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National Atlas for Sustainability

Eco-Health Browser Bibliography

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Abbey DE, N Nishino, WF McDonnell, et al. 1999. Long-term inhalable particles and other air pollutants related to mortality in nonsmokers. Am. J. Respir. Crit. Care Med. 159(2): 373-38.

Long-term ambient concentrations of inhalable particles less than 10 µm in diameter (PM10) (1973- 1992) and other air pollutantstotal suspended sulfates, sulfur dioxide, ozone (O3), and nitrogen dioxidewere related to 1977-1992 mortality in a cohort of 6,338 nonsmoking California Seventh-day Adventists. In both sexes, PM10 showed a strong association with mortality for any mention of nonmalignant respiratory disease on the death certificate, adjusting for a wide range of potentially confounding factors, including occupational and indoor sources of air pollutants. The adjusted relative risk (RR) for this cause of death as associated with an interquartile range (IQR) difference of 43 d/yr when PM10 exceeded 100 µg/m3 was 1.18 (95% confidence interval [CI]: 1.02, 1.36). In males, PM10 showed a strong association with lung cancer deathsRR for an IQR was 2.38 (95% CI: 1.42, 3.97). Ozone showed an even stronger association with lung cancer mortality for males with an RR of 4.19 (95% CI: 1.81, 9.69) for the IQR difference of 551 h/yr when O3 exceeded 100 parts per billion. Sulfur dioxide showed strong associations with lung cancer mortality for both sexes. Other pollutants showed weak or no association with mortality.

Adams P, GE Hendershot, MA Marano, eds.1999. Current estimates from the National Health Interview Survey, 1996. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, Office of Health Research, Statistics and Technology. National Center for Health Statistics; 1999 (200): 1 - 203.

No abstract provided.

Akbari H, DM Kurn, SE Bretz, JW Hanford. 1997. Peak power and cooling energy savings of shade trees. Energy and Buildings 25(2): 139-48.

In summer of 1992, we monitored peak power and cooling energy savings from shade trees in two houses in Sacramento, CA. The collected data include air-conditioning electricity use, indoor and outdoor dry bulb temperatures and humidities, roof and ceiling surface temperatures, inside and outside wall temperatures, insolation, and wind speed and direction. Shade trees at the two monitored houses yielded seasonal cooling energy savings of 30%, corresponding to an average daily savings of 3.6 and 4.8 kWh/d. Peak demand savings for the same houses were 0.6 and 0.8 kW (about 27% savings in one house and 42% in the other). The monitored houses were modeled with the DOE-2.1E simulation program. The simulation results underestimated the cooling energy savings and peak power reductions by as much as twofold.

Almanza E, M Jerrett, et al. 2012. A study of community design, greenness, and physical activity in children using satellite, GPS and accelerometer data. Health & Place 18(1): 46-54.

This study examined relationships between greenness exposure and free-living physical activity behavior of children in smart growth and conventionally designed communities. Normalized Difference Vegetation Index (NDVI) was used to quantify children's (n=208) greenness exposure at 30-s epoch accelerometer and GPS data points. A generalized linear mixed model with a kernel density smoothing term for addressing spatial autocorrelation was fit to analyze residential neighborhood activity data. Excluding activity at home and during school-hours, an epoch-level analysis found momentary greenness exposure was positively associated with the likelihood of contemporaneous moderate-to-vigorous physical activity (MVPA). This association was stronger for smart growth residents who experienced a 39% increase in odds of MVPA for a 10th to 90th percentile increase in exposure to greenness (OR=1.39, 95% CI 1.36 - 1.44). An individual-level analysis found children who experienced >20 min of daily exposure to greener spaces (>90th percentile) engaged in nearly 5 times the daily rate of MVPA of children with nearly zero daily exposure to greener spaces (95% CI 3.09-7.20).

American Cancer Society - Cancer Facts and Figures 2011. Accessed February 2013.

Anderson NB, Ed. 2004. Hostility: Psychophysiology. Encyclopedia of health and behavior. Thousand Oaks CA: Sage Publications. pp 529.

No abstract provided.

Annerstedt M, P-O Ostergren, et al. 2012. Green qualities in the neighbourhood and mental health - results from a longitudinal cohort study in Southern Sweden. BMC Public Health 12(1): 337.

BACKGROUND:Poor mental health is a major issue worldwide and causality is complex. For diseases with multifactorial background synergistic effects of person- and place- factors can potentially be preventive. Nature is suggested as one such positive place-factor. In this cohort study we tested the effect of defined green qualities (Serene, Space, Wild, Culture, Lush) in the environment at baseline on mental health at follow-up. We also studied interaction effects on mental health of those place factors and varied person factors (financial stress, living conditions, and physical activity).

METHODS:Data on person factors were extracted from a longitudinal (years 1999/2000 and 2005) population health survey (n=24945). The participants were geocoded and linked to data on green qualities from landscape assessments, and stored in the Geographical Information System (GIS). Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated, and multivariate logistic analyses were performed.

RESULTS:Mental health was not affected by access to the chosen green qualities, neither in terms of amount nor in terms of any specific quality. However, we found a reduced risk for poor mental health at follow-up among women, through a significant interaction effect between physical activity and access to the qualities Serene or Space. For men the tendencies were similar, though not significant. Regarding the other three green qualities, as well as amount of qualities, no statistically certain synergistic effects were found. Likewise, no significant synergies were detected between green qualities and the other person-factors. Only advanced exercise significantly reduced the risk for poor mental health among women, but not for men, compared to physical inactivity.

CONCLUSIONS:The results do not directly support the hypothesis of a preventive mental health effect by access to the green qualities. However, the additive effect of serene nature to physical activity contributed to better mental health at follow-up. This tendency was equal for both sexes, but statistically significant only for women.Objective landscape assessments may be important in detangling geographic determinants of health. This study stresses the importance of considering interaction effects when dealing with disorders of multifactorial background.

Anxiety Disorders Association of America. Accessed February 2013.

Araya M, M Olivares, F Pizarro, et al. 2004. Community-based randomized double-blind study of gastrointestinal effects and copper exposure in drinking water. Environmental Health Perspectives 112(10): 1068-73.

We assessed gastrointestinal effects in 1,365 adults exposed to either < 0.01 (controls), 2, 4, or 6 mg copper/L of drinking water for 2 months in a randomized, double-blind community-based study. The risk of symptoms increased with increasing Cu exposure and decreased with time. The best model by counting-process analysis included Cu concentration and sex. The risk of symptoms remained significantly higher in women than in men during weeks 1-4 for all concentrations tested; at week I comparison with the < 0.01-mg/L group showed that differences became significant in women at 4 mg/L [relative risk (RR) = 1.53; 95% confidence interval (CI), 1.02-2.05), and in men at 6 mg/L (RR = 1.9; 95% CI, 1.02-2-79). At week 2 for men and week 4 in women, the Cu concentration required to obtain significant differences on symptom report was > 6 mg Cu/L. We conclude that exposure to Cu in drinking water results in gastrointestinal symptoms, which are modulated by Cu concentration, time, and sex.

Armson D, P Stringer, et al. 2012. The effect of tree shade and grass on surface and globe temperatures in an urban area. Urban Forestry & Urban Greening 11(3): 245-255.

The process of urbanisation alters the thermal balance of an area resulting in an urban heat island effect where cities can be several degrees centigrade warmer than the surrounding rural landscape. This increased heat can make cities uncomfortable places and, during heat waves, can pose serious health risks. This study looked at the role that trees and grass can play in reducing regional and local temperatures in urban areas during the summer within the urban landscape of Manchester, UK. In June and July 2009 and 2010, we monitored the surface temperatures of small plots composed of concrete and grass in the presence or absence of tree shading, and measured globe temperatures above each of the surfaces. The same measures were also recorded at mid-day on larger expanses of asphalt and grass in an urban park. Both surface and shade greatly affected surface temperatures. Grass reduced maximum surface temperatures by up to 24 degrees C, similar to model predictions, while tree shade reduced them by up to 19 degrees C. In contrast, surface composition had little effect upon globe temperatures, whereas shading reduced them by up to 5-7 degrees C. These results show that both grass and trees can effectively cool surfaces and so can provide regional cooling, helping reduce the urban heat island in hot weather. In contrast grass has little effect upon local air or globe temperatures, so should have little effect on human comfort, whereas tree shade can provide effective local cooling.

Arthritis Foundation - Osteoarthritis. Accessed February 2013.


Baker DB, RP Richards, TT Loftus, JW Kramer. 2004. A new flashiness index: characteristics and applications to Midwestern rivers and streams. Journal of the American Water Resources Association, 40 (2): p 503 -22.

The term flashiness reflects the frequency and rapidity of short term changes in streamflow, especially during runoff events. Flashiness is an important component of a stream's hydrologic regime. A variety of land use and land management changes may lead to increased or decreased flashiness, often to the detriment of aquatic life. This paper presents a newly developed flashiness index, which is based on mean daily flows. The index is calculated by dividing the pathlength of flow oscillations for a time interval (i.e., the sum of the absolute values of day-to-day changes in mean daily flow) by total discharge during that time interval. This index has low interannual variability, relative to most flow regime indicators, and thus greater power to detect trends. Index values were calculated for 515 Midwestern streams for the 27-year period from 1975 through 2001. Statistically significant increases were present in 22 percent of the streams, primarily in the eastern portion of the study area, while decreases were present in 9 percent, primarily in the western portion. Index values tend to decrease with increasing watershed area and with increasing unit area ground water inputs. Area compensated index values often shift at ecoregion boundaries. Potential index applications include evaluation of programs to restore more natural flow regimes.

Barbone F, M Bovenzi, F Cavallieri, G Stanza. 1995. Air pollution and lung cancer in Trieste, Italy. American Journal of Epidemiology 141(12): 1161-69.

To investigate the relation between air pollution and histologic type of lung cancer, the authors conducted a case-control study among men who had died in Trieste, Italy, from 1979 to 1981 and from 1985 to 1986. Through the local autopsy registry, 755 cases of lung cancer and 755 controls were identified. Information on smoking habits, occupation, and place of residence was obtained from each subject's next of kin. Air pollution at the residence of each subject was estimated from the average value of total particulate at the nearest monitoring station. Logistic regression was used to evaluate the effect of residence and air pollution on lung cancer after adjustment for age, smoking habits, likelihood of exposure to occupational carcinogens, and social group. The risk of lung cancer increased with increasing level of air pollution for all types of lung cancer combined (p = 0.022), for small cell carcinoma (p = 0.016), and for large cell carcinoma (p = 0.049). Compared with inhabitants of the resid ential area, residents of the rural area had a relative risk (RR) of 0.6 (95% confidence interval (Cl) 0.4–1.0). The RR was 1.5 (95% Cl 1.0–2.2) for residents of the center of the city and 1.4 (95% Cl 1.0-2.1) for residents of the industrial area. In the center of the city, the excess risk was almost completely restricted to small cell carcinoma (RR = 2.0) and to large cell carcinoma (RR = 2.6). In the industrial area, the risk was increased especially for adenocarcinoma (RR = 2.1). These results provide evidence that air pollution is a moderate risk factor for certain histologic types of lung cancer.

Barton J, M Griffin, et al. 2012. Exercise-, nature- and socially interactive-based initiatives improve mood and self-esteem in the clinical population. Perspectives in Public Health 132(2): 89-96.

Aims: This study evaluated two existing group-based health promotion initiatives (a social club and a swimming group) and compared these to a new green exercise programme (weekly countryside and urban park walks). Methods: Participants represented a clinical population (N = 53) and were all experiencing a range of mental health problems. They only attended one of the three programmes and sessions were held once a week for six weeks in all initiatives. Composite questionnaires incorporating two standardized measures to analyse changes in self-esteem and mood were completed before and after all sessions. Results: A significant main effect for self-esteem and mood pre and post activity (p < 0.001) was reported after participating in a single session. The change in self-esteem was significantly greater in the green exercise group compared with the social activities club (p < 0.001). Dose responses showed that both self-esteem and mood levels improved over the six-week period and improvements were related to attendance in the green exercise group. Conclusions: Green exercise as a health-promoting initiative for people experiencing mental ill health is equally as effective as existing programmes. Combining exercise, nature and social components in future initiatives may play a key role in managing and supporting recovery from mental ill health, suggesting a potential 'green' approach to mental healthcare and promotion.

Barton J and J Pretty. 2010. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental Science & Technology 44(10): 3947-55.

Green exercise is activity in the presence of nature. Evidence shows it leads to positive short and long-term health outcomes. This multistudy analysis assessed the best regime of dose(s) of acute exposure to green exercise required to improve self-esteem and mood (indicators of mental health). The research used meta-analysis methodology to analyze 10 UK studies involving 1252 participants. Outcomes were identified through a priori subgroup analyses, and dose-responses were assessed for exercise intensity and exposure duration. Other subgroup analyses included gender, age group, starting health status, and type of habitat. The overall effect size for improved self-esteem was d = 0.46 (CI 0.34-0.59, p < 0.00001) and for mood d = 0.54 (CI 0.38-0.69, p < 0.00001). Dose responses for both intensity and duration showed large benefits from short engagements in green exercise, and then diminishing but still positive returns. Every green environment improved both self-esteem and mood; the presence of water generated greater effects. Both men and women had similar improvements in self-esteem after green exercise, though men showed a difference for mood. Age groups: for self-esteem, the greatest change was in the youngest, with diminishing effects with age; for mood, the least change was in the young and old. The mentally ill had one of the greatest self-esteem improvements. This study confirms that the environment provides an important health service.

Bass B, KKY Liu, BA Baskaran. 2003. Evaluating rooftop and vertical gardens as an adaptation strategy for urban areas. NRC Institute for Research in Construction, NRC Canada.

Green roof infrastructure has become a multi-million dollar industry in Germany and is gaining popularity in other European countries as well. Green roof infrastructure is more than just soil and plants on a roof, but consists of specialized membranes and drainage barriers to support the growing of vegetation on top of buildings. The benefits of this technology were researched and presented in the Canada Mortgage and Housing Corporation Report Greenbacks from Green Roofs (Peck at el., 1999). Many of the advantages of these technologies, such as the reduction of stormwater runoff, the reduction of cooling loads and the reduction of the urban heat island suggested that this technology could play a role in helping Canadian cities adapt to climate change. The goal of this research was to assess these benefits in a Canadian context.

Baumgardner D, S Varela, et al. 2012. The role of a peri-urban forest on air quality improvement in the Mexico City megalopolis. Environmental Pollution 163, April: 174-183.

Air quality improvement by a forested, peri-urban national park was quantified by combining the Urban Forest Effects (UFORE) and the Weather Research and Forecasting coupled with Chemistry (WRF-Chem) models. We estimated the ecosystem-level annual pollution removal function of the park's trees, shrub and grasses using pollution concentration data for carbon monoxide (CO), ozone (O3), and particulate matter less than 10 microns in diameter (PM10), modeled meteorological and pollution variables, and measured forest structure data. Ecosystem-level O3 and CO removal and formation were also analyzed for a representative month. Total annual air quality improvement of the park's vegetation was approximately 0.02% for CO, 1% for O3, and 2% for PM10, of the annual concentrations for these three pollutants. Results can be used to understand the air quality regulation ecosystem services of peri-urban forests and regional dynamics of air pollution emissions from major urban areas.

Bayer-Oglesby L, L Grize, et al. 2005). Decline of ambient air pollution levels and improved respiratory health in Swiss children. Environmental Health Perspectives 113(11): 1632-1637.

The causality of observed associations between air pollution and respiratory health in children is still subject to debate. If reduced air pollution exposure resulted in improved respiratory health of children, this would argue in favor of a causal relation. We investigated whether a rather moderate decline of air pollution levels in the 1990s in Switzerland was associated with a reduction in respiratory symptoms and diseases in school children. In nine Swiss communities, 9,591 children participated in cross sectional health assessments between 1992 and 2001. Their parents completed identical questionnaires on health status and covariates. We assigned to each child an estimate of regional particles with an aerodynamic diameter < 10 ug/m3 (PM10) and determined change in PM10 since the first survey. Adjusted for socioeconomic, health-related, and indoor factors, declining PM10 was associated in logistic regression models with declining prevalence of chronic cough [odds ratio (OR) per 10-ug/m3 decline = 0.65, 95% con?dence interval (CI), 0.54-0.79], bronchitis (OR = 0.66; 95% CI, 0.55-0.80), common cold (OR = 0.78; 95% CI, 0.68-0.89), nocturnal dry cough (OR = 0.70; 95% CI, 0.60-0.83), and conjunctivitis symptoms (OR = 0.81; 95% CI, 0.70-0.95). Changes in prevalence of sneezing during pollen season, asthma, and hay fever were not associated with the PM10 reduction. Our findings show that the reduction of air pollution exposures contributes to improved respiratory health in children. No threshold of adverse effects of PM10 was apparent because we observed the bene?cial effects for relatively small changes of rather moderate air pollution levels. Current air pollution levels in Switzerland still exceed limit values of the Swiss Clean Air Act; thus, children's health can be improved further.

Bealey WJ, AG McDonald, E Nemitz; RDonovan, U Dragosits, TR Duffy, D Fowler. 2006. Estimating the reduction of urban PM10 concentrations by trees within an environmental information system for planners. Journal of Environmental Management 85(1): 44-58.

Trees have been widely quoted as effective scavengers of both gaseous and particulate pollutants from the atmosphere. Recent work on the deposition of urban aerosols onto woodland allows the effect of tree planting strategies on airborne aerosol concentrations to be quantified and considered within the planning process. By identifying the potential planting locations in the local authority area, and applying them within a dispersion and deposition model, the potential magnitude of reduction in the ambient concentration of PM(10), achievable through urban tree planting, has been quantified for two UK cities. As part of the Environmental Information Systems for Planners (EISP), flow diagrams, based on planning decisions, have incorporated output from the model to make decisions on land use planning ranging from development plans and strategic planning, to development control. In this way, for any new developments that contribute to the local PM(10) level, the mitigation by planting trees can be assessed, and in some cases, reductions can be sufficient to meet air quality objectives for PM(10).

Beaumont JJ, RM Sedman, SD Reynolds et al. 2008. Cancer mortality in a Chinese population exposed to hexavalent chromium in drinking water. Epidemiology 19(1): 12-23.

Background: In 1987, investigators in Liaoning Province, China, reported that mortality rates for all cancer, stomach cancer, and lung cancer in 1970-1978 were higher in villages with hexavalent chromium (Cr+6)-contaminated drinking water than in the general population. The investigators reported rates, but did not report statistical measures of association or precision.

Methods: Using reports and other communications from investigators at the local Jinzhou Health and Anti-Epidemic Station, we obtained data on Cr+6 contamination of groundwater and cancer mortality in 9 study regions near a ferrochromium factory. We estimated: (1) person-years at risk in the study regions, based on census and population growth rate data, (2) mortality counts, based on estimated person-years at risk and previously reported mortality rates, and (3) rate ratios and 95% confidence intervals.

Results: The all-cancer mortality rate in the combined 5 study regions with Cr+6-contaminated water was negligibly elevated in comparison with the rate in the 4 combined study regions without contaminated water (rate ratio = 1.13; 95% confidence interval = 0.86-1.46), but was somewhat more elevated in comparison with the whole province (1.23; 0.97-1.53). Stomach cancer mortality in the regions with contaminated water was more substantially elevated in comparison with the regions without contaminated water (1.82; 1.11-2.91) and the whole province (1.69; 1.12-2.44). Lung cancer mortality was slightly elevated in comparison with the unexposed study regions (1.15; 0.62-2.07), and more strongly elevated in comparison with the whole province (1.78; 1.03-2.87). Mortality from other cancers combined was not elevated in comparison with either the unexposed study regions (0.86; 0.53-1.36) or the whole province (0.92; 0.58-1.38).

Conclusions: While these data are limited, they are consistent with increased stomach cancer risk in a population exposed to Cr+6 in drinking water. (C) 2008 Lippincott Williams & Wilkins, Inc.

Beck S, D Wojdyla, L Say et al. 2010. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bulletin of the World Health Organization; 88:31-8.

Beckett KP, P Freer-Smith, G Taylor. 2000. Effective tree species for local air-quality management. Journal of Arboriculture 26(1): 12-9.

The beneficial effect that trees have on air quality is often stated in arboricultural literature but has rarely been researched. The presented study aims to identify trees from 5 contrasting species that maximize the benefit to local air quality. Results show that all trees examined captured large quantities of airborne particulates, from the health-damaging size fractions (particle diameters of 10 to 2.5 um, 2.5 to 1 um, and <1 um). Coniferous species were found to capture more particles than did broad-leaves, with pines (Pinus spp.) capturing significantly more material than cypresses (Cupresses spp.). Of the broad-leaved species, whitebeam (Sorbus aria) captured the most and poplar (Populus spp.) the least weight of particles. Trees situated close to a busy road captured significantly more material from the largest particle size fraction than those situated at a rural, background site. There was very little variation between the 2 sites in the weight of particulates from the 2 smallest particle size fractions (i.e., the fractions that are potentially the most damaging to human health).

Bell JF, JS Wilson, G Liu. 2008. Neighborhood greenness and 2-year changes in body mass index of children and youth. American Journal of Preventive Medicine 35(6): 547-53.

Background: Available studies of the built environment and the BMI of children and youth suggest a contemporaneous association with neighborhood greenness in neighborhoods with high population density. The current study tests whether greenness and residential density are independently associated with 2-year changes in the BMI of children and youth.

Methods: The sample included children and youth aged 3–16 years who lived at the same address for 24 consecutive months and received well-child care from a Marion County IN clinic network within the years 1996–2002 (n3831). Multiple linear regression was used to examine associations among age- and gender-specific BMI z-scores in Year 2, residential density, and a satellite-derived measure of greenness, controlling for baseline BMI z-scores and other covariates. Logistic regression was used to model associations between an indicator of BMI z-score increase from baseline to Time 2 and the above-mentioned predictors.

Results: Higher greenness was significantly associated with lower BMI z-scores at Time 2 reagardless of residential density characteristics.Higher residential density was not associated with Time 2 BMI z-scores in models regardless of greenness. Higher greenness was also associated with lower odds of children’s and youth’s increasing their BMI z-scores over 2 years (OR=.87; 95% CI=0.79, 0.97).

Conclusions: Greenness may present a target for environmental approaches to preventing child obesity.Children and youth living in greener neighborhoods had lower BMI z-scores at Time 2, presumably due to increased physical activity or time spent outdoors. Conceptualizations of walkability from adult studies, based solely on residential density, may not be relevant to children and youth in urban environments.

Bell ML and DL Davis. 2001. Reassessment of the lethal London fog of 1952: novel indicators of acute and chronic consequences of acute exposure to air pollution. Environmental Health Perspectives 109(3): 389-94.

This article develops and assesses novel indicators of respiratory and other morbidity and mortality following London's lethal smog in the winter of 1952. Public health insurance claims, hospital admission rates for cardiac and respiratory disease, pneumonia cases, mortality records, influenza reports, temperature, and air pollutant concentrations are analyzed for December-February 1952-1953 and compared with those for the previous year or years. Mortality rates for the smog episode from December 1952 to February 1953 were 50-300% higher than the previous year. Claims that the smog only elevated health risks during and immediately following the peak fog 5-9 December 1952 and that an influenza epidemic accounted fully for persisting mortality increases in the first 2 months of 1953 are rejected. We estimate about 12,000 excess deaths occurred from December 1952 through February 1953 because of acute and persisting effects of the 1952 London smog. Pollution levels during the London smog were 5-19 times above current regulatory standards and guidelines and approximate current levels in some rapidly developing regions. Ambient pollution in many regions poses serious risks to public health.

Bennet G. 1970. Bristol floods 1968. Controlled survey of effects on health of local community disaster. British Medical Journal 3(5720): 454-8.

An investigation into the health of people in Bristol flooded in July 1968 was made by means of a controlled survey and a study of mortality rates. There was a 50% increase in the number of deaths among those whose homes had been flooded, with a conspicuous rise in deaths from cancer.Surgery attendances rose by 53%, referrals to hospital and hospital admissions more than doubled. In all respects the men appeared less well able to cope with the experience of disaster than the women.

Berman MG, J Jonides, S Kaplan. 2008. The cognitive benefits of interacting with nature. Psychological Science 19(12): 1207-12.

We compare the restorative effects on cognitive functioning of interactions with natural versus urban environments. Attention restoration theory (ART) provides an analysis of the kinds of environments that lead to improvements in directed-attention abilities. Nature, which is filled with intriguing stimuli, modestly grabs attention in a bottom-up fashion, allowing top-down directed-attention abilities a chance to replenish. Unlike natural environments, urban environments are filled with stimulation that captures attention dramatically and additionally requires directed attention (e.g., to avoid being hit by a car), making them less restorative. We present two experiments that show that walking in nature or viewing pictures of nature can improve directed-attention abilities as measured with a backwards digit-span task and the Attention Network Task, thus validating attention restoration theory.

Better Medicine - Respiratory Symptoms. Accessed February 2013.

Beutel MW, CD Newton, et al. 2009. Nitrate removal in surface-flow constructed wetlands treating dilute agricultural runoff in the lower Yakima Basin, Washington. Ecological Engineering 35(10): 1538-1546.

Constructed treatment wetlands (CTWs) have been used effectively to treat a range of wastewaters and non-point sources contaminated with nitrogen (N). But documented long-termcase studies of CTWs treating dilute nitrate-dominated agricultural runoff are limited. This study presents an analysis of four years of water quality data for a 1.6-ha surface-flow CTW treating irrigation return flows in Yakima Basin in central Washington. The CTW consisted of a sedimentation basin followed by two surface-flow wetlands in parallel, each with three cells. Inflow typically contained 1-3 mg-N/L nitrate and <0.4 mg-N/L total Kjeldahl N (TKN). Hydraulic loading was fairly constant, ranging from around 125 cm/d in the sedimentation basin to 12 cm/d in the treatment wetlands. Concentration removal ef?ciencies for nitrate averaged 34% in the sedimentation basin and 90�93% in the treatment wetlands. Total N removal ef?ciencies averaged 21% and 57-63% in the sedimentation basin and treatment wetlands, respectively. Area-based first-order removal rate constants for nitrate in the wetlands averaged 142�149 m/yr. Areal removal rates for nitrate in treatment wetlands averaged 139�146 mg-N/m2 /d. Outflow from the CTWtypically contained <0.1 mgN/L nitrate and <0.6 mg-N/L TKN. Rates of nitrate loss in wetlands were highly seasonal, generally peaking in the summer months (June�August). Nitrate loss rates also correlated signi?cantly with water temperature (positively) and dissolved oxygen (negatively). Based on the modified Arrhenius relationship,  for nitrate loss in the wetlands was 1.05�1.09. The CTW also signi?cantly affected temperature and dissolved oxygen concentration in waters ?owing through the system. On average, the sedimentation basin caused an increase in temperature (+1.7 C) and dissolved oxygen (+1.5 mg/L); in contrast the wetlands caused a decrease in temperature (-1.6 C) and dissolved oxygen (-5.0 mg/L). Results show that CTWs with surface-?ow wetlands can be extremely effective at polishing dilute non-point sources, particularly in semi-arid environments where warm temperatures and low oxygen levels in treatment wetland water promote biological denitrification.

Birch G, M Fazeli & C Matthai. 2005. Efficiency of an infiltration basin in removing contaminants from urban stormwater. Environmental Monitoring and Assessment, 101(1), 23-38.

The efficiency of a Stormwater Infiltration Basin (SIB) to remove contaminants from urban stormwater was assessed in the current investigation. The SIB, installed in an urban suburb in eastern Sydney (Australia), was monitored over seven rainfall events to assess the removal efficiency of the remedial device for total suspended solids (TSS), nutrients (TP, TKN, Nox, TN), trace metals (Cd, Cr, Cu, Fe, Mn, Ni, Pb, Zn), organochlorine pesticides and faecal coliforms (FC) from stormwater. The weighted average concentration (WAC) of TSS in the stormwater effluent from the SIB was reduced by an average of 50%, whereas the WAC of Cu, Pb and Zn were also reduced by an average 68%, 93% and 52%, respectively. However, the WAC of Cr, Fe, Mn and Ni displays either similar concentrations as the stormwater influent (Cr and Mn), or substantially higher concentrations (Fe and Ni), due possibly to leaching of fine-grained zeolite clay particles in the filtration bed. The mean removal efficiency of the SIB for total phosphorus (TP) and total Kjeldahl nitrogen (TKN) was 51% and 65%, respectively. In contrast, the average WAC of oxidisable nitrogen (nitrate and nitrite nitrogen or Nox) is about 2.5 times greater in the effluent (1.34 � 0.69 mg L�1) than in the incoming stormwater (0.62 � 0.25 mg L�1). The WAC of total nitrogen (TN) was similar for stormwater at the in-flow and out-flow points. The SIB was very efficient in removing FC from stormwater; and the WAC of almost 70 (100 mL)�1 at inflow was reduced to <2000 cfu (100 Ml)�1 at the outflow, representing a mean removal efficiency of 96%. Due to the low concentrations of Cd, organochlorine pesticides and PAHs in the stormwater, it was not possible to assess the efficiency of the SIB in removing these contaminants.

Bolund P and S Hunhammar. 1999. Ecosystem services in urban areas. Ecological Economics 29(2): 293-301.

Humanity is increasingly urban, but continues to depend on Nature for its survival. Cities are dependent on the ecosystems beyond the city limits, but also benefit from internal urban ecosystems. The aim of this paper is to analyze the ecosystem services generated by ecosystems within the urban area. 'Ecosystem services' refers to the benefits human populations derive from ecosystems. Seven different urban ecosystems have been identified: street trees; lawns/parks; urban forests; cultivated land; wetlands; lakes/sea; and streams. These systems generate a range of ecosystem services. In this paper, six local and direct services relevant for Stockholm are addressed: air filtration, micro climate regulation, noise reduction, rainwater drainage, sewage treatment, and recreational and cultural values. It is concluded that the locally generated ecosystem services have a substantial impact on the quality-of-life in urban areas and should be addressed in land-use planning.

Bouchard M, F Laforest, et al. 2007. Hair manganese and hyperactive behaviors: Pilot study of school-age children exposed to tap water. Environmental Health Perspectives 115(1): 122-7.

Background: Neurotoxic effects are known to occur with inhalation of manganese particulates, but very few data are available on exposure to Mn in water. We undertook a pilot study in a community in Quebec (Canada) where naturally occurring high Mn levels were present in the public water system. Our objective was to test the hypothesis that greater exposure to Mn via drinking water would be reflected in higher Mn content in hair which, in turn, would be associated with increased level of hyperactive behaviors.

Methods: Forty-six children participated in the study, 24 boys and 22 girls, 6-15 years of age (median, 11 years). Their homes received water from one of two wells (W) with different Mn concentrations: W1: mean 610 ?g/L; W2: mean 160 ?g/L. The Revised Conners' Rating Scale for parents (CPRS-R) and for teachers (CTRS-R) were administered, providing T-scores on the following subscales: Oppositional, Hyperactivity, Cognitive Problems/Inattention, and ADHD Index.

Results: Children whose houses were supplied by W1 had higher hair Mn (MnH) than those supplied by W2 (mean 6.2 +- 4.7 g/g vs. 3.3 +- 3.0 g/g, p = 0.025). MnH was significantly associated with T-scores on the CTRS-R Oppositional (p = 0.020) and Hyperactivity (p = 0.002) subscales, after adjustment for age, sex, and income. All children with Oppositional and Hyperactivity T-scores 65 had MnH > 3.0 g/g.

Conclusions: The findings of this pilot study are sufficiently compelling to warrant more extensive investigations into the risks of Mn exposure in drinking water.

Bowler DE, LM Buyung-Ali, TM Knight and AS Pullin. 2010. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health 10: 456.

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 selfreported 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. Metaanalysis 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.

Brack C. 2002. Pollution mitigation and carbon sequestration by an urban forest. Environmental Pollution 116, Supplement 1(0): S195-S200.

At the beginning of the 1900s, the Canberra plain was largely treeless. Graziers had carried out extensive clearing of the original trees since the 1820s leaving only scattered remnants and some plantings near homesteads. With the selection of Canberra as the site for the new capital of Australia, extensive tree plantings began in 1911. These trees have delivered a number of benefits, including aesthetic values and the amelioration of climatic extremes. Recently, however, it was considered that the benefits might extend to pollution mitigation and the sequestration of carbon. This paper outlines a case study of the value of the Canberra urban forest with particular reference to pollution mitigation. This study uses a tree inventory, modelling and decision support system developed to collect and use data about trees for tree asset management. The decision support system (DISMUT) was developed to assist in the management of about 400,000 trees planted in Canberra. The size of trees during the 5-year Kyoto Commitment Period was estimated using DISMUT and multiplied by estimates of value per square meter of canopy derived from available literature. The planted trees are estimated to have a combined energy reduction, pollution mitigation and carbon sequestration value of US$20-67 million during the period 2008-2012.

Bradshaw CJA, NS Sodhi, et al. 2007. Global evidence that deforestation amplifies flood risk and severity in the developing world. Global Change Biology 13(11): 2379-95.

With the wide acceptance of forest-protection policies in the developing world comes a requirement for clear demonstrations of how deforestation may erode human well-being and economies. For centuries, it has been believed that forests provide protection against flooding. However, such claims have given rise to a heated polemic, and broad-scale quantitative evidence of the possible role of forests in flood protection has not been forthcoming. Using data collected from 1990 to 2000 from 56 developing countries, we show using generalized linear and mixed-effects models contrasted with information-theoretic measures of parsimony that flood frequency is negatively correlated with the amount of remaining natural forest and positively correlated with natural forest area loss (after controlling for rainfall, slope and degraded landscape area). The most parsimonious models accounted for over 65% of the variation in flood frequency, of which nearly 14% was due to forest cover variables alone. During the decade investigated, nearly 100,000 people were killed and 320 million people were displaced by floods, with total reported economic damages exceeding US$1151 billion. Extracted measures of flood severity (flood duration, people killed and displaced, and total damage) showed some weaker, albeit detectable correlations to natural forest cover and loss. Based on an arbitrary decrease in natural forest area of 10%, the model-averaged prediction of flood frequency increased between 4% and 28% among the countries modeled. Using the same hypothetical decline in natural forest area resulted in a 4-8% increase in total flood duration. These correlations suggest that global-scale patterns in mean forest trends across countries are meaningful with respect to flood dynamics. Unabated loss of forests may increase or exacerbate the number of flood-related disasters, negatively impact millions of poor people, and inflict trillions of dollars in damage in disadvantaged economies over the coming decades. This first global-scale empirical demonstration that forests are correlated with flood risk and severity in developing countries reinforces the imperative for large-scale forest protection to protect human welfare, and suggests that reforestation may help to reduce the frequency and severity of flood-related catastrophes.

Branas CC, RA Cheney, et al. 2011.A difference-in-differences analysis of health, safety, and greening vacant urban space. American Journal of Epidemiology 174(11): 1296-1306.

Greening of vacant urban land may affect health and safety. The authors conducted a decade-long difference-in-differences analysis of the impact of a vacant lot greening program in Philadelphia, Pennsylvania, on health and safety outcomes. "Before" and "after" outcome differences among treated vacant lots were compared with matched groups of control vacant lots that were eligible but did not receive treatment. Control lots from 2 eligibility pools were randomly selected and matched to treated lots at a 3:1 ratio by city section. Random-effects regression models were fitted, along with alternative models and robustness checks. Across 4 sections of Philadelphia, 4,436 vacant lots totaling over 7.8 million square feet (about 725,000 m2) were greened from 1999 to 2008. Regression-adjusted estimates showed that vacant lot greening was associated with consistent reductions in gun assaults across all 4 sections of the city (P < 0.001) and consistent reductions in vandalism in 1 section of the city (P < 0.001). Regression-adjusted estimates also showed that vacant lot greening was associated with residents' reporting less stress and more exercise in select sections of the city (P < 0.01). Once greened, vacant lots may reduce certain crimes and promote some aspects of health. Limitations of the current study are discussed. Community-based trials are warranted to further test these findings.

Bratman GN, JP Hamilton, et al. 2012. The impacts of nature experience on human cognitive function and mental health. Annals of the New York Academy of Sciences 1249(1): 118-136.

Scholars spanning a variety of disciplines have studied the ways in which contact with natural environments may impact human well-being. We review the effects of such nature experience on human cognitive function and mental health, synthesizing work from environmental psychology, urban planning, the medical literature, and landscape aesthetics. We provide an overview of the prevailing explanatory theories of these effects, the ways in which exposure to nature has been considered, and the role that individuals' preferences for nature may play in the impact of the environment on psychological functioning. Drawing from the highly productive but disparate programs of research in this area, we conclude by proposing a system of categorization for different types of nature experience. We also outline key questions for future work, including further inquiry into which elements of the natural environment may have impacts on cognitive function and mental health; what the most effective type, duration, and frequency of contact may be; and what the possible neural mechanisms are that could be responsible for the documented effects.

Braun-Fahrlander, JC Vuille, et al. 1997. Respiratory health and long-term exposure to air pollutants in Swiss schoolchildren. SCARPOL Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen. Am. J. Respir. Crit. Care Med. 155(3): 1042-9.

The impact of long-term exposure to air pollution on respiratory and allergic symptoms and illnesses was assessed in a cross-sectional study of schoolchildren (ages 6 to 15 yr, n = 4,470) living in 10 different communities in Switzerland. Air pollution measurements (particulate matter less than 10 microns in diameter [PM10], nitrogen dioxide [NO2], sulfur dioxide [SO2], and ozone) and meteorologic data were collected in each community. Reported symptom rates of chronic cough, nocturnal dry cough, and bronchitis, adjusted for individual risk factors, were positively associated with PM10, NO2, and SO2. The strongest relationship was observed for PM10 (adjusted odds ratios for chronic cough, nocturnal dry cough, and bronchitis between the most and the least polluted community for PM10 were 3.07 [95% CI: 1.62 to 5.81], 2.88 [95% CI: 1.69 to 4.89], and 2.17 [95% CI: 1.21 to 4.89], respectively). The high correlation between the average concentrations of the pollutants makes the assessment of the relative importance of each pollutant difficult. No association between long-term exposure to air pollution and classic asthmatic and allergic symptoms and illnesses was found. There was some indication that frequency of fog is a risk factor of chronic cough and bronchitis, independent of air pollution. In conclusion, this study provides further evidence that rates of respiratory illnesses and symptoms among children augment with increasing levels of air pollution even in countries like Switzerland with moderate average air pollution concentrations.

Brook RD, B Urch, et al. 2009. Insights into the mechanisms and mediators of the effects of air pollution exposure on blood pressure and vascular function in healthy humans. Hypertension 54(3): 659-67.

Fine particulate matter air pollution plus ozone impairs vascular function and raises diastolic blood pressure. We aimed to determine the mechanism and air pollutant responsible. The effects of pollution on heart rate variability, blood pressure, biomarkers, and brachial flow-mediated dilatation were determined in 2 randomized, double-blind, crossover studies. In Ann Arbor, 50 subjects were exposed to fine particles (150 ?g/m3) plus ozone (120 parts per billion) for 2 hours on 3 occasions with pretreatments of an endothelin antagonist (Bosentan, 250 mg), antioxidant (Vitamin C, 2 g), or placebo. In Toronto, 31 subjects were exposed to 4 different conditions (particles plus ozone, particles, ozone, and filtered air). In Toronto, diastolic blood pressure significantly increased (2.9 and 3.6 mm Hg) only during particle-containing exposures in association with particulate matter concentration and reductions in heart rate variability. Flow-mediated dilatation significantly decreased (2.0% and 2.9%) only 24 hours after particle-containing exposures in association with particulate matter concentration and increases in blood tumor necrosis factor ?. In Ann Arbor, diastolic blood pressure significantly similarly increased during all of the exposures (2.5 to 4.0 mm Hg), a response not mitigated by pretreatments. Flow-mediated dilatation remained unaltered. Particulate matter, not ozone, was responsible for increasing diastolic blood pressure during air pollution inhalation, most plausibly by instigating acute autonomic imbalance. Only particles from urban Toronto additionally impaired endothelial function, likely via slower proinflammatory pathways. Our findings demonstrate credible mechanisms whereby fine particulate matter could trigger acute cardiovascular events and that aspects of exposure location may be an important determinant of the health consequences.

Brydon J, I Oh, et al. 2009. Evaluation of mitigation methods to manage contaminant transfer in urban watershed. Water Qual. Res. J. Can. 44(1): 1-15.

Three case studies on trace metal contamination in urban stormwater are presented from the Greater Vancouver area of British Columbia. In the i rst case study, the spatial and temporal variability in trace metals in sediments were determined in the completely urbanized Brunette watershed. A natural lake in the middle of the watershed acts as a sediment detention system, and an analysis of the sediment core showed the historic accumulation of metal and selective organic contaminants in sediments since the early 1800s. Suspended sediments transported during storm events showed significantly higher concentrations of trace metals than bedload sediments, and the largest proportion of the geochemically active metals was found to be associated with the organic-sulphur-based fraction. Benthic organism survival tests showed mixed results with lower survival and growth in urban sediments than in control sediments from a forested watershed. In the second case study, signii cant correlations were obtained between percent impervious cover and trace metal concentrations in 28 subwatersheds with various degrees of urbanization. It is shown that imperviousness combined with traffic density can significantly improve the prediction of metal contamination in highly urbanized watersheds. In the third case study i ve urban stormwater detention systems were examined over one year to determine how effective these systems were in removing metal contamination. The results were highly variable depending on a wide range of physical conditions, land use activities, trafi c volume, and detention system designs. The range of total metal detention was between -15 to +72% for copper (Cu), lead (Pb), and zinc (Zn), while iron (Fe) and manganese (Mn) retention was generally poor. Labile Zn was more effectively retained in four of the five ponds, and a significant relationship was found between percent imperviousness, trafi c volume, and Zn concentrations in water, sediment, and labile form.

