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Background: Everyday people are exposed to multiple environmental factors, such as surrounding green, air pollution and traffic noise. These exposures are generally spatially correlated. Hence, when estimating associations of surrounding green, air pollution or traffic noise with health outcomes, the other exposures should be taken into account. The aim of this study was to evaluate associations of long-term residential exposure to surrounding green, air pollution and traffic noise with mortality.Methods: We followed approximately 10.5 million adults (aged ≥ 30 years) living in the Netherlands from 1 January 2013 until 31 December 2018. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 and 1000 m), annual average ambient air pollutant concentrations [including particulate matter (PM2.5), nitrogen dioxide (NO2)] and traffic noise with non-accidental and cause-specific mortality, adjusting for potential confounders.Results: In single-exposure models, surrounding green was negatively associated with all mortality outcomes, while air pollution was positively associated with all outcomes. In two-exposure models, associations of surrounding green and air pollution attenuated but remained. For respiratory mortality, in a two-exposure model with NO2 and NDVI 300 m, the HR of NO2 was 1.040 (95%CI: 1.022, 1.059) per IQR increase (8.3 µg/m3) and the HR of NDVI 300 m was 0.964 (95%CI: 0.952, 0.976) per IQR increase (0.14). Road-traffic noise was positively associated with lung cancer mortality only, also after adjustment for air pollution or surrounding green.Conclusions: Lower surrounding green and higher air pollution were associated with a higher risk of non-accidental and cause-specific mortality. Studies including only one of these correlated exposures may overestimate the associations with mortality of that exposure. [ABSTRACT FROM AUTHOR]

Self-perceived general health (SGH) is one of the most inclusive and widely used measures of health status and a powerful predictor of mortality. However, only a limited number of studies evaluated associations of combined environmental exposures on SGH. Our aim was to evaluate associations of combined residential exposure to surrounding green, air pollution and traffic noise with poor SGH in the Netherlands. We linked data on long-term residential exposure to surrounding green based on the Normalized Difference Vegetation Index (NDVI) and a land-use database (TOP10NL), air pollutant concentrations (including particulate matter (PM 10 , PM 2.5), and nitrogen dioxide (NO 2)) and road- and rail-traffic noise with a Dutch national health survey, resulting in a study population of 354,827 adults. We analyzed associations of single and combined exposures with poor SGH. In single-exposure models, NDVI within 300 m was inversely associated with poor SGH [odds ratio (OR) = 0.91, 95% CI: 0.89, 0.94 per IQR increase], while NO 2 was positively associated with poor SGH (OR = 1.07, 95% CI: 1.04, 1.11 per IQR increase). In multi-exposure models, associations with surrounding green and air pollution generally remained, but attenuated. Joint odds ratios (JOR) of combined exposure to air pollution, rail-traffic noise and decreased surrounding green were higher than the odds ratios of single-exposure models. Studies including only one of these correlated exposures may overestimate the risk of poor SGH attributed to the studied exposure, while underestimating the risk of combined exposures. • Surrounding green was inversely associated with poor SGH. • Air pollution was positively associated with poor SGH. • In multi-exposure models, associations with surrounding green and air pollution generally remained, but attenuated. • Studies including only one of these exposures may overestimate the risk of poor SGH attributed to the studied exposure. [ABSTRACT FROM AUTHOR]

Background: Most previous studies that investigated associations of surrounding green, air pollution or traffic noise with mortality focused on single exposures., Objectives: The aim of this study was to evaluate combined associations of long-term residential exposure to surrounding green, air pollution and traffic noise with total non-accidental and cause-specific mortality., Methods: We linked a national health survey (Public Health Monitor, PHM) conducted in 2012 to the Dutch longitudinal mortality database. Subjects of the survey who were 30 years or older on 1 January 2013 (n = 339,633) were followed from 1 January 2013 till 31 December 2017. