health effects of inland surface waters: A review. Int J Hyg Environ Health. 2011;214(6):449-460. doi:10.1016/j.ijheh.2011.05.001","Völker S, Kistemann T. Reprint of: \"I'm always entirely happy when I'm here!\" Urban blue enhancing human health and well-being in Cologne and Düsseldorf, Germany. Soc Sci Med. 2013;91:141-152. doi:10.1016/j. socscimed.2013.04.016","Gascon M, Zijlema W, Vert C, White MP, Nieuwenhuijsen MJ. Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies. Int J Hyg Envir Heal. 2017;4(8). doi:10.1016/j.ijheh.2017.08.004","MacKerron G, Mourato S. Happiness is greater in natural environments. Glob Environ Chang. 2013;23(5):992-1000. doi:10.1016/j.gloenvcha.2013.03.010","White MP, Pahl S, Ashbullby KJ, Herbert S, Depledge MH. Feelings of restoration from recent nature visits. J Environ Psychol. 2013;35:40-51. doi:10.1016/j.jenvp.2013.04.002","Annerstedt M, Jönsson P, Wallergård M, et al. Inducing physiological stress recovery with sounds of nature in a virtual reality forest - Results from a pilot study. Physiol Behav. 2013;118:240-250. doi:10.1016/j. physbeh.2013.05.023","Schipperijn J, Ekholm O, Stigsdotter UK, et al. Factors influencing the use of green space: Results from a Danish national representative survey. Landsc Urban Plan. 2010;95(3):130-137. doi:10.1016/j. landurbplan.2009.12.010","White MP, Wheeler BW, Herbert S, Alcock I, Depledge MH. Coastal proximity and physical activity: Is the coast an under-appreciated public health resource? Prev Med (Baltim). 2014;69:135-140. doi:10.1016/j. ypmed.2014.09.016","Ashbullby KJ, Pahl S, Webley P, White MP. The beach as a setting for families' health promotion: A qualitative study with parents and children living in coastal regions in Southwest England. Heal Place. 2013;23:138-147. doi:10.1016/j.healthplace.2013.06.005","White MP, Bell S, Elliott LR, Jenkin R, Wheeler BW, Depledge MH. The health benefits of blue exercise in the UK. In: Barton J, Bragg R, Wood C, Pretty J, eds. Green Exercise : Linking Nature, Health and Well-Being. Abingdon, UK: Routledge; 2016:211","Völker S, Baumeister H, Classen T, Hornberg C, Kistemann T. Evidence for the temperature-mitigating capacity of urban blue space - A health geographic perspective. Erdkunde. 2013;67(4):355-371. doi:10.3112/ erdkunde.2013.04.05","Hajat S, Vardoulakis S, Heaviside C, Eggen B. Climate change effects on human health: projections of temperature-related mortality for the UK during the 2020s, 2050s and 2080s. J Epidemiol Commun Heal Heal. 2014;68(7):641-648. doi:10.1136/jech-2013-202449","Bengston DN, Fletcher JO, Nelson KC. Public policies for managing urban growth and protecting open space: Policy instruments and lessons learned in the United States. Landsc Urban Plan. 2004;69(2-3):271-286. doi:10.1016/j. landurbplan.2003.08.007","Ward Thompson C. Activity, exercise and the planning and design of outdoor spaces. J Environ Psychol. 2013;34:79-96. doi:10.1016/j.jenvp.2013.01.003","WHO. Health 2020: A European Policy Framework and Strategy for the 21st Century. Bonn; 2013. doi:10.1017/ CBO9781107415324.004","Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800. doi:10.1016/S0140- 6736(15)60692-4","McMichael AJ. Globalization, Climate Change, and Human Health. N Engl J Med. 2013;368(14):1335-1343. doi:10.1056/NEJMra1109341","Mishra HS, Bell S, Vassiljev P, Kuhlmann F, Niin G, Grellier J. The development of a tool for assessing the environmental qualities of urban blue spaces. Urban For Urban Green. 2020;49(January):126575. doi:10.1016/j. ufug.2019.126575","Kahila M, Kyttä M. SoftGIS as a Bridge-Builder in Collaborative Urban Planning. In: Geertman S, Stillwell JCH, eds. Planning Support Systems Best Practice and New Methods. Dordrecht: Springer Netherlands; 2009:389-411. doi:10.1007/978-1-4020-8951-0_19"]}