Budd R, A O'Geen, K S Goh, S Bondarenko & J Gan. 2009. Efficacy of Constructed Wetlands in Pesticide Removal from Tailwaters in the Central Valley, California. Environmental Science & Technology, 43(8), 2925-2930.

Pollutants in agricultural irrigation return flow (tailwater) constitute a significant nonpoint source of pollution in intensive agricultural regions such as the Central Valley of California. Constructed wetlands (CWs) represent a feasible mitigation option to remove pollutants including pesticides in the tailwater. In this study, we evaluated two CWs in the Central Valley for their performance in removing pyrethroid and organophosphate insecticides under field-scale production conditions. Both CWs were found to be highly effective in reducing pyrethroid concentrations in the tailwater, with season-average concentration reductions ranging from 52 to 94%. The wetlands also reduced the flow volume by 68-87%, through percolation and evapotranspiration. When both concentration and volume reductions were considered, the season-average removal of pyrethroids ranged from 95 to 100%. The primary mechanism for pyrethroid removal was through sedimentation of pesticide-laden particles, which was influenced by hydraulic residence time and vegetation density. Temporal analysis indicates a potential efficiency threshold during high flow periods. The season-average removal of chlorpyrifos ranged 52-61%. The wetlands, however, were less effective at removing diazinon, likely due to its limited sorption to sediment particles. Analysis of pesticide partitioning showed that pyrethroids were enriched on suspended particles in the tailwater. Monitoring of pesticide association with suspended solids and bed sediments suggested an increased affinity of pyrethroids for lighter particles with the potential to move further downstream before subject to sedimentation. Results from this study show that flow-through CWs, when properly designed, are an effective practice for mitigating hydrophobic pesticides in the irrigation tailwater.

Burnett RT, JR Brook, et al. 1997. Association between ozone and hospitalization for respiratory diseases in 16 Canadian cities. Environmental Research 72(1): 24-31

The effects of tropospheric ozone on lung function and respiratory symptoms have been well documented at relatively high concentrations. However, previous investigations have failed to establish a clear association between tropospheric ozone and respiratory diseases severe enough to require hospitalization after controlling for climate, and with gaseous and particulate air pollution at the lower concentrations typically observed in Canada today. To determine if low levels of tropospheric ozone contribute to hospitalization for respiratory disease, air pollution data were compared to hospital admissions for 16 cities across Canada representing 12.6 million people. During the 3927-day period from April 1, 1981, to December 31, 1991, there were 720,519 admissions for which the principle diagnosis was a respiratory disease. After controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, soiling index, and dew point temperature, the daily high hour concentration of ozone recorded 1 day previous to the date of admission was positively associated with respiratory admissions in the April to December period but not in the winter months. The relative risk for a 30 ppb increase in ozone varied from 1.043 (P less than 0.0001) to 1.024 (P= 0.0258) depending on the selection of covariates in the regression model and subset of cities examined. The association between ozone and respiratory hospitalizations varied among cities, with relative risks ranging from 1.000 to 1.088 after simultaneous covariate adjustment. Particulate matter and carbon monoxide were also positively associated with respiratory hospitalizations. These results suggest that ambient air pollution at the relatively low concentrations observed in this study, including tropospheric ozone, is associated with excess admissions to hospital for respiratory diseases in populations experiencing diverse climates and air pollution profiles.


Calderon-Garciduenas L, A Mora-Tiscareno, et al. 2008. Air pollution, cognitive deficits and brain abnormalities: A pilot study with children and dogs. Brain and Cognition 68(2): 117-127.

Exposure to air pollution is associated with neuroinflammation in healthy children and dogs in Mexico City. Comparative studies were carried out in healthy children and young dogs similarly exposed to ambient pollution in Mexico City. Children from Mexico City (n: 55) and a low polluted city (n:18) underwent psychometric testing and brain magnetic resonance imaging MRI. Seven healthy young dogs with similar exposure to Mexico City air pollution had brain MRI, measurement of mRNA abundance of two inflammatory genes cyclooxygenase-2, and interleukin 1 [beta] in target brain areas, and histopathological evaluation of brain tissue. Children with no known risk factors for neurological or cognitive disorders residing in a polluted urban environment exhibited significant deficits in a combination of fluid and crystallized cognition tasks. Fifty-six percent of Mexico City children tested showed prefrontal white matter hyperintense lesions and similar lesions were observed in dogs (57%). Exposed dogs had frontal lesions with vascular subcortical pathology associated with neuroinflammation, enlarged Virchow-Robin spaces, gliosis, and ultrafine particulate matter deposition. Based on the MRI findings, the prefrontal cortex was a target anatomical region in Mexico City children and its damage could have contributed to their cognitive dysfunction. The present work presents a groundbreaking, interdisciplinary methodology for addressing relationships between environmental pollution, structural brain alterations by MRI, and cognitive deficits/delays in healthy children.

California Dept of Public Health. 2009. California Birth Defects Monitoring Program: Heart Defects.

Carter, R III, SN Cheuvront, et al. 2005. Epidemiology of hospitalizations and deaths from heat illness in soldiers. Medicine & Science in Sports & Exercise 37(8): 1338-44.

Purpose: Serious heat illness has received considerable recent attention due to catastrophic heat waves in the United States and Europe, the deaths of high-profile athletes, and military deployments. Methods: This study documents heat illness hospitalizations and deaths for the U.S. Army from 1980 through 2002. Hospitalization data were obtained from the Total Army Injury Health Outcomes Database (TAIHOD) coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). North Atlantic Treaty Organization Standardization Agreement codes were searched for heat injuries in an effort to detect cases that were not found during the ICD-9-CM search. Results: Five-thousand two-hundred forty-six soldiers were hospitalized, and 37 died due to heat illness. Our results indicate: 1) approximately 60% reduction in hospitalization rates (fewer heat exhaustion cases) over the 22-yr period; 2) fivefold increase in heat stroke hospitalization rates (1.8 per 100,000 in 1980 to 14.5 per 100,000 in 2001); 3) heat stroke cases were associated with dehydration (17%), rhabdomyolysis (25%), and acute renal failure (13%); 4) lower hospitalizations rates among African and Hispanic Americans compared with Caucasians (incidence density ratio, 0.76 [95% confidence interval, 0.71-0.82]; 5) greater rates of hospitalizations and heat strokes among recruits from northern than southern states (incidence density ratio, 1.69 [95% confidence interval, 1.42-1.90]; and 6) greater rates of hospitalizations and heat strokes among women than men (incidence density ratio, 1.18 [95% confidence interval, 1.09-1.27]). Conclusions: Exertional heat illness continues to be a military problem during training and operations. Whereas the hospitalization rate of heat illness is declining, heat stroke has markedly increased.

CDC - Asthma. Accessed February 2013.

CDC - Bronchitis (Acute). Accessed February 2013.

CDC - Cardiovascular Diseases. 2011. MMWR - Prevalence of Coronary Heart Disease --- United States, 2006-2010. October 14, 2011 / 60(40);1377-1381. Accessed October 2011.

CDC - Chronic Obstructive Pulmonary Disease (COPD). Accessed February 2013.

CDC- Cognitive Function. 2011. Executive Summary Progress Report on The CDC Healthy Brain Initiative: 2006-2011. Atlanta, GA.

CDC - Gastrointestinal Infection. Accessed February 2013.

CDC - Hypertension. 2011. MMWR - Prevalence of Hypertension and Controlled Hypertension - United States, 2005 - 2008. January 14, 2011 / 60(01); 94-97.

CDC- Mortality. 2011.

CDC - Overweight and Obesity. Accessed February 2013.

CDC - Premature (Preterm) Birth. Accessed February 2013.

CDC - Stress. Accessed February 2013.

CDC - Stroke. Accessed February 2013.

Cervinka R, K Roderer, et al. 2012. Are nature lovers happy? On various indicators of well-being and connectedness with nature. Journal of Health Psychology 17(3): 379-388.

Connectedness with nature (CN) is seen as a personal disposition relevant for environmental as well as human health. In five questionnaire studies (N = 547) we systematically investigated the relationship between various operationalizations of well-being and CN. CN was assessed with two different tools in parallel. All significant correlations were controlled for the effects of age and gender. Psychological well-being, meaningfulness and vitality were found to be robustly correlated with CN. We highlight the relevance of CN with respect to human health and further discuss conceptual differences unraveled by the concurrent application of two CN-tools.

Chiesura A. 2004. The role of urban parks for the sustainable city. Landscape and Urban Planning 68(1): 129-138.

International efforts to preserve the natural environment are mainly concerned with large, bio-diverse and relatively untouched ecosystems or with individual animal or vegetal species, either endangered or threatened with extinction. Much less attention is being paid to that type of nature close to where people live and work, to small-scale green areas in cities and to their benefits to people. Increasing empirical evidence, however, indicates that the presence of natural areas contributes to the quality of life in many ways. Besides many environmental and ecological services, urban nature provides important social and psychological benefits to human societies, which enrich human life with meanings and emotions. The main concern of this paper is to address the importance of urban nature for citizens' well being and for the sustainability of the city they inhabit. Some results of a survey conducted among visitors of an urban park in Amsterdam (The Netherlands) are presented and discussed. The issues investigated concern people's motives for urban nature, the emotional dimension involved in the experience of nature and its importance for people's general well being. Results confirm that the experience of nature in urban environment is source of positive feelings and beneficial services, which fulfill important immaterial and non-consumptive human needs. Implications for the sustainability of the city will be analyzed and discussed.

Chiu H-F, S-S Tsai, et al. 2007. Nitrate in drinking water and risk of death from bladder cancer: An ecological case-control study in Taiwan. Journal of Toxicology and Environmental Health, Part A: Current Issues 70(12): 1000 - 1004.

The relationship between nitrate levels in drinking water and bladder cancer development is controversial. A matched cancer case-control with nitrate ecology study was used to investigate the association between bladder cancer mortality occurrence and nitrate exposure from Taiwan drinking water. All bladder cancer deaths of Taiwan residents from 1999 through 2003 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each cancer case. Data on nitrate-nitrogen (NO3-N) levels in drinking water throughout Taiwan were collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was assumed to be the source of the subject's nitrate exposure via drinking water. The adjusted odds ratios for bladder cancer death for those with high nitrate levels in their drinking water were 1.76 (1.28–2.42) and 1.96 (1.41–2.72) as compared to the lowest tertile. The results of the present study show that there was a significant positive relationship between the levels of nitrate in drinking water and risk of death from bladder cancer.

Cohen D A, J S Ashwood, et al. 2006. Public Parks and Physical Activity Among Adolescent Girls. Pediatrics 118(5): e1381-e1389.

OBJECTIVES. Physical activity may be constrained or facilitated by local environments. The availability of neighborhood facilities for physical activity may be particularly relevant for youth, who are unable to drive and whose activity is often limited to the immediate distance they are able to walk or bicycle. Several studies have shown that proximity to recreational facilities and parks is one of the most important predictors of physical activity. Because the United States already has an extensive infrastructure of parks, with 70% of adults indicating that they live within walking distance of a park or playground, parks may be a potential venue for increasing physical activity. This might be particularly important for adolescent girls, whose physical activity levels decline substantially as they go through puberty. The goal of this study was to examine the association between park proximity, park type, and park features and physical activity in adolescent girls.

PATIENTS AND METHODS. This was a cross-sectional study using baseline data from the Trial of Activity for Adolescent Girls. It included 1556 grade 6 girls who were randomly selected from 6 middle schools in each of the following 6 field site areas: Washington, DC, and Baltimore, Maryland; Columbia, South Carolina; Minneapolis, Minnesota; New Orleans, Louisiana; Tucson, Arizona; and San Diego, California. Girls wore accelerometers for 6 days to measure metabolic equivalent-weighted moderate-to-vigorous physical activity, a measure accounting for the volume and intensity of activity. Metabolic equivalent-weighted moderate-to-vigorous physical activity was calculated for the hours outside of school time using 2 different cutpoints, activity levels greater than or equal to 3.0 metabolic equivalents and greater than or equal to 4.6 metabolic equivalents, the latter indicating activity at the intensity of a brisk walk or higher. We mapped all of the parks within 1 mile of each girl's home. Trained staff used a checklist to document the presence of facilities and amenities at each park, including passive amenities, such as drinking fountains, restrooms, and areas with shade, as well as active amenities like basketball courts, multipurpose fields, playgrounds, and tennis courts.

RESULTS. Mean nonschool metabolic equivalent-weighted moderate/vigorous physical activity, using the 4.6 metabolic equivalent cutoff, was 611.1 minutes (range: 49.7-4718.6 metabolic equivalent minutes per 6 days) and 1704.8 metabolic equivalent minutes per 6 days (range: 276.2-5792.6 metabolic equivalent minutes per 6 days) when using the 3.0 metabolic equivalent cutpoint. Many girls had multiple parks within a 1-mile radius of their homes: 57% had greater than or equal to 1 type of park, the majority being neighborhood or community parks; 42% had between 1 and 3 parks, 37% had greater than or equal to 4 parks, and 14% had greater than or equal to 8 parks. The type, number, and specific parks features were associated with girls' nonschool metabolic equivalent-weighted moderate/vigorous physical activity. At the 4.6 metabolic equivalent cutpoint, higher levels of nonschool metabolic equivalent-weighted moderate/vigorous physical activity were associated with both neighborhood and community parks (22 metabolic equivalent minutes) and miniparks (40 metabolic equivalent minutes). Each park, regardless of type, in the half-mile around each girl's home was associated with an increase in nonschool metabolic equivalent-weighted moderate/vigorous physical activity by 2.8% or 17.2 nonschool minutes of metabolic equivalent-weighted moderate/vigorous physical activity per 6 days. Beyond a half-mile, each park increased nonschool metabolic equivalent-weighted moderate/vigorous physical activity by 1.1% or 6.7 metabolic equivalent minutes per 6 days. For the average girl with 3.5 parks within a 1-mile radius of home, the presence of parks accounted for 36.5 extra nonschool metabolic equivalent minutes per 6 days, ?6% of total nonschool metabolic equivalent-weighted moderate/vigorous physical activity. Using the 3.0 metabolic equivalent cutpoint, this sums to an additional 68 metabolic equiva ent minutes of nonschool metabolic equivalent-weighted moderate/vigorous physical activity over 6 days, or 4% of the total. The most common amenities in the parks were playgrounds, multipurpose fields, and picnic areas. Slightly more than one third of girls lived within a half-mile of a park with a basketball court, and >20% had access to walking paths and tennis courts in their local park. Higher levels of nonschool metabolic equivalent-weighted moderate/vigorous physical activity per 6 days were associated with walking paths (13 metabolic equivalent minutes), running tracks (82 metabolic equivalent minutes), playgrounds (28 metabolic equivalent minutes), and basketball courts (30 metabolic equivalent minutes). Parks with streetlights and floodlights were also associated with an increase of 18 and 22 minutes of nonschool metabolic equivalent-weighted moderate/vigorous physical activity, respectively. With the 3.0 metabolic equivalent cutoff for metabolic equivalent-weighted moderate/vigorous physical activity, additional nonschool metabolic equivalent minutes more than doubled when girls had miniparks (92 metabolic equivalent minutes), natural resource areas (36 metabolic equivalent minutes), walking paths (59 metabolic equivalent minutes), and running tracks (208 metabolic equivalent minutes) within a half-mile of their homes. Skateboard areas and special-use parks were negatively associated with nonschool metabolic equivalent-weighted moderate/vigorous physical activity in adolescent girls.

CONCLUSIONS. Adolescent girls who live near more parks, particularly near those with amenities that are conducive to walking and with active features, engage in more nonschool metabolic equivalent-weighted moderate/vigorous physical activity than those with fewer parks. Whether this is because of actual use of the parks or neighborhood choice could not be determined. Although the magnitude of the association between parks and additional minutes of metabolic equivalent-weighted moderate/vigorous physical activity was small for an individual, amounting to an average of 4%-6% of a girl's total nonschool metabolic equivalent-weighted moderate/vigorous physical activity, it is likely to have a large population-level association. Because of the potential population level impact, the use of parks to promote physical activity should be further studied.

Colcombe S and AF Kramer. 2003. Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychological Science 14(2): 125-30.

A meta-analytic study was conducted to examine the hypothesis that aerobic fitness training enhances the cognitive vitality of healthy but sedentary older adults. Eighteen intervention studies published between 1966 and 2001 were entered into the analysis. Several theoretically and practically important results were obtained. Most important, fitness training was found to have robust but selective benefits for cognition, with the largest fitness-induced benefits occurring for executive-control processes. The magnitude of fitness effects on cognition was also moderated by a number of programmatic and methodological factors, including the length of the fitness-training intervention, the type of the intervention, the duration of training sessions, and the gender of the study participants. The results are discussed in terms of recent neuroscientific and psychological data that indicate cognitive and neural plasticity is maintained throughout the life span.

Cole D N and T E Hall. 2010. Experiencing the restorative components of wilderness environments: Does congestion interfere and does length of exposure matter? Environment and Behavior, 42(6): 806-823.

Wilderness should provide opportunities for stress reduction and restoration of mental fatigue. Visitors, surveyed as they exited wilderness trailheads, were asked for self-assessments of stress reduction and mental rejuvenation and the extent to which they experienced various restorative components of the environment-attributes deemed by attention restorative theory to be conducive to restoration. Day and overnight hikers on both very high use and moderate use trails were studied. Most respondents reported substantial stress reduction and mental rejuvenation and most experienced the environment in ways considered conducive to restoration. At the moderate to high use levels we studied, psychological restoration did not vary significantly with level of congestion, suggesting that concern about restorative experiences is not a valid rationale for limiting use on wilderness trails. Day trips reduced stress and allowed for mental rejuvenation to the same degree that overnight trips did. However, several of the restorative components of environment were experienced to a significantly greater degree as length of trip increased.

Coley RL, WC Sullivan, FE Kuo. 1997. Where does community grow? The social context created by nature in urban public housing. Environment and Behavior 29(4): 468-94.

This study examines how the availability of nature influences the use of outdoor public spaces in two Chicago public housing developments. Ninety-six observations were collected of the presence and location of trees and the presence and location of youth and adults in semiprivate spaces at one high-rise and one low-rise public housing development. Results consistentiy indicated that natural landscaping encourages greater use of outdoor areas by residents. Spaces with trees attracted larger groups of people, as well as more mixed groups of youth and adults, than did spaces devoid of nature. In addition, more dense groupings of trees and trees that are located close to public housing buildings attracted larger groups of people. These findings suggest that natural elements such as trees promote increased opportunities for social interactions, monitorng of outdoor areas, and supervision of children in impovershed urban neighborhoods.

Currie B and B Bass. 2008. Estimates of air pollution mitigation with green plants and green roofs using the UFORE model. Urban Ecosystems 11(4): 409-422.

The purpose of this study was to investigate the effect of green roofs and green walls on air pollution in urban Toronto. The research looked at the synergistic effects on air pollution mitigation of different combinations of vegetation by manipulating quantities of trees, shrubs, green roofs and green walls in the study area. The effects of these manipulations were simulated with the Urban Forest Effects (UFORE) model developed by the USDA Forest Service Northeastern Regional Station. While UFORE contains several modules, Module-D quantifies the levels of air pollution for contaminants such as NO 2 , S0 2 , CO, PM 10 and ozone as well as hourly pollution removal rates and the economic value of pollutant removal. Six vegetation scenarios were developed within the Toronto study area to compare different subsets of vegetation and their effect on air contaminants. Results of the study indicate that grass on roofs (extensive green roofs) could augment the effect of trees and shrubs in air pollution mitigation, placing shrubs on a roof (intensive green roofs) would have a more significant impact. By extension, a 10-20% increase in the surface area for green roofs on downtown buildings would contribute significantly to the social, financial and environmental health of all citizens.


Dadvand P, A de Nazelle, et al. 2012. Green space, health inequality and pregnancy. Environment International 40(0): 110-115.

Green spaces have been suggested to improve physical and mental health and well-being by increasing physical activity, reducing air pollution, noise, and ambient temperature, increasing social contacts and relieving psychophysiological stress. Although these mechanisms also suggest potential beneficial effects of green spaces on pregnancy outcomes, to our knowledge there is no available epidemiological evidence on this impact. We investigated the effects of surrounding greenness and proximity to major green spaces on birth weight and gestational age at delivery and described the effect of socioeconomic position (SEP) on these relationships. This study was based on a cohort of births (N = 8246) that occurred in a major university hospital in Barcelona, Spain, during 2001-2005. We determined surrounding greenness from satellite retrievals as the average of Normalized Difference Vegetation Index (NDVI) in a buffer of 100 m around each maternal place of residence. To address proximity to major green spaces, a binary variable was used to indicate whether maternal residential address is situated within a buffer of 500 m from boundaries of a major green space. For each indicator of green exposure, linear regression models were constructed to estimate change in outcomes adjusted for relevant covariates including individual and area level SEP. None of the indicators of green exposure was associated with birth weight and gestational age. After assessing effect modification based on the level of maternal education, we detected an increase in birth weight (grams) among the lowest education level group (N = 164) who had higher surrounding NDVI (Regression coefficient (95% confidence interval (CI) of 436.3 (43.1, 829.5)) or lived close to a major green space (Regression coefficient (95% CI)) of 189.8 (23.9, 355.7)). Our findings suggest a beneficial effect of exposure to green spaces on birth weight only in the lowest SEP group.

Dadvand P and A de Nazelle. 2012. Surrounding Greenness and Exposure to Air Pollution During Pregnancy: An Analysis of Personal Monitoring Data. Environ Health Perspect 120(9): 1286-1290.

Background: Green spaces are reported to improve health status, including beneficial effects on pregnancy outcomes. Despite the suggestions of air pollution-related health benefits of green spaces, there is no available evidence on the impact of greenness on personal exposure to air pollution.

Objectives: We investigated the association between surrounding greenness and personal exposure to air pollution among pregnant women and to explore the potential mechanisms, if any, behind this association.

Methods: In total, 65 rounds of sampling were carried out for 54 pregnant women who resided in Barcelona during 2008-2009. Each round consisted of a 2-day measurement of particulate matter with aerodynamic diameter ? 2.5 ?m (PM2.5) and a 1-week measurement of nitric oxides collected simultaneously at both the personal and microenvironmental levels. The study participants were also asked to fill out a time-microenvironment-activity diary during the sampling period. We used satellite retrievals to determine the surrounding greenness as the average of Normalized Difference Vegetation Index (NDVI) in a buffer of 100 m around each maternal residential address. We estimated the impact of surrounding greenness on personal exposure levels, home-outdoor and homeindoor pollutant levels, and maternal time-activity.

Results: Higher residential surrounding greenness was associated with lower personal, homeindoor, and home-outdoor PM2.5 levels, and more time spent at home-outdoor.

Conclusions: We found lower levels of personal exposure to air pollution among pregnant women residing in greener areas. This finding may be partly explained by lower home-indoor pollutant levels and more time spent in less polluted home-outdoor environment by pregnant women in greener areas.

Dadvand P, J Sunyer, et al. 2012. Surrounding Greenness and Pregnancy Outcomes in Four Spanish Birth Cohorts. Environ Health Perspect 120 (10): 1481-1487.

Background: Green spaces have been associated with improved physical and mental health; however, the available evidence on the impact of green spaces on pregnancy is scarce.

Objectives: We investigated the association between surrounding greenness and birth weight, head circumference, and gestational age at delivery.

Methods: This study was based on 2,393 singleton live births from four Spanish birth cohorts (Asturias, Gipuzkoa, Sabadell, and Valencia) located in two regions of the Iberian Peninsula with distinct climates and vegetation patterns (2003-2008). We defined surrounding greenness as average of satellite-based Normalized Difference Vegetation Index (NDVI) (Landsat 4-5 TM data at 30 m x 30 m resolution) during 2007 in buffers of 100 m, 250 m, and 500 m around each maternal place of residence. Separate linear mixed models with adjustment for potential confounders and a random cohort effect were used to estimate the change in birth weight, head circumference, and gestational age for 1-interquartile range increase in surrounding greenness.

Results: Higher surrounding greenness was associated with increases in birth weight and head circumference [adjusted regression coefficients (95% confidence interval) of 44.2 g (20.2 g, 68.2 g) and 1.7 mm (0.5 mm, 2.9 mm) for an interquartile range increase in average NDVI within a 500-m buffer] but not gestational age. These findings were robust against the choice of the buffer size and the season of data acquisition for surrounding greenness, and when the analysis was limited to term births. Stratified analyses indicated stronger associations among children of mothers with lower education, suggesting greater benefits from surrounding greenness.

Conclusions: Our findings suggest a beneficial impact of surrounding greenness on measures of fetal growth but not pregnancy length.

Dales RE, H Zwanenburg, et al. 1991. Respiratory health effects of home dampness and molds among Canadian children. American Journal of Epidemiology 134(2): 196-203.

In 1988, the authors conducted a questionnaire-based study on the health effects of the indoor environment in 30 Canadian communities. This paper focuses on the association between the respiratory health of young children and home dampness and molds. A total of 17, 962 parents or guardians of schoolchildren received a questionnaire, and 14, 948 (83.2%) questionnaires were returned. Children living in mobile homes, tents, and boats were excluded as were those with cystic fibrosis, leaving 13, 495 children included in the study group. The housing stock was distributed as follows: 81% were one-family detached homes, 6% were one-family attached homes, and 13% were buildings for two or more families. Molds were reported in 32.4%, flooding in 24.1%, and moisture in 14.1% of the homes. Prevalences of all respiratory symptoms were consistently higher in homes with reported molds or dampness; i.e., adjusted odds ratios ranged from 1.32 (95% confidence interval 1.06-1.39) for bronchitis to 1.89 (95% confidence interval 1.58-2.26) for cough. The prevalence of home dampness or molds, 37.8%, indicates that it is an important public health issue. Further studies are required to elucidate the pathogenesis. Am J Epidemiol 1991; 134: 196-203.

Dallimer M, K N Irvine, et al. 2012. Biodiversity and the feel-good factor: Understanding associations between self-reported human well-being and species richness. BioScience 62(1): 47-55.

Over half of the world's human population lives in cities, and for many, urban greenspaces are the only places where they encounter biodiversity. This is of particular concern because there is growing evidence that human well-being is enhanced by exposure to nature. However, the specific qualities of greenspaces that offer the greatest benefits remain poorly understood. One possibility is that humans respond positively to increased levels of biodiversity. Here, we demonstrate the lack of a consistent relationship between actual plant, butterfly, and bird species richness and the psychological well-being of urban greenspace visitors. Instead, well-being shows a positive relationship with the richness that the greenspace users perceived to be present. One plausible explanation for this discrepancy, which we investigate, is that people generally have poor biodiversity-identification skills. The apparent importance of perceived species richness and the mismatch between reality and perception pose a serious challenge for aligning conservation and human well-being agendas.

Deletic A & TD Fletcher. 2006. Performance of grass filters used for stormwater treatment--a field and modeling study. Journal of Hydrology, 317(3-4), 261-275.

Grass swales and filter strips are among the simplest and most cost-effective form of stormwater control measures. Despite this, relatively few controlled studies have been undertaken to assess their performance, and very few models are available to predict their efficiency. This paper focuses on fieldperformance of grassfilters in removal of total suspended solids (TSS) from overland flow, and verification of TRAVA, a model of sediment behaviour in grassfilters (published earlier in Deletic, A., 2001. Modelling of water and sediment transport over grassed areas. Journal of Hydrology 248, 168-182; Deletic, A., 2005. Sediment behaviour in runoff over grassed surfaces. Journal of Hydrology 301, 108-122). Limited nutrient removal data were collected, at one of the field sites. The paper presents results from controlled field tests undertaken on agrassfilter strip in Aberdeen, Scotland, and agrass swale in Brisbane, Australia. In both studies TSS concentrations were recorded along the grass, for artificial inflow of water and sediment of different flow rates and sediment concentrations. In the Aberdeen study the emphasis was on performance in relation to different sediment particle sizes, while for the Brisbane swale, treatmentperformance for total nitrogen (TN), and total phosphorus (TP) were also recorded. Both experimental programmes had an unsteady input of pollutants. The Aberdeen strip reduced sediment inflow concentrations by 61-86%, whilst the Brisbane swale removed an average of 69, 46, and 56% of the total loads of TSS, TP and TN, respectively. TRAVA was used to model both the strip and swale. For the Aberdeen strip, the differences between the measured and modelled sediment loading rates were within +-25% of measured. Modelled concentrations in outflow from the Brisbane swale were within +-17% of measured. The predicted mass of total sediment removed during experiments was within +-50% of measured for the Aberdeen strip and +-11% for the Brisbane swale. TRAVA is therefore shown to be a reliable tool for prediction of the performance of grassfilters used for stormwatertreatment

Delfino RJ, AM Murphy-Moulton, et al. 1997. Effects of air pollution on emergency room visits for respiratory illnesses in Montreal, Quebec. Am. J. Respir. Crit. Care Med. 155(2): 568-76.

As an approach to evaluating the public health burden from current air pollution levels, we examined the relationship of daily emergency room (ER) visits for respiratory illnesses (25 hospitals, average 98 visits/d) to air pollution in Montreal, Canada, from June through September, 1992 and 1993. Air pollutants measured included ozone (O3), particulate matter diameter less than 10 microm (PM10) and less than 2.5 microm (PM2.5), the sulfate fraction of PM2.5 (SO4), and aerosol strong acidity (H+). Temporal trends, autocorrelation, and weather were controlled for in time-series regressions. For 1992, no significant associations with ER visits were found. However, 33% of the particulate data were missing. For 1993, 1-h maximum O3, PM10, PM2.5, and SO4 were all positively associated with respiratory visits for patients over 64 yr of age (p less than 0.02). An increase to the mean level of 1-h maximum O3 (36 ppb) was associated with a 21% increase over the mean number of daily ER visits (95% confidence interval [CI]: 8 to 34%). Effects of particulates were smaller, with mean increases of 16% (4 to 28%), 12% (2 to 21%) and 6% (1 to 12%) for PM10, PM2.5, and SO4, respectively. Relative mass effects were PM2.5 > PM10 >> SO4. Ozone and PM10 levels never exceeded 67 ppb and 51 microg/m3, respectively (well below the U.S. National Ambient Air Quality Standards of 120 ppb and 150 microg/m3, respectively). The present findings have public health implications with regard to the adverse health effects of urban photochemical air pollution on older individuals.

Diaz FJ, AT O'Geen, et al. 2010. Efficacy of constructed wetlands for removal of bacterial contamination from agricultural return flows. Agricultural Water Management 97(11): 1813-1821.

Water quality degradation from bacterial pathogens is one of the leading causes of surface water impairment in California agricultural watersheds. In the San Joaquin Valley, approximately 50 and 100% of water samples collected from three different irrigation return flows exceeded the Escherichia coli standard of 126 cfu 100 mL?1 and the enterococci standard of 33 cfu 100 mL?1, respectively, as required for water discharge into state waterways. These results show that runoff from irrigated crops can contribute a significant load of bacteria indicators and potentially pathogenic microorganisms to waterways. Constructed wetlands are gaining recognition as a management practice for use in irrigated agriculture to reduce bacterial loads and a wide variety of water quality contaminants in agricultural return flows prior to discharge into waterways. Based on input�output sampling of four wetlands, 66-91% of E. coli concentrations and 86�94% of enterococci concentrations were retained in the wetlands. Removal efficiencies in terms of bacteria load were even higher, 80-87% and 88-97% for E. coli and enterococci, respectively, due to water losses (seepage and evapotranspiration) within the wetland. Of all the parameters considered, hydraulic residence time (HRT) appeared to be the factor having the greatest effect on the efficiency of bacteria indicator removal. Remarkably, a HRT of less than a day can achieve considerable bacteria indicator retention (70%), which allows for relatively small wetland areas being able to treat runoff from large agricultural areas (up to 360:1 in this study).

DiBlasi CJ, H Li, AP Davis & U Ghosh. 2008. Removal and fate of polycyclic aromatic hydrocarbon pollutants in an urban stormwater bioretention facility. Environmental Science & Technology, 43(2), 494-502.

This research investigated the removal and fate of 16 USEPA priority pollutant polycyclic aromatic hydrocarbons (PAHs) from urban stormwater runoff through a bioretention cell. Bioretention is an infiltration/filtration practice containing a mixed layer of about 90 cm of soil, sand, and organic matter, planted with appropriate vegetation. Field water quality monitoring and bioretention media core analyses were performed. The results indicate that bioretention is a promising management practice to control runoff PAH pollutants. The PAH event mean concentration (EMC) reduction ranged from 31 to 99%, with a mean discharge EMC of 0.22 �g/L. The mass load decreased from a mean value of 0.0180 kg/ha yr to 0.0025 kg/ha yr, suggesting an average PAH mass load reduction of 87% to the discharging watershed. The most dominant PAH species monitored were fluoranthene and pyrene. Influent PAHs indicated strong affiliation with runoff total suspended solids (TSS). As such, PAH removal positively correlated with TSS removal. Low rainfall depth was associated with high influent PAH concentration and resulted in favorable PAH removal. Source investigation suggested that the PAHs measured in the monitored cell were from pyrogenic sources, likely resulting from vehicle combustion processes. Sealers used in parking lots and driveway coatings were also a possible source of PAHs. Media core analyses indicated that the intercepted PAH compounds transported only a few centimeters vertically in the soil media near the runoff entrance location, suggesting that a shallow cell design may be adequate for systems focusing on PAH removal.

Diener E, W Ng, J Harter, A Raksha. 2010. Wealth and happiness across the world: Material prosperity predicts life evaluation, whereas psychosocial prosperity predicts positive feeling. Journal of Personality and Social Psychology 99(1): 52-61.

The Gallup World Poll, the first representative sample of planet Earth, was used to explore the reasons why happiness is associated with higher income, including the meeting of basic needs, fulfillment of psychological needs, increasing satisfaction with one's standard of living, and public goods. Across the globe, the association of log income with subjective well-being was linear but convex with raw income, indicating the declining marginal effects of income on subjective well-being. Income was a moderately strong predictor of life evaluation but a much weaker predictor of positive and negative feelings. Possessing luxury conveniences and satisfaction with standard of living were also strong predictors of life evaluation. Although the meeting of basic and psychological needs mediated the effects of income on life evaluation to some degree, the strongest mediation was provided by standard of living and ownership of conveniences. In contrast, feelings were most associated with the fulfillment of psychological needs: learning, autonomy, using one's skills, respect, and the ability to count on others in an emergency. Thus, two separate types of prosperity-economic and social psychological-best predict different types of well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Dietz ME & JC Clausen. 2005. Saturation to improve pollutant retention in a rain garden. Environmental Science & Technology, 40(4), 1335-1340.

Rain gardens have been recommended as a best management practice to treat stormwater runoff. Replicate rain gardens were constructed in Haddam, CT, to treat roof runoff. The objective of this study was to assess whether the creation of a saturated zone in a rain garden improved retention of pollutants. The gardens were sized to store 2.54 cm (1 in) of runoff. Results show high retention of flow; only 0.8% overflowed. Overall, concentrations of nitrite+ nitrate-N, ammonia-N, and total-N (TN) in roof runoff were reduced significantly by the rain gardens. Total-P concentrations were significantly increased by both rain gardens. ANCOVA results show significant reductions in TN (18%) due to saturation. Redox potential also decreased in the saturated garden. Rain garden mulch was found to be a sink for metals, nitrogen, and phosphorus, but rain garden soils were a source for these pollutants. The design used for these rain gardens was effective for flow retention, but did not reduce concentrations of all pollutants even when modified. These findings suggest that high flow and pollutant retention could be achieved with the 2.54 cm design method, but the use of an underdrain could reduce overall pollutant retention.

Dockery DW, J Cunningham, et al. 1996. Health effects of acid aerosols on North American children: respiratory symptoms. Environmental Health Perspectives 104(5): 500-05.

We examined the respiratory health effects of exposure to acidic air pollution among 13,369 white children 8 to 12 years old from 24 communities in the United States and Canada between 1988 and 1991. Each child's parent or guardian completed a questionnaire. Air quality and meteorology were measured in each community for a 1-year period. We used a two-stage logistic regression model to analyze the data, adjusting for the potential confounding effects of sex, history of allergies, parental asthma, parental education, and current smoking in the home. Children living in the community with the highest levels of particle strong acidity were significantly more likely [odds ratio (OR) = 1.66; 95% confidence interval (CI) 1.11-2.48] to report at least one episode of bronchitis in the past year compared to children living in the least-polluted community. Fine particulate sulfate was also associated with higher reporting of bronchitis (OR = 1.65; 95% CI 1.12-2.42). No other respiratory symptoms were significantly higher in association with any of the air pollutants of interest. No sensitive subgroups were identified. Reported bronchitis, but neither asthma, wheeze, cough, nor phlegm, were associated with levels of particle strong acidity for these children living in a nonurban environment.

Dockery DW, CA Pope, et al. 1993. An Association between Air Pollution and Mortality in Six U.S. Cities. New England Journal of Medicine 329(24): 1753-9.

Background: Recent studies have reported associations between particulate air pollution and daily mortality rates. Population-based, cross-sectional studies of metropolitan areas in the United States have also found associations between particulate air pollution and annual mortality rates, but these studies have been criticized, in part because they did not directly control for cigarette smoking and other health risks.

Methods: In this prospective cohort study, we estimated the effects of air pollution on mortality, while controlling for individual risk factors. Survival analysis, including Cox proportional-hazards regression modeling, was conducted with data from a 14-to-16-year mortality follow-up of 8111 adults in six U.S. cities.

Results: Mortality rates were most strongly associated with cigarette smoking. After adjusting for smoking and other risk factors, we observed statistically significant and robust associations between air pollution and mortality. The adjusted mortality-rate ratio for the most polluted of the cities as compared with the least polluted was 1.26 (95 percent confidence interval, 1.08 to 1.47). Air pollution was positively associated with death from lung cancer and cardiopulmonary disease but not with death from other causes considered together. Mortality was most strongly associated with air pollution with fine particulates, including sulfates.

Conclusions: Although the effects of other, unmeasured risk factors cannot be excluded with certainty, these results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.

Donovan GH and DT Butry. 2009. The value of shade: Estimating the effect of urban trees on summertime electricity use. Energy and Buildings 41(6): 662-668.

We estimated the effect of shade trees on the summertime electricity use of 460 single-family homes in Sacramento, California. Results show that trees on the west and south sides of a house reduce summertime electricity use, whereas trees on the north side of a house increase summertime electricity use. The current level of tree cover on the west and south sides of houses in our sample reduced summertime electricity use by 185 kWh (5.2%), whereas north-side trees increased electricity use by 55 kWh (1.5%). Results also show that a London plane tree, planted on the west side of a house, can reduce carbon emissions from summertime electricity use by an average of 31% over 100 years.

Donovan GH, YL Michael, et al. 2011. Urban trees and the risk of poor birth outcomes. Health & Place 17: 390-393.

This paper investigated whether greater tree-canopy cover is associated with reduced risk of poor birth outcomes in Portland, Oregon. Residential addresses were geo-coded and linked to classified- aerial imagery to calculate tree-canopy cover in 50,100, and 200m buffers around each home in our sample (n�5696). Detailed data on maternal characteristics and additional neighborhood variables were obtained from birth certificates and tax records.We found that a 10% increase in tree-canopy cover within 50 m of a house reduced the number of small for gestational age births by 1.42 per 1000 births (95% CI�0.11�2.72).Results suggest that the natural environment may affect pregnancy outcomes and should be evaluated in future research.

Du W, D FitzGerald, et al. 2010. Health impacts of floods. Prehosp Distaster Med 25(3): 265-272.

INTRODUCTION: Floods are the most common hazard to cause disasters and have led to extensive morbidity and mortality throughout the world. The impact of floods on the human community is related directly to the location and topography of the area, as well as human demographics and characteristics of the built environment.

OBJECTIVES: The aim of this study is to identify the health impacts of disasters and the underlying causes of health impacts associated with floods. A conceptual framework is developed that may assist with the development of a rational and comprehensive approach to prevention, mitigation, and management.

METHODS: This study involved an extensive literature review that located >500 references, which were analyzed to identify common themes, findings, and expert views. The findings then were distilled into common themes.

RESULTS: The health impacts of floods are wide ranging, and depend on a number of factors. However, the health impacts of a particular flood are specific to the particular context. The immediate health impacts of floods include drowning, injuries, hypothermia, and animal bites. Health risks also are associated with the evacuation of patients, loss of health workers, and loss of health infrastructure including essential drugs and supplies. In the medium-term, infected wounds, complications of injury, poisoning, poor mental health, communicable diseases, and starvation are indirect effects of flooding. In the long-term, chronic disease, disability, poor mental health, and poverty-related diseases including malnutrition are the potential legacy.

CONCLUSIONS: This article proposes a structured approach to the classification of the health impacts of floods and a conceptual framework that demonstrates the relationships between floods and the direct and indirect health consequences.

Dussaillant AR, CH Wu, KW Potter. 2004. Richards Equation Model of a Rain Garden. Journal of Hydrologic Engineering 9(3): 219-225.

Traditional stormwater management does not mitigate groundwater depletion resulting from groundwater pumping and reduction in recharge. Infiltration practices, such as rain gardens, offer a potentially effective approach for addressing groundwater depletion. A rain garden is a landscaped garden in a shallow depression that receives the stormwater from nearby impervious surfaces, focusing recharge. We have developed a numerical model that can be applied in rain garden design and evaluation. Water flow through the rain garden soil is modeled over three layers: a root zone, a middle storage layer of high conductivity, and a subsoil lower layer. To continuously simulate recharge, runoff, and evapotranspiration, the model couples the Richards Equation with a surface water balance. The model was applied to the climate of southern Wisconsin. Simulation results show that very high recharge rates are possible during the non-snowfall season. (The model does not handle snowmelt.) A rain garden with an area of about 10-20% of the contributing impervious area maximizes groundwater recharge. Increasing the depression depth increases recharge and saturation times, affecting plant survival. Rain garden feasibility also depends on the subsoil hydraulic conductivity.