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 m and 1000 m), annual average air pollutant concentrations (including particulate matter (PM 10 , PM 2.5 ), nitrogen dioxide (NO 2 )) and traffic noise with non-accidental, circulatory disease, respiratory disease, lung cancer and neurodegenerative disease mortality., Results: We observed 26,886 non-accidental deaths over 1.627.365 person-years of follow-up. Surrounding green, air pollution and traffic noise exposure were not significantly associated with non-accidental or cause-specific mortality. For non-accidental mortality, we found a hazard ratio (HR) of 0.99 (0.98, 1.01) per IQR increase in NDVI 300 m, a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in NO 2 , a HR of 0.98 (0.97, 1.00) per IQR increase in PM 2.5 and a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in road-traffic noise. Analyses restricted to non-movers or excluding subjects aged 85+ years did not change the findings., Conclusion: We found no evidence for associations of long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental or cause-specific mortality in a large population based survey in the Netherlands, possibly related to the relatively short follow-up period., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Green space has been hypothesized to improve cardiometabolic health of adolescents, whereas air pollution and traffic noise may negatively impact cardiometabolic health., Objectives: To examine the associations of green space, air pollution and traffic noise with cardiometabolic health in adolescents aged 12 and 16 years., Methods: Waist circumference, blood pressure, cholesterol and glycated hemoglobin (HbA1c) were measured in subsets of participants of the Dutch PIAMA birth cohort, who participated in medical examinations at ages 12 (n = 1505) and/or 16 years (n = 797). We calculated a combined cardiometabolic risk score for each participant, with a higher score indicating a higher cardiometabolic risk. We estimated exposure to green space (i.e. the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300 m and 3000 m), air pollution (by land-use regression models) and traffic noise (using the Standard Model Instrumentation for Noise Assessments (STAMINA) model) at the adolescents' home addresses at the time of the medical examinations. We assessed associations of these exposures with cardiometabolic health outcomes at ages 12 and 16 by multiple linear regression, adjusting for potential confounders., Results: We did not observe consistent patterns of associations of green space, air pollution and traffic noise with the cardiometabolic risk score, blood pressure, total cholesterol levels, the total/HDL cholesterol ratio and HbA1c. We found inverse associations of air pollution with waist circumference at both age 12 and 16. These associations weakened after adjustment for region, except for particulate matter with a diameter of <2.5 μm (PM 2.5 ) at age 12. The association of PM 2.5 with waist circumference at age 12 remained after adjustment for green space and road traffic noise (adjusted difference - 1.42 cm [95% CI -2.50, -0.35 cm] per 1.16 μg/m 3 increase in PM 2.5 )., Conclusion: This study does not provide evidence for beneficial effects of green space or adverse effects of air pollution and traffic noise on cardiometabolic health in adolescents., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Surrounding green, air pollution, and noise have been associated with cardiometabolic diseases, but most studies have assessed only one of these correlated exposures., Objectives: We aimed to evaluate associations of combined exposures to green, air pollution, and road traffic noise with cardiometabolic diseases., Methods: In this cross-sectional study, we studied associations between self-reported physician-diagnosed diabetes, hypertension, heart attack, and stroke from a Dutch national health survey of 387,195 adults and residential surrounding green, annual average air pollutant concentrations [including particulate matter with aerodynamic diameter [Formula: see text] ([Formula: see text]), PM with aerodynamic diameter [Formula: see text] ([Formula: see text]), nitrogen dioxide ([Formula: see text]), and oxidative potential (OP) with the dithiothreitol (DTT) assay ([Formula: see text])] and road traffic noise. Logistic regression models were used to analyze confounding and interaction of surrounding green, air pollution, and noise exposure., Results: In single-exposure models, surrounding green was inversely associated with diabetes, while air pollutants ([Formula: see text], [Formula: see text]) and road traffic noise were positively associated with diabetes. In two-exposure analyses, associations with green and air pollution were attenuated but remained. The association between road traffic noise and diabetes was reduced to unity when adjusted for surrounding green or air pollution. Air pollution and surrounding green, but not road traffic noise, were associated with hypertension in single-exposure models. The weak inverse association of surrounding green with hypertension attenuated and lost significance when adjusted for air pollution. Only [Formula: see text] was associated with stroke and heart attack., Conclusions: Studies including only one of the correlated exposures surrounding green, air pollution, and road traffic noise may overestimate the association of diabetes and hypertension attributed to the studied exposure. https://doi.org/10.1289/EHP3857.

