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Objective To test relatively simple and complex models for examining model fit, higher‐level variation in, and correlates of, GP consultations, where known nonhierarchical data structures are present. Setting New South Wales (NSW), Australia. Design Association between socioeconomic circumstances and geographic remoteness with GP consultation frequencies per participant was assessed using single‐level, hierarchical, and multiple membership cross‐classified (MMCC) models. Models were adjusted for age, gender, and a range of socioeconomic and demographic confounds. Data Collection/Extraction Methods A total of 261,930 participants in the Sax Institute's 45 and Up Study were linked to all GP consultation records (Medicare Benefits Schedule; Department of Human Services) within 12 months of baseline (2006‐2009). Principal Findings Deviance information criterion values indicated the MMCC negative binomial regression was the best fitting model, relative to an MMCC Poisson equivalent and simpler hierarchical and single‐level models. Between‐area variances were relatively consistent across models, even when between GP variation was estimated. Lower rates of GP consultation outside of major cities were only observed once between‐GP variation was assessed simultaneously with between‐area variation in the MMCC models. Conclusions Application of the MMCC model is necessary for estimation of variances and effect sizes in sources of big data on primary care in which complex nonhierarchical clustering by geographical area and GP is present.
Thomas Astell‐Burt; Michael A. Navakatikyan; Leonard F. Arnolda; Xiaoqi Feng. Multilevel modeling of geographic variation in general practice consultations. Health Services Research 2021, 1 .
AMA StyleThomas Astell‐Burt, Michael A. Navakatikyan, Leonard F. Arnolda, Xiaoqi Feng. Multilevel modeling of geographic variation in general practice consultations. Health Services Research. 2021; ():1.
Chicago/Turabian StyleThomas Astell‐Burt; Michael A. Navakatikyan; Leonard F. Arnolda; Xiaoqi Feng. 2021. "Multilevel modeling of geographic variation in general practice consultations." Health Services Research , no. : 1.
Growing body of research recognizes the importance of green spaces on the perinatal outcomes however, further evidence from different geographies are warranted. We aimed to investigate association between, and differential responses to, maternal exposure to green space and birthweight. Birth records (n = 82,221) were extracted from the Perinatal Data Collection (PDC) in Sydney’s metropolitan area between January 2016 and December 2017. Association between green space quantity and birthweight, term birthweight, low birthweight, term low birthweight and preterm were assessed using linear and logistic regressions. Potential modification by area-level socioeconomic status and maternal country of birth were tested using interaction terms. Difference in birth weight for the ≥40% versus <20% green space within SA2s was 59.0 g (95%CI: 42.9, 75.3) in unadjusted models which dropped to 25.6 g (95%CI: 13.0, 38.2) in adjusted models. Stratified analysis suggested stronger associations for babies of mothers from affluent neighbourhoods, while statistically significant association was not observed in deprived areas. Furthermore, the association was more pronounced among babies to mothers who were born overseas. Associations were consistent for term births. Higher levels of green space were associated with lower odds of preterm birth in adjusted models. However, we did not identify statistically significant association between green space quantity and the risk of low birthweight (LBW). Our study suggests that green space may support healthier birth outcomes and help to reduce the birthweight gap between newborns of mothers born in Australia and overseas. However, disproportionate benefits among women in affluent neighbourhoods may widen socioeconomic inequities in birthweight.
Selin Akaraci; Xiaoqi Feng; Thomas Suesse; Bin Jalaludin; Thomas Astell-Burt. Greener neighbourhoods, healthier birth outcomes? Evidence from Australia. Environmental Pollution 2021, 278, 116814 .
AMA StyleSelin Akaraci, Xiaoqi Feng, Thomas Suesse, Bin Jalaludin, Thomas Astell-Burt. Greener neighbourhoods, healthier birth outcomes? Evidence from Australia. Environmental Pollution. 2021; 278 ():116814.
Chicago/Turabian StyleSelin Akaraci; Xiaoqi Feng; Thomas Suesse; Bin Jalaludin; Thomas Astell-Burt. 2021. "Greener neighbourhoods, healthier birth outcomes? Evidence from Australia." Environmental Pollution 278, no. : 116814.