Dvorak B and A Volder. 2012. Rooftop temperature reduction from unirrigated modular green roofs in south-central Texas. Urban Forestry & Urban Greening (0). In press.

Modular green roofs were investigated to better understand surface and membrane level temperature expectations of unirrigated green roofs during hot summer conditions in south-central Texas. We used three succulent monocultures, Sedum kamtschaticum, Delosperma cooperi, Talinum calycinum syn. Phemeranthus calycinus and one unplanted control module, each replicated 3 times. Media surface and below media temperatures were monitored, as well as soil water content and general weather conditions (RH, air temperature). Temperatures at the surface and below the media surface were compared with temperatures of a standard roof surface. We found that diurnal surface temperature reductions were very stable throughout the summer. Much larger temperature reductions were achieved below the modules than at the soil surface. Temperature reductions at the soil surface were predominantly driven by soil volumetric water content (VWC) and, to a lesser degree, air temperature while species and percent cover had small modifying effects through interactions with VWC and air temperature. Temperature reductions below the modules were driven by surface soil temperature, while increasing VWC led to a small decrease in temperature reductions at the membrane level. Mean daily temperature reductions achieved were 18.0 degrees C at the soil surface and 27.5 degrees C below the module, thus demonstrating that unirrigated, succulent-based green roofs can provide significant rooftop temperature reductions during hot, dry summer conditions.

Dwyer JF, EG McPherson, et al. 1992. Assessing the benefits and costs of the urban forest. Journal of Arboriculture 18(5): 227-234.

Abstract. With effective planning and management, urban trees and forests will provide a wide range of important benefits to urbanites. These include a more pleasant, healthful, and comfortable environment to live, work, and play in, savings in the costs of providing a wide range of urban services, and substantial improvements in individual and community wellbeing. Urban forestry plans should begin with consideration of the contribution that trees and forests can make to people's needs. Planning and management efforts should focus on how the forest can best meet those needs. Past planning and management efforts have not been as effective as they might have been because planners and managers have underestimated the potential benefits that urban trees and forests can provide, and have not understood the planning and management efforts needed to provide those benefits, particularly the linkages between benefits and characteristics of the urban forest and its management.


Egan BM, Y Zhao, RN Axon. 2010. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. The Journal of the American Medical Association 303(20): 2043-2050.

Context: Hypertension is a major risk factor for cardiovascular disease and treatment and control of hypertension reduces risk. The Healthy People 2010 goal was to achieve blood pressure (BP) control in 50% of the US population.

Objective: To assess progress in treating and controlling hypertension in the United States from 1988-2008.

Design, Setting, and Participants: The National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2008 in five 2-year blocks included 42,856 adults aged older than 18 years, representing a probability sample of the US civilian population.

Main Outcome: Measures Hypertension was defined as systolic BP of at least 140 mm Hg and diastolic BP of at least 90 mm Hg, self-reported use of antihypertensive medications, or both. Hypertension control was defined as systolic BP values of less than 140 mm Hg and diastolic BP values of less than 90 mm Hg. All survey periods were age-adjusted to the year 2000 US population.

Results: Rates of hypertension increased from 23.9% (95% confidence interval [CI], 22.7%-25.2%) in 1988-1994 to 28.5% (95% CI, 25.9%-31.3%; P<.001) in 1999-2000, but did not change between 1999-2000 and 2007-2008 (29.0%; 95% CI, 27.6%-30.5%; P=.24). Hypertension control increased from 27.3% (95% CI, 25.6%-29.1%) in 1988-1994 to 50.1% (95% CI, 46.8%-53.5%; P=.006) in 2007-2008, and BP among patients with hypertension decreased from 143.0/80.4 mm Hg (95% CI, 141.9-144.2/79.6-81.1 mm Hg) to 135.2/74.1 mm Hg (95% CI, 134.2-136.2/73.2-75.0 mm Hg; P=.02/P<.001). Blood pressure control improved significantly more in absolute percentages between 1999-2000 and 2007-2008 vs 1988-1994 and 1999-2000 (18.6%; 95% CI, 13.3%-23.9%; vs 4.1%; 95% CI, 0.5% to 8.8%; P<.001). Better BP control reflected improvements in awareness (69.1%; 95% CI, 67.1%-71.1%; vs 80.7%; 95% CI, 78.1%-83.0%; P for trend�=�.03), treatment (54.0%; 95% CI, 52.0%-56.1%; vs 72.5%; 95% CI, 70.1%-74.8%; P=.004), and proportion of patients who were treated and had controlled hypertension (50.6%; 95% CI, 48.0%-53.2%; vs 69.1%; 95% CI, 65.7%-72.3%; P=.006). Hypertension control improved significantly between 1988-1994 and 2007-2008, across age, race, and sex groups, but was lower among individuals aged 18 to 39 years vs 40 to 59 years (P<.001) and 60 years or older (P<.001), and in Hispanic vs white individuals (P=.004).

Conclusions: Blood pressure was controlled in an estimated 50.1% of all patients with hypertension in NHANES 2007-2008, with most of the improvement since 1988 occurring after 1999-2000. Hypertension control was significantly lower among younger than middle-aged individuals and older adults, and Hispanic vs white individuals.

Ellaway A, S Macintyre, et al. 2005. Graffiti, greenery, and obesity in adults: secondary analysis of European cross sectional survey. BMJ 331(7517): 611-612.

No abstract provided

EMedicine Health - Chronic Kidney Disease. Accessed February 2013.

Escobedo FJ and DJ Nowak. 2009. Spatial heterogeneity and air pollution removal by an urban forest. Landscape and Urban Planning 90(3-4): 102-110.

Estimates of air pollution removal by the urban forest have mostly been based on mean values of forest structure variables for an entire city. However, the urban forest is not uniformly distributed across a city because of biophysical and social factors. Consequently, air pollution removal function by urban vegetation should vary because of this spatial heterogeneity. This paper presents a different approach to evaluate how the spatial heterogeneity of the urban forest influences air pollution removal at the socioeconomic subregion scale. Air pollution removal for July 1997 to June 1998 and July 2000 to June 2001 were estimated using measured urban forest structure data from three socioeconomic subregions in Santiago, Chile. Dry deposition was estimated using hourly climate, mixing height, and pollutant concentration data. Pollution removal rates among the three socioeconomic subregions were different because of heterogeneous urban forest structure and pollution concentrations. Air pollution removal per square meter of tree cover was greatest in the low socioeconomic subregion. Pollution removal during 1997-1998 was different from 2000 to 2001 due to pollution concentration differences. Seasonal air quality improvement also differed among the subregions. Results can be used to design management alternatives at finer administrative scales such as districts and neighborhoods that maximize the pollution removal rates by the urban forest in a subregion. Policies that affect the functionality of urban forest structure must consider spatial heterogeneity and scale when making region-wide recommendations. Similarly, when modeling the functionality of the urban forest, models must capture this spatial heterogeneity for inter-city comparisons.

Eskenazi B, K Harley, et al. 2004. Association of in utero organophosphate pesticide exposure and fetal growth and length of gestation in an agricultural population. Environmental Health Perspectives 112(10): 1116-24.

Although pesticide use is widespread, little is known about potential adverse health effects of in utero exposure. We investigated the effects of organophosphate pesticide exposure during pregnancy on fetal growth and gestational duration in a cohort of low-income, Latina women living in an agricultural community in the Salinas Valley, California. We measured nonspecific metabolites of organophosphate pesticides (dimethyl and diethyl phosphates) and metabolites specific to malathion (malathion dicarboxylic acid), chlorpyrifos [O,O-diethyl O-(3,5,6-trichloro-2-pyridinyl) phosphoro-thioate], and parathion (4-nitrophenol) in maternal urine collected twice during pregnancy. We also measured levels of cholinesterase in whole blood and butyryl cholinesterase in plasma in maternal and umbilical cord blood. We failed to demonstrate an adverse relationship between fetal growth and any measure of in utero organophosphate pesticide exposure. In fact, we found increases in body length and head circumference associated with some exposure measures. However, we did find decreases in gestational duration associated with two measures of in utero pesticide exposure: urinary dimethyl phosphate metabolites [adjusted = 0.41 weeks per log10 unit increase; 95% confidence interval (CI), 0.75-0.02; p=0.02], which reflect exposure to dimethyl organophosphate compounds such as malathion, and umbilical cord cholinesterase (adjusted== 0.34 weeks per unit increase; 95% CI, 0.13-0.55; p=0.001). Shortened gestational duration was most clearly related to increasing exposure levels in the latter part of pregnancy. These associations with gestational age may be biologically plausible given that organophosphate pesticides depress cholinesterase and acetylcholine stimulates contraction of the uterus. However, despite these observed associations, the rate of preterm delivery in this population (6.4%) was lower than in a U.S. reference population.

Evans GW, SD Colome, DF Shearer. 1988. Psychological reactions to air pollution. Environmental Research 45(1): 1-15.

Interviews with a large representative sample of Los Angeles residents reveal that these citizens are somewhat aware and concerned about air pollution, but not knowledgeable about its causes. Direct behaviors to reduce causes of pollution or one's exposure to it are rare. A moderate percentage of people seek out information about air pollution or complain about it. Fewer follow state health advisories by reducing automobile driving or restricting activity during air pollution episodes. Preliminary modeling of citizen compliance with air pollution health advisories suggests that personal beliefs about negative health effects are a important predictor of compliance. Finally, modest but significant relationships are noted between ambient photochemical oxidants and anxiety symptoms. The latter finding controls for age, socioeconomic status, and temperature.


Faber Taylor A and F E Kuo. 2011. Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children's Play Settings. Applied Psychology: Health and Well-Being 3(3): 281-303.

Background: An estimated 4.4 million children in the United States suffer from Attention Deficit/Hyperactivity Disorder (ADHD), and most would benefit from a low-cost, side-effect-free way of managing their symptoms. Previous research suggests that after isolated exposures to greenspace, children's ADHD symptoms are reduced. This study examined whether routine exposures to greenspace, experienced through children's everyday play settings, might yield ongoing reductions in ADHD symptoms. Methods: Data on 421 children's ADHD symptoms and usual play settings were collected using a national Internet-based survey of parents. Results: Findings suggest that everyday play settings make a difference in overall symptom severity in children with ADHD. Specifically, children with ADHD who play regularly in green play settings have milder symptoms than children who play in built outdoor and indoor settings. This is true for all income groups and for both boys and girls. Interestingly, for hyperactive children, the apparent advantage of green spaces is true only for relatively open green settings. Conclusions: These and previous findings collectively suggest that it is time for randomised clinical trials testing the impacts of regular exposure to greenspace as a treatment for ADHD.

Faber Taylor A and FE Kuo. 2009. Children with attention deficits concentrate better after walk in the park. Journal of Attention Disorders 12(5): 402-409.

Objective: In the general population, attention is reliably enhanced after exposure to certain physical environments, particularly natural environments. This study examined the impacts of environments on attention in children with ADHD. Method: In this within subjects design, each participant experienced each of three treatments (environments) in single blind controlled trials. Seventeen children 7 to12 years old professionally diagnosed with ADHD experienced each of three environments-a city park and two other well-kept urban settings-via individually guided 20-minute walks. Environments were experienced 1 week apart, with randomized assignment to treatment order. After each walk, concentration was measured using Digit Span Backwards. Results: Children with ADHD concentrated better after the walk in the park than after the downtown walk (p = .0229) or the neighborhood walk (p = .0072). Effect sizes were substantial (Cohen's d =.52 and .77, respectively) and comparable to those reported for recent formulations of methylphenidate. Conclusion: Twenty minutes in a park setting was sufficient to elevate attention performance relative to the same amount of time in other settings. These findings indicate that environments can enhance attention not only in the general population but also in ADHD populations. "Doses of nature" might serve as a safe, inexpensive, widely accessible new tool in the tool kit for managing ADHD symptoms. (J. of Att. Dis. 2009; 12(5) 402-409)

Faber Taylor A, F E Kuo, et al. 2002. Views of Nature and Self-Disciplione: Evidence from Inner City Children. Journal of Environmental Psychology 22(1-2): 49-63.

Children growing up in the inner city are at risk of academic underachievement, juvenile delinquency, teenage pregnancy, and other important negative outcomes. Avoiding these outcomes requires self-discipline. Self-discipline, in turn, may draw on directed attention, a limited resource that can be renewed through contact with nature. This study examined the relationship between near-home nature and three forms of self-discipline in 169 inner city girls and boys randomly assigned to 12 architecturally identical high-rise buildings with varying levels of nearby nature. Parent ratings of the naturalness of the view from home were used to predict children's performance on tests of concentration, impulse inhibition, and delay of gratification. Regressions indicated that, on average, the more natural a girl's view from home, the better her performance at each of these forms of self-discipline. For girls, view accounted for 20% of the variance in scores on the combined self-discipline index. For boys, who typically spend less time playing in and around their homes, view from home showed no relationship to performance on any measure. These findings suggest that, for girls, green space immediately outside the home can help them lead more effective, self-disciplined lives. For boys, perhaps more distant green spaces are equally important.

Faber Taylor A, F Kuo, W Sullivan. 2001. Coping with ADD: The surprising connection to green play settings. Environment and Behavior 33(1): 54-77.

Attention Restoration Theory suggests that contact with nature supports attentional functioning, and a number of studies have found contact with everyday nature to be related to attention in adults. Is contact with everyday nature also related to the attentional functioning of children? This question was addressed through a study focusing on children with Attention Deficit Disorder (ADD). This study examined the relationship between children's nature exposure through leisure activities and their attentional functioning using both within and between-subjects comparisons. Parents were surveyed regarding their child's attentional functioning after activities in several settings. Results indicate that children function better than usual after activities in green settings and that the "greener" a child's play area, the less severe his or her attention deficit symptoms. Thus, contact with nature may support attentional functioning in a population of children who desperately need attentional support.

Farley K and J Veitch. 2001. A Room With A View: A review of the effects of windows on work and well-being. IRC-RR-136.

The paper concerns the effects of windows on work and well-being. Literature from a variety of disciplines was reviewed although most recent research was found in the area of environmental psychology. The most consistent finding in the literature is that people prefer natural rather than built or urban views from windows. Windows with views of nature were found to enhance work and well-being in a number of ways including increasing job satisfaction, interest value of the job, perceptions of selfproductivity, perceptions of physical working conditions, life satisfaction, and decreasing intention to quit and the recovery time of surgical patients. However, the access to a view did not improve the performance of students or actual productivity of office workers. The positive psychological and health effects of natural views were explained in the context of recent psychological theories. The direction and potential for future research is discussed.

Flegal KM, MD Carroll, et al. 2010. Prevalence and trends in obesity among US adults, 1999-2008. The Journal of the American Medical Association 303(3): 235-241.

Context: The prevalence of obesity increased in the United States between 1976-1980 and 1988-1994 and again between 1988-1994 and 1999-2000.

Objective: To examine trends in obesity from 1999 through 2008 and the current prevalence of obesity and overweight for 2007-2008.

Design, Setting, and Participants: Analysis of height and weight measurements from 5555 adult men and women aged 20 years or older obtained in 2007-2008 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 2007-2008 were compared with results obtained from 1999 through 2006.

Main Outcome: Measure Estimates of the prevalence of overweight and obesity in adults. Overweight was defined as a body mass index (BMI) of 25.0 to 29.9. Obesity was defined as a BMI of 30.0 or higher.

Results: In 2007-2008, the age-adjusted prevalence of obesity was 33.8% (95% confidence interval [CI], 31.6%-36.0%) overall, 32.2% (95% CI, 29.5%-35.0%) among men, and 35.5% (95% CI, 33.2%-37.7%) among women. The corresponding prevalence estimates for overweight and obesity combined (BMI ?25) were 68.0% (95% CI, 66.3%-69.8%), 72.3% (95% CI, 70.4%-74.1%), and 64.1% (95% CI, 61.3%-66.9%). Obesity prevalence varied by age group and by racial and ethnic group for both men and women. Over the 10-year period, obesity showed no significant trend among women (adjusted odds ratio [AOR] for 2007-2008 vs 1999-2000, 1.12 [95% CI, 0.89-1.32]). For men, there was a significant linear trend (AOR for 2007-2008 vs 1999-2000, 1.32 [95% CI, 1.12-1.58]); however, the 3 most recent data points did not differ significantly from each other.

Conclusions In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women. The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.

Flom B, C Johnson, et al. 2011. The Natural School Counselor: Using nature to promote mental health in schools. Journal of Creativity in Mental Health 6(2): 118-131.

As children and adolescents spend less time outdoors, research increasingly demonstrates that natural environments play an important role in healthy development. School counselors work to optimize student learning and psychosocial development, while serving as frontline professionals promoting mental health among youth. This literature review examines outcomes of recent research on the connection between nature, mental health, and learning in school-aged youth. It outlines opportunities for infusing nature into all aspects of the school counseling program. Two case examples illustrate how creative school counselors incorporate outdoor environments into their comprehensive school counseling programs.

Food and Drug Administration (FDA) - Foodborne Illness (Gastrointestinal). Accessed February 2013.

Franco O H, C de Laet, et al. 2005. EFfects of physical activity on life expectancy with cardiovascular disease. Archives of Internal Medicine 165 (20): 2355-2360.

Background: Physical inactivity is a modifiable risk factor for cardiovascular disease. However, little is known about the effects of physical activity on life expectancy with and without cardiovascular disease. Our objective was to calculate the consequences of different physical activity levels after age 50 years on total life expectancy and life expectancy with and without cardiovascular disease.

Methods: We constructed multistate life tables using data from the Framingham Heart Study to calculate the effects of 3 levels of physical activity (low, moderate, and high) among populations older than 50 years. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to disease, and disease to death) by levels of physical activity and adjusted for age, sex, smoking, any comorbidity (cancer, left ventricular hypertrophy, arthritis, diabetes, ankle edema, or pulmonary disease), and examination at start of follow-up period.

Results: Moderate and high physical activity levels led to 1.3 and 3.7 years more in total life expectancy and 1.1 and 3.2 more years lived without cardiovascular disease, respectively, for men aged 50 years or older compared with those who maintained a low physical activity level. For women the differences were 1.5 and 3.5 years in total life expectancy and 1.3 and 3.3 more years lived free of cardiovascular disease, respectively.

Conclusions: Avoiding a sedentary lifestyle during adulthood not only prevents cardiovascular disease independently of other risk factors but also substantially expands the total life expectancy and the cardiovascular disease-free life expectancy for men and women. This effect is already seen at moderate levels of physical activity, and the gains in cardiovascular disease-free life expectancy are twice as large at higher activity levels.

Freeman C, K J M Dickinson, et al. 2012. "My garden is an expression of me": Exploring householders' relationships with their gardens. Journal of Environmental Psychology 32(2): 135-143.

Domestic gardens offer immense potential as sites for native biodiversity conservation. In urban areas they often comprise the largest land use, thus presenting an accessible and immediate way for urban dwellers to connect with nature and to support and enhance native biodiversity. This paper presents findings from a study of 55 domestic gardens undertaken in Dunedin, New Zealand, which explores householders' relationships with their gardens. The study data was derived from two interviews with householders, two photo exercises (approximately a year apart), together with a number of biological studies of the gardens. Gardens proved to be very important for our householders; for physical and mental health, as an expression of ownership and identity, as sites for social relationships, for connecting with nature and as site of domestic produce production. Householders' connections with nature were idiosyncratic, multifaceted and exhibited in ways that are more complex and varied than those usually considered by those working in the natural sciences and indeed biophilia supporters. We emphasize the importance of the people side of nature in seeking to build and support positive ecological change in the urban environment and the value of combining natural and social science approaches.

French J, R Ing, S Von Allmen, R Wood. 1983. Mortality from flash floods: a review of National Weather Service Reports, 1969-81. Public Health Reports 98(6): 584-588

Of all weather-related disasters that occur in the United States, floods are the main cause of death, and most flood-related deaths are attributed to flash floods. Whenever a weather-related disaster involves 30 or more deaths or more than $100 million in property damage, the National Weather Service (NWS) forms a survey team to investigate the disaster and write a report of findings. All NWS survey reports on flash floods issued during 1969-81 were reviewed to determine the mortality resulting from such floods, the effect of warnings on mortality, and the circumstances contributing to death. A total of 1,185 deaths were associated with 32 flash floods, an average of 37 deaths per flash flood. The highest average number of deaths per event was associated with the four flash floods in which dams broke after heavy rains. Although there were 18 flash floods in 1977-81 and only 14 in 1969-76, the number of deaths was 2Y2 times greater during the earlier period. More than twice as many deaths were associated with flash floods for which the survey team considered the warnings inadequate than with those with warnings considered adequate. Ninety-three percent of the deaths were due to drowning and 42 percent of these drownings were car related. The other drownings occurred in homes, at campsites, or when persons were crossing bridges and streams. The need for monitoring dams during periods of heavy rainfall is highlighted.

Frumkin H 2001. Beyond toxicity: Human health and the natural environment. American Journal of Preventive Medicine 20(3): 234-240.

Research and teaching in environmental health have centered on the hazardous effects of various environmental exposures, such as toxic chemicals, radiation, and biological and physical agents. However, some kinds of environmental exposures may have positive health effects. According to E.O. Wilson's "biophilia" hypothesis, humans are innately attracted to other living organisms. Later authors have expanded this concept to suggest that humans have an innate bond with nature more generally. This implies that certain kinds of contact with the natural world may benefit health. Evidence supporting this hypothesis is presented from four aspects of the natural world: animals, plants, landscapes, and wilderness. Finally, the implications of this hypothesis for a broader agenda for environmental health, encompassing not only toxic outcomes but also salutary ones, are discussed. This agenda implies research on a range of potentially healthful environmental exposures, collaboration among professionals in a range of disciplines from public health to landscape architecture to city planning, and interventions based on research outcomes.

Fuller RA, KN Irvine, et al. 2007. Psychological benefits of green space increase with biodiversity. Biology Letters 3(4): 390-394.

The world's human population is becoming concentrated into cities, giving rise to concerns that it is becoming increasingly isolated from nature. Urban public greenspaces form the arena of many people's daily contact with nature and such contact has measurable physical and psychological benefits. Here we show that these psychological benefits increase with the species richness of urban greenspaces. Moreover, we demonstrate that greenspace users can more or less accurately perceive species richness depending on the taxonomic group in question. These results indicate that successful management of urban greenspaces should emphasize biological complexity to enhance human well-being in addition to biodiversity conservation.


Gallagher LG, TF Webster, et al. 2010. Using residential history and groundwater modeling to examine drinking water exposure and breast cancer. Environmental Health Perspectives 118(6): 749-55.

BACKGROUND: Spatial analyses of case control data have suggested a possible link between breast cancer and groundwater plumes in upper Cape Cod, Massachusetts.

OBJECTIVE: We integrated residential histories, public water distribution systems, and groundwater modeling within geographic information systems (GIS) to examine the association between exposure to drinking water that has been contaminated by wastewater effluent and breast cancer.

METHODS: Exposure was assessed from 1947 to 1993 for 638 breast cancer cases who were diagnosed from 1983 to 1993 and 842 controls; we took into account residential mobility and drinking water source. To estimate the historical impact of effluent on drinking water wells, we modified a modular three-dimensional finite-difference groundwater model (MODFLOW) from the U.S. Geological Survey. The analyses included latency and exposure duration.

RESULTS: Wastewater effluent impacted the drinking water wells of study participants as early as 1966. For > 0-5 years of exposure (versus no exposure), associations were generally null. Adjusted odds ratios (AORs) for > 10 years of exposure were slightly increased, assuming latency periods of 0 or 10 years [AOR = 1.3; 95% confidence interval (Cl), 0.9-1.9 and AOR = 1.6; 95% CI, 0.8-3.2, respectively]. Statistically significant associations were estimated for ever-exposed versus never-exposed women when a 20-year latency period was assumed (AOR = 1.9; 95% Cl, 1.0-3.4). A sensitivity analysis that classified exposures assuming lower well-pumping rates showed similar results.

CONCLUSION: We investigated the hypothesis generated by earlier spatial analyses that exposure to drinking water contaminated by wastewater effluent may be associated with breast cancer. Using a detailed exposure assessment, we found an association with breast cancer that increased with longer latency and greater exposure duration.

Gatseva PD and MD Argirova. 2008. High-nitrate levels in drinking water may be a risk factor for thyroid dysfunction in children and pregnant women living in rural Bulgarian areas. International Journal of Hygiene and Environmental Health 211(5-6): 555-9.

Nitrate inhibits the accumulation of iodide in thyroid gland. The aim of present study was to evaluate the influence of this ion on the iodine status of two risk population groups. Subjects of study were pregnant women and children aged between 3 and 6 years from two villages in Bulgaria with high- and low-nitrate levels in drinking water. The relative risk of thyroid disorders for the pregnant women living in the village with high-nitrate levels in drinking water expressed as an odds ratio was 5.294 (95% confidence intervals 1.003-27.939; P=0.0454) and was considered as significant. Statistically significant differences were found between the goiter rate in exposed and non-exposed pregnant women. The relative risk of thyroid dysfunction for the children exposed to a high-nitrate level, expressed as an odds ratio was 2.333 (95% confidence intervals 0.8491-6.412; P=0.1396) and was considered as not significant; the goiter prevalence in the exposed children was also not statistically different. The results of the study confirmed the role of high-nitrate level in drinking water as a risk factor for thyroid dysfunction in vulnerable population groups.

George MG, X Tong, et al. 2011. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Annals of Neurology 70(5): 713 - 21.

Objective: The aim of this study was to determine acute stroke hospitalization rates for children and young adults and the prevalence of stroke risk factors among children and young adults hospitalized for acute stroke.

Methods: The study population consisted of 1995-2008 hospitalizations from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke hospitalizations were identified by the primary International Classification of Diseases, 9th ed, Clinical Modification (ICD-9-CM) code. Seven consecutive 2-year time intervals were selected. Three age groups were utilized: 5 to 14 years, 15 to 34 years, and 35 to 44 years. Stroke risk factors and comorbidities among those hospitalized with acute stroke were identified by secondary ICD-9-CM codes.

Results: During the period of study, the prevalence of hospitalizations of acute ischemic stroke increased among all age and gender groups except females aged 5 to 14 years. Females aged 15 to 34 years and males and females aged 35 to 44 years showed a decrease in the prevalence of hospitalizations for subarachnoid hemorrhage, whereas females aged 5 to 14 years showed increases for subarachnoid hemorrhage. Hypertension, diabetes, obesity, lipid disorders, and tobacco use were among the most common coexisting conditions, and their prevalence increased from 1995 to 2008 among adolescents and young adults (aged 15-44 years) hospitalized with acute ischemic stroke. Interpretation: Increases in the prevalence of ischemic stroke hospitalizations and coexisting traditional stroke risk factors and health risk behaviors were identified among acute ischemic stroke hospitalizations in young adults. Our results from national surveillance data accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults.

Gidlof-Gunnarsson A and E Ohrstrom. 2007. Noise and well-being in urban residential environments: The potential role of perceived availability to nearby green areas. Landscape and Urban Planning 83(2-3): 115-126.

A growing body of literature indicates that contact with nature influence people's health and psychological well-being both directly and by moderating processes. A questionnaire study was conducted in urban residential settings with high road-traffic noise exposure (LAeq, 24 h = 60-68 dB). Out of 500 residents, 367 lived in dwellings with access to a quiet side (LAeq, 24 h ? 45 dB free field value; "noise/quiet"-condition) and 133 had no access to a quiet side ("noise/noise"-condition). The present paper examines whether perceived availability to nearby green areas affects various aspects of well-being in these two noise-condition groups. For both those with and without access to a quiet side, the results show that "better" availability to nearby green areas is important for their well-being and daily behavior by reducing long-term noise annoyances and prevalence of stress-related psychosocial symptoms, and by increasing the use of spaces outdoors. In the process of planning health-promoting urban environments, it is essential to provide easy access to nearby green areas that can offer relief from environmental stress and opportunities for rest and relaxation, to strive for lower sound levels from road traffic, as well as to design "noise-free" sections indoors and outdoors.

Gielen MH, SC van der Zee, et al. 1997. Acute effects of summer air pollution on respiratory health of asthmatic children. Am. J. Respir. Crit. Care Med. 155(6): 2105-08.

In the early summer of 1995, the acute respiratory effects of ambient air pollution were studied in a panel of 61 children, ages 7 to 13 yr, of whom 77% were taking asthma medication. Peak flow was measured twice daily with MiniWright meters at home and the occurrence of acute respiratory symptoms and medication use was registered daily by the parents in a diary. Exposure to air pollution was characterized by the ambient concentrations of ozone, PM10, and black smoke. During the study period, maximal 1-h ozone concentrations never exceeded 130 microg/m3, and 24-h black smoke and PM10 concentrations were never higher than 41 and 60 microg/m3 respectively. Associations of air pollution and health outcomes were evaluated using time series analysis. After adjusting for pollen, time trend, and day of the week, black smoke in particular was associated with acute respiratory symptoms and with medication use. Less strong associations were found for PM10 and ozone. These results suggest that in this panel of children, most of whom had asthma, relatively low levels of particulate matter and ozone in ambient air are able to increase symptoms and medication use.

Giles-Corti B, MH Broomhall, et al. 2005. Increasing walking: How important is distance to, attractiveness, and size of public open space? American Journal of Preventive Medicine 28(2, Supplement 2): 169-176.

Background Well-designed public open space (POS) that encourages physical activity is a community asset that could potentially contribute to the health of local residents. Methods In 1995-1996, two studies were conducted-an environmental audit of POS over 2 acres (n =516) within a 408-km2 area of metropolitan Perth, Western Australia; and personal interviews with 1803 adults (aged 18 to 59 years) (52.9% response rate). The association between access to POS and physical activity was examined using three accessibility models that progressively adjusted for distance to POS, and its attractiveness and size. In 2002, an observational study examined the influence of attractiveness on the use of POS by observing users of three pairs of high- and low-quality (based on attractiveness) POS matched for size and location. Results Overall, 28.8% of respondents reported using POS for physical activity. The likelihood of using POS increased with increasing levels of access, but the effect was greater in the model that adjusted for distance, attractiveness, and size. After adjustment, those with very good access to large, attractive POS were 50% more likely to achieve high levels of walking (odds ratio, 1.50; 95% confidence level, 1.06�2.13). The observational study showed that after matching POS for size and location, 70% of POS users observed visited attractive POS. Conclusions Access to attractive, large POS is associated with higher levels of walking. To increase walking, thoughtful design (and redesign) of POS is required that creates large, attractive POS with facilities that encourage active use by multiple users (e.g., walkers, sports participants, picnickers).

Grahn P and UA Stigsdotter. 2003. Landscape planning and stress. Urban Forestry & Urban Greening 2(1): 1-18.

Stress and stress-related illnesses, as reflected in medical records, have increased dramatically among adults and children in Western societies. A growing part of the budget for medical service in Sweden is used for individuals suffering from different stress-related illnesses such as burnout syndrome, insomnia and fatigue, depression, feelings of panic, etc. In this paper, we present results from a study in which 953 randomly selected individuals in nine Swedish cities answered a questionnaire about their health and their use of different urban open green spaces in and close to the city. The results indicate that city landscape planning may affect the health of town-dwellers. Statistically significant relationships were found between the use of urban open green spaces and self-reported experiences of stress � regardless of the informant's age, sex and socio-economic status. The results suggest that the more often a person visits urban open green spaces, the less often he or she will report stress-related illnesses. The same pattern is shown when time spent per week in urban open green spaces is measured. The distance to public urban open green spaces seems to be of decisive importance, as is access to a garden, in the form of a private garden or a green yard immediately adjacent to, for instance, an apartment building. People do not usually compensate for lack of green environments in their own residential area with more visits to public parks or urban forests. According to our results, laying out more green areas close to apartment houses, and making these areas more accessible, could make for more restorative environments. Outdoor areas that provide environments free from demands and stress, and that are available as part of everyday life, could have significant positive effects on the health of town-dwellers in Sweden. This may also apply to other Western societies.

Grigsby-Toussaint D, S-H Chi, et al. 2011. Where they live, how they play: Neighborhood greenness and outdoor physical activity among preschoolers. International Journal of Health Geographics 10 (1): 66.

Background: Emerging empirical evidence suggests exposure to "green" environments may encourage higher levels of physical activity among children. Few studies, however, have explored this association exclusively in pre-school aged children in the United States. We examined whether residing in neighborhoods with higher levels of greenness was associated with higher levels of outdoor physical activity among preschoolers. In addition, we also explored whether outdoor playing behaviors (e.g., active vs. quiet) were influenced by levels of neighborhood greenness independent of demographic and parental support factors.

Results : Higher levels of neighborhood greenness as measured by the Normalized Difference Vegetation Index (NDVI) was associated with higher levels of outdoor playing time among preschool-aged children in our sample. Specifically, a one unit increase in neighborhood greenness increased a child's outdoor playing time by approximately 3 minutes. A dose-response relationship was observed between increasing levels of parental support for physical activity (e.g., time spent playing with children) and child outdoor physical activity (p < 0.01).

Conclusions : Consistent with previous studies, neighborhood greenness influences physical activity behavior. However, for preschoolers, parental involvement may be more critical for improving physical activity levels.

Guite, H F, C Clark, et al. 2006. The impact of the physical and urban environment on mental well-being. Public Health 120 (12): 1117-1126.

Objectives: To examine the strength of association between physical and social factors in the built environment and mental well-being, and to determine which factors are the most important.

Study Design : A postal survey based on a theoretical model of domains that might link the physical and urban environment with mental well-being was sent to 2696 adults aged 18 years or over, in four areas of Greenwich, London. Mental health was measured using the SF36 subscales for mental health (MH) and vitality (V). Additional household and area level data were appended for each respondent from a range of sources.

Results : 1012 questionnaires were returned (38% response rate). At the univariate level significant confounders that were associated with poorer mental well-being were being female, 85+ years, unemployed or retired, on housing benefit, council tenant, two or more children, and having requested re-housing Better mental well-being was associated with being aged 65 years to 84 years (better MH and V). Within domain analysis, adjusting for each of the confounding factors, resulted in the following factors being significantly associated with being in the lowest quartile for MH score: (i) control over the internal environment (damp), (ii) design and maintenance (not liking the look of the estate/road, (iii) noise (neighbour noise), (iv) density and escape (feeling over-crowded in the home, being dissatisfied with green spaces, dissatisfied with social and entertainment facilities) being dissatisfied with community facilities (such as libraries and community centres) was only significant for vitality, (v) fear of crime and harassment (feeling unsafe to go out in the day, feeling unsafe to go out at night, agreeing that needles and syringes left lying around are a problem) (vi) social participation (not enough events to get people together, not enough places to stop and chat). When these 12 factors were entered into a single model with the significant confounders five remained significantly associated with being in the lowest quartile for MH or V: neighbour noise MH OR 2.71 [95% CI 1.48, 4.98]; feeling over-crowded in the home MH OR 2.22 [1.42, 3.48]; being dissatisfied with access to green open spaces MH OR 1.69 [1.05, 2.74]; access to community facilities V OR 1.92, [1.24, 3.00]; feeling unsafe to go out in the day MH OR 1.64 [1.02, 2.64]; V OR 1.58 [1.00, 2.49].

Conclusions: This study confirms an association between the physical environment and mental well-being across a range of domains. The most important factors that operate independently are neighbour noise, sense of over-crowding in the home and escape facilities such as green spaces and community facilities, and fear of crime. This study highlights the need to intervene on both design and social features of residential areas to promote mental well-being.


Hansen A, P Bi, et al. 2008. The effect of heat waves on mental health in a temperate Australian city. Environmental Health Perspectives 116(10): 1369-75.

Objective: The goal of this study was to identify mental, behavioral, and cognitive disorders that may be triggered or exacerbated during heat waves, predisposing individuals to heat-related morbidity and mortality.

Design: Using health outcome data from Adelaide, South Australia, for 1993-2006, we estimated the effect of heat waves on hospital admissions and mortalities attributed to mental, behavioral, and cognitive disorders. We analyzed data using Poisson regression accounting for overdispersion and controlling for season and long-term trend, and we performed threshold analysis using hockey stick regression.

Results: Above a threshold of 26.7 C, we observed a positive association between ambient temperature and hospital admissions for mental and behavioral disorders. Compared with non-heat-wave periods, hospital admissions increased by 7.3% during heat waves. Specific illnesses for which admissions increased included organic illnesses, including symptomatic mental disorders; dementia; mood (affective) disorders; neurotic, stress related, and somatoform disorders; disorders of psychological development; and senility. Mortalities attributed to mental and behavioral disorders increased during heat waves in the 65- to 74-year age group and in persons with schizophrenia, schizotypal, and delusional disorders. Dementia deaths increased in those up to 65 years of age.

Conclusion: Our results suggest that episodes of extreme heat pose a salient risk to the health and well-being of the mentally ill.

Hansen B, P Reich, PSLake & T Cavagnaro. 2010. Minimum width requirements for riparian zones to protect flowing waters and to conserve biodiversity: a review and recommendations (pp. 101). Victoria, Australia: Department of Sustainability and Environment.

Hansmann R, S-M Hug, K. Seeland. 2007. Restoration and stress relief through physical activities in forests and parks. Urban Forestry & Urban Greening 6(4): 213-25.

A field survey assessed the restorative effects of visiting an urban forest and a city park in Zurich, Switzerland. Respondents rated their headaches, level of stress, and how balanced they felt both prior to visiting the outdoor location and at the time of being interviewed. Suffering from headaches and stress decreased significantly, and feeling well-balanced increased significantly. The recovery ratio for stress was 87%, and the reduction in headaches was 52%, in terms of the possible improvements on five-point rating scales. With respect to feeling well-balanced, the observed changes amounted to 40% of the possible enhancement. Positive effects increased with length of visit, and individuals practising sports (e.g., jogging, biking, playing ball) showed significantly higher improvements than those engaged in less strenuous activities (e.g., taking a walk or relaxing). These findings support previous research on how exercise in green spaces promotes well-being and recovery from stress.

Hart JE, F Laden, et al. 2009. Exposure to traffic pollution and increased risk of rheumatoid arthritis. Environmental Health Perspectives 117(7): 1065-9.

Background : Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that affects approximately 1% of the adult population, and to date, genetic factors explain less than 50% of the risk. Particulate air pollution, especially of traffic origin, has been linked to systemic inflammation in many studies.

Objectives : We examined the association of distance to road, a marker of traffic pollution exposure, and incidence of RA in a prospective cohort study.

Methods : We studied 90,297 U.S. women in the Nurses' Health Study. We used a geographic information system to determine distance to road at the residence in 2000 as a measure of traffic exposure. Using Cox proportional hazard models, we examined the association of distance to road and incident RA (1976-2004) with adjustment for a large number of potential confounders.

Results : In models adjusted for age, calendar year, race, cigarette smoking, parity, lactation, menopausal status and hormone use, oral contraceptive use, body mass index, physical activity, and census-tract-level median income and house value, we observed an elevated risk of RA [hazard ratio (HR) = 1.31; 95% confidence interval (CI), 0.98-1.74] in women living within 50 m of a road, compared with those women living 200 m or farther away. We also observed this association in analyses among nonsmokers (HR = 1.62; 95% CI, 1.04-2.52), nonsmokers with rheumatoid factor (RF)-negative RA (HR = 1.77; 95% CI, 0.93-3.38), and nonsmokers with RF-positive RA (HR = 1.51; 95% CI, 0.82-2.77). We saw no elevations in risk in women living 50-200 m from the road.

Conclusions : The observed association between exposure to traffic pollution and RA suggests that pollution from traffic in adulthood may be a newly identified environmental risk factor for RA.

Harte JL and GH Eifert. 1995. The effects of running, environment, and attentional focus on athletes catecholamine and cortisol levels and mood. Psychophysiology 32(1): 49-54.

This study was designed to examine some of the psychoneuroendocrine effects of exercise-induced emotional experiences and the mediating effects of environmental setting and subjects' attentional focus. Trained runners were tested during an outdoor run and two indoor treadmill running conditions. Excretions of catecholamines and Cortisol significantly increased after all running conditions but not after a control condition. Results indicate that patterns of endocrine and concomitant emotional change through exercise differ when environmental setting and attentional focus are altered in such a way that a normally pleasant task such as running becomes tedious and negatively evaluated. These findings support the notion that setting, attention, and cognitive appraisal may alter the emotional experience associated with physical exercise.

Hartig T, GW Evans, et al. 2003. Tracking restoration in natural and urban field settings. Journal of Environmental Psychology 23(2): 109-123.

We compared psychophysiological stress recovery and directed attention restoration in natural and urban field settings using repeated measures of ambulatory blood pressure, emotion, and attention collected from 112 randomly assigned young adults. To vary restoration needs, we had half of the subjects begin the environmental treatment directly after driving to the field site. The other half completed attentionally demanding tasks just before the treatment. After the drive or the tasks, sitting in a room with tree views promoted more rapid decline in diastolic blood pressure than sitting in a viewless room. Subsequently walking in a nature reserve initially fostered blood pressure change that indicated greater stress reduction than afforded by walking in the urban surroundings. Performance on an attentional test improved slightly from the pretest to the midpoint of the walk in the nature reserve, while it declined in the urban setting. This opened a performance gap that persisted after the walk. Positive affect increased and anger decreased in the nature reserve by the end of the walk; the opposite pattern emerged in the urban environment. The task manipulation affected emotional self-reports. We discuss implications of the results for theories about restorative environments and environmental health promotion measures.