Background: Evidence is emerging that poor mental health is associated with the environmental exposures of surrounding green, air pollution and traffic noise. Most studies have evaluated only associations of single exposures with poor mental health., Objectives: To evaluate associations of combined exposure to surrounding green, air pollution and traffic noise with poor mental health., Methods: In this cross-sectional study, we linked data from a Dutch national health survey among 387,195 adults including questions about psychological distress, based on the Kessler 10 scale, to an external database on registered prescriptions of anxiolytics, hypnotics & sedatives and antidepressants. We added data on residential surrounding green in a 300 m and a 1000 m buffer based on the Normalized Difference Vegetation Index (NDVI) and a land-use database (TOP10NL), modeled annual average air pollutant concentrations (including particulate matter (PM 10 , PM 2.5 ), and nitrogen dioxide (NO 2 )) and modeled road- and rail-traffic noise (Lden and Lnight) to the survey. We used logistic regression to analyze associations of surrounding green, air pollution and traffic noise exposure with poor mental health., Results: In single exposure models, surrounding green was inversely associated with poor mental health. Air pollution was positively associated with poor mental health. Road-traffic noise was only positively associated with prescription of anxiolytics, while rail-traffic noise was only positively associated with psychological distress. For prescription of anxiolytics, we found an odds ratio [OR] of 0.88 (95% CI: 0.85, 0.92) per interquartile range [IQR] increase in NDVI within 300 m, an OR of 1.14 (95% CI: 1.10, 1.19) per IQR increase in NO 2 and an OR of 1.07 (95% CI: 1.03, 1.11) per IQR increase in road-traffic noise. In multi exposure analyses, associations with surrounding green and air pollution generally remained but attenuated. Joint odds ratios [JOR], based on the Cumulative Risk Index (CRI) method, of combined exposure to air pollution, traffic noise and decreased surrounding green were higher than the ORs of single exposure models. Associations of environmental exposures with poor mental health differed somewhat by age., Conclusions: Studies including only one of these three correlated exposures may overestimate the influence of poor mental health attributed to the studied exposure, while underestimating the influence of combined environmental exposures., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Green space may influence health through several pathways, for example, increased physical activity, enhanced social cohesion, reduced stress, and improved air quality. For green space to increase physical activity and social cohesion, spending time in green spaces is likely to be important., Objectives: We examined whether adolescents visit green spaces and for what purposes. Furthermore, we assessed the predictors of green space visits., Methods: In this cross-sectional study, data for 1911 participants of the Dutch PIAMA (Prevention and Incidence of Asthma and Mite Allergy) birth cohort were analyzed. At age 17, adolescents reported how often they visited green spaces for physical activities, social activities, relaxation, and to experience nature and quietness. We assessed the predictors of green space visits altogether and for different purposes by log-binomial regression., Results: Fifty-three percent of the adolescents visited green spaces at least once a week in summer, mostly for physical and social activities. Adolescents reporting that a green environment was (very) important to them visited green spaces most frequently {adjusted prevalence ratio (PR) [95% confidence interval (CI)] very vs. not important: 6.84 (5.10, 9.17) for physical activities and 4.76 (3.72, 6.09) for social activities}. Boys and adolescents with highly educated fathers visited green spaces more often for physical and social activities. Adolescents who own a dog visited green spaces more often to experience nature and quietness. Green space visits were not associated with the objectively measured quantity of residential green space, i.e., the average normalized difference vegetation index (NDVI) and percentages of urban, agricultural, and natural green space in circular buffers around the adolescents' homes., Conclusions: Subjective variables are stronger predictors of green space visits in adolescents than the objectively measured quantity of residential green space. https://doi.org/10.1289/EHP2429.

Recently, short-term monitoring campaigns have been carried out to investigate the spatial variation of air pollutants within cities. Typically, such campaigns are based on short-term measurements at relatively large numbers of locations. It is largely unknown how well these studies capture the spatial variation of long term average concentrations. The aim of this study was to evaluate the within-site temporal and between-site spatial variation of the concentration of ultrafine particles (UFPs) and black carbon (BC) in a short-term monitoring campaign. In Amsterdam and Rotterdam (the Netherlands) measurements of number counts of particles larger than 10nm as a surrogate for UFP and BC were performed at 80 sites per city. Each site was measured in three different seasons of 2013 (winter, spring, summer). Sites were selected from busy urban streets, urban background, regional background and near highways, waterways and green areas, to obtain sufficient spatial contrast. Continuous measurements were performed for 30 min per site between 9 and 16 h to avoid traffic spikes of the rush hour. Concentrations were simultaneously measured at a reference site to correct for temporal variation. We calculated within- and between-site variance components reflecting temporal and spatial variations. Variance ratios were compared with previous campaigns with longer sampling durations per sample (24h to 14 days). The within-site variance was 2.17 and 2.44 times higher than the between-site variance for UFP and BC, respectively. In two previous studies based upon longer sampling duration much smaller variance ratios were found (0.31 and 0.09 for UFP and BC). Correction for temporal variation from a reference site was less effective for the short-term monitoring campaign compared to the campaigns with longer duration. Concentrations of BC and UFP were on average 1.6 and 1.5 times higher at urban street compared to urban background sites. No significant differences between the other site types and urban background were found. The high within to between-site concentration variances may result in the loss of precision and low explained variance when average concentrations from short-term campaigns are used to develop land use regression models., (Copyright © 2014 Elsevier B.V. All rights reserved.)