Background Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have significant issues with sustained use, with up to 98% of people only using the app for a short time before dropping out and/or dropping use down to the point where the app is no longer effective at helping to manage disease. Objective Our objectives are to systematically appraise and perform a meta-analysis on dropout rates in apps for chronic disease and to qualitatively synthesize possible reasons for these dropout rates that could be addressed in future interventions. Methods MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, Cochrane CENTRAL (Central Register of Controlled Trials), and Embase were searched from 2003 to the present to look at mobile health (mHealth) and attrition or dropout. Studies, either randomized controlled trials (RCTs) or observational trials, looking at chronic disease with measures of dropout were included. Meta-analysis of attrition rates was conducted in Stata, version 15.1 (StataCorp LLC). Included studies were also qualitatively synthesized to examine reasons for dropout and avenues for future research. Results Of 833 studies identified in the literature search, 17 were included in the review and meta-analysis. Out of 17 studies, 9 (53%) were RCTs and 8 (47%) were observational trials, with both types covering a range of chronic diseases. The pooled dropout rate was 43% (95% CI 29-57), with observational studies having a higher dropout rate (49%, 95% CI 27-70) than RCTs in more controlled scenarios, which only had a 40% dropout rate (95% CI 16-63). The studies were extremely varied, which is represented statistically in the high degree of heterogeneity (I2>99%). Qualitative synthesis revealed a range of reasons relating to attrition from app-based interventions, including social, demographic, and behavioral factors that could be addressed. Conclusions Dropout rates in mHealth interventions are high, but possible areas to minimize attrition exist. Reducing dropout rates will make these apps more effective for disease management in the long term. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019128737; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128737
Gideon Meyerowitz-Katz; Sumathy Ravi; Leonard Arnolda; Xiaoqi Feng; Glen Maberly; Thomas Astell-Burt. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. Journal of Medical Internet Research 2020, 22, e20283 .
AMA StyleGideon Meyerowitz-Katz, Sumathy Ravi, Leonard Arnolda, Xiaoqi Feng, Glen Maberly, Thomas Astell-Burt. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. Journal of Medical Internet Research. 2020; 22 (9):e20283.
Chicago/Turabian StyleGideon Meyerowitz-Katz; Sumathy Ravi; Leonard Arnolda; Xiaoqi Feng; Glen Maberly; Thomas Astell-Burt. 2020. "Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis." Journal of Medical Internet Research 22, no. 9: e20283.
BackgroundWe examined to what extent perceived neighbourhood crime moderates, associations between type 2 diabetes mellitus (T2DM) and perceived local amenities, recreational facilities, footpaths and public transit, and potential mediation of environmental characteristics—T2DM association by physical activity, social contact, sleep and body mass index (BMI).MethodsThe 45 and Up Study data of 36, 224 individuals collected from 2010 to 2015 were analysed in 2019 using multilevel logistic regression to examine the association between T2DM and clustering of unfavourable built environment, and any difference in the association with increasing unfavourable environment and area disadvantage. We performed causal mediation analyses stratified by crime to examine whether crime moderated the strength of identified local amenities–T2DM pathways.ResultsThe results showed that irrespective of crime, perceived lack of local amenities was associated with increased odds of developing T2DM, and BMI mediated 40% and 30.3% of this association among those who reported unsafe and safe daytime crime, respectively. The proportion mediated by BMI among those who reported unsafe and safe night-time crime was 27.3% and 35.1%, respectively. Walking mediated 5.7% of the local amenities–T2DM association among those who reported safe daytime crime. The odds of T2DM increased with rising unfavourable environment and area disadvantage.ConclusionsThe results suggest that the availability of neighbourhood amenities may lower T2DM risk by increasing walking and reducing BMI regardless of area crime. Policies to enhance access to local amenities and prevent crime, especially in disadvantaged areas, may support healthy behaviour and physical health that can potentially reduce T2DM risk.
Tashi Dendup; Xiaoqi Feng; P. Y. O’Shaughnessy; Thomas Astell-Burt. Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis. Journal of Epidemiology and Community Health 2020, 1 .
AMA StyleTashi Dendup, Xiaoqi Feng, P. Y. O’Shaughnessy, Thomas Astell-Burt. Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis. Journal of Epidemiology and Community Health. 2020; ():1.
Chicago/Turabian StyleTashi Dendup; Xiaoqi Feng; P. Y. O’Shaughnessy; Thomas Astell-Burt. 2020. "Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis." Journal of Epidemiology and Community Health , no. : 1.
Association between urban green space quality and older adult outdoor recreation may vary across contrasting community contexts, but few international comparisons have been made. Data on older adult outdoor recreation and the quality of thirty-two (32) green spaces were collected using established tools (Systematic Observation of Play and Recreations in the Community and the Community Park Audit Tool) adapted for the cities of Sydney, Singapore and Dhaka between February to May 2017. Descriptive statistics and Poisson regressions were used to analyse the association between older adult recreation and measures of green space quality in each city. Higher quality green space was associated with more sedentary activity (β = 0.02, p < 0.005) and walking (β = 0.034, p < 0.005) after adjusting for differences between cities. Further tests suggested both sedentary activity and walking were higher in parks scoring more favourably on safety. Vigorous recreational activities were more common in parks scoring more favourably on accessibility, safety and landscape quality. Differences in associations between older adult recreation with each quality indicator were observed between cities. Interestingly, the expected association between quality and recreational activity could be different where high-quality urban green spaces are abundant (e.g. Singapore).