Hartig T, M Mang, et al. 1991. Restorative effects of natural environment experiences. Environment and Behavior 23(1): 3-26.

The utility of different theoretical models of restorative experience was explored in a quasi-experimental field study and a true experiment. The former included wilderness backpacking and nonwilderness vacation conditions, as well as a control condition in which participants continued with their daily routines. The latter had urban environment, natural environment, and passive relaxation conditions. Multimethod assessments of restoration consisted of self-reports of affective states, cognitive performance, and, in the latter study, physiological measures. Convergent self-report and performance results obtained in both studies offer evidence of greater restorative effects arising from experiences in nature. Implications for theory, methodology, and design are discussed.

Hayborn D. 2011. Central Park: Nature, context and human wellbeing. Journal of Wellbeing 1(2).

his paper considers evidence that social and physical contexts, particularly natural environments, are surprisingly important for human wellbeing. In particular, the pursuit of happiness seems to be less a matter of individual choice than is commonly supposed. These ideas are explored through an examination of New York's Central Park.

Hefting MM, J-C Clement, P Bienkowski et al. 2005. The role of vegetation and litter in the nitrogen dynamics of riparian buffer zones in Europe. Ecological Engineering, 24(5), 465-482.

Herzele AV, S de Vries. 2011. Linking green space to health: A comparative study of two urban neighborhoods in Ghent, Belgium. Population and Environment.

This paper investigates the nature of the relationship between the greenness of the local environment and the health and well-being of its inhabitants by looking at a number of possible mediators within the same study: physical activity, perceived stress, ability to concentrate, social cohesion and neighbourhood satisfaction. Data were collected through a survey of residents in two neighbourhoods that differ objectively in green space provision, but which are largely similar in demographics, socio-economic factors, housing conditions and other environmental characteristics, apart from green space. Of the three dependent variables of interest: self-reported general health, bodily functioning and general well-being (happiness), it was self-reported happiness that differed significantly between the two neighbourhoods, with greater happiness in the greener neighbourhood. Amongst the possible mediators, people's satisfaction with their neighbourhood differed significantly: those living in the greener neighbourhood were more satisfied. Mediation analysis indicated that neighbourhood satisfaction fully mediates the relationship between neighbourhood greenness and happiness. Among the specific (environmental and social) neighbourhood qualities asked about, perception of neighbourhood greenness was found to be the most important predictor of neighbourhood satisfaction. Additional analysis showed that the view from the living room-green or not green-fully mediates the relationship between neighbourhood greenness and neighbourhood satisfaction. This study underscores the importance of nearby green space for people's overall well-being and suggests the need for green space to be evaluated in terms of visual proximity, that is, whether and how it is experienced from the street and the home.

Heschong Mahone Group. 2003. Windows and Classrooms: Student Performance and the Indoor Environment.

This study investigates whether daylight and other aspects of the indoor environment in elementary classrooms have an effect on student learning, as measured by improvement on standardized math and reading tests over an academic year. The study uses regression analysis to compare the performance of over 8000 3rd through 6th grade students in 450 classrooms in the Fresno Unified School District, CA. A statistical analysis was conducted in which traditional education explanatory variables, such as student and teacher demographic characteristics, were controlled for. Numerous other physical attributes of the classroom and the indoor environment are also considered as potential influences. In addition to the statistical analysis, 40 classrooms were observed during normal operation and over 100 teachers were surveyed on their classroom operating experience and preferences. Variables describing a better view out of windows are found to be positively and significantly associated with better student learning, while variables describing window glare, sun penetration and lack of visual control are associated with negative performance. In addition, attributes of classrooms associated with acoustic conditions and air quality issues are also significant. The findings are discussed relative to a previous study at San Juan Capistrano that found that more daylight improved students' performance. The results emphasize the statistical value of working with very large data sets, and of studying the interactions between environmental variables.

Hibbert, Alden R. 1967. Forest treatment effects on water yield. Coweeta Hydrologic Laboratory, Southeastern Forest Experiment Station, Forest Service, U.S. Department of Agriculture, Asheville, North Carolina.

Results are reported for thirty-nine studies of the effect of altering forest cover on water yield. Taken collectively, these studies reveal that forest reduction increases water yield, and that reforestation decreases water yield. Results of individual treatments vary widely and for the most part are unpredictable. First-year response to complete forest reduction varies from 34 mm to more than 450 mm of increased streamflow. A practical upper limit of yield increase appears to be about 4.5 mm per year for each percent reduction in forest cover, but most treatments produce less than half this amount. There is strong evidence that in well-watered regions, at least, streamflow response is proportional to reduction in forest cover. As the forest regrows following treatment, increases in streamflow decline; the rate of decline varies between catchments, but appears to be related to the rate of forest recovery. Seasonal distribution of streamflow response to treatment is variable; response in streamflow may be almost immediate or considerably delayed, depending on climate, soils, topography, and other factors.

Hillsdon M, J Panter, et al. 2006. The relationship between access and quality of urban green space with population physical activity. Public Health 120(12): 1127-1132.

Objectives: This study examined the association between access to quality urban green space and levels of physical activity.

Study design: A cross-sectional examination of the relationship between access to quality urban green space and level of recreational physical activity in 4950 middle-aged (40-70 years) respondents from the European Prospective Investigation into Cancer and Nutrition (EPIC), who resided in Norwich, UK.

Methods: Using geographic information systems (GIS), three measures of access to open green space were calculated based on distance only, distance and size of green space and distance, size and quality of green space. Multiple regression models were used to determine the relationship between the three indicators of access to open green space and level of recreational physical activity.

Results: There was no evidence of clear relationships between recreational activity and access to green spaces. Non-significant associations were apparent for all variables, and there was no evidence of a clear trend in regression coefficients across quartiles of access for either the distance, size adjusted, and quality and size-adjusted models. Furthermore, the neighbourhood measures of access to green spaces showed non-significant associations with recreational physical activity.

Conclusions: Access to urban green spaces does not appear to be associated with population levels of recreational physical activity in our sample of middle-aged adults.

Hollis GE and JR Thompson. 1993. Water resource developments and their hydrological impacts. In: G.E. Hollis, W.M. Adams, M. Aminu-Kano, Editors, The Hadejia-Nguru wetlands: Environment, Economy and Sustainable Development of a Sahelian Floodplain Wetland. 149 - 90. IUCN: Gland & Cambridge, UK.

No abstract provided

Hong B, KE Limburg, et al. 2012. An integrated monitoring/modeling framework for assessing human-nature interactions in urbanizing watersheds: Wappinger and Onondaga Creek watersheds, New York, USA. Environmental Modelling & Software 32(0): 1-15.

In much of the world, rapidly expanding areas of impervious surfaces due to urbanization threaten water resources. Although tools for modeling and projecting land use change and water quantity and quality exist independently, to date it is rare to find an integrated, comprehensive modeling toolkit to readily assess the future course of urban sprawl, and the uncertainties of its impact on watershed ecosystem health. We have developed a combined socio-economic-ecological toolbox, running on the ArcGIS platform, to analyze subsequent impacts on streamflow and nutrient export using the spatial pattern of urbanization in response to anticipated socio-economic conditions and scenarios. We have applied our toolbox to two New York State catchment areas, Onondaga Creek watershed and Wappinger Creek, that have undergone rapid development in the last decades. Uncertainties in temporal trends of new housing permits, spatial distribution of development detection and development potential, and stream conditions were evaluated using three separate toolsets (ArcECON, ArcGEOMOD, and ArcGWLF, respectively). The toolbox capabilities are demonstrated through a year 2020 scenario prediction and analysis, where the aforementioned tools were explicitly linked to determine future housing development, spread of impervious areas, runoff generation, and stream nitrate flux. Higher economic growth was estimated to induce increased new housing permits and spread of impervious surface areas, leading to flashier streamflow as well as worsening stream condition, which was aggravated when only the forest lands were allowed to be developed.

Horwitz P and CM Finlayson. 2011. Wetlands as settings for human health: incorporating ecosystem services and health impact assessment into water resource management. BioScience 61(9): 678-688.

Reconsidering the relationship between human well-being and environmental quality is central for the management of wetlands and water resources and for public health itself. We propose an integrated strategy involving three approaches. The first is to make assessments of the ecosystem services provided by wetlands more routine. The second is to adopt the "settings" approach, most developed in health promotion, wherein wetlands are one of the settings for human health and provide a context for health policies. Finally, a layered suite of health issues in wetland settings is developed, including core requirements for human health (food and water); health risks from wetland exposures; and broader social determinants of health in wetland settings, including livelihoods and lifestyles. Together, these strategies will allow wetland managers to incorporate health impact assessment processes into their decisionmaking and to examine the health consequences of trade-offs that occur in planning, investment, development, and decisionmaking outside their direct influence.

House J S, Landis K R, & D Umberson. 1988. Social relationships and health. Science, 241(4865): 540-545.

Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health. Prospective studies, which control for baseline health status, consistently show increased risk of death among persons with a low quantity, and sometimes low quality, of social relationships. Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes. The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored.

Hu Z, J Liebens, et al. 2008. Linking stroke mortality with air pollution, income, and greenness in northwest Florida: an ecological geographical study. International Journal of Health Geographics 7: 20.

BACKGROUND: Relatively few studies have examined the association between air pollution and stroke mortality. Inconsistent and inclusive results from existing studies on air pollution and stroke justify the need to continue to investigate the linkage between stroke and air pollution. No studies have been done to investigate the association between stroke and greenness. The objective of this study was to examine if there is association of stroke with air pollution, income and greenness in northwest Florida. RESULTS: Our study used an ecological geographical approach and dasymetric mapping technique. We adopted a Bayesian hierarchical model with a convolution prior considering five census tract specific covariates. A 95% credible set which defines an interval having a 0.95 posterior probability of containing the parameter for each covariate was calculated from Markov Chain Monte Carlo simulations. The 95% credible sets are (-0.286, -0.097) for household income, (0.034, 0.144) for traffic air pollution effect, (0.419, 1.495) for emission density of monitored point source polluters, (0.413, 1.522) for simple point density of point source polluters without emission data, and (-0.289,-0.031) for greenness. Household income and greenness show negative effects (the posterior densities primarily cover negative values). Air pollution covariates have positive effects (the 95% credible sets cover positive values). CONCLUSION: High risk of stroke mortality was found in areas with low income level, high air pollution level, and low level of exposure to green space.


Islam M N, K-S Rahman, et al. 2012. Pollution attenuation by roadside greenbelt in and around urban areas. Urban Forestry & Urban Greening 11(4): 460-464.

Greenbelts are effective tools for mitigation of traffic induced air and noise pollution. In this study, the potential role of greenbelts along the roadside for the reduction of air pollution and noise levels has been assessed by using seasonally monitored data in a megacity of Bangladesh. Correlation analysis was performed between the vegetation status, measured by canopy density and shelterbelt porosity, and the total suspended particles (TSP) removal percentage. Further, the reduction of noise level was also analyzed. The results showed that the greenbelts greatly contributed to reduce TSP pollution and it was as much as 65%. Noise level reduction was also achieved up to 17 dB when compared to the open area. Moreover, TSP removal percentage was correlated to the crown density. Area having higher crown density demonstrated less air pollution and lower level of noise compared to the area having lower crown density. Greenbelt showed better performance in summer time than winter.


Janerich DT, AD Stark, P Greenwald, et al. 1981. Increased leukemia, lymphoma, and spontaneous abortion in Western New York following a flood disaster. Public Health Reports 96(4): 350-6.

The New York State Department of Health was asked in September 1978 to investigate a cluster of leukemias and lymphomas in a rural town in western New York State of less than 1,000 people. Four cases of these diseases had been diagnosed in the town's population in the previous 10 months. Residents were concerned about environmental hazards such as background radiation and contamination of their water supply. A total environmental study of the area was not feasible or warranted, but certain environmental studies of the area were conducted. No environmental health hazards were identified. Incidence rates for towns in the four-county area (population 281,000) surrounding the study town were analyzed, based on data from the New York State Cancer Registry. These four counties had been severely affected by the flood following the 1972 Hurricane Agnes. Examination of annual leukemia and lymphoma incidence rates for these counties for 1966--77 revealed that the rates for towns in the river valley (population 102,000), but not for nonriver-valley towns, were 20 to 50 percent above the statewide rates for 1972--77. All other cancer rates remained level throughout both periods. An analysis of spontaneous abortion rates for the four counties for 1968--77 showed a significant peak in 1973, but not for the rest of upstate New York. The peak was concentrated in the towns in the river valley. The apparent time-space cluster of leukemias and lymphomas in conjunction with a marked increase in the spontaneous abortion rate suggests an unidentified flood-related environmental exposure.

Jarup L, L Hellstrom, et al. 2000. Low level exposure to cadmium and early kidney damage: the OSCAR study. Occupational and Environmental Medicine 57(10): 668-72.

OBJECTIVES: To study the dose-response relation between cadmium dose and renal tubular damage in a population of workers and people environmentally or occupationally exposed to low concentrations of cadmium.

METHODS: Early kidney damage in 1021 people, occupationally or environmentally exposed to cadmium, was assessed from cadmium in urine to estimate dose, and protein HC (α1-microglobulin) in urine to assess tubular proteinuria.

RESULTS: There was an age and sex adjusted correlation between cadmium in urine and urinary protein HC. The prevalence of tubular proteinuria ranged from 5% among unexposed people to 50% in the most exposed group. The corresponding prevalence odds ratio was 6.0 (95% confidence interval (95% CI) 1.6 to 22) for the highest exposure group, adjusted for age and sex. Multiple logistic regression analysis showed an increasing prevalence of tubular proteinuria with urinary cadmium as well as with age. After adjustment to the mean age of the study population (53 years), the results show an increased prevalence of 10% tubular proteinuria (taking into account a background prevalence of 5%) at a urinary cadmium concentration of 1.0 nmol/mmol creatinine.

CONCLUSION: Renal tubular damage due to exposure to cadmium develops at lower levels of cadmium body burden than previously anticipated.

Jim CY and W Y Chen. 2009. Ecosystem services and valuation of urban forests in China. Cities 26(4): 187-194.

Urban forests are integral components of urban ecosystems, which could generate significant ecosystem services, such as offsetting carbon emission, removing air pollutants, regulating the microclimate, and recreation. These ecosystem services contribute to improving environmental quality, quality of life, and sustainable urban development. Despite a long history of inserting vegetation in human settlements in China, modern scientific study of this natural-cum-cultural resource did not start until the 1990s. Specifically, the identification and valuation of ecosystem services provided by urban forests are relatively new but fast growing research fields. This paper reviews studies on the major ecosystem services provided by urban forests in China, including microclimatic amelioration (mainly evapotranspiration-cooling effects), carbon dioxide sequestration, oxygen generation, removal of gaseous and particulate pollutants, recreational and amenity. Various valuation techniques have been applied, most of which are still at the embryonic stage. There are rooms to improve the research scope and methods. Some pertinent research gaps and implications on current and future development of urban forestry in China were distilled from the research findings.

Jones, TS, AP Liang, et al. 1982. Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, MO. The Journal of the American Medical Association 247(24): 3327-31.

The morbidity and mortality associated with the 1980 heat wave in St Louis and Kansas City, Mo, were assessed retrospectively. Heat-related illness and deaths were identified by review of death certificates and hospital, emergency room, and medical examiners' records in the two cities. Data from the July 1980 heat wave were compared with data from July 1978 and 1979, when there were no heat waves. Deaths from all causes in July 1980 increased by 57% and 64% in St Louis and Kansas City, respectively, but only 10% in the predominantly rural areas of Missouri. About one of every 1,000 residents of the two cities was hospitalized for or died of heat-related illness. Incidence rates (per 100,000) of heatstroke, defined as severe heat illness with documented hyperthermia, were 26.5 and 17.6 for St Louis and Kansas City, respectively. No heatstroke cases occurred in July 1979. Heatstroke rates were ten to 12 times higher for persons aged 65 years or older than for those younger than 65 years. The ratios of age-adjusted heatstroke rates were approximately 3:1 for nonwhite v white persons and about 6:1 for low v high socioeconomic status. Public health preventive measures in future heat waves should be directed toward the urban poor, the elderly, and persons of other-than-white races.

Jose S. 2009. Agroforestry for ecosystem services and environmental benefits: an overview. Agroforestry Systems 76(1): 1-10.

Agroforestry systems are believed to provide a number of ecosystem services; however, until recently evidence in the agroforestry literature supporting these perceived benefits has been lacking. This special issue brings together a series of papers from around the globe to address recent findings on the ecosystem services and environmental benefits provided by agroforestry. As prelude to the special issue, this paper examines four major ecosystem services and environmental benefits of agroforestry: (1) carbon sequestration, (2) biodiversity conservation, (3) soil enrichment and (4) air and water quality. Past and present evidence clearly indicates that agroforestry, as part of a multifunctional working landscape, can be a viable land-use option that, in addition to alleviating poverty, offers a number of ecosystem services and environmental benefits. This realization should help promote agroforestry and its role as an integral part of a multifunctional working landscape the world over.


Kahn Jr, PH, B Friedman, et al. 2008. A plasma display window?--The shifting baseline problem in a technologically mediated natural world. Journal of Environmental Psychology 28(2): 192-9.

Humans will continue to adapt to an increasingly technological world. But are there costs to such adaptations in terms of human well being? Toward broaching this question, we investigated physiological effects of experiencing a HDTV quality real-time view of nature through a plasma display "window." In an office setting, 90 participants (30 per group) were exposed either to (a) a glass window that afforded a view of a nature scene, (b) a plasma window that afforded a real-time HDTV view of essentially the same scene, or (c) a blank wall. Results showed that in terms of heart rate recovery from low-level stress the glass window was more restorative than a blank wall; in turn, a plasma window was no more restorative than a blank wall. Moreover, when participants spent more time looking at the glass window, their heart rate tended to decrease more rapidly; that was not the case with the plasma window. Discussion focuses on how the purported benefits of viewing nature may be attenuated by a digital medium.

Kaplan R. 1993. The role of nature in the context of the workplace. Landscape and Urban Planning 26(1-4): 193-201.

The well-being of the workforce is clearly a matter of concern to the employer. Such concern translates to considerable costs in the form of fringe benefit packages, health promotion programs, ergonomics, and other ways to reduce absence and enhance health and satisfaction. Despite such efforts, however, one way to address well-being that entails relatively low costs has been largely ignored in the work context. Proximity and availability of the natural environment can foster many desired outcomes, even if the employee does not spend a great amount of time in the natural setting. A theoretical framework is presented that helps explain why even the view from the window can have a positive impact with respect to well-being. Results from two studies offer some substantiation. Further research on the role of nature in the workplace is essential; however, decisions to provide health promoting programs and to enhance fringe benefit packages have not been offered as a direct consequence of empirical verification. While providing windows at work may not be a simple matter, other ways to increase contact with vegetation may provide a low-cost, high-gain approach to employee well-being and effectiveness.

Kaplan S. 1995. The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology 15(3): 169-182.

Directed attention plays an important role in human information processing; its fatigue, in turn, has far-reaching consequences. Attention Restoration Theory provides an analysis of the kinds of experiences that lead to recovery from such fatigue. Natural environments turn out to be particularly rich in the characteristics necessary for restorative experiences. An integrative framework is proposed that places both directed attention and stress in the larger context of human-environment relationships.

Karjalainen E, T Sarjala, et al. 2010. Promoting human health through forests: overview and major challenges. Environmental Health and Preventive Medicine 15(1): 1-8.

This review aims to contribute to the ongoing discussion about human health, global change, and biodiversity by concentrating on the relationships between forests and human health. This review gives a short overview of the most important health benefits that forests provide to humans, and the risks that forests may pose to human health. Furthermore, it discusses the future challenges for the research on the links between forests and human health, and for delivering health through forests in practice. Forests provide enormous possibilities to improve human health conditions. The results of a vast amount of research show that forest visits promote both physical and mental health by reducing stress. Forests represent rich natural pharmacies by virtue of being enormous sources of plant and microbial material with known or potential medicinal or nutritional value. Forest food offers a safety net for the most vulnerable population groups in developing countries, and healthy forest ecosystems may also help in regulation of infectious diseases. Utilizing forests effectively in health promotion could reduce public health care budgets and create new sources of income. Main challenges to delivering health through forests are due to ecosystem and biodiversity degradation, deforestation, and climate change. In addition, major implementation of research results into practice is still lacking. Inadequate implementation is partly caused by insufficient evidence base and partly due to the lack of policy-makers' and practitioners' awareness of the potential of forests for improving human health. This calls for strong cooperation among researchers, policy-makers, and practitioners as well as between different sectors, especially between health and environmental professionals.

Katsouyanni K, G Touloumi, et al. 1997. Short term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. BMJ 314(7095): 1658.

Objectives: To carry out a prospective combined quantitative analysis of the associations between all cause mortality and ambient particulate matter and sulphur dioxide.

Design: Analysis of time series data on daily number of deaths from all causes and concentrations of sulphur dioxide and particulate matter (measured as black smoke or particles smaller than 10 ?m in diameter (PM10)) and potential confounders.

Setting: 12 European cities in the APHEA project (Air Pollution and Health: a European Approach).

Main outcome measure: Relative risk of death.

Results: In western European cities it was found that an increase of 50 ?g/m3 in sulphur dioxide or black smoke was associated with a 3% (95% confidence interval 2% to 4%) increase in daily mortality and the corresponding figure for PM10 was 2% (1% to 3%). In central eastern European cities the increase in mortality associated with a 50 ?g/m3 change in sulphur dioxide was 0.8% (-0.1% to 2.4%) and in black smoke 0.6% (0.1% to 1.1%). Cumulative effects of prolonged (two to four days) exposure to air pollutants resulted in estimates comparable with the one day effects. The effects of both pollutants were stronger during the summer and were mutually independent.

Conclusions: The internal consistency of the results in western European cities with wide differences in climate and environmental conditions suggest that these associations may be causal. The long term health impact of these effects is uncertain, but today's relatively low levels of sulphur dioxide and particles still have detectable short term effects on health and further reductions in air pollution are advisable.

Kearney PM, M. Whelton, et al. 2005. Global burden of hypertension: analysis of worldwide data. The Lancet 365(9455): 217-23.

Background - Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. Methods - We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Results - Overall, 26�4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5�26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Interpretation - Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.

Kessler RC, S Galea, RT Jones, HA Parker. 2006. Mental illness and suicidality after Hurricane Katrina. Hurricane Katrina Community Advisory Group. Bulletin of the World Health Organization 84(12): 930-9.

Objective: To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey.

Methods: The National Comorbidity Survey-Replication, conducted between February 2001 and February 2003, interviewed 826 adults in the Census Divisions later affected by Hurricane Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the same area before the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of personal growth that resulted from the trauma (for example, increased closeness to a loved one, increased religiosity). Outcome measures used were the K6 screening scale of serious mental illness and mild-moderate mental illness and questions about suicidal ideation, plans and attempts.

Findings: Respondents to the post-Katrina survey had a significantly higher estimated prevalence of serious mental illness than respondents to the earlier survey (11.3% after Katrina versus 6.1% before; c�1= 10.9; P less than 0.001) and mild�moderate mental illness (19.9% after Katrina versus 9.7% before; c�1 = 22.5; P less than 0.001). Among respondents estimated to have mental illness, though, the prevalence of suicidal ideation and plans was significantly lower in the post-Katrina survey (suicidal ideation 0.7% after Katrina versus 8.4% before; c�1 = 13.1; P less than 0.001; plans for suicide 0.4% after Katrina versus 3.6% before; c�1 = 6.0; P = 0.014). This lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma (faith in one's own ability to rebuild one's life, and realization of inner strength), without which between-survey differences in suicidality were insignificant.

Conclusion: Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.

Kettles MK, SR Browning, et al. 1997. Triazine herbicide exposure and breast cancer incidence: An ecologic study of Kentucky counties. Environmental Health Perspectives 105(11): 1222-1227.

The incidence of breast cancer in the United States has steadily increased for the past three decades. Exposure to excess estrogen, in both natural and synthetic forms, has been implicated as a risk factor for the development of this disease. Considerable interest has been focused on organochlorines, such as the triazine herbicides, and their possible role in the initiation or promotion of human breast cancer. To explore this relationship, an ecologic study of Kentucky counties was designed. Exposure to triazines was estimated by use of water contamination data, corn crop production, and pesticide use data. A summary index of triazine herbicide exposure was developed to classify counties into low, medium, or high exposure levels. Data on county breast cancer rates were obtained from the state registry. A Poisson regression analysis was performed, controlling for age, race, age at first live birth, income, and level of education. Results revealed a statistically significant increase in breast cancer risk with medium and high levels of triazine exposure [odds ratio (OR) = 1.14, p < 0.0001 and OR = 1.2, p < 0.0001, respectively]. The results suggest a relationship between exposure to triazine herbicides and increased breast cancer risk, but conclusions concerning causality cannot be drawn, due to the limitations inherent in ecologic study design.

Khan S, I Ahmad, MT Shah, S Rehman & A Khaliq. 2009. Use of constructed wetland for the removal of heavy metals from industrial wastewater. Journal of Environmental Management, 90(11), 3451-3457.

Kidney and Urologic Diseases Information Clearinghouse - Chronic Kidney Disease. Accessed February 2013.

Kline JD, RS Rosenberger, EM White. 2011. A national assessment of physical activity in US National Forests. Journal of Forestry 109(6): 343-51.

In an era of declining timber harvests on federal lands, the US Forest Service has sought to better describe the public benefits associated with the nation's continued investment in managing the national forests. We considered how national forests contribute to public health by providing significant outdoor recreation opportunities. Physical inactivity has become a persistent national concern owing to its association with chronic diseases, obesity, and other public health concerns. We estimated the net energy expenditure (in calories) for a range of outdoor recreation activities engaged in by visitors to national forests. We conclude that national forest contributions to physical activity among the American public likely are significant and could be enhanced with continued and targeted investments in recreation infrastructure and public outreach.

Knobeloch L, M Ziarnik, et al. 1994. Gastrointestinal upsets associated with ingestion of copper-contaminated water. Environmental Health Perspectives 102(11): 958-61.

During 1992 and 1993 the Wisconsin Division of Health investigated five cases in which copper-contaminated drinking water was suspected of causing gastrointestinal upsets. Each of these case studies was conducted after our office was notified of high copper levels in drinking water or notified of unexplained illnesses. Our findings suggest that drinking water that contains copper at levels above the federal action limit of 1.3 mg/l may be a relatively common cause of diarrhea, abdominal cramps, and nausea. These symptoms occurred most frequently in infants and young children and among residents of newly constructed or renovated homes.

Korpela KM, M Ylen, et al. 2010. Favorite green, waterside and urban environments, restorative experiences and perceived health in Finland. Health Promotion International 25(2): 200-209.

The study investigated restorative experiences in relation to respondents' everyday favorite places and analysed the associations between the use of favorite places, restorative experiences, their determinants and aspects of self-rated health. A simple random sample of 1273 inhabitants, aged between 15 and 75 years, of two major cities in Finland (Helsinki and Tampere) completed a postal questionnaire. A subsample of the answers from inhabitants with a self-reported distance from home to a favorite place of 15 km or less (n = 1089) was analysed. Restorative experiences in favorite exercise and activity outdoor areas, waterside environments and extensively managed natural settings (mainly urban woodlands) were stronger than in favorite places in built urban settings or green spaces in urban settings (mostly parks). The results revealed a link between the need for restoration (worries and stress), the use of environmental self-regulation strategies (favorite places) and restorative outcomes. The more worries about money and work (during the last month) a person had, the more stressed a person had felt during the last year, the less energetic s/he had felt, the lower was the number of visits to the favorite place (during the last 6 months) and the lower the typical level of restorative experiences. Inconsistently, the direct path suggested that the more worries about money and work, the higher the typical level of restorative experiences. The findings increase knowledge of health-enhancing environments and have implications for stress and work recovery research.

Knowlton K, M Rotkin-Ellman, et al. 2009. The 2006 California heat wave: Impacts on hospitalizations and emergency department visits. Environmental Health Perspectives 117(1): 61 - 7.

Background: Climate models project that heat waves will increase in frequency and severity. Despite many studies of mortality from heat waves, few studies have examined morbidity.

Objectives: In this study we investigated whether any age or race/ethnicity groups experienced increased hospitalizations and emergency department (ED) visits overall or for selected illnesses during the 2006 California heat wave.

Methods: We aggregated county-level hospitalizations and ED visits for all causes and for 10 cause groups into six geographic regions of California. We calculated excess morbidity and rate ratios (RRs) during the heat wave (15 July to 1 August 2006) and compared these data with those of a reference period (8-14 July and 12-22 August 2006).

Results: During the heat wave, 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. ED visits for heat-related causes increased across the state [RR = 6.30; 95% confidence interval (CI), 5.67-7.01], especially in the Central Coast region, which includes San Francisco. Children (0-4 years of age) and the elderly (= 65 years of age) were at greatest risk. ED visits also showed significant increases for acute renal failure, cardiovascular diseases, diabetes, electrolyte imbalance, and nephritis. We observed significantly elevated RRs for hospitalizations for heat-related illnesses (RR = 10.15; 95% CI, 7.79-13.43), acute renal failure, electrolyte imbalance, and nephritis.

Conclusions: The 2006 California heat wave had a substantial effect on morbidity, including regions with relatively modest temperatures. This suggests that population acclimatization and adaptive capacity influenced risk. By better understanding these impacts and population vulnerabilities, local communities can improve heat wave preparedness to cope with a globally warming future.

Kubzansky LD, I Kawachi, D Sparrow. 1999. Socioeconomic status, hostility, and risk factor clustering in the normative aging study: Any help from the concept of allostatic load? Annals of Behavioral Medicine 21(4): 330-8.

Objective: To examine the relationships between socioeconomic status (SES), psychosocial vulnerability (hostility), and allostatic load. Allostatic load refers to the cumulative physiological cost of adaptation to stress.

Method: We examined the relationships, between SES (as measured by educational attainment), hostility, and allostatic load in the Normative Aging Study, a longitudinal study of community-dwelling men aged 21 to 80 years and free of known chronic medical conditions at entry in the 1960s. In 1986, the revised Minnesota Multiphasic Personality Inventory was administered by mail, from which a hostility measure was derived by summing the scores from three Cook-Medley subscales: Hostile Affect, Hostile Attribution, Aggressive Responding. An index of allostatic load was constructed from data collected during physical exams conducted between 1987 and 1990 (i.e. measures reflecting "wear and tear" on the cardiovascular, endocrine, and metabolic systems). Cross-sectional relationships between education, hostility, and allostatic load were examined in 818 men.

Results Separate linear regression analyses indicated that lower levels of educational attainment and greater hostility were both associated with higher allostatic load scores ( p <.05 and p <.01, respectively). Less education was also associated with higher hostility ( p <.001). When allostatic load was regressed simultaneously on education and hostility, the effect of education was attenuated, while hostility ( p <.05) maintained an independent affect.

Conclusions: Our findings suggest that lower levels of education and greater hostility are associated with greater "wear and tear" on the body. The effects of education on allostatic load may be mediated by hostility.

Kunst AE, CWN Looman, LP Mackenbach. 1993. Outdoor air temperature and mortality in the Netherlands: A time-series analysis. American Journal of Epidemiology 137(3): 331-41.

Death rates become progressively higher when outdoor air temperature rises above or falls below 20-25 C. This study addresses the question of whether this relation is largely attributable to the direct effects of exposure to heat and cold on the human body in general, and on the circulatory system in particular. The association between daily mortality and daily temperatures in the Nethetlands in the period 1979-1987 was examined by controlling for influenza incidence, air pollution, and season; distinguishing lag periods; examining effect modification by wind speed and relative humidity; and distinguishing causes of death. Important direct effects of exposure to cold and heat on mortality were suggested by the following findings: 1) control for influenza incidence reduced cold-related mortality by only 34% and reduced heat-related mortality by 23% (the role of air pollution and season was negligible); 2) 62% of the "unexplained" cold-related mortality, and all heat-related mortality, occurred within 1 week; and 3) effect modification by wind speed was in the expected direction. The finding that 57% of "unexplained" cold-related mortality and 26% of the "unexplained" heat-related mortality was attributable to cardiovascular diseases suggests that direct effects are only in part the result of increased stress on the circulatory system. For heat-related mortality, direct effects on the respiratory system are probably more important. For cold-related mortality, the analysis yielded evidence of an important indirect effect involving increased incidence of influenza and other respiratory infections.

Kuo FE and WC Sullivan. 2001. Aggression and Violence in the inner city - Effect of environment via mental Fatigue. Environment and Behavior 33(4): 543-71.

S. Kaplan suggested that one outcome of mental fatigue may be an increased propensity for outbursts of anger and even violence. If so, contact with nature, which appears to mitigate mental fatigue, may reduce aggression and violence. This study investigated that possibility in a setting and population with relatively high rates of aggression: inner-city urban public housing residents. Levels of aggression were compared for 145 urban public housing residents randomly assigned to buildings with varying levels of nearby nature (trees and grass). Attentional functioning was assessed as an index of mental fatigue. Residents living in relatively barren buildings reported more aggression and violence than did their counterparts in greener buildings. Moreover, levels of mental fatigue were higher in barren buildings, and aggression accompanied mental fatigue. Tests for the proposed mechanism and for alternative mechanisms indicated that the relationship between nearby nature and aggression was fully mediated through attentional functioning.

Kuo FE.and A FaberTaylor. 2004. A potential natural treatment for ADD/ADHD: evidence from a national study. American Journal of Public Health 94(9) 1580 -6.

Objectives. We examined the impact of relatively "green" or natural settings on attention-deficit/hyperactivity disorder (ADHD) symptoms across diverse subpopulations of children.

Methods. Parents nationwide rated the aftereffects of 49 common after-school and weekend activities on children's symptoms. Aftereffects were compared for activities conducted in green outdoor settings versus those conducted in both built outdoor and indoor settings.

Results. In this national, nonprobability sample, green outdoor activities reduced symptoms significantly more than did activities conducted in other settings,even when activities were matched across settings. Findings were consistent across age, gender, and income groups; community types; geographic regions; and diagnoses.

Conclusions. Green outdoor settings appear to reduce ADHD symptoms in children across a wide range of individual, residential, and case characteristics.

Kuo FE, WC Sullivan, et al. 1998. Fertile ground for community: Inner-city neighborhood common spaces. American Journal of Community Psychology 26(6): 823-51.Kuo, F. S., Williams (1998). "Fertile Ground for Community: Inner-City Neighborhood Common Spaces." American Journal of Community Psychology 26(6): 823-851.

Research suggests that the formation of neighborhood social ties (NSTs) may substantially depend on the informal social contact which occurs in neighborhood common spaces, and that in inner-city neighborhoods where common spaces are often barren no-man's lands, the presence of trees and grass supports common space use and informal social contact among neighbors. We found that for 145 urban public housing residents randomly assigned to 18 architecturally identical buildings, levels of vegetation in common spaces predict both use of common spaces and NSTs; further, use of common spaces mediated the relationship between vegetation and NSTS. In addition, vegetation and NSTs were significantly related to residents' senses of safety and adjustment. These findings suggest that the use and characteristics of common spaces may play a vital role in the natural growth of community, and that improving common spaces may be an especially productive focus for community organizing efforts in inner-city neighborhoods.

Kweon B-S, WC Sullivan, AR Wiley. 1998. Green common spaces and the social integration of inner-city older adults. Environment and Behavior 30(6): 832-58.

For older adults, social integration and the strength of social ties are profoundly important predictors of well-being and longevity. Can the physical environment be designed to promote older adults' social integration with their neighbors? We examined this possibility by testing the relationships between varying amount of exposure to green outdoor common spaces and the strength of ties among neighbors. Results of interviews with 91 older adults (between the ages of 64 and 91 years) from one inner-city neighborhood show that the use of green outdoor common spaces predicted both the strength of neighborhood social ties and sense of community. Although the strength of these relationships were modest, the findings suggest that the characteristics of outdoor common spaces can play a role in the formation and maintenance of social ties among older adult residents of inner-city neighborhoods. The results have implications for designers, managers, and residents of housing developments.


Lachowycz K, AP Jones, et al. 2010. What can global positioning systems tell us about the contribution of different types of urban greenspace to children's physical activity? Health & Place , Volume 18, Issue 3, May 2012, Pages 586-594.

Urban greenspace is hypothesised to be an important location for physical activity in children, but their actual use of the resource to be active is not well known. In this study, global positioning systems (GPS) and accelerometers were used to measure activity within green environments for 902 English children aged 11-12. We summarised activity intensities in different types of greenspace on weekday evenings, weekend days and by season. Around half of outdoor moderate-vigorous activity took place in greenspace at the weekend and use was consistent across seasons. The findings suggest the importance of certain types of greenspace to children's physical activity.

Lafortezza R, G Carrus, et al. 2009. Benefits and well-being perceived by people visiting green spaces in periods of heat stress. Urban Forestry & Urban Greening 8(2): 97-108.

In urban environments, green spaces have proven to act as ameliorating factors of some climatic features related to heat stress, reducing their effects and providing comfortable outdoor settings for people. In addition, green spaces have demonstrated greater capacity, compared with built-up areas, for promoting human health and well-being. In this paper, we present results of a study conducted in Italy and the UK with the general goal to contribute to the theoretical and empirical rationale for linking green spaces with well-being in urban environments. Specifically, the study focused on the physical and psychological benefits and the general well-being associated with the use of green spaces on people when heat stress episodes are more likely to occur. A questionnaire was set up and administered to users of selected green spaces in Italy and the UK (n=800). Results indicate that longer and frequent visits of green spaces generate significant improvements of the perceived benefits and well-being among users. These results are consistent with the idea that the use of green spaces could alleviate the perception of thermal discomfort during periods of heat stress.

Laino, Charlene. 2008. More Strokes in the U.S. than in Europe. WebMD Health News. February 22, 2008.

Lautenschlager NT, KL Cox, et al. 2008. Effect of physical activity on cognitive function in older adults at risk for Alzheimer Disease. The Journal of the American Medical Association 300(9): 1027-37.

Context: Many observational studies have shown that physical activity reduces the risk of cognitive decline; however, evidence from randomized trials is lacking.

Objective: To determine whether physical activity reduces the rate of cognitive decline among older adults at risk

Design and Setting: Randomized controlled trial of a 24-week physical activity intervention conducted between 2004 and 2007 in metropolitan Perth, Western Australia. Assessors of cognitive function were blinded to group membership.

Participants: We recruited volunteers who reported memory problems but did not meet criteria for dementia. Three hundred eleven individuals aged 50 years or older were screened for eligibility, 89 were not eligible, and 52 refused to participate. A total of 170 participants were randomized and 138 participants completed the 18-month assessment.Intervention Participants were randomly allocated to an education and usual care group or to a 24-week home-based program of physical activity

Main Outcome: Measure Change in Alzheimer Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores (possible range, 0-70) over 18 months.

Results: In an intent-to-treat analysis, participants in the intervention group improved 0.26 points (95% confidence interval,-0.89 to 0.54) and those in the usual care group deteriorated 1.04 points (95% confidence interval, 0.32 to 1.82) on the ADAS-Cog at the end of the intervention. The absolute difference of the outcome measure between the intervention and control groups was -1.3 points (95% confidence interval,-2.38 to -0.22) at the end of the intervention. At 18 months, participants in the intervention group improved 0.73 points (95% confidence interval, -1.27 to 0.03) on the ADAS-Cog, and those in the usual care group improved 0.04 points (95% confidence interval, -0.46 to 0.88). Word list delayed recall and Clinical Dementia Rating sum of boxes improved modestly as well, whereas word list total immediate recall, digit symbol coding, verbal fluency, Beck depression score, and Medical Outcomes 36-Item Short-Form physical and mental component summaries did not change significantly.

Conclusions: In this study of adults with subjective memory impairment, a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period.

Law BM. 2011. Top 10 Causes of Low Birth Weight Babies. Discovery fit and health.

Lee A C K and R Maheswaran .2011. The health benefits of urban green spaces: a review of the evidence. Journal of Public Health 33(2): 212-222

Background: Urban development projects can be costly and have health impacts. An evidence-based approach to urban planning is therefore essential. However, the evidence for physical and non-physical health benefits of urban green space is unclear.

Methods: A literature search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly. Their findings were then thematically categorized.

Results: There is weak evidence for the links between physical, mental health and well-being, and urban green space. Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important. However, many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations.

Conclusion: Most studies reported findings that generally supported the view that green space have a beneficial health effect. Establishing a causal relationship is difficult, as the relationship is complex. Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.

Lee J, BJ Park, et al. 2011. Effect of forest bathing on physiological and psychological responses in young Japanese male subjects. Public Health 125(2): 93-100.

Summary/Objective :To provide scientific evidence supporting the efficacy of forest bathing as a natural therapy by investigating its physiological benefits using biological indicators in outdoor settings.

Study design: Within-group comparisons were used to examine psychological and physiological responses to exposure to real forest and urban environments.

Methods: Young Japanese male adults participated in a 3-day, 2-night field experiment. Physiological responses as well as self-reported psychological responses to forest and urban environmental stimuli were measured in real settings. The results of each indicator were compared against each environmental stimulus.

Results: Heart rate variability analysis indicated that the forest environment significantly increased parasympathetic nervous activity and significantly suppressed sympathetic activity of participants compared with the urban environment. Salivary cortisol level and pulse rate decreased markedly in the forest setting compared with the urban setting. In psychological tests, forest bathing significantly increased scores of positive feelings and significantly decreased scores of negative feelings after stimuli compared with the urban stimuli.