38. Using urban blue spaces to benefit population health and wellbeing

Author

Hall, Kerri L, Garrett, Joanne K, White, Mathew P, Grellier, James, Wuijts, Susanne, and Fleming, Lora E

Subjects
bluespace, 13. Climate action, well-being, 11. Sustainability, 1. No poverty, evidence-based policy, health, 15. Life on land, environment, 6. Clean water, urban planning
Abstract

This report presents an overview of the key messages that came out of the research conducted within the BlueHealth project. In particular, it explains what is meant by "BlueHealth" research, what challenges society faces regarding urban "blue spaces", and how the urban environment can exploit blue infrastructure as a health and well-being resource. We show how an evidence base can be built up with primary studies, and then be implemented in practice with different kinds of interventions. This report is useful as a primer for a wide range of decision-makers, including those making policy, designing and planning our cities and towns, and working towards improved public health and environmental quality in the face of 21st century challenges., {"references":["Solomon S. Water: The Epic Struggle for Wealth, Power, and Civilization. Harper Collins; 2011","EEA: State of Europe's seas Report No 2. Publications Office of the European Union; 2017","Bell S. Health and well-being aspects of urban blue space: The new urban landscape research field. Landsc Archit Spec Ed - Resilient Landscapes. 2019;26:113-119.","Grellier J, White MP, Albin M, et al. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces. BMJ Open. 2017;7(e016188):1-10. doi:10.1136/bmjopen-2017-016188","ISCA/Cebr. The Economic Cost of Physical Inactivity.; 2015. doi:10.5040/9781492595731.ch-014","Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476–493. https://doi.org/10.1093/ije/dyu038","Jacob, D., Kotova, L., Teichmann, C., Sobolowski, S. P., Vautard, R., Donnelly, C., Koutroulis, A. G., Grillakis, M. G., Tsanis, I. K., Damm, A., Sakalli, A., & van Vliet, M. T. H. (2018). Climate Impacts in Europe Under +1.5°C Global Warming. Earth's Future, 6(2), 264–285. https://doi.org/10.1002/2017EF000710","Vousdoukas, M. I., Mentaschi, L., Voukouvalas, E., Bianchi, A., Dottori, F., & Feyen, L. (2018). Climatic and socioeconomic controls of future coastal flood risk in Europe. In Nature Climate Change (Vol. 8, Issue 9, pp. 776–780). Nature Publishing Group. https://doi.org/10.1038/s41558-018-0260-4","Scoccimarro, E., Fogli, P. G., & Gualdi, S. (2017). The role of humidity in determining perceived temperature extremes scenarios in Europe. Environ Res Lett. https://doi.org/10.1088/1748-9326/aa8cdd","Elliott, L. R., White, M. P., Sarran, C., Grellier, J., Garrett, J. K., Scoccimarro, E., Smalley, A. J., & Fleming, L. E. (2019). The effects of meteorological conditions and daylight on nature-based recreational physical activity in England. Urban Forestry & Urban Greening, 42(October 2018), 39–50. https://doi.org/10.1016/j.ufug.2019.05.005","Wheeler, B. W., White, M. P., Stahl-Timmins, W., & Depledge, M. H. (2012). Does living by the coast improve health and wellbeing. Health and Place, 18(5), 1198–1201. https://doi.org/10.1016/j.healthplace.2012.06.015","Hooyberg, A., Roose, H., Grellier, J., Elliott, L. R., Lonneville, B., White, M. P., Michels, N., De Henauw, S., Vandegehuchte, M., & Everaert, G. (2020). General health and residential proximity to the coast in Belgium: Results from a cross-sectional health survey. Environ Res, 184(February), 109225. https://doi.org/10.1016/j.envres.2020.109225","Garrett, J. K., Clitherow, T. J., White, M. P., Wheeler, B. W., & Fleming, L. E. (2019). Coastal proximity and mental health among urban adults in England: The moderating effect of household income. Health and Place, 59, 102200. https://doi.org/10.1016/j.healthplace.2019.102200","Gibbons, S., Mourato, S., & Resende, G. M. (2014). The Amenity Value of English Nature: A Hedonic Price Approach. Environmental and Resource Economics, 57(2), 175–196. https://doi.org/10.1007/s10640-013-9664-9","Elliott, L. R., White, M. P., Grellier, J., Rees, S. E., Waters, R. D., & Fleming, L. E. (2018). Recreational visits to marine and coastal environments in England: Where, what, who, why, and when? Marine Policy, 97(March), 305–314. https://doi.org/10.1016/j.marpol.2018.03.013","White, M. P., Wheeler, B. W., Herbert, S., Alcock, I., & Depledge, M. H. (2014). Coastal proximity and physical activity: Is the coast an under-appreciated public health resource? Preventive Medicine, 69, 135–140. https://doi.org/10.1016/j.ypmed.2014.09.016","Garrett, J. K., White, M. P., Elliott, L. R., Wheeler, B. W., & Fleming, L. E. (2020). Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income. Environmental Research, 190, 109899. https://doi.org/10.1016/j.envres.2020.109899","Korfmacher, K. S., Aviles, K., Cummings, B. J., Daniell, W., Erdmann, J., & Garrison, V. (2014). Health impact assessment of urban waterway decisions. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph120100300","Vert, C., Carrasco-Turigas, G., Zijlema, W., Espinosa, A., Cano-Riu, L., Elliott, L. R., Litt, J., Nieuwenhuijsen, M. J., & Gascon, M. (2019). Impact of a riverside accessibility intervention on use, physical activity, and wellbeing: A mixed methods pre-post evaluation. Landscape and Urban Planning, 190(March), 103611. https://doi.org/10.1016/j.landurbplan.2019.103611","Vert, C., Nieuwenhuijsen, M. J., Gascon, M., Grellier, J., Fleming, L. E., White, M. P., & Rojas-Rueda, D. (2019). Health Benefits of Physical Activity Related to An Urban Riverside Regeneration. Int J Environ Res Public Health, 16(462), 1–16. https://doi.org/10.3390/ijerph16030462","Vert, C., Gascon, M., Ranzani, O., Márquez, S., Triguero-Mas, M., Carrasco-Turigas, G., Arjona, L., Koch, S., Llopis, M., Donaire-Gonzalez, D., Elliott, L. R., & Nieuwenhuijsen, M. J. (2020). Physical and mental health effects of repeated short walks in a blue space environment: A randomised crossover study. Environmental Research, 188, 109812. https://doi.org/10.1016/j.envres.2020.109812","Plymouth City Council. (2019) Active Neighbourhoods Urban nature delivering healthier communities for people and wildlife Final Report (2016–2019).","BlueHealth Consortium. (2020) Urban regeneration: Teats Hill. https://bluehealth2020.eu/projects/urban-beach-regeneration/","BlueHealth Consortium. (2020) Urban coastline: Tallinn. https://bluehealth2020.eu/projects/tallinn/","BlueHealth Consortium. (2020) Urban canal: Tartu. https://bluehealth2020.eu/projects/anne-kanal/","Wuijts, S., Friederichs, L., Hin, J. A., Schets, F. M., van Rijswick, H. F. M. W., & Driessen, P. P. J. (2020). Governance conditions to overcome the challenges of realizing safe urban bathing water sites. International Journal of Water Resources Development, 00(00), 1–25. https://doi.org/10.1080/07900627.2020.1755617","Pilgaard, F. I. H., Östergren, P. O., Olin, A., Kling, S., Albin, M., & Björk, J. (2019). Socioeconomic differences in swimming ability among children in Malmö, southern Sweden: Initial results from a community-level intervention. Scandinavian Journal of Public Health, November 2018, 1–7. https://doi.org/10.1177/1403494818821478","Borja, A., White, M. P., Berdalet, E., Bock, N., Eatock, C., Kristensen, P., Leonard, A., Lloret, J., Pahl, S., Parga, M., Prieto, J. V., Wuijts, S., & Fleming, L. E. (2020). Moving Toward an Agenda on Ocean Health and Human Health in Europe. Frontiers in Marine Science, 7(February). https://doi.org/10.3389/fmars.2020.00037","Yeo, N. L., White, M. P., Alcock, I., Garside, R., Dean, S. G., Smalley, A. J., & Gatersleben, B. (2020). What is the best way of delivering virtual nature for improving mood? An experimental comparison of high definition TV, 360° video, and computer generated virtual reality. Journal of Environmental Psychology, 72. https://doi.org/10.1016/j.jenvp.2020.101500","Tanja-Dijkstra, K., Pahl, S., White, M. P., Auvray, M., Stone, R. J., Andrade, J., May, J., Mills, I., & Moles, D. R. (2018). The Soothing Sea: A Virtual Coastal Walk Can Reduce Experienced and Recollected Pain. Environment and Behavior, 50(6), 599–625. https://doi.org/10.1177/0013916517710077"]}

39. Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing.