Conclusion: Physiological data from this field experiment provide important scientific evidence on the health benefits of forest bathing. The results support the concept that forest bathing has positive effects on physical and mental health, indicating that it can be effective for health promotion. Despite the small sample size in this study, a very clear tendency towards positive physiological and psychological outcomes in forests was observed.

Lee KH, TM Isenhart & RC Schultz. 2003. Sediment and nutrient removal in an established multi-species riparian buffer. Journal of Soil and Water Conservation, 58(1), 1-8.

Riparian buffers are widely recommended as a tool for removing nonpoint source pollutants from agricultural areas especially those carried by surface runoff. A field plot study was conducted to determine the effectiveness of an established multi-species buffer in trapping sediment, nitrogen, and phosphorus from cropland runoff during natural rainfall events. Triplicate plots were installed in a previously established buffer with a 4.1 by 22.1 m (14 x 73 ft.) cropland source area paired with either no buffer, a 7.1 m (23 ft) switchgrass (Panicum virgatum L. cv. Cave-n-Rock) buffer, or a 16.3 m (53.5 ft) switchgrass/woody buffer (7.1 m swithgrass/9.2 m woody) located at the lower end of each plot. The switchgrass buffer removed 95% of the sediment, 80% of the total-nitrogen (N), 62% of the nitrate-nitrogen (NO3-N), 78% of the total-phosphorus (P), and 58% of the phosphate-phosphorus (PO4-P). The switchgrass/woody buffer removed 97% of the sediment, 94% of the total-N, 85% of the NO3-N, 91% of the total-P, and 80% of the PO4-P in the runoff. There was a significant negative correlation between the trapping effectiveness of the buffers and the intensity and total rainfall of individual storms. While the 7 m (23 ft) switchgrass buffer was effective in removing sediment and sediment-bound nutrients, the added width of the 16.3 m (53.5 ft) switchgrass/woody buffer increased the removal efficiency of soluble nutrients by over 20%. Similar or even greater reductions might have been found if the 16.3 m (53.5 ft) buffer had been planted completely to native warm-season grasses. In this buffer, combinations of the dense, stiff, native warm-season grass and woody vegetation improved the removal effectiveness for the nonpoint source pollutants from agricultural areas.

Li Q. 2010. Effect of forest bathing trips on human immune function. Environmental Health and Preventive Medicine 15(1): 9-17.

In Japan, a forest bathing trip, called "Shinrinyoku" in Japanese, is a short, leisurely visit to a forest; it is regarded as being similar to natural aromatherapy. This review focuses on the effects of forest bathing trips on human immune function. Beginning in 2005, adult Japanese individuals, both male and female, participated in a series of studies aimed at investigating the effect of forest bathing trips on human immune function. The subjects experienced a 3-day/2-night trip to forest areas, and blood and urine were sampled on days 2 (the first sampling during each trip) and 3 (the second sampling during each trip), and on days 7 and 30 after the trips. Natural killer (NK) activity, the numbers of NK, granulysin-, perforin-, and granzymes A/B-expressing lymphocytes in the blood, and the concentration of urinary adrenaline were measured. The same measurements were made before the trips on a normal working day as a control. The mean values of NK activity and the numbers of NK, granulysin-, perforin-, and granzymes A/B-expressing cells on forest bathing days were significantly higher than those on the control days, whereas the mean values of the concentration of urinary adrenaline on forest bathing days were significantly lower than that on the control days in both male and female subjects. The increased NK activity lasted for more than 30 days after the trip, suggesting that a forest bathing trip once a month would enable individuals to maintain a higher level of NK activity. In contrast, a visit to the city as a tourist did not increase NK activity, the numbers of NK cells, or the level of intracellular granulysin, perforin, and granzymes A/B. These findings indicate that forest bathing trips resulted in an increase in NK activity, which was mediated by increases in the number of NK cells and the levels of intracellular granulysin, perforin, and granzymes A/B.

Lilienfeld SO and H Arkowitz. 2010. Are Men the More Belligerent Sex? Scientific American; April 5, 2010.

Linos A, A Petralias, et al. 2011. Oral ingestion of hexavalent chromium through drinking water and cancer mortality in an industrial area of Greece - An ecological study. Environmental Health 10(1): 50.

BACKGROUND: Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem, making this a question of significant public health importance.

METHODS: We conducted an ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population.

RESULTS: A total of 474 deaths were observed. The SMR for all cause mortality was 98 (95% CI 89-107) and for all cancer mortality 114 (95% CI 94-136). The SMR for primary liver cancer was 1104 (95% CI 405-2403, p-value<0.001). Furthermore, statistically significantly higher SMRs were identified for lung cancer (SMR=145, 95% CI 100-203, p-value=0.047) and cancer of the kidney and other genitourinary organs among women (SMR=368, 95% CI 119-858, p-value=0.025). Elevated SMRs for several other cancers were also noted (lip, oral cavity and pharynx 344, stomach 121, female breast 134, prostate 128, and leukaemias 168), but these did not reach statistical significance.

CONCLUSIONS: Elevated cancer mortality in the Oinofita area of Greece supports the hypothesis of hexavalent chromium carcinogenicity via the oral ingestion pathway of exposure. Further studies are needed to determine whether this association is causal, and to establish preventive guidelines and public health recommendations.

Lipton RB, WF Stewart, et al. 2001. Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache: The Journal of Head and Face Pain 41(7): 646-57.

Objective.-To describe the prevalence, sociodemographic profile, and the burden of migraine in the United States in 1999 and to compare results with the original American Migraine Study, a 1989 population-based study employing identical methods.

Methods.-A validated, self-administered questionnaire was mailed to a sample of 20 000 households in the United States. Each household member with severe headache was asked to respond to questions about symptoms, frequency, and severity of headaches and about headache-related disability. Diagnostic criteria for migraine were based on those of the International Headache Society. This report is restricted to individuals 12 years and older.

Results.-Of the 43 527 age-eligible individuals, 29 727 responded to the questionnaire for a 68.3% response rate. The prevalence of migraine was 18.2% among females and 6.5% among males. Approximately 23% of households contained at least one member suffering from migraine. Migraine prevalence was higher in whites than in blacks and was inversely related to household income. Prevalence increased from aged 12 years to about aged 40 years and declined thereafter in both sexes. Fifty-three percent of respondents reported that their severe headaches caused substantial impairment in activities or required bed rest. Approximately 31% missed at least 1 day of work or school in the previous 3 months because of migraine; 51% reported that work or school productivity was reduced by at least 50%.

Conclusions.-Two methodologically identical national surveys in the United States conducted 10 years apart show that the prevalence and distribution of migraine have remained stable over the last decade. Migraine-associated disability remains substantial and pervasive. The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999 commensurate with the growth of the population. Migraine is an important target for public health interventions because it is highly prevalent and disabling.

Lottrup L, P Grahn, et al. 2012. Workplace greenery and perceived level of stress: Benefits of access to a green outdoor environment at the workplace. Landscape and Urban Planning (0). In press.

Dealing with stress and stress-related diseases is an increasing problem in both developed and developing countries and has an enormous cost for individuals, companies, and societies. A positive relationship between access to a green outdoor environment at work, and decreased stress has been found in previous studies, and this relationship is in line with a vast body of research in other contexts. The aim of this study is to investigate whether access to a green outdoor environment at work is related to employees' perceived level of stress and attitude toward the workplace. The study is based on data from a questionnaire answered by 439 randomly selected individuals in Sweden. The questionnaire addressed the respondents' level of stress and workplace attitude, and the characteristics and accessibility of the outdoor environment at the respondents' workplace. The results showed significant relationships between physical and visual access to workplace greenery, and a positive workplace attitude and decreased level of stress for male respondents. For female respondents, a significant relationship between physical and visual access to workplace greenery and a positive workplace attitude was found, but not between access to workplace greenery and level of stress. Furthermore, a positive workplace attitude was related to decreased levels of stress for female respondents, but not for male respondents. These findings support existing research which suggests that the workplace outdoor environment is an asset for employees' wellbeing and level of stress, and they indicate that gender plays a central role in realizing the benefits of such environments.

Louv R. 2005. Last child in the woods: Saving our children from nature-deficit disorder. Chapel Hill, NC: Algonquin Books.

No abstract provided

Lovasi G S, M D M Bader, et al. 2012. Body Mass Index, Safety Hazards, and Neighborhood Attractiveness. American Journal of Preventive Medicine 43(4): 378-384.

Background: Neighborhood attractiveness and safety may encourage physical activity and help individuals maintain a healthy weight. However, these neighborhood characteristics may not be equally relevant to health across all settings and population subgroups.

Purpose: To evaluate whether potentially attractive neighborhood features are associated with lower BMI, whether safety hazards are associated with higher BMI, and whether environment�environment interactions are present such that associations for a particular characteristic are stronger in an otherwise supportive environment.

Methods: Survey data and measured height and weight were collected from a convenience sample of 13,102 adult New York City (NYC) residents in 2000�2002; data analyses were completed 2008�2012. Built-environment measures based on municipal GIS data sources were constructed within 1-km network buffers to assess walkable urban form (density, land-use mix, transit access); attractiveness (sidewalk cafs, landmark buildings, street trees, street cleanliness); and safety (homicide rate, pedestrianauto collision and fatality rate). Generalized linear models with cluster-robust SEs controlled for individual and area-based sociodemographic characteristics.

Results: The presence of sidewalk cafes, density of landmark buildings, and density of street trees were associated with lower BMI, whereas the proportion of streets rated as clean was associated with higher BMI. Interactions were observed for sidewalk caf�s with neighborhood poverty, for street-tree density with walkability, and for street cleanliness with safety. Safety hazard indicators were not independently associated with BMI.

Conclusions: Potentially attractive community and natural features were associated with lower BMI among adults in NYC, and there was some evidence of effect modification.

Lovasi GS, JW Quinn, et al. 2008. Children living in areas with more street trees have lower asthma prevalence. Journal of Epidemiology and Community Health 62:647-9.

Introduction: Childhood asthma prevalence in the US increased by 50% from 1980 to 2000, with especially high prevalence in poor urban communities. Methods: Asthma prevalence among children ages 4-5 years old and asthma hospitalizations among children less than 15 years old were available for 42 health service catchment areas within New York City. Street tree counts were provided by the New York City Department of Parks and Recreation. We also measured proximity to pollution sources, socio-demographic characteristics, and population density for each area. Results: Controlling for potential confounders, an increase in tree density of one standard deviation (SD: 343 trees/km2) was associated with a lower asthma prevalence (relative risk [RR]: 0.71 per SD of tree density; 95% CI [confidence interval]: 0.64-0.79), but not asthma hospitalizations (RR: 0.89 per SD of tree density; 95% CI: 0.75-1.06). Conclusions: Street trees were associated with a lower prevalence of early childhood asthma. Our study does not permit inference that trees are causally related to asthma at the individual-level. The PlaNYC sustainability initiative, which includes a commitment to plant one million trees by the year 2017, offers an opportunity for a large prospective evaluation.

Luber G. and M McGeehin. 2008. Climate change and extreme heat events. American Journal of Preventive Medicine 35(5): 429-35

The association between climate change and the frequency and intensity of extreme heat events is now well established. General circulation models of climate change predict that heatwaves will become more frequent and intense, especially in the higher latitudes, affecting large metropolitan areas that are not well adapted to them. Exposure to extreme heat is already a significant public health problem and the primary cause of weather-related mortality in the U.S. This article reviews major epidemiologic risk factors associated with mortality from extreme heat exposure and discusses future drivers of heat-related mortality, including a warming climate, the urban heat island effect, and an aging population. In addition, it considers critical areas of an effective public health response including heat response plans, the use of remote sensing and GIS methodologies, and the importance of effective communications strategies.

Lucas, Richard E. "Happiness." Encyclopedia of Social Psychology. 2007. SAGE Publications. 10 Nov. 2011.

Happiness. Accessed February 2013.


Maas J, S M E van Dillen, et al. 2009. Social contacts as a possible mechanism behind the relation between green space and health. Health & Place 15(2):586-95.

This study explored whether social contacts are an underlying mechanism behind the relationship between green space and health. We measured social contacts and health in 10,089 residents of the Netherlands and calculated the percentage of green within 1 and a 3km radius around the postal code coordinates for each individual's address. After adjustment for socio-economic and demographic characteristics, less green space in people's living environment coincided with feelings of loneliness and with perceived shortage of social support. Loneliness and perceived shortage of social support partly mediated the relation between green space and health.

Maas J, RA Verheij, et al. 2009. Morbidity is related to a green living environment. J Epidemiol Community Health 63: 967-973.

Background: As a result of increasing urbanisation, people face the prospect of living in environments with few green spaces. There is increasing evidence for a positive relation between green space in people's living environment and self-reported indicators of physical and mental health. This study investigates whether physicianassessed morbidity is also related to green space in people's living environment.

Methods: Morbidity data were derived from electronic medical records of 195 general practitioners in 96 Dutch practices, serving a population of 345 143 people. Morbidity was classified by the general practitioners according to the International Classification of PrimaryCare. The percentage of green space within a 1 km and 3 km radius around the postal code coordinates was derived from an existing database and was calculated for each household. Multilevel logistic regression analyses were performed, controlling for demographic and socioeconomic characteristics.

Results: The annual prevalence rate of 15 of the 24 disease clusters was lower in living environments with more green space in a 1 km radius. The relation was strongest for anxiety disorder and depression. The relation was stronger for children and people with a lower socioeconomic status. Furthermore, the relation was strongest in slightly urban areas and not apparent in very strongly urban areas.

Conclusion: This study indicates that the previously established relation between green space and a number of self-reported general indicators of physical and mental health can also be found for clusters of specific physician-assessed morbidity. The study stresses the importance of green space close to home for children and lower socioeconomic groups.

Maas J, RA Verheij, et al. 2008. Physical activity as a possible mechanism behind the relationship between green space and health: A multilevel analysis. BMC Public Health 8(1): 206.

Background: The aim of this study was to investigate whether physical activity (in general, and more specifically, walking and cycling during leisure time and for commuting purposes, sports and gardening) is an underlying mechanism in the relationship between the amount of green space in people's direct living environment and self-perceived health. To study this, we first investigated whether the amount of green space in the living environment is related to the level of physical activity. When an association between green space and physical activity was found, we analysed whether this could explain the relationship between green space and health.

Methods: The study includes 4.899 Dutch people who were interviewed about physical activity, self-perceived health and demographic and socioeconomic background. The amount of green space within a one-kilometre and a three-kilometre radius around the postal code coordinates was calculated for each individual. Multivariate multilevel analyses and multilevel logistic regression analyses were performed at two levels and with controls for socio-demographic characteristics and urbanicity.

Results: No relationship was found between the amount of green space in the living environment and whether or not people meet the Dutch public health recommendations for physical activity, sports and walking for commuting purposes. People with more green space in their living environment walked and cycled less often and fewer minutes during leisure time; people with more green space garden more often and spend more time on gardening. Furthermore, if people cycle for commuting purposes they spend more time on this if they live in a greener living environment. Whether or not people garden, the time spent on gardening and time spent on cycling for commuting purposes did not explain the relationship between green space and health.

Conclusion: Our study indicates that the amount of green space in the living environment is scarcely related to the level of physical activity. Furthermore, the amount of physical activity undertaken in greener living environments does not explain the relationship between green space and health.

Maas J, RA Verheij, et al. 2006. Green space, urbanity, and health: how strong is the relation? Journal of Epidemiology and Community Health 60 (7): 587-92.

Study objectives: 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.Design: 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.Methods: Multilevel logistic regression analyses were performed at three levels-that is, individual level, family level, and practice level-controlled for sociodemographic characteristics.Main results: 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.Conclusions: 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.

Mackay G J and J T Neill. 2010. The effect of "green exercise" on state anxiety and the role of exercise duration, intensity, and greenness: A quasi-experimental study. Psychology of Sport and Exercise 11(3): 238-245.

Objective The study aimed to explore the short-term effects of "green exercise" on state anxiety and to examine the influence of exercise type, intensity, duration, and degree of greenness. Method A quasi-experimental design involved eight pre-existing outdoor exercise groups (N=頠101) who completed pre- and post-exercise questionnaires. Results Results indicated a significant reduction in participants' state anxiety following green exercise experiences (d�=�-0.47). However, there was a significant interaction between anxiety changes and the type of green exercise, with effect sizes for the groups ranging between 0.14 and 1.02. The largest anxiety reductions were reported by the Road Cycling, Boxercise, and Mountain Biking groups. Exercise intensity and duration did not impact on state-anxiety changes, however higher degrees of perceived environmental greenness were associated with larger reductions in anxiety. Conclusions Green exercise effected moderate short-term reductions in anxiety, with greater reductions evident for some exercise groups and for participants who perceived themselves to be exercising in more�natural environments. These findings support claims for mental health benefits of green exercise but they also highlight the need to better understand individual and group differences and the role of perceived environmental "greenness".

Madlock, Annette D. "Self-Esteem." Encyclopedia of Identity. 2010. SAGE Publications. 8 Dec. 2011.

No abstract provided

Mahar MT, SK Murphy, et al. 2006. Effects of a classroom-based program on physical activity and on-task behavior. Medicine & Science in Sports & Exercise 38(12): 2086-94.

Purpose: This study evaluated the effects of a classroom-based physical activity program on children's in-school physical activity levels and on-task behavior during academic instruction. Methods: Physical activity of 243 students was assessed during school hours. Intervention-group students (N = 135) received a classroom-based program (i.e., Energizers). The control group (N = 108) did not receive Energizers. On-task behavior during academic instruction time was observed for 62 third-grade (N = 37) and fourth-grade students (N = 25) before and after Energizers activities. An independent groups t-test compared in-school physical activity levels between intervention and control classes. A multiple-baseline across-classrooms design was used to evaluate the effectiveness of the Energizers on on-task behavior. Additionally, a two-way (time [pre- vs postobservation] x period [baseline vs intervention]) repeated-measures analysis of variance compared on-task behavior between observation periods. Magnitudes of mean differences were evaluated with Cohen's delta (ES). Results: Students in the intervention group took significantly (P < 0.05) more in-school steps (5587 +/- 1633) than control-group students (4805 +/- 1543), and the size of this difference was moderate (ES = 0.49). The intervention was effective in improving on-task behavior; after the Energizers were systematically implemented, on-task behavior systematically improved. The improvement in on-task behavior of 8% between the pre-Energizers and post-Energizers observations was statistically significant (P < 0.017), and the difference was moderate (ES = 0.60). Likewise, the least on-task students improved on-task behavior by 20% after Energizers activities. This improvement was statistically significant (P < 0.001) and meaningful (ES = 2.20). Conclusion: A classroom-based physical activity program was effective for increasing daily in-school physical activity and improving on-task behavior during academic instruction.

Maillard E, S Payraudeau, E Faivre, C Gregoire, SGangloff & G Imfeld. 2011. Removal of pesticide mixtures in a stormwater wetland collecting runoff from a vineyard catchment. Science of The Total Environment, May 1; 409(11):2317-24.

Wetlands can collect contaminated runoff from agricultural catchments and retain dissolved and particleladen pesticides. However, knowledge about the capacity and functioning of wetland systems with respect to the removal of pesticides is very limited. Here we show that stormwater wetlands can efficiently remove pesticides in runoff from vineyard catchments during the period of pesticide application, although flow and hydrochemical conditions of the wetland largely vary over time. During the entire agricultural season, the inflowing load of nine fungicides, six herbicides, one insecticide and four degradation products was 8.039 g whereas the outflowing load was 2.181 g. Removal rates of dissolved loads by the wetland ranged from 39% (simazine) to 100% (cymoxanil, gluphosinate, kresoxim methyl and terbuthylazine). Dimethomorph, diuron, glyphosate, metalaxyl and tetraconazole were more efficiently removed in spring than in summer. More than 88% of the input mass of suspended solids was retained, underscoring the capability of the wetland to trap pesticide-laden particles via sedimentation. Only the insecticide flufenoxuron was frequently detected in the wetland sediments. Our results demonstrate that stormwater wetlands can efficiently remove pesticide mixtures in agricultural runoff during critical periods of pesticide application, although fluctuations in the runoff regime and hydrochemical characteristics can affect the removal rates of individual pesticides.

Maine MA, NL Sune, & SC Lagger. 2004. Chromium bioaccumulation: comparison of the capacity of two floating aquatic macrophytes. Water Research, 38(6), 1494-1501.

The capacity of Salvinia herzogii and Pistia stratiotes to remove Cr (III) from water and their behaviour at different Cr (III) concentrations were studied in outdoor experiments. Cr distribution in aerial parts and roots with time and the possible mechanisms of Cr uptake were analyzed. Both macrophytes efficiently removed Cr from water at concentrations of 1, 2, 4 and 6�mg Cr�L-1. S. herzogii was the best adapted species. At a greater initial concentration, greater bioaccumulation rates were observed. Root Cr uptake was a rapid process that was completed within the first 24�h. Cr uptake through direct contact between the leaves and the solution is the main cause of the increase of Cr in the aerial parts, Cr being poorly translocated from the roots to the aerial parts. Both mechanisms were fast processes. The Cr uptake mechanism involves two components: a fast component and a slow one. The former occurs mainly due to the roots and leaves adsorption and is similar for both species. The slow component is different for each species probably because in P. stratiotes a Cr precipitation occurs induced by the roots.

Manes F, G Incerti, et al. 2012. Urban ecosystem services: tree diversity and stability of tropospheric ozone removal. Ecological Applications 22(1): 349-360.

Urban forests provide important ecosystem services, such as urban air quality improvement by removing pollutants. While robust evidence exists that plant physiology, abundance, and distribution within cities are basic parameters affecting the magnitude and ef?ciency of air pollution removal, little is known about effects of plant diversity on the stability of this ecosystem service. Here, by means of a spatial analysis integrating system dynamic modeling and geostatistics, we assessed the effects of tree diversity on the removal of tropospheric ozone (O3) in Rome, Italy, in two years (2003 and 2004) that were very different for climatic conditions and ozone levels. Different tree functional groups showed complementary uptake patterns, related to tree physiology and phenology, maintaining a stable community function across different climatic conditions. Our results, although depending on the city-speci?c conditions of the studied area, suggest a higher function stability at increasing diversity levels in urban ecosystems. In Rome, such ecosystem services, based on published unitary costs of externalities and of mortality associated with O3, can be prudently valued to roughly US$2 and $3 million/year, respectively.

Matsuoka R H. 2010. Student performance and high school landscapes: Examining the links. Landscape and Urban Planning 97(4): 273-282.

High school students today are experiencing unprecedented levels of school-related stress. At the same time, a growing body of research has linked views of nature with restoration from mental fatigue and stress reduction. How important are such views for students while they are at school? This study investigated 101 public high schools in southeastern Michigan to examine the role played by the availability of nearby nature in student academic achievement and behavior. The analyses revealed consistent and systematically positive relationships between nature exposure and student performance. Specifically, views with greater quantities of trees and shrubs from cafeteria as well as classroom windows are positively associated with standardized test scores, graduation rates, percentages of students planning to attend a four-year college, and fewer occurrences of criminal behavior. In addition, large expanses of landscape lacking natural features are negatively related to these same test scores and college plans. These featureless landscapes included large areas of campus lawns, athletic fields, and parking lots. All analyses accounted for student socio-economic status and racial/ethnic makeup, building age, and size of school enrollment.

Mayo Clinic - Heat Stroke. Accessed February 2013.

McElroy JA, A Trentham-Dietz, et al. 2008. Nitrogen-nitrate exposure from drinking water and colorectal cancer risk for rural women in Wisconsin, USA. Journal of Water and Health 6(3): 399-409.

One unintentional result of widespread adoption of nitrogen application to croplands over the past 50 years has been nitrate contamination of drinking water with few studies evaluating the risk of colorectal cancer. in our population-based case-control study of 475 women age 20-74 years with colorectal cancer and 1447 community controls living in rural Wisconsin, drinking water nitrate exposure were interpolated to subjects residences based on measurements which had been taken as part of a separate water quality survey in 1994. Individual level risk factor data was gathered in 1990--1992 and 1999-2001. Logistic regression models estimated the risk of colorectal cancer for the study period, separately and pooled. In the pooled analyses, an overall colorectal cancer risk was not observed for exposure to nitrate-nitrogen in the highest category (>= 10 ppm) compared to the lowest category (<0.5 ppm). However, a 2.9 fold increase risk was observed for proximal colon cancer cases in the highest compared to the lowest category. Statistically significant increased distal colon or rectal cancer risk was not observed. These results suggest that if an association exists with nitrate-nitrogen exposure from residential drinking water consumption, it may be limited to proximal colon cancer.

McPherson E, J Simpson, et al. 1999. Benefit cost analysis of Modesto's municipal urban forest. Journal of Arboriculture 25(5): 235-248.

Abstract. This study answers the question: Do the accrued benefits from Modesto's urban forest justify an annual municipal budget that exceeds $2 million? Results indicate that the benefits residents obtain from Modesto's 91,179 public trees exceeded management costs by a factor of nearly 2.In fiscal year 1997-1998, Modesto spent $2.6 million for urban forestry ($14.36/resident, $28.77/tree), and 74% of this amount was for mature tree care. Total annual benefits from Modesto's urban forest were $4.95 million ($27.12/ resident, $54.33/tree). Net benefits for FY 1997-1998 were $2,329,900 ($12.76/resident, $25.55/tree). Annual air-pollutant uptake was 154 metric tonnes (3.7 lb/tree), with an implied value of $1.48 million ($16/ tree). Aesthetics and other benefits had an estimated value of $1.5 million ($17/tree). Building shade and cooler summer temperatures attributed to street and park trees saved 110,133 MBtu, valued at $870,000 (122 kWh/tree, $10/ tree). Smaller benefits resulted from reductions in stormwater runoff (292,000 m3 or 845 gal/tree, $616,000 or $7/tree) and atmospheric carbon dioxide (13,900 t or 336 lb/tree, $460,000 or $5/tree). Due to the population's relatively even-aged structure and heavy reliance on mature Modesto ash for benefits, management strategies are needed that may reduce net benefits but increase diversity and stability.

McPherson G, JR Simpson, et al. 2005. Municipal forest benefits and costs in five US cities. Journal of Forestry 103: 411-6.

Increasingly, city trees are viewed as a best management practice to control stormwater, an urban-heat-island mitigation measure for cleaner air, a CO2-reduction option to offset emissions, and an alternative to costly new electric power plants. Measuring benefits that accrue from the community forest is the first step to altering forest structure in ways that will enhance future benefits. This article describes the structure, function, and value of street and park tree populations in Fort Collins, Colorado; Cheyenne, Wyoming; Bismarck, North Dakota; Berkeley, California; and Glendale, Arizona. Although these cities spent $13-65 annually per tree, benefits ranged from $31 to $89 per tree. For every dollar invested in management, benefits returned annually ranged from $1.37 to $3.09. Strategies each city can take to increase net benefits are presented.

Mechler R, M Amann, W Schopp. 2002. A methodology to estimate changes in statistical life expectancy due to the control of particulate matter air pollution. International Institute for Applied Systems Analysis.

Studies in the United States have shown that those living in less polluted cities live longer than those living in more polluted cities. After adjustments for other factors, an association remained between ambient concentrations of fine particles and shorter life expectancy. This paper presents a methodology to apply the findings of these epidemiological studies to scenarios to control fine particulate matter in Europe and to estimate the resulting losses in statistical life expectancy that can be attributed to particulate matter pollution. Calculations are carried out for all of Europe with a 50*50 km resolution, distinguishing higher PM2.5 levels in urban areas. The methodology uses population statistics and projections from the United Nations, and applies changes in mortality risk identified by the epidemiological studies to the life tables for the individual countries. The preliminary implementation suggests that, for constant 1990 pollution levels, statistical life expectancy is reduced by approximately 500 days (95 percent confidence interval ranging from 168 - 888 days). By 2010, the control measures presently decided for emissions of primary particles and the precursors of secondary aerosols are expected to reduce these losses to about 280 days (94 - 497), while the theoretical maximum technically feasible emission reductions could bring reduced life expectancy below 200 (65 - 344) days. While the quantifications in this study must be considered as preliminary, the methodology will allow the introduction of health impacts from fine particulate matter into a multi-pollutant/multi-effect framework so that control measures can be explored taking full account of their ancillary benefits for acidification, eutrophication and ground-level ozone.

MedlinePlus - Chronic Obstructive Pulmonary Disease. (COPD) Accessed February 2013.

MedlinePlus - Confusion. Accessed February 2013.

MedlinePlus - Fatigue. Accessed February 2013.

MedlinePlus - Migraine. Accessed February 2013.

MedlinePlus - Thyroid Disease. Accessed February 2013.

Mentens J, D Raes, M Hermy. 2006. Green roofs as a tool for solving the rainwater runoff problem in the urbanized 21st century? Landscape and Urban Planning 77(3): 217-26.

During the last two decades, a large amount of research has been published in German on the reduction of rainwater runoff for different types of roof greening. This paper analyzes the original measurements reported in 18 publications. Rainfall-runoff relationships for an annual and seasonal time scale were obtained from the analysis of the available 628 data records. The derived empirical models allowed us to assess the surface runoff from various types of roofs, when roof characteristics and the annual or seasonal precipitation are given. The annual rainfall-runoff relationship for green roofs is strongly determined by the depth of the substrate layer. The retention of rainwater on green roofs is lower in winter than in summer. The application of the derived annual relationship for the region of Brussels showed that extensive roof greening on just 10% of the buildings would already results in a runoff reduction of 2.7% for the region and of 54% for the individual buildings. Green roofs can therefore be a useful tool for reducing urban rainfall runoff. Yet in order to provide a greater effect on overall runoff they should be accompanied by other means of runoff reduction and/or water retention.

Miller KA, DS Siscovick, et al. 2007. Long-term exposure to air pollution and incidence of cardiovascular events in women. New England Journal of Medicine 356(5): 447-58.

Background: Fine particulate air pollution has been linked to cardiovascular disease, but previous studies have assessed only mortality and differences in exposure between cities. We examined the association of long-term exposure to particulate matter of less than 2.5 ?m in aerodynamic diameter (PM2.5) with cardiovascular events.

Methods: We studied 65,893 postmenopausal women without previous cardiovascular disease in 36 U.S. metropolitan areas from 1994 to 1998, with a median follow-up of 6 years. We assessed the women's exposure to air pollutants using the monitor located nearest to each woman's residence. Hazard ratios were estimated for the first cardiovascular event, adjusting for age, race or ethnic group, smoking status, educational level, household income, body-mass index, and presence or absence of diabetes, hypertension, or hypercholesterolemia.

Results: A total of 1816 women had one or more fatal or nonfatal cardiovascular events, as confirmed by a review of medical records, including death from coronary heart disease or cerebrovascular disease, coronary revascularization, myocardial infarction, and stroke. In 2000, levels of PM2.5 exposure varied from 3.4 to 28.3 ?g per cubic meter (mean, 13.5). Each increase of 10 ?g per cubic meter was associated with a 24% increase in the risk of a cardiovascular event (hazard ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41) and a 76% increase in the risk of death from cardiovascular disease (hazard ratio, 1.76; 95% CI, 1.25 to 2.47). For cardiovascular events, the between-city effect appeared to be smaller than the within-city effect. The risk of cerebrovascular events was also associated with increased levels of PM2.5 (hazard ratio, 1.35; 95% CI, 1.08 to 1.68).

Conclusion: Long-term exposure to fine particulate air pollution is associated with the incidence of cardiovascular disease and death among postmenopausal women. Exposure differences within cities are associated with the risk of cardiovascular disease.

Millenium Ecosystem Assessment. 2005.

Millenium Ecosystem Assessment. Accessed February 2013.

Ming J, L Xian-guo, et al. 2007. Flood mitigation benefit of wetland soil - A case study in Momoge National Nature Reserve in China. Ecological Economics 61(2-3): 217-23.

Wetlands have many important functions. To a wide range of wildlife species, they offer critically important habitats. They also act to mitigate flooding, regulate micro and macro climate changes, degrade pollutants and control erosion etc. Wetland benefits are these functions, which provide direct, indirect, and non-use values to humans. In this study, field soil data are used to calculate the flood mitigation benefits of wetland soils within the Momoge National Nature Reserve, Jilin Province, the People's Republic of China. Calculations are based upon environmental economic assessment methods and GIS techniques. The estimated flood mitigation capacity of wetland soils within the Momoge Reserve was 7.15  104נm3/hm2/yr. This translated into an economic benefit of 5700 $/hm2/yr due to flood mitigation. Spatial differences in the flood mitigation ability of soils were observed across the Momoge wetlands. Benefits associated with flood mitigation were highest within the middle reaches of the Momoge wetlands and least in the East. This quantitative analysis of flood mitigation benefit, with its investigation of wetland soils, will be a useful reference both for the assessment of wetland values in the local region and also for the greater understanding wetland function and value assessment methods.

Mitchell R and F Popham. 2008. Effect of exposure to natural environment on health inequalities: an observational population study. Lancet 372(9650): 1655-60.

Background: Studies have shown that exposure to the natural environment, or so-called green space, has an independent effect on health and health-related behaviours. We postulated that income-related inequality in health would be less pronounced in populations with greater exposure to green space, since access to such areas can modify pathways through which low socio-economic position can lead to disease. Methods: We classified the population of England at younger than retirement age (n=40 813 236) into groups on the basis of income deprivation and exposure to green space. We obtained individual mortality records (n=366 348) to establish whether the association between income deprivation, all-cause mortality, and cause-specific mortality (circulatory disease, lung cancer, and intentional self-harm) in 2001 - 05, varied by exposure to green space measured in 2001, with control for potential confounding factors. We used stratified models to identify the nature of this variation. Findings: The association between income deprivation and mortality differed significantly across the groups of exposure to green space for mortality from all causes (p<0.0001) and circulatory disease (p= 0.0212), but not from lung cancer or intentional self-harm. Health inequalities related to income deprivation in all-cause mortality and mortality from circulatory diseases were lower in populations living in the greenest areas. The incidence rate ratio (IRR) for all-cause mortality for the most income deprived quartile compared with the least deprived was 1.93 (95% CI 1.86 - 2.01) in the least green areas, whereas it was 1.43 (1.34 - 1.53) in the most green. For circulatory diseases, the IRR was 2.19 (2.04 - 2.34) in the least green areas and 1.54 (1.38 - 1.73) in the most green. There was no effect for causes of death unlikely to be affected by green space, such as lung cancer and intentional self-harm. Interpretation: Populations that are exposed to the greenest environments also have lowest levels of health inequality related to income deprivation. Physical environments that promote good health might be important to reduce socio-economic health inequalities.

Mitsch WJ and JG Gosselink. 2007. Wetlands. 4th ed. John Wiley and Sons, New Jersey.


Morita E, M Imai, et al. 2011. A before and after comparison of the effects of forest walking on the sleep of a community-based sample of people with sleep complaints. BioPsychoSocial Medicine 5(1): 1-7.

Background: Sleep disturbance is a major health issue in Japan. This before-after study aimed to evaluate the immediate effects of forest walking in a community-based population with sleep complaints.

Methods: Participants were 71 healthy volunteers (43 men and 28 women). Two-hour forest-walking sessions were conducted on 8 different weekend days from September through December 2005. Sleep conditions were compared between the nights before and after walking in a forest by self-administered questionnaire and actigraphy data.

Results: Two hours of forest walking improved sleep characteristics; impacting actual sleep time, immobile minutes, self-rated depth of sleep, and sleep quality. Mean actual sleep time estimated by actigraphy on the night after forest walking was 419.8 +- 128.7 (S.D.) minutes whereas that the night before was 365.9 +- 89.4 minutes (n = 42). Forest walking in the afternoon improved actual sleep time and immobile minutes compared with forest walking in the forenoon. Mean actual sleep times did not increase after forenoon walks (n = 26) (the night before and after forenoon walks, 380.0 +- 99.6 and 385.6 +- 101.7 minutes, respectively), whereas afternoon walks (n = 16) increased mean actual sleep times from 342.9 +- 66.2 to 475.4 +-150.5 minutes. The trend of mean immobile minutes was similar to the abovementioned trend of mean actual sleep times.

Conclusions: Forest walking improved nocturnal sleep conditions for individuals with sleep complaints, possibly as a result of exercise and emotional improvement. Furthermore, extension of sleep duration was greater after an afternoon walk compared to a forenoon walk. Further study of a forest-walking program in a randomized controlled trial is warranted to clarify its effect on people with insomnia.

Morita E, S Fukuda, et al. 2007. Psychological effects of forest environments on healthy adults: Shinrin-yoku (forest-air bathing, walking) as a possible method of stress reduction. Public Health 121(1): 54-63.

Objectives Shinrin-yoku (walking and/or staying in forests in order to promote health) is a major form of relaxation in Japan; however, its effects have yet to be completely clarified. The aims of this study were: (1) to evaluate the psychological effects of shinrin-yoku in a large number of participants; and (2) to identify the factors related to these effects. Methods Four hundred and ninety-eight healthy volunteers took part in the study. Surveys were conducted twice in a forest on the same day (forest day) and twice on a control day. Outcome measures were evaluated using the Multiple Mood Scale-Short Form (hostility, depression, boredom, friendliness, wellbeing and liveliness) and the State-Trait Anxiety Inventory A-State Scale. Statistical analyses were conducted using analysis of variance and multiple regression analyses. Results Hostility (P<0.001) and depression (P<0.001) scores decreased significantly, and liveliness (P=0.001) scores increased significantly on the forest day compared with the control day. The main effect of environment was also observed with all outcomes except for hostility, and the forest environment was advantageous. Stress levels were shown to be related to the magnitude of the shinrin-yoku effect; the higher the stress level, the greater the effect. Conclusions This study revealed that forest environments are advantageous with respect to acute emotions, especially among those experiencing chronic stress. Accordingly, shinrin-yoku may be employed as a stress reduction method, and forest environments can be viewed as therapeutic landscapes. Therefore, customary shinrin-yoku may help to decrease the risk of psychosocial stress-related diseases, and evaluation of the long-term effects of shinrin-yoku is warranted.

Mowafi M, Z Khadr, et al. 2012. Is access to neighborhood green space associated with BMI among Egyptians? A multilevel study of Cairo neighborhoods. Health & Place 18(2): 385-390.

Evidence of a link between green space and obesity has increased in the developed world, but few studies have been conducted in the developing world. Our study tests whether availability of neighborhood green space is associated with BMI among adults in Cairo, Egypt. Using data from the 2007 Cairo Urban Inequity Study, we conducted multilevel analyses and found no significant green space-BMI association, leading us to conclude that this intervention may not be as promising in this developing world context as it has been in some western urban contexts. Other aspects of the urban environment should be evaluated to better understand neighborhood variations in obesity in Cairo.

Murray CJL and AD Lopez. 1997. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The Lancet 349(9063): 1436-42.

Summary/Background: Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons.Methods DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed.Findings Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene.Interpretation: The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.

Mytton O T, N Townsend, et al. 2012. Green space and physical activity: An observational study using Health Survey for England data. Health & Place 18(5): 1034-1041.

Past studies have suggested that a link between health outcomes and green space is due to increased levels of physical activity of individuals living in areas with more green space. We found a positive association between green space and physical activity levels. The odds of achieving the recommended amount of physical activity was 1.27 (95% CI: 1.13-1.44) for people living in the greenest quintile in England compared to those living in the least green quintile, after controlling for individual and environmental factors. However, no association was found between green space and types of physical activity normally associated with green space. An association was found with other types of physical activity (gardening and do-it-yourself, and occupational physical activity). These findings suggest that although there is a positive association between physical activity and green space it may not be explained by individuals using green space for recreation.


Nassauer J I. Ed. 1997. Placing nature: culture and landscape ecology. Island Press.

No abstract provided.

National Alliance on Mental Illness - Mental Illness. Accessed February 2013.

National Heart Lung and Blood Institute - High Blood Pressure. Accessed February 2013.

National Heart Lung and Blood Institute - Pneumonia. Accessed February 2013.

National Institute of Mental Health: Prevalence of Serious Mental Illness Along U.S. Adults by Age, Sex, and Race.

Netz Y, M-J Wu, BJ Becker, G Tenenbaum. 2005. Physical activity and psychological well-being in advanced age: A meta-analysis of intervention studies. Psychology and Aging 20(2): 272-84.

A meta-analysis examined data from 36 studies linking physical activity to well-being in older adults without clinical disorders. The weighted mean-change effect size for treatment groups (dC. = 0.24) was almost 3 times the mean for control groups (dC. = 0.09). Aerobic training was most beneficial (dC. = 0.29), and moderate intensity activity was the most beneficial activity level (dC. = 0.34). Longer exercise duration was less beneficial for several types of well-being, though findings are inconclusive. Physical activity had the strongest effects on self-efficacy (dC. = 0.38), and improvements in cardiovascular status, strength, and functional capacity were linked to well-being improvement overall. Social� cognitive theory is used to explain the effect of physical activity on well-being.

Nielsen TS and KB Hansen. 2007. Do green areas affect health? Results from a Danish survey on the use of green areas and health indicators. Health & Place 13(4): 839-50.

The article presents the result from a Danish survey on access and use of green areas and the impact on experienced stress and obesity. The statistical results indicate that access to a garden or short distances to green areas from the dwelling are associated with less stress and a lower likelihood of obesity. The number of visits cannot explain the effects of green areas on the health indicators. It is suggested that the significance of distance to green areas is mainly derived from its correlation with the character of the neighbourhood and its conduciveness to outdoor activities and "healthy" modes of travel.

Nowak D J. 1994. Air Pollution Removal by Chicago's Urban Forest. In McPherson, E. Gregory; Nowak, David J.; Rowntree, Rowan A. eds. 1994. Chicago's urban forest ecosystem: results of the Chicago Urban Forest Climate Project. Gen. Tech. Rep. NE-186. Radnor, PA: U.S. Department of Agriculture, Forest Service, Northeastern Forest Experiment Station: 201 p.

In 1991, trees in the City of Chicago (1 1 percent tree cover) removed an estimated 15 metric tons (t) (1 7 tons) of carbon monoxide (CO), 84 t (93 tons) of sulfur dioxide (SOz), 89 t (98 tons) of nitrogen dioxide (NO2), 191 t (210 tons) of ozone ( 0 3 ) , and 212 t (234 tons) of particulate matter less than 10 microns (PMI 0). Across the study region of Cook and DuPage Counties, trees (in-leaf season) removed an average of 1.2 t/ day (1.3 tonslday) of CO, 3.7 t/day (4.0 tonslday) of SO2, 4.2 tlday (4.6 tonslday) of NO2, 8.9 tlday (9.8 tonslday) of PM10 and 10.8 tlday (1 1.9 tonstday) of 0 3 . The value of pollution removal in 1991 was estimated at $1 million for trees in Chicago and $9.2 million for trees across the study area. ~ v e r a g e hourly improvement (in-leaf season) in air quality due to all trees in the study area ranged from 0.002 percent for CO to 0.4 percent for PM10. Maximum hourly improve- ment was estimated at 1.3 percent for SO2, though localized improvements in air quality can reach 5 to 10 percent or greater in areas of relatively high tree cover, particularly under stable atmospheric conditions during the daytime (in-leaf season). Large, healthy trees remove an estimated 60 to 70 times more pollution than small trees. This paper discusses the ways in which urban trees affect air quality, limitations to estimates of pollution removal by trees in the Chicago area, and management considerations for improving air quality with urban trees.

Nowak DJ and DE Crane. 2002. Carbon storage and sequestration by urban trees in the USA. Environmental Pollution 116(3): 381-389.

Based on field data from 10 USA cities and national urban tree cover data, it is estimated that urban trees in the coterminous USA currently store 700 million tonnes of carbon ($14,300 million value) with a gross carbon sequestration rate of 22.8 million tC/yr ($460 million/year). Carbon storage within cities ranges from 1.2 million tC in New York, NY, to 19,300 tC in Jersey City, NJ. Regions with the greatest proportion of urban land are the Northeast (8.5%) and the southeast (7.1%). Urban forests in the north central, northeast, south central and southeast regions of the USA store and sequester the most carbon, with average carbon storage per hectare greatest in southeast, north central, northeast and Pacific northwest regions, respectively. The national average urban forest carbon storage density is 25.1 tC/ha, compared with 53.5 tC/ha in forest stands. These data can be used to help assess the actual and potential role of urban forests in reducing atmospheric carbon dioxide, a dominant greenhouse gas.

Nowak D J, D E Crane, et al. 2006. Air pollution removal by urban trees and shrubs in the United States. Urban Forestry & Urban Greening 4(3-4): 115-123.

A modeling study using hourly meteorological and pollution concentration data from across the coterminous United States demonstrates that urban trees remove large amounts of air pollution that consequently improve urban air quality. Pollution removal (O3, PM10, NO2, SO2, CO) varied among cities with total annual air pollution removal by US urban trees estimated at 711,000 metric tons ($3.8 billion value). Pollution removal is only one of various ways that urban trees affect air quality. Integrated studies of tree effects on air pollution reveal that management of urban tree canopy cover could be a viable strategy to improve air quality and help meet clean air standards.


Ostro BD. 1990. Associations between morbidity and alternative measures of particulate matter. Risk Analysis 10(3): 421-7.

This paper explores the association between acute respiratory morbidity and different measures of exposure to airborne particulate matter, including sulfates, total suspended particulates, and fine and inhalable particulates. Regression analysis was used to test for the impacts of these alternative measures of particulate matter on respiratory morbidity using the 1979 -1981 annual Health Interview Surveys and EPA's Inhalable Particle Monitoring Network. The general results indicate that, of the surrogate measures for particulate matter, sulfates appear to have the greatest association with morbidity. To the extent that sulfuric acid aerosols are correlated with airborne sulfates, the results suggest that respiratory impairment sufficient to lead to days of reduced activity may be related to the existence of acidity in the air. These findings are consistent with the results of ecological studies reporting an association between mortality and exposures to fine particles and sulfates.

Ostro BD. 1994. Estimating health effects of air pollution: a method with an application to Jakarta. P. R. Department. Washington, DC. Working Paper 1301.

To develop efficient strategies for pollution control, it is essential to assess both the costs of control and the benefits that may result. These benefits will often included improvements in public health, including reductions in both morbidity and premature mortality. Until recently, there has been little guidance about how to calculate the benefits of air pollution controls and how to use those estimates to assign priorities to different air pollution control strategies. The author describes a method for quantifying the benefits of reduced ambient concentrations of pollutants (such as ozone and particulate matter) typically found in urban areas worldwide. The author then applies the method to data on Jakarta, Indonesia, an area characterized by little wind, high population concentration (8 million people), congested roads, and ambient air pollution. The magnitude of the benefits of pollution control depend on the level of air pollution, the expected effects on health of the pollutants (dose-response), the size of the population affected and the economic value of these effects. The results for Jakarta suggest that significant benefits result from reducing exposure to both outdoor and indoor air pollutants. For example, if annual concentrations of particulate matter were reduced to the midpoint of the World Health Organization guideline (and former U.S. ambient standard), the estimates indicate a reduction per year of 1,400 premature deaths (with a range of 900 to 1,900), 49,000 emergency room visits, 600,000 asthma attacks, 7.6 million restricted activity days (including work loss), 124,000 cases of bronchitis in children, and 37 million minor respiratory symptoms. In the case of Jakarta, the methodology suggests that reducing exposure to lead and nitrogen dioxide should also be a high priority. An important consequence of ambient lead pollution is a reduction in learning abilities for children, measured as I.Q loss. Apart from that, reducing the proportion of respirable particles can reduce the amount of illness and premature mortality. Clearly, air pollution represents a significant public health hazard to residents of Jakarta and other cities consistently exposed to high levels of air pollution, such as Bangkok, Mexico City, and Santiago, Chile.

Osungbade KO and OK Ige. 2011. Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening. Journal of Pregnancy 2011.

Objectives. Review of public health perspectives of preeclampsia in developing countries and implications for health system strengthening.

Methods. Literature from Pubmed (MEDLINE), AJOL, Google Scholar, and Cochrane database were reviewed.

Results. The prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7%. Many challenges exist in the prediction, prevention, and management of preeclampsia. Promising prophylactic measures like low-dose aspirin and calcium supplementation need further evidence before recommendation for use in developing countries. Treatment remains prenatal care, timely diagnosis, proper management, and timely delivery. Prevailing household, community, and health system factors limiting effective control of preeclampsia in these countries were identified, and strategies to strengthen health systems were highlighted.

Conclusion. Overcoming the prevailing challenges in the control of preeclampsia in developing countries hinges on the ability of health care systems to identify and manage women at high risk.


Paffenbarger RS, R Hyde, et al. 1986. Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine 314(10): 605-13.

We examined the physical activity and other life-style characteristics of 16,936 Harvard alumni, aged 35 to 74, for relations to rates of mortality from all causes and for influences on length of life. A total of 1413 alumni died during 12 to 16 years of follow-up (1962 to 1978). Exercise reported as walking, stair climbing, and sports play related inversely to total mortality, primarily to death due to cardiovascular or respiratory causes. Death rates declined steadily as energy expended on such activity increased from less than 500 to 3500 kcal per week, beyond which rates increased slightly. Rates were one quarter to one third lower among alumni expending 2000 or more kcal during exercise per week than among less active men. With or without consideration of hypertension, cigarette smoking, extremes or gains in body weight, or early parental death, alumni mortality rates were significantly lower among the physically active. Relative risks of death for individuals were highest among cigarette smokers and men with hypertension, and attributable risks in the community were highest among smokers and sedentary men. By the age of 80, the amount of additional life attributable to adequate exercise, as compared with sedentariness, was one to more than two years.

Park B-J., Y Tsunetsugu, et al. 2008. Physiological effects of Shinrin-yoku (taking in the atmosphere of the forest) in a mixed forest in Shinano Town, Japan. Scandinavian Journal of Forest Research 23(3): 278-283.

Abstract The purpose of this study was to examine the physiological effects of Shinrin-yoku (taking in the atmosphere of the forest). The subjects were 12 male university students. On the first day of the experiments, six subjects went to the forest area, and the other six went to a city area as a control. On the second day, subjects went to the opposite areas as a cross-check. In the afternoon, they were seated on chairs watching the landscapes of their given area for 15 min. Heart rate variability (HRV), salivary cortisol and pulse rate were measured as physiological indices in the morning and in the evening at the place of accommodation, before and after watching the landscapes in the field areas. The high-frequency power of HRV of subjects in the forest area was significantly higher than that of subjects in the city area. The pulse rate of subjects in the forest area was significantly lower than that of subjects in the city area. The salivary cortisol concentration of the subjects in the forest area was significantly lower than that of subjects in the city area. The results of physiological measurements show that Shinrin-yoku was an effective form of relaxation.

Peacock J, R Hine, J Pretty. 2007. Got the blues, then find some greenspace: The mental health benefits of green exercise activities and green care. Wivenhoe Park, Colchester, Centre for Environment and Society, Department of Biological Sciences, University of Essex.

No abstract provided

Penna MLF and MP Duchiade. 1991. Air pollution and infant mortality from pneumonia in the Rio de Janeiro metropolitan area. Bulletin of the Pan American Health Organization (United States); (WHO); 25(1): 47-54.

The authors report the results of an investigation into the possible association between air pollution and infant mortality from pneumonia in the Rio de Janeiro Metropolitan Area. This investigation employed multiple linear regression analysis (stepwise method) for infant mortality from pneumonia in 1980, including the study population's areas of residence, incomes, and pollution exposure as independent variables. With the income variable included in the regression, a statistically significant association was observed between the average annual level of particulates and infant mortality from pneumonia. While this finding should be accepted with caution, it does suggest a biological association between these variables. The authors' conclusion is that air quality indicators should be included in studies of acute respiratory infections in developing countries.

Pereira G, S Foster, et al. 2012. The association between neighborhood greenness and cardiovascular disease: an observational study. BMC Public Health 12(1): 466.

BACKGROUND:Previous studies have demonstrated links between cardiovascular disease and physical inactivity and poor air quality, which are both associated with neighborhood greenness. However, no studies have directly investigated neighborhood greenness in relation to coronary heart disease risk. We investigated the effect of neighborhood greenness on both self-reported and hospital admissions of coronary heart disease or stroke, accounting for ambient air quality, socio-demographic, behavioral and biological factors.

METHOD:Cross-sectional study of 11,404 adults obtained from a population representative sample for the period 2003-2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600m service area surrounding the residential address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Logistic regression was used to assess associations with medically diagnosed and hospitalization for coronary heart disease or stroke.

RESULTS:The odds of hospitalization for heart disease or stroke was 37% (95% CI: 8%, 57%) lower among adults in neighborhoods with highly variable greenness (highest tertile) compared to those in predominantly green, or predominantly non-green neighborhoods (lowest tertile). This effect was independent of the absolute levels of neighborhood greenness. There was weaker evidence for associations with the mean level of neighborhood greenness.

CONCLUSION:Variability in neighborhood greenness is a single metric that encapsulates two potential promoters of physical activity - an aesthetically pleasing natural environment and access to urban destinations. Variability in greenness within a neighborhood was negatively associated with coronary heart disease and stroke.

Pickett STA, ML Cadenasso, AM Grove, CH Nilon, RV Pouyat, WC Zipper & R Costanza. 2001. Urban Ecological Systems: Linking Terrestrial, Ecological, Physical, and Socioeconomic Components of Urban Areas. Annu. Rev. Ecol. Syst. 2001. 32:127-57.

Ecological studies of terrestrial urban systems have been approached along several kinds of contrasts: ecology in as opposed to ecology of cities; biogeochemical compared to organismal perspectives, land use planning versus biological, and disciplinary versus interdisciplinary. In order to point out how urban ecological studies are poised for significant integration, we review key aspects of these disparate literatures. We emphasize an open definition of urban systems that accounts for the exchanges of material and influence between cities and surrounding landscapes. Research on ecology in urban systems highlights the nature of the physical environment, including urban climate, hydrology, and soils. Biotic research has studied flora, fauna, and vegetation, including trophic effects of wildlife and pets. Unexpected interactions among soil chemistry, leaf litter quality, and exotic invertebrates exemplify the novel kinds of interactions that can occur in urban systems. Vegetation and faunal responses suggest that the configuration of spatial heterogeneity is especially important in urban systems. This insight parallels the concern in the literature on the ecological dimensions of land use planning. The contrasting approach of ecology of cities has used a strategy of biogeochemical budgets, ecological footprints, and summaries of citywide species richness. Contemporary ecosystem approaches have begun to integrate organismal, nutrient, and energetic approaches, and to show the need for understanding the social dimensions of urban ecology. Social structure and the social allocation of natural and institutional resources are subjects that are well understood within social sciences, and that can be readily accommodated in ecosystem models of metropolitan areas. Likewise, the sophisticated understanding of spatial dimensions of social differentiation has parallels with concepts and data on patch dynamics in ecology and sets the stage for comprehensive understanding of urban ecosystems. The linkages are captured in the human ecosystem framework.

Plante TG, C Cage, et al. 2006. Psychological benefits of exercise paired with virtual reality: outdoor exercise energizes whereas indoor virtual exercise relaxes. International Journal of Stress Management 13(1): 108-17.

In the present study the authors sought to evaluate the psychological effects of exercise when paired with virtual reality. One-hundred and twelve introductory psychology students (47 male and 65 female) were randomly assigned to one of three 20-min experimental conditions including (a) taking a brisk outdoor walk around a college campus, (b) walking on a laboratory treadmill combined with a virtual reality video presentation of the same college campus walk, or (c) viewing the virtual reality walk without participating in any actual exercise. Several standardized mood and enjoyment measures were administered immediately before and after the experimental conditions. Results suggest that greater energy was experienced while walking outside whereas less energy was reported when viewing the virtual reality walk with no actual exercise. These findings were most pronounced for female participants. Both female and male participants walking in the laboratory with the virtual reality were more relaxed and experienced the least tension of the three conditions.

Poloniecki JD, RW Atkinson, et al. 1997. Daily time series for cardiovascular hospital admissions and previous day's air pollution in London, UK. Occupational and Environmental Medicine 54(8): 535-40.

OBJECTIVE: To test for a significant association between air pollution and emergency hospital admissions for circulatory diseases (international classification of diseases-9 390-459) in London, England, that would be consistent with a causal effect of pollution on the previous day.

METHODS: Long term concurrent trends, temperature, humidity, day of the week, influenza epidemic of 1989, and cyclical covariations with periodicity > 20 days in daily measures of pollution and admissions for 1987-94 were allowed for.

RESULTS: There were 373556 admissions. No association was found between O3 and circulatory diseases. Four other pollutants were associated with acute myocardial infarction and circulatory diseases combined. P values and attributable cases (95% confidence intervals) for acute myocardial infarction were: black smoke P = 0.003, 2.5% (0.8% to 4.3%); NO2 P = 0.002, 2.7% (0.8% to 4.6%); CO P = 0.001, 2.1% (0.7% to 3.5%); and SO2 P = 0.0006, 1.7% (0.7% to 2.6%). There were also associations between black smoke and angina (P = 0.02), NO2 and arrhythmia (P = 0.04), and CO and other circulatory diseases (P = 0.004), but none with heart failure. Acute myocardial infarction was the only diagnosis for which there were significant associations with and without adjustment for cyclical terms. The associations with acute myocardial infarction were significant only in the cool season.

CONCLUSION: Population data were consistent with 1 in 50 heart attacks currently presenting at London hospitals being triggered by outdoor air pollution. Further research is now needed to investigate whether background concentrations of black smoke, NO2, CO, and SO2 are a preventable cause of myocardial infarction. These results, if applied to all myocardial infarctions in the United Kingdom, indicate a potential saving of 6000 heart attacks a year.

Ponka A and M Virtanen. 1994. Chronic bronchitis, emphysema, and low-level air pollution in Helsinki, 1987-1989. Environmental Research 65(2): 207-217.

The effects of low levels of air pollution and weather conditions on the number of patients admitted to hospitals for exacerbation of chronic bronchitis or emphysema (n = 2807) was studied in Helsinki during a 3-year period, 1987-1989. The daily number of admissions via the emergency room was significantly associated with prevailing levels of sulfur dioxide (SO2) and nitrogen dioxide (NO2) in Poisson regressions controlled for weather, season, time trends, and day of the week, whereas the total number of admissions (via the emergency room and otherwise) was not significantly associated with these pollutants. The effect of SO, was observed only among those under 65 years old; a significant peak of admissions was seen during the same day (RR, 1.31 for a 2.7-fold increase in SO2; 95% CI, 1.01-1.70; P = 0.039), and another after a 3-day lag (RR, 1.39; 95% CI, 1.05-1.86; P = 0.021). The effect of NO2 was strongest after a 6-day lag and was significant only among those over 64 years old (RR, 1.31;95% CI, 1.03-1.66; P = 0.022). The average of mean 24-hr concentrations of NO, was 39 [mu]g/m3 (0.021 ppm) and that for SO2 was 19 mu g/m3 (0.0067 ppm). No relationship was found between admissions and the concentrations of total suspended particulates (TSP) or ozone (O3), the temperature, or the relative humidity. However, the number of admissions among those over 64 years of age was significantly lower, irrespective of temperature, during the summer than during other seasons. The mean daily concentration of O3 was fairly low (22 [mu]g/m3 or 0.011 ppm), but that of TSP was high, 76 [mu]g/m3. The mean temperature was low, +4.7�C. These results suggest that SO2 and NO2 concentrations lower than those given as guidelines in many countries, and lower than previously shown, may increase the incidence of symptoms in some patients with chronic bronchitis or emphysema.

Pope 3rd CA, MJ Thun, et al. 1995. Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am. J. Respir. Crit. Care Med. 151(3): 669-74.

Time-series, cross-sectional, and prospective cohort studies have observed associations between mortality and particulate air pollution but have been limited by ecologic design or small number of subjects or study areas. The present study evaluates effects of particulate air pollution on mortality using data from a large cohort drawn from many study areas. We linked ambient air pollution data from 151 U.S. metropolitan areas in 1980 with individual risk factor on 552,138 adults who resided in these areas when enrolled in a prospective study in 1982. Deaths were ascertained through December, 1989. Exposure to sulfate and fine particulate air pollution, which is primarily from fossil fuel combustion, was estimated from national data bases. The relationships of air pollution to all-cause, lung cancer, and cardiopulmonary mortality was examined using multivariate analysis which controlled for smoking, education, and other risk factors. Although small compared with cigarette smoking, an association between mortality and particulate air pollution was observed. Adjusted relative risk ratios (and 95% confidence intervals) of all-cause mortality for the most polluted areas compared with the least polluted equaled 1.15 (1.09 to 1.22) and 1.17 (1.09 to 1.26) when using sulfate and fine particulate measures respectively. Particulate air pollution was associated with cardiopulmonary and lung cancer mortality but not with mortality due to other causes. Increased mortality is associated with sulfate and fine particulate air pollution at levels commonly found in U.S. cities. The increase in risk is not attributable to tobacco smoking, although other unmeasured correlates of pollution cannot be excluded with certainty.

Pope 3rd, CA, RT Burnett, et al. 2002. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. Journal of the American Medical Association 287(9): 1132-41.

Context: Associations have been found between day-to-day particulate air pollution and increased risk of various adverse health outcomes, including cardiopulmonary mortality. However, studies of health effects of long-term particulate air pollution have been less conclusive.

Objective: To assess the relationship between long-term exposure to fine particulate air pollution and all-cause, lung cancer, and cardiopulmonary mortality.

Design, Setting, and Participants: Vital status and cause of death data were collected by the American Cancer Society as part of the Cancer Prevention II study, an ongoing prospective mortality study, which enrolled approximately 1.2 million adults in 1982. Participants completed a questionnaire detailing individual risk factor data (age, sex, race, weight, height, smoking history, education, marital status, diet, alcohol consumption, and occupational exposures). The risk factor data for approximately 500 000 adults were linked with air pollution data for metropolitan areas throughout the United States and combined with vital status and cause of death data through December 31, 1998.

Main Outcome Measure: All-cause, lung cancer, and cardiopulmonary mortality.

Results: Fine particulate and sulfur oxide�related pollution were associated with all-cause, lung cancer, and cardiopulmonary mortality. Each 10-�g/m3 elevation in fine particulate air pollution was associated with approximately a 4%, 6%, and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality, respectively. Measures of coarse particle fraction and total suspended particles were not consistently associated with mortality.

Conclusion: Long-term exposure to combustion-related fine particulate air pollution is an important environmental risk factor for cardiopulmonary and lung cancer mortality.

Power MC, MG Weisskopf, et al. 2010. Traffic-related air pollution and cognitive function in a cohort of older men. Environmental Health Perspectives 119(5):682-7.

Background: Traffic-related particles induce oxidative stress and may exert adverse effects on central nervous system function, which could manifest as cognitive impairment. Objective: To assess the association between black carbon (BC), a marker of traffic-related air pollution, and cognition in older men.

Methods: 680 men (mean age (SD): 71 (7)) from the VA Normative Aging Study completed a battery of 7 cognitive tests at least once between 1996 and 2007. We assessed long-term exposure to traffic-related air pollution using a validated spatiotemporal land-use regression model for BC.

Results: The association between BC and cognition was non-linear and BC estimates were logtransformed for all analyses (ln(BC)). In a multivariable-adjusted model, for each doubling in BC on the natural scale, the odds of having an MMSE score at or below 25 was 1.3 times higher (95% confidence interval (95%CI): 1.1, 1.6). In a multivariable-adjusted model for global cognitive function, which combined scores from the remaining 6 tests, a doubling of BC was associated with a 0.054 standard deviation lower test score (95%CI: -0.103, -0.006), an effect size similar to that observed with a difference in age of 1.9 years in our data. There was no evidence of heterogeneity by cognitive test. In sensitivity analyses adjusting for past lead exposure, the association with MMSE scores was similar (OR: 1.3, 95%CI: 1.1, 1.7) but the association with global cognition was somewhat attenuated (-0.038 per doubling in BC, 95%CI: -0.089, 0.012).

Conclusions: Ambient traffic-related air pollution was associated with decreased cognitive function in older men.

Prescott GJ, GR Cohen, et al. 1998. Urban air pollution and cardiopulmonary ill health: a 14.5 year time series study. Occupational and Environmental Medicine 55(10): 697-4.

OBJECTIVES: To examine possible associations between daily concentrations of urban air pollutants and hospital emergency admissions and mortality due to cardiac and pulmonary disease.

METHODS: A time series study was conducted in the City of Edinburgh, which has a population of about 450,000. Poisson log linear regression models were used to investigate the relation of the daily event rate with daily air pollution concentrations of sulphur dioxide (SO2) and black smoke from 1981 to 1995, and of nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and particulate matter (PM10) from 1992 to 1995. Adjustments were made for seasonal and weekday variation, daily temperature, and wind speed.

RESULTS: The most significant findings were positive associations over the period 1981-95 between black smoke as a mean of the previous three days and daily all cause mortality in people aged > or = 65, and respiratory mortality also in this age group (3.9% increase in mortality for a 10 micrograms/m3 increment in black smoke). For hospital emergency admissions between 1992 and 1995 the two most significant findings (p < 0.05) were for cardiovascular admissions of people aged > or = 65 which showed a positive association with PM10 as a mean of the 3 previous days, and a negative association with O3 as a mean of the previous three days. Analyses of outcomes based on linkage with previous cardiorespiratory emergency admissions did not show substantially different results.

CONCLUSION: These data suggest that in the City of Edinburgh, after correction for confounders, there was a small but significant association between concentrations of black smoke and respiratory mortality in the older age group, probably attributable to higher pollution levels in the early part of the study period. There were also generally weak and variable associations between day to day changes in concentrations of urban air pollutants at a single central point and emergency hospital admission rates from cardiac and respiratory disease.

Pretty J, J Peacock, et al. 2005. The mental and physical health outcomes of green exercise. International Journal of Environmental Health Research 15(5): 319-7. (n=100)

Both physical activity and exposure to nature are known separately to have positive effects on physical and mental health. We have investigated whether there is a synergistic benefit in adopting physicalactivities whilst being directly exposed to nature ('green exercise'). Five groups of 20 subjects were exposed to a sequence of 30 scenes projected on a wall whilst exercising on a treadmill. Four categories of scenes were tested: rural pleasant, rural unpleasant, urban pleasant and urban unpleasant. The control was running without exposure to images. Blood pressure and two psychological measures (selfesteem and mood) were measured before and after the intervention. There was a clear effect of both exercise and different scenes on blood pressure, self-esteem and mood. Exercise alone significantly reduced blood pressure, increased self-esteem, and had a positive significant effect on 4 of 6 mood measures. Both rural and urban pleasant scenes produced a significantly greater positive effect on selfesteem than the exercise-only control. This shows the synergistic effect of green exercise in both rural and urban environments. By contrast, both rural and urban unpleasant scenes reduced the positive effects of exercise on self-esteem. The rural unpleasant scenes had the most dramatic effect, depressing the beneficial effects of exercise on three different measures of mood. It appears that threats to the countryside depicted in rural unpleasant scenes have a greater negative effect on mood than already urban unpleasant scenes. We conclude that green exercise has important public and environmental health consequences.

Pretty, J. G., Murray; Peacock, Jo; Hine, Rachel; Sellens, Martin; South, Nigel (2005) A Countryside for Health and Well-Being: The Physical and Mental Health Benefits of Green Exercise. (n=263)

No abstract provided

Pullman, Marcie. 2009. Conifer PM2.5 Deposition and Re-Suspension in Wind and Rain Events. Plant Science - Thomas Whitlow Ithaca, NY, Cornell University. MS.

Recent EPA rulings allow State Implementation Plans (SIP) to include new urban tree plantings as a measure of air pollution abatement, creating an urgent need for accurate estimates of pollution removal by trees. Deposition velocities (Vd) of particulates to trees have been reported for a number of species without explicitly recognizing that observed deposition is a net process, the sum of particle deposition and re-suspension. This has implications for atmospheric models that include a separate re-suspension term to estimate PM loading to trees. Wind tunnel tests at 5 m/s wind speed report 2.5% resuspension with a conifer species over a half day (Ould-Dada). However, in the native environment higher wind speeds are suspected to be responsible for the majority of resuspension of PM2.5. In the present study, three conifer species were dosed with KNO3 Dp 2.5 ?m particulates and exposed in a wind tunnel to winds of 6.5, 10, and 13 m/s for 5, 10, or 20 minutes, to determine PM2.5 resuspension rates. Deposition velocities were also determined over a range of PM concentrations. Though the removal of particles from the air is small, re-suspension from Pinus strobus increased from 0% at 6.5 m/s to 20% of the original dose removed at 10 m/s and 50% of the original dose removed at 13 m/s. Taxus cuspidata had low rates of resuspension (20% of the original dose) at all three wind speeds, while Tsuga canadensis had no resuspension. Vd are 0.02 cm/s for Tsuga, 0.01 cm/s for Pinus, and 0.005 for Taxus. Deposition velocity was found to be related to complexity of needle and branch arrangement, and not of total needle surface area as hypothesized. Re-suspension is likely to result from mechanical jarring of needles at high wind speeds rather than direct scouring by the wind. An analysis of wind conditions in upstate New York revealed that wind events of a magnitude sufficient to cause resuspension in Pinus occur 1.25% of the time in January and 0.07% of the time in July. The implications of these findings are: models of pollution removal by urban trees (ie, The Urban Forest Effects Model, UFORE) underestimate the amount of PM2.5 retained by leaves by 50%.

Putnam RD, 2000. Bowling Alone: The Collapse and Revival of American Community. New York: Simon and Schuster.

No abstract provided



Raanaas R K, G G Patil, et al. 2012. Health benefits of a view of nature through the window: a quasi-experimental study of patients in a residential rehabilitation center. Clinical Rehabilitation 26(1): 21-32.

OBJECTIVE: To examine the health benefits of a bedroom window view to natural surroundings for patients undergoing a residential rehabilitation programme.

DESIGN: Longitudinal quasi-experiment.

SETTING: A residential rehabilitation centre.

SUBJECTS: Two-hundred and seventy-eight coronary and pulmonary patients provided data at all measurement points during the programme.

INTERVENTION: Blind, quasi-random allocation to a private bedroom with a panoramic view to natural surroundings or with a view either partially or entirely blocked by buildings.

MAIN MEASURES: Self-reported physical and mental health (SF-12), subjective well-being, emotional states, use of the private bedroom and leisure activities.

CONCLUSION: For women, a blocked view appeared to negatively influence change in physical health (time x view x gender interaction, F(4,504)=2.51, P=0.04), whereas for men, a blocked view appeared to negatively influence change in mental health (time x view x gender interaction, F(4,504)=5.67, P<0.01). Pulmonary patients with a panoramic view showed greater improvement in mental health than coronary patients with such a view (time x view x diagnostic group interaction, F(4,504)=2.76, P=?0.03). Those with a panoramic view to nature more often chose to stay in their bedroom when they wanted to be alone than those with a blocked view (odds ratio (OR)=?2.32, 95% confidence interval (CI) 1.08-5.01). An unobstructed bedroom view to natural surroundings appears to have better supported improvement in self-reported physical and mental health during a residential rehabilitation programme, although the degree of change varied with gender and diagnostic group.

Raglin JS and WP Morgan. 1987. Influence of exercise and quiet rest on state anxiety and blood pressure. Medicine & Science in Sports & Exercise 19(5): 456-63.

A series of investigations was performed in which Ss rested quietly for 40-min and performed aerobic exercise on separate occasions. Blood pressure (BP) and state anxiety were assessed prior to and following the conditions. In the first experiment, 15 normotensive Ss were assessed during the 3-h following the treatments. The results revealed that state anxiety and BP were reduced following both conditions. The exercise-induced BP reductions remained significant for 2 to 3 h (P < 0.05), whereas the BP reductions returned to baseline within 20-min following cessation of quiet rest. The second experiment involved an evaluation of the effects of exercise and quiet rest on 15 pharmacologically controlled hypertensive Ss. A significant reduction in systolic BP (P < 0.05) was observed following exercise and quiet rest. State anxiety was reduced following quiet rest and exercise (P < 0.05). It is concluded that exercise and quiet rest have similar effects on state anxiety, and both conditions are followed by a transitory reduction in blood pressure. These anti-anxiety effects, however, are sustained for a longer period following exercise.

Rai U N, S Sinha, R D Tripathi & P Chandra. 1995. Wastewater treatability potential of some aquatic macrophytes: Removal of heavy metals. Ecological Engineering, 5(1), 5-12.

Free-floating, submerged and emergent plants (Hydrodictyon reticulatum, Spirodela polyrrhiza, Chara corallina, Ceratophyllum demersum, Vallisneria spiralis, Bacopa monnieri, Alternanthera sessilis and Hygrorrhiza aristata) were evaluated for their heavy metal (Cu, Cr, Fe, Mn, Cd, Ph) removal potential under laboratory conditions. Treatability study was carried out using pond water contaminated with the effluents from various industrial sources. Plants differ in the extent of metal accumulation; however, metals present in relatively high concentrations were accumulated more. Results showed a decrease in Cr level from 4.866 �M to below maximum permissible limit by C. demersum, H. reticulatum and S. polyrrhiza within 15 d. Similarly, elevated levels of Fe were reduced to below permissible limit by C. demersum and H. reticulatum after 15 d. Manganese concentration (6.63 �M) were reduced to 1.63 p M by C. demersum and H. reticulatum in 7 d. Bacopa monnieri and H. aristata decreased Cd levels from 0.155 �M to 0.009 �M whereas S. polyrrhiza and H. reticulatum reduced levels to 0.036 �M after 15 d of treatment. More than 70% Pb was removed by C. demersum, H. aristata and H. reticulatum within 15 d. Results suggest the use of these plants for metal abatement in dilute wastewaters.

Reacher M, K McKenzie, C Lane, T Nichols, et al. 2004. Health impacts of flooding in Lewes: a comparison of reported gastrointestinal and other illness and mental health in flooded and non-flooded households. Communicable Disease and Public Health 7(1): 39 - 46.

Severe flooding may become more frequent due to global warming. A historical cohort study was conducted by telephone interview for new episodes of illness in all age groups, and for psychological distress in adults, following severe river flooding on 12 October 2000 in the town of Lewes in Southern England. Two hundred and twenty-seven residents of 103 flooded households and 240 residents of 104 non-flooded households in the same postal district were recruited by random selection of addresses from a post flooding survey and a commercial database respectively. Having been flooded was associated with earache (RR 2.2 [1.1,4.1] p = 0.02), and a significant increase in risk of gastroenteritis with depth of flooding (RR 1.7 [0.9,3.0] p = 0.09, p for trend by flood depth = 0.04). Adults had a four-times higher risk of psychological distress defined as a score of > 4 in response to the 12- item General Health Questionnaire (GHQ-12) (RR 4.1 [2.6, 6.4] p < 0.0005, p for trend by flood depth = 0.01). Associations between flooding and new episodes of physical illness in adults diminished after adjustment for psychological distress. Flooding remained highly significantly associated with psychological distress after adjustment for physical illnesses. Psychological distress may explain some of the excess physical illness reported by flooded adults and possibly by children as well. Policies to promote population resilience to flooding where flood prevention has failed must include practical support for flood victims and provision of appropriate psychological support. Associations with physical illnesses affirm the need for advice and assistance with individual, household and environmental hygiene and access to medical services.

Regan L and R Rai. 2000. Epidemiology and the medical causes of miscarriage. Best Practice & Research Clinical Obstetrics & Gynaecology 14(5): 839-854.

Human reproduction is extraordinarily wasteful. The reasons for this have taxed all of the contributors to this book. As we move into the 21st century it is sobering to reflect on the fact that we have failed to harness the power of the evolving revolution in molecular medical biology to answer the fundamental question: why is the fate of a fertilized egg so hazardous and so unsuccessful? The following account summarizes our limited knowledge of the epidemiology of miscarriage and then moves on to consider some of the medical causes of miscarriage. The contribution of genetic abnormalities to the problem of pregnancy wastage is discussed elsewhere in this volume.

Reid C E, M S O'Neill, et al. 2009. Mapping community determinants of heat vulnerability. Environmental Health Perspectives 117(11): 1730-6.

Backgrouund: The evidence that heat waves can result in both increased deaths and illness is substantial, and concern over this issue is rising because of climate change. Adverse health impacts from heat waves can be avoided, and epidemiologic studies have identified specific population and community characteristics that mark vulnerability to heat waves.

Objectives: We situated vulnerability to heat in geographic space and identified potential areas for intervention and further research.

Methods: We mapped and analyzed 10 vulnerability factors for heat-related morbidity/mortality in the United States: six demographic characteristics and two household air conditioning variables from the U.S. Census Bureau, vegetation cover from satellite images, and diabetes prevalence from a national survey. We performed a factor analysis of these 10 variables and assigned values of increasing vulnerability for the four resulting factors to each of 39,794 census tracts. We added the four factor scores to obtain a cumulative heat vulnerability index value.

Results: Four factors explained 75% of the total variance in the original 10 vulnerability variables: social/environmental vulnerability (combined education/poverty/race/green space), social isolation, air conditioning prevalence, and proportion elderly/diabetes. We found substantial spatial variability of heat vulnerability nationally, with generally higher vulnerability in the Northeast and Pacific Coast and the lowest in the Southeast. In urban areas, inner cities showed the highest vulnerability to heat.

Conclusions: These methods provide a template for making local and regional heat vulnerability maps. After validation using health outcome data, interventions can be targeted at the most vulnerable populations.

Remick R A. 2002. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ 167 (11): 1253-60.

No abstract provided

Richardson E A and R Mitchell. 2010. Gender differences in relationships between urban green space and health in the United Kingdom. Social Science & Medicine 71(3): 568-575.

Natural environments, or 'green spaces', have been associated with a wide range of health benefits. Gender differences in neighbourhood effects on health have been found in a number of studies, although these have not been explored in relation to green space. We conducted the first UK-wide study of the relationship between urban green space and health, and the first such study to investigate gender differences in this relationship. An ecological approach was used. Two land use datasets were used to create a proportional green space measure (% by area) at the UK Census Area Statistic ward scale. Our sample consisted of 6432 urban wards, with a total population of 28.6 million adults aged 16�64 years in 2001. We selected health outcomes that were plausibly related to green space (cardiovascular disease mortality, respiratory disease mortality and self-reported limiting long-term illness) and another that was expected to be unrelated (lung cancer mortality). Negative binomial regression models examined associations between urban green space and these health outcomes, after controlling for relevant confounders. Gender differences in these associations were observed and tested. Male cardiovascular disease and respiratory disease mortality rates decreased with increasing green space, but no significant associations were found for women. No protective associations were observed between green space and lung cancer mortality or self-reported limiting long-term illness for either men or women. Possible explanations for the observed gender differences in the green space and health relationship are gender differences in perceptions and usage of urban green spaces. We conclude that it is important not to assume uniform health benefits of urban green space for all population subgroups. Additionally, urban green space measures that capture quality as well as quantity could be more suited to studying green space and health relationships for women.

Richardson E A, J Pearce, et al. 2010. The association between green space and cause-specific mortality in urban New Zealand: an ecological analysis of green space utility. BMC Public Health (10).

BACKGROUND: There is mounting international evidence that exposure to green environments is associated with health benefits, including lower mortality rates. Consequently, it has been suggested that the uneven distribution of such environments may contribute to health inequalities. Possible causative mechanisms behind the green space and health relationship include the provision of physical activity opportunities, facilitation of social contact and the restorative effects of nature. In the New Zealand context we investigated whether there was a socioeconomic gradient in green space exposure and whether green space exposure was associated with cause-specific mortality (cardiovascular disease and lung cancer). We subsequently asked what is the mechanism(s) by which green space availability may influence mortality outcomes, by contrasting health associations for different types of green space.

METHODS: This was an observational study on a population of 1,546,405 living in 1009 small urban areas in New Zealand. A neighbourhood-level classification was developed to distinguish between usable (i.e., visitable) and non-usable green space (i.e., visible but not visitable) in the urban areas. Negative binomial regression models were fitted to examine the association between quartiles of area-level green space availability and risk of mortality from cardiovascular disease (n = 9,484; 1996 - 2005) and from lung cancer (n = 2,603; 1996 - 2005), after control for age, sex, socio-economic deprivation, smoking, air pollution and population density.

RESULTS: Deprived neighbourhoods were relatively disadvantaged in total green space availability (11% less total green space for a one standard deviation increase in NZDep2001 deprivation score, p < 0.001), but had marginally more usable green space (2% more for a one standard deviation increase in deprivation score, p = 0.002). No significant associations between usable or total green space and mortality were observed after adjustment for confounders.

CONCLUSION: Contrary to expectations we found no evidence that green space influenced cardiovascular disease mortality in New Zealand, suggesting that green space and health relationships may vary according to national, societal or environmental context. Hence we were unable to infer the mechanism in the relationship. Our inability to adjust for individual-level factors with a significant influence on cardiovascular disease and lung cancer mortality risk (e.g., diet and alcohol consumption) will have limited the ability of the analyses to detect green space effects, if present. Additionally, green space variation may have lesser relevance for health in New Zealand because green space is generally more abundant and there is less social and spatial variation in its availability than found in other contexts.

Richardson E A, R Mitchell, et al. 2012. Green cities and health: a question of scale? Journal of Epidemiology and Community Health 66(2): 160-165.

Background: Cities are expanding and accommodating an increasing proportion of the world's population. It is important to identify features of urban form that promote the health of city dwellers. Access to green space has been associated with health benefits at both individual and neighbourhood level. We investigated whether a relationship between green space coverage and selected mortality rates exists at the city level in the USA. Methods: An ecological cross-sectional study. A detailed land use data set was used to quantify green space for the largest US cities (n=49, combined population of 43 million). Linear regression models were used to examine the association between city-level 'greenness' and city-level standardised rates of mortality from heart disease, diabetes, lung cancer, motor vehicle fatalities and all causes, after adjustment for confounders. Results: There was no association between greenness and mortality from heart disease, diabetes, lung cancer or automobile accidents. Mortality from all causes was significantly higher in greener cities. Conclusions: While considerable evidence suggests that access to green space yields health benefits, we found no such evidence at the scale of the American city. In the USA, greener cities tend also to be more sprawling and have higher levels of car dependency. Any benefits that the green space might offer seem easily eclipsed by these other conditions and the lifestyles that accompany them. The result merits further investigation as it has important implications for how we increase green space access in our cities.

Ritz B, F Yu, et al 2002. Ambient air pollution and risk of birth defects in Southern California. American Journal of Epidemiology 155(1): 17-25.

The authors evaluated the effect of air pollution on the occurrence of birth defects ascertained by the California Birth Defects Monitoring Program in neonates and fetuses delivered in southern California in 1987�1993. By using measurements from ambient monitoring stations of carbon monoxide (CO), nitrogen dioxide, ozone, and particulate matter <10 ?m in aerodynamic diameter, they calculated average monthly exposure estimates for each pregnancy. Conventional, polytomous, and hierarchical logistic regression was used to estimate odds ratios for subgroups of cardiac and orofacial defects. Odds ratios for cardiac ventricular septal defects increased in a dose-response fashion with increasing second-month CO exposure (odds ratio (OR)2nd quartile CO = 1.62, 95% confidence interval (CI): 1.05, 2.48; OR3rd quartile CO = 2.09, 95% CI: 1.19, 3.67; OR4th quartile CO = 2.95, 95% CI: 1.44, 6.05). Similarly, risks for aortic artery and valve defects, pulmonary artery and valve anomalies, and conotruncal defects increased with second-month ozone exposure. The study was inconclusive for other air pollutants. The authors' results are supported by the specificity of the timing of the effect and some evidence from animal data; however, this is the first known study to link ambient air pollution during a vulnerable window of development to human malformations. Confirmation by further studies is needed.