Author

White, Mathew P., Pahl, Sabine, Wheeler, Benedict W., Depledge, Michael H., and Fleming, Lora E.

Subjects
*CITY dwellers, *NEIGHBORHOODS & society, *POPULATION & the environment, *WELL-being, *HEALTH, *SOCIAL history, *ECOLOGY, *MENTAL health, *RECREATION, *RESIDENTIAL patterns
Abstract

Despite growing interest in the relationships between natural environments and subjective wellbeing (SWB), previous studies have various methodological and theoretical limitations. Focusing on urban/peri-urban residents (n=7272) from a nationally representative survey of the English population, we explored the relationships between three types of exposure: i) 'neighbourhood exposure', ii) 'visit frequency', and iii) 'specific visit'; and four components of SWB: i) evaluative, ii) eudaimonic, iii) positive experiential and iv) negative experiential. Controlling for area and individual level socio-demographics and other aspects of SWB, visit frequency was associated with eudaimonic wellbeing and a specific visit with positive experiential wellbeing. People who visited nature regularly felt their lives were more worthwhile, and those who visited nature yesterday were happier. The magnitude of the association between weekly nature visits and eudaimonic wellbeing was similar to that between eudaimonic wellbeing and life circumstances such as marital status. Findings are relevant for policies to protect and promote public access to natural environments. [ABSTRACT FROM AUTHOR]

Published
2017
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40. Development of a browser application to foster research on linking climate and health datasets: Challenges and opportunities.

Author

Hajat, Shakoor, Whitmore, Ceri, Sarran, Christophe, Haines, Andy, Golding, Brian, Gordon-Brown, Harriet, Kessel, Anthony, and Fleming, Lora E

Subjects
*CLIMATOLOGY, *HEALTH, *DATA analysis, *REGRESSION analysis, *CLIMATE change
Abstract

Background Improved data linkages between diverse environment and health datasets have the potential to provide new insights into the health impacts of environmental exposures, including complex climate change processes. Initiatives that link and explore big data in the environment and health arenas are now being established. Objectives To encourage advances in this nascent field, this article documents the development of a web browser application to facilitate such future research, the challenges encountered to date, and how they were addressed. Methods A ‘storyboard approach’ was used to aid the initial design and development of the application. The application followed a 3-tier architecture: a spatial database server for storing and querying data, server-side code for processing and running models, and client-side browser code for user interaction and for displaying data and results. The browser was validated by reproducing previously published results from a regression analysis of time-series datasets of daily mortality, air pollution and temperature in London. Results Data visualisation and analysis options of the application are presented. The main factors that shaped the development of the browser were: accessibility, open-source software, flexibility, efficiency, user-friendliness, licensing restrictions and data confidentiality, visualisation limitations, cost-effectiveness, and sustainability. Conclusions Creating dedicated data and analysis resources, such as the one described here, will become an increasingly vital step in improving understanding of the complex interconnections between the environment and human health and wellbeing, whilst still ensuring appropriate confidentiality safeguards. The issues raised in this paper can inform the future development of similar tools by other researchers working in this field. [ABSTRACT FROM AUTHOR]

Published
2017
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41. Blue space, health and well-being: A narrative overview and synthesis of potential benefits.

Author

White, Mathew P., Elliott, Lewis R., Gascon, Mireia, Roberts, Bethany, and Fleming, Lora E.

Subjects
*WELL-being, *SPACE, *FORESTS & forestry
Abstract

Research into the potential health and well-being benefits from exposure to green spaces such as parks and woodlands has led to the development of several frameworks linking the different strands of evidence. The current paper builds on these to provide a model of how exposure to aquatic environments, or blue spaces such as rivers, lakes and the coast, in particular, may benefit health and well-being. Although green and blue spaces share many commonalities, there are also important differences. Given the breadth of the research, spanning multiple disciplines and research methodologies, a narrative review approach was adopted which aimed to highlight key issues and processes rather than provide a definitive balance of evidence summary. Novel aspects of our framework included the inclusion of outcomes that are only indirectly good for health through being good for the environment, the addition of nature connectedness as both a trait and state, and feedback loops where actions/interventions to increase exposure are implemented. Limitations of the review and areas for future work, including the need to integrate potential benefits with potential risks, are discussed. [ABSTRACT FROM AUTHOR]

Published
2020
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