Rodriguez D A, G-H Cho, et al. 2012. Out and about: Association of the built environment with physical activity behaviors of adolescent females. Health & Place 18(1): 55-62.

Locational data, logged on portable GPS units and matched with accelerometer data, was used to examine associations of the built environment with physical activity and sedentary behaviors of adolescent females. In a sample of 293 adolescent females aged 15 to 18 years old in Minneapolis and San Diego, the built environment around each GPS point and its corresponding sedentary, light, and moderate-to-vigorous intensity physical activity was examined using random intercept multinomial logistic regression models. The odds of higher physical activity intensity (3-level outcome: sedentary, light, MVPA) were higher in places with parks, schools, and high population density, during weekdays, and lower in places with more roads and food outlets. Understanding the places where physical activity and sedentary behaviors occur appears to be a promising strategy to clarify relationships and inform policy aimed at increasing physical activity and reducing sedentary behaviors.

Roe J and P Aspinall .2011. The restorative benefits of walking in urban and rural settings in adults with good and poor mental health. Health & Place 17(1): 103-113.

People differ in their potential for psychological restoration but there is little evidence on the role of varying mental health state or settings in the process. This paper reports two quasi-experiments which compare the restorative benefits of walking in urban and rural settings in two groups of adults with good and poor mental health. Two aspects of restoration are examined, firstly mood, the other using personal project techniques (Little, 1983) to capture an under-explored aspect of cognitive restoration through reflection on everyday life tasks. Results are consistent with a restorative effect of landscape: the rural walk was advantageous to affective and cognitive restoration in both health groups when compared to an urban walk. However, beneficial change took place to a greater extent in the poor health group. Differential outcomes between health groups were found in the urban setting, which was most advantageous to restoration in the poor mental health group. This study extends restorative environments research by showing that the amount of change and context for restoration can differ amongst adults with variable mental health.

Rowe D. 2011. Green roofs as a means of pollution abatement. Environmental Pollution 159(8-9): 2100-2110.

Green roofs involve growing vegetation on rooftops and are one tool that can help mitigate the negative effects of pollution. This review encompasses published research to date on how green roofs can help mitigate pollution, how green roof materials influence the magnitude of these benefits, and suggests future research directions. The discussion concentrates on how green roofs influence air pollution, carbon dioxide emissions, carbon sequestration, longevity of roofing membranes that result in fewer roofing materials in landfills, water quality of stormwater runoff, and noise pollution. Suggestions for future directions for research include plant selection, development of improved growing substrates, urban rooftop agriculture, water quality of runoff, supplemental irrigation, the use of grey water, air pollution, carbon sequestration, effects on human health, combining green roofs with complementary related technologies, and economics and policy issues.

Ryan R M, N Weinstein, et al. 2010. Vitalizing effects of being outdoors and in nature. Journal of Environmental Psychology 30(2): 159-68.

Five studies utilizing survey, experimental, and diary methods assessed the effects of being outdoors on subjective vitality. In Study 1, we used a vignette method to examine whether being outdoors was associated with vitality, above and beyond the influences of physical activity and social interactions. Study 2 explored the effects of being outdoors on vitality through an experimental design contrasting indoor and outdoor walks. In Study 3, participants were exposed to photographic scenes of either nature or buildings. Results showed that only the nature scenes enhanced subjective vitality. Studies 4 and 5 used a diary methodology to examine within-person variations in subjective energy as a function of being outdoors, again controlling for physical and social activity. Being outdoors was associated with greater vitality, a relation that was mediated by the presence of natural elements. Limitations of these studies are discussed, as well as their implications for research on energy and vitalization.


Sadock BJ, HI Kaplan & VA Sadock. 2007. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (10th ed.). Philadelphia, PA, Lippincott, Williams & Wilkins.

No abstract provided

Sanders R A. 1986. Urban vegetation impacts on the hydrology of Dayton, Ohio. Urban Ecology 9(3-4): 361-76.

Both the amount of stormwater runoff and its rate of discharge are greatly influenced by urban development. But one of the many benefits afforded by urban vegetation is its amelioration of extremes in urban runoff regimes. Using data for a 6-h, 1-year storm event on surface cover types for the city of Dayton, OH, the specific role of vegetation in lessening urban impacts on runoff is assessed. Estimates of runoff are obtained for 77 of Dayton's 79 neighborhoods for three scenarios: one for existing cover types (artificial surfaces, exposed soil, herbaceous cover, and tree canopy cover); one in which trees are hypothetically removed; and a third that places exposed soil in vegetation and increases tree canopy cover to achievably greater amounts. For this intensive storm in which the role of vegetation is less readily apparent than for gentler storms, existing tree canopies alone work to lower potential runoff by about 7%. This could be increased to nearly 12% by modestly increasing canopy coverage of the land surface. Effects on potential peak runoff rates are found throughout the city. Results suggest that when these hydrologic impacts are coupled with tree and other vegetation impacts in the city, a city can justify increasing attention to planning and managing its urban vegetation resource.

Samet J M, F Dominici, et al. 2000. Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994." The New England Journal of Medicine 343(24): 1742-9.

Background: Air pollution in cities has been linked to increased rates of mortality and morbidity in developed and developing countries. Although these findings have helped lead to a tightening of air-quality standards, their validity with respect to public health has been questioned.

Methods: We assessed the effects of five major outdoor-air pollutants on daily mortality rates in 20 of the largest cities and metropolitan areas in the United States from 1987 to 1994. The pollutants were particulate matter that is less than 10 um in aerodynamic diameter (PM 10), ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. We used a two-stage analytic approach that pooled data from multiple locations.

Results: After taking into account potential confounding by other pollutants, we found consistent evidence that the level of PM 10 is associated with the rate of death from all causes and from cardiovascular and respiratory illnesses. The estimated increase in the relative rate of death from all causes was 0.51 percent (95 percent posterior interval, 0.07 to 0.93 percent) for each increase in the PM 10 level of 10 ug per cubic meter. The estimated increase in the relative rate of death from cardiovascular and respiratory causes was 0.68 percent (95 percent posterior interval, 0.20 to 1.16 percent) for each increase in the PM 10 level of 10 ug per cubic meter. There was weaker evidence that increases in ozone levels increased the relative rates of death during the summer, when ozone levels are highest, but not during the winter. Levels of the other pollutants were not significantly related to the mortality rate.

Conclusions: There is consistent evidence that the levels of fine particulate matter in the air are associated with the risk of death from all causes and from cardiovascular and respiratory illnesses. These findings strengthen the rationale for controlling the levels of respirable particles in outdoor air.

Schoonover J, K Williard, J Zaczek, J Mangun & A Carver. 2005. Nutrient attenuation in agricultural surface runoff by riparian buffer zones in Southern Illinois, USA. Agroforestry Systems, 64(2), 169-180.

Nutrients in overland flow from agricultural areas are a common cause of stream and lake water quality impairment. One method of reducing excess nutrient runoff from non-point sources is to restore or enhance existing riparian areas as vegetative buffers. A field scale study was conducted to assess the ability of remnant giant cane (Arundinaria gigantea (Walt.) Muhl.) and forest riparian buffer zones to attenuate nutrients in agricultural surface runoff from natural precipitation events. Two adjacent, 10.0 m wide riparian buffers were instrumented with 16 overland flow collectors to monitor surface runoff for nitrate, ammonium, and orthophosphate. Measurements were taken at 3.3 m increments within each buffer. The forest buffer significantly reduced incoming dissolved nitrate-N, dissolved ammonium-N, total ammonium-N, and total orthophosphate masses in surface runoff by 97, 74, 68, and 78 , respectively within the 10.0 m riparian buffer. Nutrient reductions within the cane buffer were 100 for all three nutrients due to relatively high infiltration rates. Significant reductions of total ammonium- N and total orthophosphate were detected by 3.3 m in the cane buffer and at 6.6 m in the forest buffer. Results suggest that both giant cane and forest vegetation are good candidates to incorporate into riparian buffer restoration designs for southern Illinois as well as in other regions within their native range with similar climatic and physiographic conditions.

Schulz R & SKC Peall. 2000. Effectiveness of a constructed wetland for retention of nonpoint-source pesticide pollution in the Lourens River Catchment, South Africa. Environmental Science & Technology, 35(2), 422-426.

Constructed wetlands have been widely used to control both point- and nonpoint-source pollution in surface waters. However, our knowledge about their effectiveness in retaining agricultural pesticide pollution is limited. A 0.44-ha vegetated wetland built along a tributary of the Lourens River, Western Cape, South Africa, was studied to ascertain retention of runoff-related agricultural pollution. Total suspended solids, orthophosphate, and nitrate were retained in the wetland in the proportions 15, 54, and 70%, respectively, during dry weather conditions (with rainfall less than 2 mm/d) and 78, 75, and 84% during wet conditions (with rainfall between 2 and 35 mm/d). Retention of water-diluted azinphos-methyl introduced via runoff at a level of 0.85 �g/L was between 77 and 93%. Chlorpyrifos and endosulfan were measured during runoff in inlet water at 0.02 and 0.2 �g/L, respectively. However, both pesticides were undetectable in the outlet water samples. During a period of 5 months, an increased concentration of various insecticides was detected in the suspended particles at the wetland inlet:? azinphos-methyl, 43 �g/kg; chlorpyrifos, 31 �g/kg; and prothiofos, 6 �g/kg. No organophosphorus pesticides were found in the outlet suspended-particle samples, highlighting the retention capability of the wetland. A toxicological evaluation employing a Chironomus bioassay in situ at the wetland inlet and outlet revealed an 89% reduction in toxicity below the wetland during runoff.

Schwartz J. 1999. Air pollution and hospital admissions for heart disease in eight U.S. counties. Epidemiology 10(1): 17-22.

This study examines the consistency of the association between particulate matter less than 10 [mu]m in aerodynamic diameter (PM10), carbon monoxide (CO), and hospital admissions for cardiovascular disease across eight urban counties with different levels of correlation between pollutants and between the pollutants and weather. I fit Poisson regression models controlling for day-of-week effects and using nonparametric smoothing to control for season and weather. Daily variation in PM10 was associated with hospital admissions for heart disease in the elderly (2.48% increase, for an interquartile range increase in exposure; 95% confidence limits = 1.82%, 3.15%). Daily variation in CO was also associated with admissions (2.79% increase, for an interquartile range (1.75 parts per million) increase in exposure; 95% confidence limits = 1.89%, 3.68%). These associations held in both humid and dry locations and were independent of the correlation between the pollutants and weather or other pollutants. The effect size estimates for PM10 and CO likewise showed no association with their correlation in each location, as one would expect if one pollutant were merely a proxy for the other. The PM10 effects are consistent with recent animal data showing cardiovascular effects and with preliminary human data showing effects on heart rate variability and plasma viscosity. The CO results are consistent with literature on angina exacerbations.

Scott K, E McPherson, et al. 1998. Air pollutant uptake by Sacramento's urban forest. Journal of Arboriculture 24(4): 224 - 234.

No abstract provided

Seeland K, S Dubendorfer, et al. 2009. Making friends in Zurich's urban forests and parks: The role of public green space for social inclusion of youths from different cultures. Forest Policy and Economics 11(1): 10-17.

Integrating the distinct cultures of foreign resident youths is a challenge for Swiss political and educational institutions. An empirical survey of pupils (n = 437) and teachers in selected schools of the city and metropolitan area of Zurich investigated leisure activities in urban forests and public green spaces for their potential to facilitate social interaction between Swiss and immigrant young people. Patterns of socialising and making friends in these outdoor locations were found to differ depending on age, school level, gender and the percentage of immigrants in each residential area. Public urban green spaces were found to play an important role for children and youths in making contacts and friends across cultures, which is considered a prerequisite for social inclusion.

Seeman T E. 1996. Social ties and health: The benefits of social integration. Annals of epidemiology, 6(5): 442-451.

This article explores the relationship between level of social integration and various aspects of health. A search of the literature published since the mid-1970s (under the MEDLINE key words, �social ties�, �social network�, �social isolation�, �social environment�) presented strong evidence that social integration leads to reduced mortality risks, and to a better state of mental health. The evidence on physical health outcomes is less conclusive. There is no consistent evidence that social integration affects the incidence of disease (at least for cardiovascular outcomes). However, social integration does appear to have a highly beneficial effect on post-myocardial infarction prognosis (functioning and longevity). A physiologic basis for these effects on health outcomes is also indicated by research demonstrating that both social isolation and nonsupportive social interactions can result in lower immune function and higher neuroendocrine and cardiovascular activity while socially supportive interactions have the opposite effects. In conclusion, available data suggest that, although social integration is generally associated with better health outcomes, the quality of existing ties also appears to influence the extent of such health benefits. Clearly, individuals' networks of social relationships represent dynamic and complex social systems that affect health outcomes.

Segala C, B Fauroux, et al. 1998. Short-term effect of winter air pollution on respiratory health of asthmatic children in Paris. European Respiratory Journal 11(3): 677-85.

There is controversy as to whether low levels of air pollution affect the symptoms and lung function in asthma. We addressed this by examining the short-term effects of winter air pollution on childhood asthma in Paris. We performed a 6 month follow-up of 84 medically diagnosed asthmatic children classified into two groups of severity. The outcomes included incidence and prevalence of asthma attacks, symptoms and use of supplementary beta2-agonists, peak expiratory flow (PEF) value and its variability. The statistical analysis controlled the lack of independence between daily health outcomes, trends and meteorology. Air pollution was associated with an increase in reports and duration of asthma attacks and asthma-like symptoms in mild asthmatic children. The strongest association was the risk of asthma attack for an increase of 50 microg x m(-3) of sulphur dioxide (SO2) on the same day (odds ratio (OR)=2.86). Maximum reduction in morning peak expiratory flow (PEF) (5%) and maximum increase in PEF variability (2%) were observed at a lag of 3 days for an increase of 50 microg x m(-3) of SO2 in the subgroup of mild asthmatics receiving no regular inhaled medication. In moderate asthmatic children, the duration of supplementary beta2-agonist use was strongly associated with air pollution. The general pattern of our results provides evidence of the effect of the low levels of air pollution encountered in Western Europe on symptoms and lung function in childhood asthma.

Semenza JC, JE McCullough, et al. 1999. Excess hospital admissions during the July 1995 heat wave in Chicago. American Journal of Preventive Medicine 16(4): 269-77.

Introduction: This study describes medical conditions treated in all 47 non-VA hospitals in Cook County, IL during the 1995 heat wave. We characterize the underlying diseases of the susceptible population, with the goal of tailoring prevention efforts. Methods: Primary and secondary discharge diagnoses made during the heat wave and comparison periods were obtained from computerized inpatient hospital discharge data to determine reasons for hospitalization, and comorbid conditions, respectively. Results: During the week of the heat wave, there were 1072 (11%) more hospital admissions than average for comparison weeks and 838 (35%) more than expected among patients aged 65 years and older. The majority of this excess (59%) were treatments for dehydration, heat stroke, and heat exhaustion; with the exception of acute renal failure no other primary discharge diagnoses were significantly elevated. In contrast, analysis of comorbid conditions revealed 23% (p = 0.019) excess admissions of underlying cardiovascular diseases, 30% (p = 0.033) of diabetes, 52% (p = 0.011) of renal diseases, and 20% (p = 0.027) of nervous system disorders. Patient admissions for emphysema (p = 0.007) and epilepsy (p = 0.009) were also significantly elevated during the heat wave week. Conclusions: The majority of excess hospital admissions were due to dehydration, heat stroke, and heat exhaustion, among people with underlying medical conditions. Short-term public health interventions to reduce heat-related morbidity should be directed toward these individuals to assure access to air conditioning and adequate fluid intake. Long-term prevention efforts should aim to improve the general health condition of people at risk through, among other things, regular physician-approved exercise.

Seybold K S and P C Hill. 2001. The Role of Religion and Spirituality in Mental and Physical Health. Current Directions in Psychological Science 10(1): 21-24.

An increased interest in the effects of religion and spirituality on health is apparent in the psychological and medical literature. Although religion in particular was thought, in the past, to have a predominantly negative influence on health, recent research suggests this relationship is more complex. This article reviews the literature on the impact of religion and spirituality on physical and mental health, concluding that the influence is largely beneficial. Mechanisms for the positive effect of religion and spirituality are proposed.

Shapiro K, P A Conrad, et al. 2010. Effect of Estuarine Wetland Degradation on Transport of Toxoplasma gondii Surrogates from Land to Sea. Applied and Environmental Microbiology 76(20): 6821-6828.

The flux of terrestrially derived pathogens to coastal waters presents a significant health risk to marine wildlife, as well as to humans who utilize the nearshore for recreation and seafood harvest. Anthropogenic changes in natural habitats may result in increased transmission of zoonotic pathogens to coastal waters. The objective of our work was to evaluate how human-caused alterations of coastal landscapes in California affect the transport of Toxoplasma gondii to estuarine waters. Toxoplasma gondii is a protozoan parasite that is excreted in the feces of infected felids and is thought to reach coastal waters in contaminated runoff. This zoonotic pathogen causes waterborne toxoplasmosis in humans and is a significant cause of death in threatened California sea otters. Surrogate particles that mimic the behavior of T. gondii oocysts in water were released in transport studies to evaluate if the loss of estuarine wetlands is contributing to an increased flux of oocysts into coastal waters. Compared to vegetated sites, more surrogates were recovered from unvegetated mudflat habitats, which represent degraded wetlands. Specifically, in Elkhorn Slough, where a large proportion of otters are infected with T. gondii, erosion of 36% of vegetated wetlands to mudflats may increase the flux of oocysts by more than 2 orders of magnitude. Total degradation of wetlands may result in increased Toxoplasma transport of 6 orders of magnitude or more. Destruction of wetland habitats along central coastal California may thus facilitate pathogen pollution in coastal waters with detrimental health impacts to wildlife and humans.

Sheldon Cohen & Denise Janicki-Deverts. 2012. Who's Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009. Journal of Applied Social Psychology 42 (6): 1320 - 34.

Psychological stress was assessed in 3 national surveys administered in 1983, 2006, and 2009. In all 3 surveys, stress was higher among women than men; and increased with decreasing age, education, and income. Unemployed persons reported high levels of stress, while the retired reported low levels. All associations were independent of one another and of race/ethnicity. Although minorities generally reported more stress than Whites, these differences lost significance when adjusted for the other demographics. Stress increased little in response to the 2008-2009 economic downturn, except among middle-aged, college-educated White men with full-time employment. These data suggest greater stress-related health risks among women, younger adults, those of lower socioeconomic status, and men potentially subject to substantial losses of income and wealth.

Si W, W Ji, et al. 2011. The function of constructed wetland in reducing the risk of heavy metals on human health. Environmental Monitoring and Assessment 181(1): 531-537.

Irrigation with polluted water from the upper Yellow River (YR) channel of Northwest China has resulted in agricultural soil being contaminated by heavy metals (HMs). This causes major concerns due to the potential health risk to the residents in this area. The present study aims to assess the efficiency of constructed wetland (CW) in reducing the heavy metal contamination in irrigation water and food crops, thus in reduction of potential health risk to the residents. The associated risk was assessed using hazard quotient (HQ) and hazard index (HI). The results showed a potential health risk to inhabitants via consumption of wheat grain irrigated with untreated water from YR. However CW could greatly reduce the human health risk of HMs contamination to local residents through significantly decreasing the concentrations of HMs in wheat grain. In theory, the reduction rate of this risk reached 35.19% for different exposure populations. Therefore, CW can be used as a system to pre-treat irrigation water and protect the residents from the potential HMs toxicity.

Smith, L. M., J. L. Case, H. M. Smith, L. C. Harwell, and J. K. Summers. 2013. Relating ecosystem services to domains of human well-being: Foundation for a U.S. Index. Ecological Indicators 28:79-90.

No abstract provided

Solecki WD, C Rosenzweig, et al. 2005. Mitigation of the heat island effect in urban New Jersey. Global Environmental Change Part B: Environmental Hazards 6(1): 39-49.

Implementation of urban heat island (UHI) mitigation strategies such as increased vegetative cover and higher-albedo surface materials can reduce the impacts of biophysical hazards in cities, including heat stress related to elevated temperatures, air pollution and associated public health effects. Such strategies also can lower the demand for air-conditioning-related energy production. Since local impacts of global climate change may be intensified in areas with UHIs, mitigation strategies could play an increasingly important role as individuals and communities adapt to climate change. We use CITYgreen, a GIS-based modeling application, to estimate the potential benefits of urban vegetation and reflective roofs as UHI mitigation strategies for case study sites in and around Newark and Camden, New Jersey. The analysis showed that urban vegetation can reduce health hazards associated with the UHI effect by removing pollutants from the air. Less affluent, inner-city neighborhoods are the ones in which the hazard potential of the UHI effect is shown to be greatest. However, these neighborhoods have less available open space for tree planting and therefore a lower maximum potential benefit. As the climate warms, these neighborhoods may face greater consequences due to interactions between the UHI effect and global climate change. Results also show that urban vegetation is an effective and economically efficient way to reduce energy consumption and costs at the sites.

Stevenson B and J Wolfers. 2008. Happiness Inequality in the United States. NBER Working Paper Series, # 14220. Journal of Legal Studies, University of Chicago Press, vol. 37(S2), pages S33-S79, 06.

Stokes B. 2007. Happiness is increasing in many countries -- but why? Pew Research Center.

Sugiyama T, E Leslie, B Giles-Corti and N Owen. 2008. Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships? Journal of Epidemiology and Community Health, 62(5).

Background: Studies have shown associations between health indices and access to "green"� environments but the underlying mechanisms of this association are not clear.

Objectives: To examine associations of perceived neighbourhood "greenness" with perceived physical and mental health and to investigate whether walking and social factors account for the relationships.

Methods: A mailed survey collected the following data from adults (n ?=? 1895) in Adelaide, Australia: physical and mental health scores (12-item short-form health survey); perceived neighbourhood greenness; walking for recreation and for transport; social coherence; local social interaction and sociodemographic variables.

Results: After adjusting for sociodemographic variables, those who perceived their neighbourhood as highly green had 1.37 and 1.60 times higher odds of better physical and mental health, respectively, compared with those who perceived the lowest greenness. Perceived greenness was also correlated with recreational walking and social factors. When walking for recreation and social factors were added to the regression models, recreational walking was a significant predictor of physical health; however, the association between greenness and physical health became non-significant. Recreational walking and social coherence were associated with mental health and the relationship between greenness and mental health remained significant.

Conclusions: Perceived neighbourhood greenness was more strongly associated with mental health than it was with physical health. Recreational walking seemed to explain the link between greenness and physical health, whereas the relationship between greenness and mental health was only partly accounted for by recreational walking and social coherence. The restorative effects of natural environments may be involved in the residual association of this latter relationship.

Swinton S M, F Lupi, et al. 2007. Ecosystem services and agriculture: Cultivating agricultural ecosystems for diverse benefits. Ecological Economics 64(2): 245-252.

Crop and rangelands are over 25% of the Earth's land area, and they are expanding. Agricultural ecosystems rely on a suite of supporting ecosystem services to provide food, fiber and fuel as well as a range of accompanying but non-marketed ecosystem services (ES). Ecosystem services from agriculture include regulation of water and climate systems, aesthetic and cultural services, as well as enhanced supporting services (such as soil fertility). Many of these ES are appreciated by people, but they lack markets, so they lack the incentives for provision that come with prices. For public policy decisions to take them into account, non-market valuation techniques are needed, such as travel cost, contingent valuation, hedonic valuation, and cost-based or factor-income approaches. This article offers an overview of ES from agriculture and non-market valuation methods as it introduces the articles in this special section on �Ecosystem Services and Agriculture.� Understanding how ecological functions generate ES is fundamental to management, but so too is understanding how humans perceive and value those services. Research is required both to design cost-effective incentives to provide ES and to measure which kinds of ES could provide the greatest overall welfare benefits to society. Agricultural ecosystems offer newly recognized potential to deliver more diverse ecosystem services and mitigate the level of past ecosystem disservices. This special section of Ecological Economics conveys both how these are becoming possible and the challenges to science and public policy design of turning that potential into reality.

Syversen N. 2005. Effect and design of buffer zones in the Nordic climate: The influence of width, amount of surface runoff, seasonal variation and vegetation type on retention efficiency for nutrient and particle runoff. Ecological Engineering, 24(5), 483-490.

Loss of nutrients and sediments from agricultural runoff causes eutrophication in surface water. Vegetated buffer zones adjacent to a stream can effectively remove and retain nutrients and sediments. It is, therefore, important to study design criteria which optimise the effect of buffer zones (BZ). This paper describes the influence of four criteria: (i) buffer zone width, (ii) amount of surface runoff water entering the BZ, (iii) seasonal variation and (iv) vegetation type. These parameters were studied after simulated and natural runoff at four different sites in Southern Norway with cold temperate climate. Surface runoff was collected before entering and after passing the BZs. The simulation experiments were short-term experiments carried out over a few days in 1992 and 1993. In the natural runoff experiments, volume proportional mixed samples were collected after each runoff period during 1992-1999. The results show significantly higher removal efficiency (in %) from 10�m wide BZs compared to 5�m widths, however, the specific retention (per m2) is higher in 5�m BZ. Buffer zones can receive particle runoff over several days without a significant decrease in their removal level. Retention efficiency between summer and autumn varied depending on the measured parameter (phosphorus, particles and nitrogen), and there were no significant differences in removal efficiency between summer and winter. The results show no significant differences between forest buffer zones (FBZ) and grass buffer zones (GBZ) regarding their retention efficiency for nitrogen and phosphorus. There was significantly higher retention efficiency in FBZ for particles. Average removal efficiencies from both simulated and natural runoff experiments varied from 60-89%, 37-81% and 81-91% for phosphorus, nitrogen and particles, respectively.

Szyszkowicz M, GG Kaplan, et al. 2009. Emergency department visits for migraine and headache: a multi-city study. International Journal of Occupational Medicine and Environmental Health 22(3): 235-42.

Objectives: We set out to examine associations between ambient air pollution concentrations and emergency department (ED) visits for migraine/headache in a multi-city study. Materials and Methods: We designed a time-series study of 64 839 ED visits for migraine (ICD-9: 346) and of 68 495 ED visits for headache (ICD-9: 784) recorded at hospitals in five different cities in Canada. The data (days) were clustered according to the hierarchical structure (location, year, month, day of week). The generalised linear mixed models technique was applied to fit the logarithm of clustered daily counts of ED visits for migraine, and separately for headache, on the levels of air pollutants, after adjusting for meteorological conditions. The analysis was performed by sex (all, male, female) and for three different seasonal periods: whole (January�December), warm (April�September), and cold (October�March). Results: For female ED visits for migraine, positive associations were observed during the warm season for sulphur dioxide (SO2), and in the cold season for particulate matter (PM2.5) exposures lagged by 2-days. The percentage increase in daily visits was 4.0% (95% CI: 0.8-7.3) for SO2 mean level change of 4.6 ppb, and 4.6% (95% CI: 1.2,-8.1) for PM2.5 mean level change of 8.3 ?g/m3. For male ED visits for headache, the largest association was obtained during the warm season for nitrogen dioxide (NO2), which was 13.5% (95% CI: 6.7-20.7) for same day exposure. Conclusions: Our findings support the associations between air pollutants and the number of ED visits for headache.


Takano T, K Nakamura, M Watanabe. 2002. Urban residential environments and senior citizens' longevity in megacity areas: the importance of walkable green spaces. J Epidemiol Community Health (56): 913-8.

Study objectives: To study the association between greenery filled public areas that are nearby a residence and easy to walk in and the longevity of senior citizens in a densely populated, developed megacity.

Design: Cohort study.

Methods: The authors analysed the five year survival of 3144 people born in 1903, 1908, 1913, or 1918 who consented to a follow up survey from the records of registered Tokyo citizens in relation to baseline residential environment characteristics in 1992.

Main results: The survival of 2211 and the death of 897 (98.9% follow up) were confirmed. The probability of five year survival of the senior citizens studied increased in accordance with the space for taking a stroll near the residence (p<0.01), parks and tree lined streets near the residence (p<0.05), and their preference to continue to live in their current community (p<0.01). The principal component analysis from the baseline residential environment characteristics identified two environment related factors: the factor of walkable green streets and spaces near the residence and the factor of a positive attitude to a person's own community. After controlling the effects of the residents' age, sex, marital status, and socioeconomic status, the factor of walkable green streets and spaces near the residence showed significant predictive value for the survival of the urban senior citizens over the following five years (p<0.01).

Conclusions: Living in areas with walkable green spaces positively influenced the longevity of urban senior citizens independent of their age, sex, marital status, baseline functional status, and socioeconomic status. Greenery filled public areas that are nearby and easy to walk in should be further emphasised in urban planning for the development and re-development of densely populated areas in a megacity. Close collaboration should be undertaken among the health, construction, civil engineering, planning, and other concerned sectors in the context of the healthy urban policy, so as to promote the health of senior citizens.

Tan J, Y Zheng, et al. 20067 Heat wave impacts on mortality in Shanghai, 1998 and 2003. International Journal of Biometerology 51(3): 193-200.

A variety of research has linked extreme heat to heightened levels of daily mortality and, not surprisingly, heat waves both in 1998 and in 2003 all led to elevated mortality in Shanghai, China. While the heat waves in the two years were similar in meteorological character, elevated mortality was much more pronounced during the 1998 event, but it remains unclear why the human response was so varied. In order to explain the differences in human mortality between the two years' heat waves, and to better understand how heat impacts human health, we examine a wide range of meteorological, pollution, and social variables in Shanghai during the summers (15 June to 15 September) of 1998 and 2003. Thus, the goal of this study is to determine what was responsible for the varying human health response during the two heat events. A multivariate analysis is used to investigate the relationships between mortality and heat wave intensity, duration, and timing within the summer season, along with levels of air pollution. It was found that for heat waves in both summers, mortality was strongly associated with the duration of the heat wave. In addition, while slightly higher than average, the air pollution levels for the two heat waves were similar and cannot fully explain the observed differences in human mortality. Finally, since the meteorological conditions and pollution levels for the two heat waves were alike, we conclude that improvements in living conditions in Shanghai, such as increased use of air conditioning, larger living areas, and increased urban green space, along with higher levels of heat awareness and the implementation of a heat warning system, were responsible for the lower levels of human mortality in 2003 compared to 1998.

Teas J, T Hurley, et al. 2007. Walking outside improves mood for healthy menopausal women. Clinical Medicine: Oncology 1: 35-43.

Background: Exercise has been shown to decrease breast cancer risk and slow the progression of breast cancer. Physician recommendations and clinical research data most often are for gym-based exercise programs. However, the importance of exercise location on mood and stress hormones that may infl uence adherence to exercise has not been addressed.

Methods: Women first walked for an hour outdoors along a university path, and then a week later, for an hour indoors on a treadmill in a typical gym environment. Pre and post outdoor and indoor exercise moods (happy, pleased, sad, frustrated, worried, angry, delighted, and joy) were assessed by a 6 point Likert questionnaire, and saliva samples were collected for analysis of cortisol, and alpha amylase (a surrogate for serum norepinephrine).

Results: Nineteen healthy, non-smoking, postmenopausal women (average age 58 � 4) participated. Compared with scores after walking outdoors, walking indoors was associated with higher scores of worry (p = 0.02; mean difference 0.9; 95% CI (0.17, 1.6) and frustration (p = 0.03; mean difference 0.9; 95% CI (0.12, 1.6), and lower scores for feelings of being pleased (p = 0.03; mean difference -0.8; 95% CI: -1.7, 0.1) and delighted (p = 0.05; mean difference -0.9; 95% CI: -1.75, -0.02). Changes in salivary hormone levels did not vary signifi cantly between the two environments.

Conclusion: Walking outdoors was associated with improved mood, but walking indoors was not. Improved mood may reduce breast cancer risk indirectly by promoting regular exercise. Physician recommendations for exercise should include gym and non-gym based exercise options.

Tennessen C M & B Cimprich. 1995. Views to nature: Effects on attention. Journal of Environmental Psychology 15(1): 77-85.

This study is based on a theoretical view which suggests that under increased demands for attention, individuals' capacity to direct attention may become fatigued. Once fatigued, attentional restoration must occur in order to return to an effectively functioning state. An attention-restoring experience can be as simple as looking at nature. The purpose of this study was to explore whether university dormitory residents with more natural views from their windows would score better than those with less natural views on tests of directed attention. Views from dormitory windows of 72 undergraduate students were categorized into four groups ranging from all natural to all built. The capacity to direct attention was measured using a battery of objective and subjective measures. Natural views were associated with better performance on attentional measures, providing support for the proposed theoretical view.

Thompson Coon J, K Boddy, et al. 2011. Does Participating in Physical Activity in Outdoor Natural Environments Have a Greater Effect on Physical and Mental Wellbeing than Physical Activity Indoors? A Systematic Review. Environmental Science & Technology 45(5): 1761-1772.

Our objective was to compare the effects on mental and physical wellbeing, health related quality of life and long-term adherence to physical activity, of participation in physical activity in natural environments compared with physical activity indoors. We conducted a systematic review using the following data sources: Medline, Embase, Psychinfo, GreenFILE, SportDISCUS, The Cochrane Library, Science Citation Index Expanded, Social Sciences Citation Index, Arts and Humanities Citation Index, Conference Proceedings Citation Index ? Science and BIOSIS from inception to June 2010. Internet searches of relevant Web sites, hand searches of relevant journals, and the reference lists of included papers and other review papers identified in the search were also searched for relevant information. Controlled trials (randomized and nonrandomized) were included. To be eligible trials had to compare the effects of outdoor exercise initiatives with those conducted indoors and report on at least one physical or mental wellbeing outcome in adults or children. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Due to the heterogeneity of identified studies a narrative synthesis was performed. Eleven trials (833 adults) were included. Most participants (6 trials; 523 adults) were young students. Study entry criteria and methods were sparsely reported. All interventions consisted of a single episode of walking or running indoors with the same activity at a similar level conducted outdoors on a separate occasion. A total of 13 different outcome measures were used to evaluate the effects of exercise on mental wellbeing, and 4 outcome measures were used to assess attitude to exercise. Most trials (n = 9) showed some improvement in mental wellbeing on one or other of the outcome measures. Compared with exercising indoors, exercising in natural environments was associated with greater feelings of revitalization and positive engagement, decreases in tension, confusion, anger, and depression, and increased energy. However, the results suggested that feelings of calmness may be decreased following outdoor exercise. Participants reported greater enjoyment and satisfaction with outdoor activity and declared a greater intent to repeat the activity at a later date. None of the identified studies measured the effects of physical activity on physical wellbeing or the effect of natural environments on exercise adherence. The hypothesis that there are added beneficial effects to be gained from performing physical activity outdoors in natural environments is very appealing and has generated considerable interest. This review has shown some promising effects on self-reported mental wellbeing immediately following exercise in nature which are not seen following the same exercise indoors. However, the interpretation and extrapolation of these findings is hampered by the poor methodological quality of the available evidence and the heterogeneity of outcome measures employed. The review demonstrates the paucity of high quality evidence on which to base recommendations and reveals an undoubted need for further research in this area. Large, well designed, longer term trials in populations who might benefit most from the potential advantages of outdoor exercise are needed to fully elucidate the effects on mental and physical wellbeing. The influence of these effects on the sustainability of physical activity initiatives also awaits investigation.

Thorndike, Edward. 1900. "Mental fatigue. I." Psychological Review 7(5): 466-482.

This paper is intended to be the first of a series of reports of a study of the nature of mental fatigue, some of the conditions affecting it, and especially its phenomena in school life. I hope also to discuss the methods and results of the many workers in this field in the light of some of the conclusions apparently justified by this study. It seemed wise not to undertake any statistical investigation of fatigue in school children until the fact of mental fatigue had been carefully studied at some length in a few cases. The present section deals, therefore, entirely with the results attained by a study of subjects whose mental history during the experiments the investigator knew, whose method of work he could control and whose phenomena he could therefore interpret with some degree of assurance. It will also be wise to reserve any references to the work of others (of whom Professor Kraepelin is the most important) until these new data are presented. The present paper may best be introduced by a quotation from a preliminary notice printed in Science. "Mental fatigue may mean either the fact of incompetency to do certain mental work, or a feeling of incompetency which parallels the fact, or the feeling or feelings denoted by our common expressions mentally tired and mentally exhausted.

Timpone, R J. 1998. Ties that bind: Measurement, demographics, and social connectedness. Political Behavior, 20(1), 53-77.

In this article I develop a taxonomy of how demographic variables are used in political science models. The functions of demographics�for description, as controls in statistical models, or as proxies for external societal cleavages or underlying individual attributes�raise questions about validity and responsible usage. To illustrate the more general problem, the construct of social connectedness is examined in regard to its relationship with various demographic variables and its impact on voter turnout. Using data from the 1992 National Election Study, the analyses indicate that marital status, church attendance, owning a home, formal group membership, education, and income are all related to social connectedness, but the impact of education and income on electoral participation does not appear to be mediated by social connectedness. The results illustrate that careful consideration of measurement issues can clarify the relationships in our substantive models and that substantive models can illuminate measurement issues as well.

Tiwary A, Refi, J Colls. 2008. Collection of ambient particulate matter by porous vegetation barriers: sampling and characterization methods. Aerosol Science 39(1): 40-7.

Sampling and characterization methods for assessing the effect of vegetative barriers on particulate matter (PM10) concentrations and functional group composition were developed and applied in a case study. Ambient PM10 was concurrently sampled upwind and downwind of a hawthorn hedge at a rural location in the UK. Fourier transform infrared (FTIR) spectra of PM10 samples were collected to characterize the functional group composition. Absorbances associated with sulfate, nitrate, ammonium, aliphatic carbon-hydrogen, and carbonyl functional groups were observed in the FTIR spectra. Calculations with gravimetric measurements show that the hedge collects PM10 mass with a collection efficiency of 34% on average. FTIR results suggest that individual functional groups might exhibit different behavior in the hedge, but further method development and sampling is necessary to calculate functional group results with more confidence. Current results show the potential of using hedges to mitigate ambient concentrations of airborne PM10, and applying these methods to a more statistically robust sample size is anticipated to aid in elucidating physico-chemical mechanisms driving collection of PM10 by hedge elements.

Townsend M. 2006. Feel blue? Touch green! Participation in forest/woodland management as a treatment for depression. Urban Forestry & Urban Greening 5(3): 111-120.

Recent research by a team from Deakin University explored the health and wellbeing benefits of civic environmentalism - voluntary communal actions undertaken to promote ecosystem sustainability, typified by membership of a "friends of parks" group. The research confirmed what was known intuitively: that belonging to such a group and undertaking the activities associated with such a group exposes people not only to the benefits of the natural environment, but also to other people and to opportunities to make a contribution which is socially valued. On the basis of those findings, a pilot project involving intentional engagement of people suffering depression and related disorders in supported nature-based activities in a woodland environment is being implemented and evaluated. This article reports on that project and discusses the implications of its findings to date, and the findings of the three earlier projects, both for urban woodland/forest managers and for the health sector. As this contribution indicates, there appears to be potential for the use of civic environmentalism to promote health, wellbeing and social connectedness for individuals and the wider population, as well as for groups with identified health vulnerabilities. However, the realization of the benefits of such an approach will be dependent on co-operation between the environment and health sectors to create and promote opportunities for increased civic environmentalism, and to identify and address the barriers to their effective use.

Tudor-Locke C, MM Brashear, W Johnson, P Katzmarzyk. 2010. Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women. International Journal of Behavioral Nutrition and Physical Activity (7): 60, 1-11.

Background: The 2005-2006 National Health and Nutrition Examination Survey (NHANES) is used to describe an accelerometer-derived physical activity/inactivity profile in normal weight (BMI < 25 kg/m2), overweight (25 ? BMI < 30 kg/m2), and obese (BMI ? 30 kg/m2) U.S. adults.

Methods: We computed physical activity volume indicators (activity counts/day, uncensored and censored steps/day), rate indicators (e.g., steps/minute), time indicators (employing NHANES activity counts/minute cut points to infer time in non-wear, sedentary, low, light, moderate, and vigorous intensities), the number of breaks in sedentary time (occasions when activity counts rose from < 100 activity/counts in one minute to ? 100 activity counts in the subsequent minute), achievement of public health guidelines, and classification by step-defined physical activity levels. Data were examined for evidence of consistent and significant gradients across BMI-defined categories.

Results: In 2005-2006, U.S adults averaged 6,564 +- SE 107 censored steps/day, and after considering non-wear time, they spent approximately 56.8% of the rest of the waking day in sedentary time, 23.7% in low intensity, 16.7% in light intensity, 2.6% in moderate intensity, and 0.2% in vigorous intensity. Overall, approximately 3.2% of U.S. adults achieved public health guidelines. The normal weight category took 7,190 +- SE 157 steps/day, and spent 25.7 +- 0.9 minutes/day in moderate intensity and 7.3 +- 0.4 minutes/day in vigorous intensity physical activity. The corresponding numbers for the overweight category were 6,879 +- 140 steps/day, 25.3 +- 0.9 minutes/day, and 5.3 +- 0.5 minutes/day and for the obese category 5,784 +- 124 steps/day, 17.3 +- 0.7 minutes/day and 3.2 +- 0.4 minutes/day. Across BMI categories, increasing gradients and significant trends were apparent in males for sedentary time and decreasing gradients and significant trends were evident in time spent in light intensity, moderate intensity, and vigorous intensity. For females, there were only consistent gradients and significant trends apparent for decreasing amounts of time spent in moderate and vigorous intensity.

Conclusions: Simple indicators of physical activity volume (i.e., steps/day) and time in light, moderate or vigorous intensity physical activity differ across BMI categories for both sexes, suggesting that these should continue to be targets for surveillance.

Tzoulas K., K Korpela, et al. 2007. Promoting ecosystem and human health in urban areas using Green Infrastructure: A literature review. Landscape and Urban Planning 81(3): 167-178.

Europe is a highly urbanised continent. The consequent loss and degradation of urban and peri-urban green space could adversely affect ecosystems as well as human health and well-being. The aim of this paper is to formulate a conceptual framework of associations between urban green space, and ecosystem and human health. Through an interdisciplinary literature review the concepts of Green Infrastructure, ecosystem health, and human health and well-being are discussed. The possible contributions of urban and peri-urban green space systems, or Green Infrastructure, on both ecosystem and human health are critically reviewed. Finally, based on a synthesis of the literature a conceptual framework is presented. The proposed conceptual framework highlights many dynamic factors, and their complex interactions, affecting ecosystem health and human health in urban areas. This framework forms the context into which extant and new research can be placed. In this way it forms the basis for a new interdisciplinary research agenda.


Ulrich RS. 1981. Natural Versus Urban Scenes. Environment and Behavior 13(5): 523-56.

Subjects viewed sixty color slides of either (1) nature with water, (2) nature dominated by vegetation, or (3) urban environments without water or vegetation. The information rates of the three slide samples were equivalent. Measurements were taken of the effects of the slide presentations on alpha amplitude, heart rate, and emotional states. Results revealed several significant differences as a function of environment, which together indicate that the two categories of nature views had more positive influences on psychophysiological states than the urban scenes. Alpha was significantly higher during the vegetation as opposed to urban slides; similarly, alpha was higher on the average when subjects viewed water rather than urban content. There was also a consistent pattern for nature, especially water, to have more positive influences on emotional states. A salient finding was that water, and to a lesser extent vegetation views, held attention and interest more effectively than the urban scenes. Implications of the findings for theory development in environmental aesthetics are discussed.

Ulrich RS. 1984. View through a window may influence recovery from surgery. Science 224(4647): 420-421.

Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall.

Ulrich RS, RF Simons, et al. 1991. Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology 11(3): 201-30.

Different conceptual perspectives converge to predict that if individuals are stressed, an encounter with most unthreatening natural environments will have a stress reducing or restorative influence, whereas many urban environments will hamper recuperation. Hypotheses regarding emotional, attentional and physiological aspects of stress reducing influences of nature are derived from a psycho-evolutionary theory. To investigate these hypotheses, 120 subjects first viewed a stressful movie, and then were exposed to color/sound videotapes of one of six different natural and urban settings. Data concerning stress recovery during the environmental presentations were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure. Findings from the physiological and verbal measures converged to indicate that recovery was faster and more complete when subjects were exposed to natural rather than urban environments. The pattern of physiological findings raised the possibility that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement in responses to the urban settings. There were directional differences in cardiac responses to the natural vs urban settings, suggesting that attention/intake was higher during the natural exposures. However, both the stressor film and the nature settings elicited high levels of involuntary or automatic attention, which contradicts the notion that restorative influences of nature stem from involuntary attention or fascination. Findings were consistent with the predictions of the psycho-evolutionary theory that restorative influences of nature involve a shift towards a more positively-toned emotional state, positive changes in physiological activity levels, and that these changes are accompanied by sustained attention/intake. Content differences in terms of natural vs human-made properties appeared decisive in accounting for the differences in recuperation and perceptual intake.

U.S. Environmental Protection Agency. 1995. America's wetlands: Our vital link between land and water. Office of Water, Office of Wetlands, Oceans and Watersheds. EPA843-K-95-001.

No abstract provided.

US EPA - Cardiovascular Disease Prevalence and Mortality. Accessed February 2013.

US National Library of Medicine - Miscarriage. Accessed February 2013.

US National Library of Medicine - Preeclampsia. Accessed February 2013.

US National Library of Medicine - Stress. Accessed February 2013.

US National Library of Medicine - Thyroid Disease (Hypothyroidism). Accessed February 2013.

US National Library of Medicine - Urinary Tract Infection. Accessed February 2013.


Vandentorren S, P Bretin, et al. 2006. August 2003 heat wave in France: Risk factors for death of elderly people living at home. The European Journal of Public Health 16(6): 583-91.

The August 2003 heat wave in France resulted in many thousands of excess deaths particularly of elderly people. Individual and environmental risk factors for death among the community-dwelling elderly were identified. We conducted a case�control survey and defined cases as people aged 65 years and older who lived at home and died from August 8 through August 13 from causes other than accident, suicide, or surgical complications. Controls were matched with cases for age, sex, and residential area. Interviewers used questionnaires to collect data. Satellite pictures provided profiles of the heat island characteristics around the homes. Lack of mobility was a major risk factor along with some pre-existing medical conditions. Housing characteristics associated with death were lack of thermal insulation and sleeping on the top floor, right under the roof. The temperature around the building was a major risk factor. Behaviour such as dressing lightly and use of cooling techniques and devices were protective factors. These findings suggest people with pre-existing medical conditions were likely to be vulnerable during heat waves and need information on how to adjust daily routines to heat waves. In the long term, building insulation and urban planning must be adapted to provide protection from possible heat waves.

van den Berg A E, S L Koole, et al. 2003. Environmental preference and restoration: How are they related? Journal of Environmental Psychology 23(2): 135- 46.

Does the widely documented tendency to prefer natural over built environments owe to the perception of greater restorative potential in natural environments? In the present experimental study we tested the mediating role of restoration in environmental preferences. Participants viewed a frightening movie, and then were shown a video of either a natural or a built environment. We used two examples of each type of environment. Participants' mood ratings were assessed before and after they viewed the frightening movie, and again after viewing the environmental video. Participants also rated the beauty of the environment shown (to indicate preference) and performed a test of concentration after viewing the environmental video. The results indicate that participants perceived the natural environments as more beautiful than the built environments. In addition, viewing natural environments elicited greater improvement in mood and marginally better concentration than viewing built environments. Mediational analyses revealed that affective restoration accounted for a substantial proportion of the preference for the natural over the built environments. Together, these results help substantiate the adaptive function of people's environmental preferences.

van den Berg, A E, J Maas, et al. 2010. Green space as a buffer between stressful life events and health. Social Science & Medicine 70(8): 1203-1210.

This study investigates whether the presence of green space can attenuate negative health impacts of stressful life events. Individual-level data on health and socio-demographic characteristics were drawn from a representative two-stage sample of 4529 Dutch respondents to the second Dutch National Survey of General Practice (DNSGP-2), conducted in 2000-2002. Health measures included: (1) the number of health complaints in the last 14 days; (2) perceived mental health (measured by the GHQ-12); and (3) a single item measure of perceived general health ranging from "excellent" to "poor". Percentages of green space in a 1-km and 3-km radius around the home were derived from the 2001 National Land cover Classification database (LGN4). Data were analysed using multilevel regression analysis, with GP practices as the group-level units. All analyses were controlled for age, gender, income, education level, and level of urbanity. The results show that the relationships of stressful life events with number of health complaints and perceived general health were significantly moderated by amount of green space in a 3-km radius. Respondents with a high amount of green space in a 3-km radius were less affected by experiencing a stressful life event than respondents with a low amount of green space in this radius. The same pattern was observed for perceived mental health, although it was marginally significant. The moderating effects of green space were found only for green space within 3�km, and not for green space within 1�km of residents' homes, presumably because the 3-km indicator is more affected by the presence of larger areas of green space, that are supposed to sustain deeper forms of restoration. These results support the notion that green space can provide a buffer against the negative health impact of stressful life events.

van den Berg AE and CG van den Berg. 2011. A comparison of children with ADHD in a natural and built setting. Child: Care, Health and Development: 37(3): 430-9.

Background: A link has been suggested between children's disconnection from nature and the recent surge in childhood disorders such as Attention Deficit Hyperactivity Disorder (ADHD). Research on benefits of nature for healthy children provides some support for such a link. However, only a few studies have directly examined the influence of contact with nature on children with ADHD.

Aim: The aim of the present research was to gain more insight into the behaviour and emotional and cognitive functioning of children with ADHD in a natural and built setting.

Methods: Two groups of six children (age 9�17) who stayed at care farms for children with ADHD in the Netherlands were systematically observed, questioned, and tested during visits to a wooded area and a small town.

Results: Both groups performed better on a concentration task in the woods than in the town, despite the fact that all children visited the town after the woods and thus their scores in the town were possibly inflated by learning effects. However, the behaviour and emotional functioning in the two settings differed between the groups. One group of children liked the woods better than the town and displayed more positive behaviours and feelings in the natural environment. The other group of children liked the town equally well as the woods and displayed positive behaviours and feelings in both settings, although they showed somewhat more non-social, aggressive, inattentive, impulsive and hyperactive behaviour in the town than in the woods.

Conclusions: These results suggest that natural areas provide a consistent positive environment for children with ADHD. However, more research is needed to obtain a fuller understanding of the influences of the physical environment on children with ADHD.

van Dillen S M E, S de Vries, et al. 2011. Greenspace in urban neighbourhoods and residents' health: adding quality to quantity. Journal of Epidemiology and Community Health.

Background Previous research shows a positive link between the amount of green area in one's residential neighbourhood and self-reported health. However, little research has been done on the quality of the green area, as well as on quantity and quality of smaller natural elements in the streetscape. This study investigates the link between the objectively assessed quantity and quality of (1) green areas and (2) streetscape greenery on the one hand and three self-reported health indicators on the other.Methods 80 Dutch urban neighbourhoods were selected, varying in the amount of nearby green area per dwelling, as determined by Geographic Information System analysis. The quality of green areas, as well as the quantity and quality of streetscape greenery, was assessed by observers using an audit tool. Residents of each neighbourhood were asked to complete a questionnaire on their own health (N=1641). In multilevel regression analyses, we examined the relationship between greenspace indicators and three health indicators, controlling for socio-demographic and socioeconomic characteristics.Results Both indicators for the quantity of greenspace were positively related to all three health indicators. Quantity and quality indicators were substantially correlated in the case of streetscape greenery. Nevertheless, the quality indicators tended to have added predictive value for the health indicators, given that the quantity information was already included in the model.Conclusions The quantity and also the quality of greenspace in one's neighbourhood seem relevant with regard to health. Furthermore, streetscape greenery is at least as strongly related to self-reported health as green areas.

Vellidis G, R Lowrance, P Gay & R K Hubbard. 2003. Nutrient Transport in a Restored Riparian Wetland. J. Environ. Qual., 32(2), 711-726.

We determined the water quality effect of a restored forested riparian wetland adjacent to a manure application area and a heavily fertilized pasture in the Georgia Coastal Plain. The buffer system was managed based on USDA recommendations and averaged 38 m in width. Water quality and hydrology data were collected from 1991�1999. A nitrate plume in shallow ground water with concentrations exceeding 10 mg NO3�N L-1 moved into the restored forested riparian wetland. Along most of the plume front, concentrations were less than 4 mg NO3�N L-1 within 25 m. Two preferential flow paths associated with past hydrologic modifications to the site allowed the nitrate plume to progress further into the restored forested riparian wetland. Surface runoff total N, dissolved reactive phosphorus (DRP), and total P concentrations averaged 8.63 mg N L-1, 1.37 mg P L-1, and 1.48 mg P L-1 , respectively, at the field edge and were reduced to 4.18 mg N L-1, 0.31 mg P L-1, and 0.36 mg P L-1 , respectively, at the restored forested riparian wetland outlet. Water and nutrient mass balance showed that retention and removal rates for nitrogen species ranged from a high of 78% for nitrate to a low of 52% for ammonium. Retention rates for both DRP and total P were 66%. Most of the N retention and removal was accounted for by denitrification. Mean annual concentrations of total N and total P leaving the restored forested riparian wetland were 1.98 mg N L-1 and 0.24 mg P L-1, respectively.

Vidon PGF & AR Hill. 2004. Landscape controls on nitrate removal in stream riparian zones. Water Resour. Res., 40(3), W03201.

We examined how landscape hydrogeologic characteristics influence groundwater nitrate removal by eight stream riparian sites on glacial till and outwash landscapes in southern Ontario, Canada. During high water table periods in 2000–2002, mean NO3 −-N input concentrations from adjacent cropland to the riparian sites ranged from 0.15 to 44.7 mg L−1. Seven of the eight sites had a mean nitrate removal efficiency of >90%. This removal occurred within the first 15 m of the riparian zone at three sites with loamy sand and sandy loam soils overlying a shallow confining layer at 1–2 m. However, at four of five sites with more conductive sand and cobble sediments the width required for 90% nitrate removal varied from >25 m to a maximum of 176 m at a site with a confining layer at 6 m. Sites linked to an extensive thick (>6 m) upland aquifer with a slope gradient of >15% at the riparian perimeter had high nitrate inputs throughout the year and were large nitrate sinks. Sites with gentle topography (<4–5%) and <2 m of permeable sediments were minor nitrate sinks because of small nitrate inputs that were limited to the late autumn-spring period. A conceptual model linking landscape hydrogeologic characteristics to riparian zone nitrate removal capacity is developed to understand and predict the effectiveness of riparian buffers at the landscape scale.

Villanueva CM, G Durand, et al. 2005. Atrazine in municipal drinking water and risk of low birth weight, preterm delivery, and small-for-gestational-age status. Occupational and Environmental Medicine 62(6): 400-5.

Background: Atrazine is a herbicide used extensively worldwide. Bioassays have shown that it is embryotoxic and embryolethal. Evidence of adverse reproductive outcomes from exposure in the general population is sparse.Aims: To evaluate the association between atrazine levels in municipal drinking water and the following adverse reproductive outcomes: increased risk of preterm delivery, low birth weight (LBW), and small-for-gestational-age (SGA) status.

Methods: A total of 3510 births that took place from 1 October 1997, to 30 September 1998 were analysed. Atrazine measurements were available for 2661 samples from water treatment plants over the past decade. A seasonal pattern was identified, with atrazine peaking from May to September. The geometric mean of the atrazine level for this period was calculated for each water distribution unit and merged with the individual data by municipality of residence.

Results: Atrazine levels in water were not associated with an increased risk of LBW or SGA status and were slightly associated with prematurity. There was an increased risk of SGA status in cases in which the third trimester overlapped in whole or in part with the May–September period, compared with those in which the third trimester occurred totally from October to April (OR = 1.37, 95% CI 1.04 to 1.81). If the entire third trimester took place from May to September, the OR was 1.54 (95% CI 1.11 to 2.13).

Conclusions: Low levels of atrazine, a narrow exposure range, and limitations in the exposure assessment partly explain the lack of associations with atrazine. Findings point to the third trimester of pregnancy as the potential vulnerable period for an increased risk of SGA birth. Exposures other than atrazine and also seasonal factors may explain the increased risk.

Volker S and T Kistemann. 2011. The impact of blue space on human health and well-being - Salutogenetic health effects of inland surface waters: A review. International Journal of Hygiene and Environmental Health 214(6): 449-460.

Water is one of the most important physical, aesthetic landscape elements and possesses importance e.g. in environmental psychology, landscape design, and tourism research, but the relationship between water and health in current literature is only investigated in the field of environmental toxicology and microbiology, not explicitly in the research field of blue space and human well-being. Due to the lack of a systematic review of blue space and well-being in the various fields of research, the aim of this review is to provide a systematic, qualitative meta-analysis of existing studies that are relevant to this issue. Benefits for health and well-being clearly related to blue space can be identified with regard to perception and preference, landscape design, emotions, and restoration and recreation. Additionally, direct health benefits have already been stated. The studies included in the review are mostly experimental studies or cross-sectional surveys, focusing on students as the subject group. There is a need for more qualitative and multi-faceted, interdisciplinary studies, using triangulation as a method to achieve a resilient image of reality. A broader study design considering all age groups would contribute to identifying benefits for the whole of society. The inattentiveness to blue space makes it difficult to measure long-term effects of blue space on well-being. There is still little respect for water and health in planning issues, although salutogenetic health benefits can be identified. To close the gap regarding missing systematic concepts, a concept for assessing salutogenetic health effects in blue space is provided. Blue space is considered therein as a multi-dimensional term including four dimensions of appropriation, as well as at least five ontological dimensions of substantiality. The aim of the concept is to support researchers and practitioners analysing health effects in blue space.

Vries S d, R A Verheij, et al. 2003. Natural environments - healthy environments? An exploratory analysis of the relationship between greenspace and health. Environment and Planning A 35(10): 1717-1731.

Abstract. Are people living in greener areas healthier than people living in less green areas? This hypothesis was empirically tested by combining Dutch data on the self-reported health of over 10 000 people with land-use data on the amount of greenspace in their living environment. In the multilevel analysis we controlled for socioeconomic and demographic characteristics, as well as urbanity. Living in a green environment was positively related to all three available health indicators, even stronger than urbanity at the municipal level. Analyses on subgroups showed that the relationship between greenspace and one of the health indicators was somewhat stronger for housewives and the elderly, two groups that are assumed to be more dependent on, and therefore exposed to, the local environ- ment. Furthermore, for all three health indicators the relationship with greenspace was somewhat stronger for lower educated people. Implications for policymaking and spatial planning are discussed briefly.

Vymazal J A N. 2005. Removal of Enteric Bacteria in Constructed Treatment Wetlands with Emergent Macrophytes: A Review. Journal of Environmental Science and Health, Part A 40(6-7): 1355-1367.

Abstract Domestic and municipal sewage contains various pathogenic or potentially pathogenic microorganisms which, depending on species concentration, pose a potential risk to human health and whose presence must therefore be reduced in the course of wastewater treatment. The removal of microbiological pollution is seldom a primary target for constructed treatment wetlands (CWs). However, wetlands are known to act as excellent biofilters through a complex of physical, chemical and biological factors which all participate in the reduction of the number of bacteria. Measurement of human pathogenic organisms in untreated and treated wastewater is expensive and technically challenging. Consequently, environmental engineers have sought indicator organisms that are (1) easy to monitor and (2) correlate with population of pathogenic organisms. The most frequently used indicators are total coliforms, fecal coliforms, fecal streptococci and Escherichia coli. The literature survey of 60 constructed wetlands with emergent vegetation around the world revealed that removal of total and fecal coliforms in constructed wetlands with emergent macrophytes is high, usually 95 to > 99% while removal of fecal streptococci is lower, usually 80?95%. Because bacterial removal efficiency is a function of inflow bacteria number, the high removal effects are achieved for untreated or mechanically pretreated wastewater. Therefore, the outflow numbers of bacteria are more important. For TC and FC the outflow concentrations are usually in the range of 102 to 105 CFU/ 100 ml while for FS the range is between 102 and 104 CFU/ 100 ml. Results from operating systems suggest that enteric microbe removal efficiency in CWs with emergent macrophytes is primarily influenced by hydraulic loading rate (HLR) and the resultant hydraulic residence time (HRT) and the presence of vegetation. Removal of enteric bacteria follows approximately a first-order relationship.


Wade TJ, SK Sandhu, et al. 2004. Did a severe flood in the Midwest cause an increase in the incidence of gastrointestinal symptoms? American Journal of Epidemiology 159(4): 398-405.

Severe flooding occurred in the midwestern United States in 2001. Since November 2000, coincidentally, data on gastrointestinal symptoms had been collected for a drinking water intervention study in a community along the Mississippi River that was affected by the flood. After the flood had subsided, the authors asked these subjects (n = 1,110) about their contact with floodwater. The objectives of this investigation were to determine whether rates of gastrointestinal illness were elevated during the flood and whether contact with floodwater was associated with increased risk of gastrointestinal illness. An increase in the incidence of gastrointestinal symptoms during the flood was observed (incidence rate ratio = 1.29, 95% confidence interval: 1.06, 1.58), and this effect was pronounced among persons with potential sensitivity to infectious gastrointestinal illness. Tap water consumption was not related to gastrointestinal symptoms before, during, or after the flood. An association between gastrointestinal symptoms and contact with floodwater was also observed, and this effect was pronounced in children. This appears to be the first report of an increase in endemic gastrointestinal symptoms in a longitudinal cohort prospectively observed during a flood. These findings suggest that severe climatic events can result in an increase in the endemic incidence of gastrointestinal symptoms in the United States.

Walters S, RK Griffiths, JG Ayres. 1994. Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke. Thorax 49(2): 133-40.

BACKGROUND--A study was performed to determine whether daily and weekly variations in the levels of smoke and sulphur dioxide (SO2) in Birmingham are related to hospital admissions for asthma and acute respiratory diseases.

METHODS--Daily numbers of hospital admissions for asthma (ICD code 493) and acute respiratory conditions (ICD 466, 480-486, 490-496) for residents of Birmingham between 1988 and 1990 were obtained from West Midlands RHA Krner inpatient data. Average daily levels of sulphur dioxide and smoke were obtained from Birmingham City Council for the same period, together with daily meteorological summaries from the Department of Geography, University of Birmingham. With the exception of one day, all air pollution measurements remained within current EC guide levels. Data were divided into seasons and the relation between hospital admissions and pollutant levels were explored by stepwise least squares regression models. Meteorological variables (temperature, pressure, humidity) were entered into the model if they showed significant association with hospital admissions during the season in question. Analysis was undertaken for daily (same day and lagged by two days) and weekly pollutant levels. Admissions were lagged behind pollution levels to allow for delayed effects of pollutants.

RESULTS--The mean daily level of smoke was 12.7 micrograms/m3 and of SO2 was 39.1 micrograms/m3, with maxima of 188.3 micrograms/m3 and 126.3 micrograms/m3, respectively. Significant associations were found between hospital admissions for respiratory disease lagged by two days, and smoke and SO2 levels during winter. Associations between admissions for asthma and smoke and SO2 levels were significant at the 5% level. These were independent of temperature, pressure, and humidity. Stepwise regression including both pollutants showed that smoke, but not SO2, was a significant independent predictor of hospital admissions for both asthma and all respiratory conditions. During winter a rise of 100 micrograms/m3 smoke might result in five (95% CI 0.6 to 9) more asthma admissions and 21.5 (95% CI 10 to 33) more acute respiratory admissions each day in Birmingham. A 100 micrograms/m3 rise in SO2 might result in four (0 to 7) more asthma admissions and 15.5 (6 to 25) more respiratory admissions each day. Independent associations were also found between weekly mean smoke and SO2 levels and all respiratory admissions during autumn and winter. During summer, daily mean smoke and SO2 levels were significantly associated with non-lagged daily admissions for all respiratory diseases (p < 0.02). There was no association between air pollution and hospital admissions during spring.

CONCLUSIONS--Daily variations in smoke and SO2 levels are significantly associated with hospital admissions for asthma and respiratory disease during winter in Birmingham at levels of air pollutants within the EC guide levels. This association was independent of potential confounding effects of weather (temperature, pressure, humidity) and suggests that current levels of air pollution can still produce significant health effects.

Wang T-N, Y-C Ko, et al. 1999. Association between indoor and outdoor air pollution and adolescent asthma from 1995 to 1996 in Taiwan. Environmental Research 81(3): 239-47.

The study aim was to estimate the contribution of indoor and outdoor air pollution to the 1-year prevalence of adolescent asthma after personal susceptibility and other potential risk factors were taken into account. A large-scaled cross-sectional study was conducted among 165,173 high school students aged 11 to 16 years in the different communities of Kaohsiung and Pintong in Taiwan, from October 1995 to June 1996. Each student and his/her parents participating in the study completed a video and a written International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire about symptoms of wheezing and allergies, passive smoking, and demographic variables. After adjustment for potential confounders, adolescents exposed to cigarette smoking (odds ratio=1.29, 95% confidence interval (CI), 1.171.42) and environmental tobacco smoke (odds ratio=1.08, 95% CI, 1.051.12) were found to suffer from asthma at an increased frequency. We observed a statistically significant association between outdoor air pollution and asthma, after controlling for potential confound variables. Total suspended particulate, nitrogen dioxide, carbon monoxide, ozone, and airborne dust particles all displayed an independent association with asthma, respectively. There were no selection biases in this community-based study, which provides evidence that passive smoking and long-term, high average outdoor air pollution are independent risk factors of asthma.

Ward MH, BA Kilfoy, et al. 2010. Nitrate intake and the risk of thyroid cancer and thyroid disease.Epidemiology 21(3): 389-95.

Background: Nitrate is a contaminant of drinking water in agricultural areas and is found at high levels in some vegetables. Nitrate competes with uptake of iodide by the thyroid, thus potentially affecting thyroid function.

Methods: We investigated the association of nitrate intake from public water supplies and diet with the risk of thyroid cancer and self-reported hypothyroidism and hyperthyroidism in a cohort of 21,977 older women in Iowa who were enrolled in 1986 and who had used the same water supply for >10 years. We estimated nitrate ingestion from drinking water using a public database of nitrate measurements (1955-1988). Dietary nitrate intake was estimated using a food frequency questionnaire and levels from the published literature. Cancer incidence was determined through 2004.

Results: We found an increased risk of thyroid cancer with higher average nitrate levels in public water supplies and with longer consumption of water exceeding 5 mg/L nitrate-N (for >= 5 years at >5 mg/L, relative risk [RR] = 2.6 [95% confidence interval (CI) = 1.1-6.2]). We observed no association with prevalence of hypothyroidism or hyperthyroidism. Increasing intake of dietary nitrate was associated with an increased risk of thyroid cancer (highest vs. lowest quartile, RR = 2.9 [1.0-8.1]; P for trend = 0.046) and with the prevalence of hypothyroidism (odds ratio = 1.2 [95% CI = 1.1-1.4]), but not hyperthyroidism.

Conclusions: Nitrate may play a role in the etiology of thyroid cancer and warrants further study.

Ward Thompson C, J Roe, et al. 2012. More green space is linked to less stress in deprived communities: Evidence from salivary cortisol patterns. Landscape and Urban Planning, Volume 105, Issue 3, 15 April 2012, Pages 221-229.

This paper traces evidence of the influence of the landscape on people's health, from ancient times to the present day, noting how access to nature and attractive green spaces has been a recurring theme in descriptions of therapeutic environments and associated healthy lifestyles. It describes how the theme of health in the picturesque debates of eighteenth century England (including such concepts as �active curiosity�) was taken up and developed in arguments for the nineteenth century urban park movement in England and North America. Recent theories on the mechanisms behind health benefits of nature and access to landscape are compared with claims made in the nineteenth century and earlier. The importance of access to the landscape appears to be as relevant as ever in the context of modern urban lifestyles but the need for better evidence and understanding remains.

WebMD: Anxiety and Panic Disorders Health Center - Causes of Mental Illness. Accessed February 2013.

WebMD: Digestive Disorders Health Center - Gastroenteritis. Accessed February 2013.

Wells N M. 2000. At Home with Nature. Environment and Behavior 32(6): 775-795.

The nearby natural environment plays a far more significant role in the well-being of children residing in poor urban environments than has previously been recognized. Using a premove/postmove longitudinal design, this research rules out the effects of various extraneous variables that have plagued previous studies and explores the linkage between the naturalness or restorativeness of the home environment and the cognitive functioning of low-income urban children. Both before and after relocation, objective measures of naturalness are employed along with a standardized instrument measuring the children�s cognitive functioning. Results indicate that children whose homes improved the most in terms of greenness following relocation also tended to have the highest levels of cognitive functioning following the move. The implications with respect to policy and design are also discussed.

Wells N M and G W Evans. 2003. Nearby Nature: A Buffer of Life Stress among Rural Children. Environment and Behavior 35(3): 311- 30.

Identifying mechanisms that buffer children from life's stress and adversity is an important empirical and practical concern. This study focuses on nature as a buffer of life stress among rural children. To examine whether vegetation near the residential environment might buffer or moderate the impact of stressful life events on children's psychological well-being, data were collected from 337 rural children in Grades 3 through 5 (mean age=9.2 years). Dependent variables include a standard parent-reported measure of children's psychological distress and children's own ratings of global self-worth. In a rural setting, levels of nearby nature moderate the impact of stressful life events on the psychological well-being of children. Specifically, the impact of life stress was lower among children with high levels of nearby nature than among those with little nearby nature. Implications of these finding are discussed with respect to our understanding of resilience and protective mechanisms.

Welsch H. 2006. Environment and happiness: Valuation of air pollution using life satisfaction data. Ecological Economics 58(4): 801-13.

This paper explores the relationship between pollution and reported subjective well-being (happiness) in ten European countries. Using a set of panel data from happiness surveys, jointly with data on income and air pollution, it examines how self-reported well-being varies with prosperity and environmental conditions and calculates the implied valuation of changes in air pollution. The paper finds that air pollution plays a statistically significant role as a predictor of inter-country and inter-temporal differences in subjective well-being. The effect of air pollution on well-being translates into a considerable monetary value of improved air quality. The improvements achieved in Western Europe in the 1990s are valued at about $750 per capita per year in the case of nitrogen dioxide and about $1400 per capita per year in the case of lead. Due to synergies among the pollutants, the value of simultaneously reducing nitrogen dioxide and lead is slightly higher than the sum of these values.

Wendel-vos GCW, AJ Schuit, et al. 2004. Factors of the physical environment associated with walking and bicycling. Med. Sci. Sports Exerc., 36(4), 725-30.

Purpose: The purpose of this study was to identify factors of the physical environment that may influence time spent on walking and bicycling.

Methods: Demographic factors and time spent on walking and bicycling (during leisure time and for commuting purposes) were assessed with a self-administered questionnaire. GIS databases were used to objectively measure the total square area of green space and recreational space (woods, parks, sport grounds, allotments for vegetable gardens, and grounds for day trips) in a circle around the postal code of a respondent with a radius of 300 and 500 m. Multilevel regression analysis was used to study the association between walking and bicycling on the one hand, and green and recreational space on the other hand. Analyses were adjusted for gender, age, and educational level.

Results: In a neighborhood defined as a circle with a 300-m radius, the square area of sport grounds was associated with bicycling in general and the square area of parks was associated with bicycling for commuting purposes. It is, however, very likely that these results reflect the association of living in the outskirts of town and time spent on bicycling.

Conclusion: The present study showed green and recreational space, specifically sport grounds and parks, to be associated with time spent on bicycling.

West S T, K A Shores, et al. 2012. Association of Available Parkland, Physical Activity, and Overweight in America's Largest Cities. Journal of Public Health Management and Practice 18(5): 423- 30 .

Objective: To examine associations between the densities of available parkland, parkland provided per capita, and levels of physical activity (PA) and overweight in urban United States.

Design: Cross-sectional correlation research using data drawn from the Trust for Public Land's 2010 City Park Facts and The Behavioral Risk Factor Surveillance System (BRFSS). City Park Facts is a report containing "basic information on urban park systems-from acreage, to facilities, to staffing, to budgets, to usership, and more" for America's 85 largest cities. The Behavioral Risk Factor Surveillance System is a state-based surveillance system that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury.

Setting: Sixty-seven metropolitan statistical areas in the United States that provided data for both reports.

Participants: Randomly selected adults aged 18 years and older who participated in the 2009 Behavioral Risk Factor Surveillance Survey in the 67 metropolitan statistical areas.

Main Outcome Measure(s): Total parkland per acre of metropolitan area was correlated to inactivity, engaging in recommended levels of moderate or vigorous PA, engaging in recommended levels of vigorous PA, and body weight. Parkland acreage per 1000 residents was correlated to these same variables. Multilevel models considered these relationships while controlling for race, family income, and age of respondents and accounting for clustering by metropolitan statistical area.

Results: There were significant, positive correlations between park density and PA (rs = 0.37, n = 67, P < .01) and between park density and exercise (rs = 0.35, n = 67, P < .01), and a negative correlation between park density and being above normal weight (rs = ?0.32, n = 67, P < .01). Adjusted multilevel models showed that parkland density in the highest versus lowest quartile was associated with significantly higher odds of meeting PA guidelines (aOR = 1.19, 95% CI: 1.08�1.30) and reduced odds of being overweight/obese (aOR = 0.85, 95% CI: 0.76�0.95).

Conclusions: Each of these findings substantiates the need for providing parkland in a community. As such, this research helps to support the notion that the development of a strong park system may lead to positive PA and health outcomes for that community.

Wetter AC, JP Goldberg, et al. 2001. How and why do individuals make food and physical activity choices? Nutrition Reviews 59(3): S11-S20

No abstract provided

Weuve J, JH Kang, et al. 2004. Physical activity, including walking, and cognitive function in older women. The Journal of the American Medical Association 292(12): 1454-61.

Context: Physical activity may help maintain cognitive function in older adults.

Objective: To examine the relation of long-term regular physical activity, including walking, to cognitive function.

Design: Women reported participation in leisure-time physical activities on biennial mailed questionnaires beginning in 1986. We assessed long-term activity by averaging energy expenditures from questionnaires in 1986 through participants' baseline cognitive assessments (1995 to 2001). We used linear regression to estimate adjusted mean differences in baseline cognitive performance and cognitive decline over 2 years, across levels of physical activity and walking.

Setting and Participants: Nurses' Health Study, including 18�766 US women aged 70 to 81 years.

Main Outcome Measure: Validated telephone assessments of cognition administered twice approximately 2 years apart (1995 to 2001 and 1997 to 2003), including tests of general cognition, verbal memory, category fluency, and attention.

Results: Higher levels of activity were associated with better cognitive performance. On a global score combining results of all 6 tests, women in the second through fifth quintiles of energy expenditure scored an average of 0.06, 0.06, 0.09, and 0.10 standard units higher than women in the lowest quintile (P for trend <.001). Compared with women in the lowest physical activity quintile, we found a 20% lower risk of cognitive impairment for women in the highest quintile of activity. Among women performing the equivalent of walking at an easy pace for at least 1.5 h/wk, mean global scores were 0.06 to 0.07 units higher compared with walking less than 40 min/wk (P?.003). We also observed less cognitive decline among women who were more active, especially those in the 2 highest quintiles of energy expenditure. Women in the fourth and fifth quintiles had mean changes in global scores that were 0.04 (95% confidence interval, 0.02-0.10) and 0.06 (95% confidence interval, 0.02-0.11) standard units better than those in the lowest quintile.

Conclusion: Long-term regular physical activity, including walking, is associated with significantly better cognitive function and less cognitive decline in older women.

Weyer PJ, JR Cerhan, et al. 2001. Municipal drinking water nitrate level and cancer risk in older women: The Iowa Women's Health Study. Epidemiology 11(3): 327-38.

Nitrate contamination of drinking water may increase cancer risk, because nitrate is endogenously reduced to nitrite and subsequent nitrosation reactions give rise to N-nitroso compounds; these compounds are highly carcinogenic and can act systemically. We analyzed cancer incidence in a cohort of 21,977 Iowa women who were 55-69 years of age at baseline in 1986 and had used the same water supply more than 10 years (87% >20 years); 16,541 of these women were on a municipal supply, and the remainder used a private well. We assessed nitrate exposure from 1955 through 1988 using public databases for municipal water supplies in Iowa (quartile cutpoints: 0.36, 1.01, and 2.46 mg per liter nitrate-nitrogen). As no individual water consumption data were available, we assigned each woman an average level of exposure calculated on a community basis; no nitrate data were available for women using private wells. Cancer incidence (N = 3,150 cases) from 1986 through 1998 was determined by linkage to the Iowa Cancer Registry. For all cancers, there was no association with increasing nitrate in drinking water, nor were there clear and consistent associations for non-Hodgkin lymphoma; leukemia; melanoma; or cancers of the colon, breast, lung, pancreas, or kidney. There were positive associations for bladder cancer [relative risks (RRs) across nitrate quartiles = 1, 1.69, 1.10, and 2.83] and ovarian cancer (RR = 1, 1.52, 1.81, and 1.84), and inverse associations for uterine cancer (RR = 1, 0.86, 0.86, and 0.55) and rectal cancer (RR = 1, 0.72, 0.95, and 0.47) after adjustment for a variety of cancer risk/protective factors, agents that affect nitrosation (smoking, vitamin C, and vitamin E intake), dietary nitrate, and water source. Similar results were obtained when analyses were restricted to nitrate level in drinking water from 1955 through 1964. The positive association for bladder cancer is consistent with some previous data; the associations for ovarian, uterine, and rectal cancer were unexpected.

Whitman S, G Good, et al. 1997. Mortality in Chicago attributed to the July 1995 heat wave."American Journal of Public Health 87(9): 1515-18.

OBJECTIVES: This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS: Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS: In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS: The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.

WHO - Cardiovascular Diseases (CVDs). Accessed February 2013.

WHO - Chronic Obstructive Pulmonary Disease (COPD). Accessed February 2013.

WHO- Longevity. Life Expectancy at Birth. Accessed September 2011.

WHO - Low Birth Weight. Feto-maternal nutrition and low birth weight. Accessed February 2013.

WHO - Mental Health. 2001. The World Health Report: 2001. Mental Health: New Understanding, New Hope. CH 2 - Burden of Mental and Behavioural Disorders.

WHO - Obesity and Overweight. Accessed February 2013.

WHO - Respiratory Symptoms. Accessed February 2013.

Whooley MA and GE Simon. 2000. Managing depression in medical outpatients. New England Journal of Medicine 343(26): 1942-50.

No abstract provided

Wilson, EO, 1984. Biophilia. Cambridge, MA: Harvard University Press.

No abstract provided

Wolch J, M Jerrett, et al. 2011. Childhood obesity and proximity to urban parks and recreational resources: A longitudinal cohort study. Health & Place 17(1): 207-214.

The objective of the research was to assess how proximity to parks and recreational resources affects the development of childhood obesity through a longitudinal study. Data were collected on 3173 children aged 9-10 from 12 communities in Southern California in 1993 and 1996. Children were followed for eight years to collect longitudinal information, including objectively measured body mass index (BMI). Multilevel growth curve models were used to assess associations between attained BMI growth at age 18 and numerous environmental variables, including park space and recreational program access. For park acres within a 500 m distance of children's homes, there were significant inverse associations with attained BMI at age 18. Effect sizes were larger for boys than for girls. Recreation programs within a 10 km buffer of children's homes were significantly and inversely associated with achieved levels in BMI at age 18, with effect sizes for boys also larger than those for girls. We conclude that children with better access to parks and recreational resources are less likely to experience significant increases in attained BMI.


Xiong J, G Guo, Q Mahmood & M Yue. 2011. Nitrogen removal from secondary effluent by using integrated constructed wetland system. Ecological Engineering, 37(4), 659-662.

The treatment capacity of an integrated constructed wetland system (CWS) that was designed to reduce nitrogen (N) from secondary effluent was explored. The integrated CWS consisted of vertical-flow constructed wetland, floating bed and sand filter. The vertical-flow wetland was filled with gravel, steel slag and peat from the bottom to the top. Vetiver zizanioides was selected to grow in the vertical-flow constructed wetland and Coix lacrymajobi L. was grown in the floating bed. The results showed that the integrated CWS displayed superior removal efficiency for nitrate nitrogen (NO3--N), ammonia nitrogen (NH4+-N), nitrite nitrogen (NO2--N), and total nitrogen (TN). The average NO3--N, NO2--N, NH4+-N and TN removal efficiencies of the integrated CWS were 98.83%, 95.60%, 98.05% and 92.41%, respectively, during the whole experimental operation. The integrated CWS may have a good potential for removing N from secondary effluent.


Yang, J,Q Yu, P Gong. 2008. Quantifying air pollution removal by green roofs in Chicago. Atmospheric Environment 42(31): 7266-7273.

The level of air pollution removal by green roofs in Chicago was quantified using a dry deposition model. The result showed that a total of 1675 kg of air pollutants was removed by 19.8 ha of green roofs in one year with O3 accounting for 52% of the total, NO2 (27%), PM10 (14%), and SO2 (7%). The highest level of air pollution removal occurred in May and the lowest in February. The annual removal per hectare of green roof was 85 kg ha?1 yr?1. The amount of pollutants removed would increase to 2046.89 metric tons if all rooftops in Chicago were covered with intensive green roofs. Although costly, the installation of green roofs could be justified in the long run if the environmental benefits were considered. The green roof can be used to supplement the use of urban trees in air pollution control, especially in situations where land and public funds are not readily available.


Zhang X, XLiu, M Zhang, RA Dahlgren & M Eitzel. 2010. A review of vegetated buffers and a meta-analysis of their mitigation efficacy in reducing nonpoint source pollution. J. Environ. Qual., 39(1), 76-84.

Vegetated buffers are a well-studied and widely used agricultural management practice for reducing nonpoint-source pollution. A wealth of literature provides experimental data on their mitigation efficacy. This paper aggregated many of these results and performed a meta-analysis to quantify the relationships between pollutant removal efficacy and buffer width, buffer slope, soil type, and vegetation type. Theoretical models for removal efficacy (Y) vs. buffer width (w) were derived and tested against data from the surveyed literature using statistical analyses. A model of the form Y = K (1-e-b�w ), (0 < K = 100) successfully captured the relationship between buffer width and pollutant removal, where K reflects the maximum removal efficacy of the buffer and b reflects its probability to remove any single particle of pollutant in a unit distance. Buffer width alone explains 37, 60, 44, and 35% of the total variance in removal efficacy for sediment, pesticides, N, and P, respectively. Buffer slope was linearly associated with sediment removal efficacy either positively (when slope = 10%) or negatively (when slope > 10%). Buffers composed of trees have higher N and P removal efficacy than buffers composed of grasses or mixtures of grasses and trees. Soil drainage type did not show a significant effect on pollutant removal efficacy. Based on our analysis, a 30-m buffer under favorable slope conditions (ט 10%) removes more than 85% of all the studied pollutants. These models predicting optimal buffer width/slope can be instrumental in the design, implementation, and modeling of vegetated buffers for treating agricultural runoff.

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