Faysal Kabir Shuvo; Xiaoqi Feng; Thomas Astell-Burt. Urban green space quality and older adult recreation: an international comparison. Cities & Health 2020, 1 -21.
AMA StyleFaysal Kabir Shuvo, Xiaoqi Feng, Thomas Astell-Burt. Urban green space quality and older adult recreation: an international comparison. Cities & Health. 2020; ():1-21.
Chicago/Turabian StyleFaysal Kabir Shuvo; Xiaoqi Feng; Thomas Astell-Burt. 2020. "Urban green space quality and older adult recreation: an international comparison." Cities & Health , no. : 1-21.
BACKGROUND Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have significant issues with sustained use, with up to 98% of people only using the app for a short time before dropping out and/or dropping use down to the point where the app is no longer effective at helping to manage disease. OBJECTIVE Our objectives are to systematically appraise and perform a meta-analysis on dropout rates in apps for chronic disease and to qualitatively synthesize possible reasons for these dropout rates that could be addressed in future interventions. METHODS MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, Cochrane CENTRAL (Central Register of Controlled Trials), and Embase were searched from 2003 to the present to look at mobile health (mHealth) and attrition or dropout. Studies, either randomized controlled trials (RCTs) or observational trials, looking at chronic disease with measures of dropout were included. Meta-analysis of attrition rates was conducted in Stata, version 15.1 (StataCorp LLC). Included studies were also qualitatively synthesized to examine reasons for dropout and avenues for future research. RESULTS Of 833 studies identified in the literature search, 17 were included in the review and meta-analysis. Out of 17 studies, 9 (53%) were RCTs and 8 (47%) were observational trials, with both types covering a range of chronic diseases. The pooled dropout rate was 43% (95% CI 29-57), with observational studies having a higher dropout rate (49%, 95% CI 27-70) than RCTs in more controlled scenarios, which only had a 40% dropout rate (95% CI 16-63). The studies were extremely varied, which is represented statistically in the high degree of heterogeneity (I2>99%). Qualitative synthesis revealed a range of reasons relating to attrition from app-based interventions, including social, demographic, and behavioral factors that could be addressed. CONCLUSIONS Dropout rates in mHealth interventions are high, but possible areas to minimize attrition exist. Reducing dropout rates will make these apps more effective for disease management in the long term. CLINICALTRIAL International Prospective Register of Systematic Reviews (PROSPERO) CRD42019128737; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128737
Gideon Meyerowitz-Katz; Sumathy Ravi; Leonard Arnolda; Xiaoqi Feng; Glen Maberly; Thomas Astell-Burt. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis (Preprint). 2020, 1 .
AMA StyleGideon Meyerowitz-Katz, Sumathy Ravi, Leonard Arnolda, Xiaoqi Feng, Glen Maberly, Thomas Astell-Burt. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis (Preprint). . 2020; ():1.
Chicago/Turabian StyleGideon Meyerowitz-Katz; Sumathy Ravi; Leonard Arnolda; Xiaoqi Feng; Glen Maberly; Thomas Astell-Burt. 2020. "Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis (Preprint)." , no. : 1.
The plausible role of nearby green space in influencing prosocial behaviour among children and adolescents has been studied recently. However, no review has been conducted of the evidence testing the association between green space and prosocial behaviour. This systematic review addresses this gap among children and adolescents. Within this review, we propose a conceptual framework describing potential pathways linking green space to prosocial behaviour, discuss the direction, magnitude, moderators, and mediators of the association, and develop a narrative synthesis of future study directions. Out of 63 extracted associations from 15 studies, 44 were in the positive or expected direction, of which 18 were reported to be statistically significant (p < 0.05). Overall, the current evidence shows that exposure to green space may potentially increase prosocial behaviour among children and adolescents, with some contingencies (e.g., child's sex and ethnic background). However, the volume and quality of this evidence is not yet sufficient to draw conclusions on causality. Further, heterogeneity in the indicators of green space exposure could lead to mixed findings. In addition, none of the included studies investigated potential mediators. Nevertheless, this review provides preliminary evidence and a basis for further investigation with rigorous study methodology capable of drawing causal inferences and testing potential effect modifiers, linking pathways, and relevant green space measures.
I Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Eme Eseme John; Xiaoqi Feng. The Relationship Between Green Space and Prosocial Behaviour Among Children and Adolescents: A Systematic Review. Frontiers in Psychology 2020, 11, 1 .
AMA StyleI Gusti Ngurah Edi Putra, Thomas Astell-Burt, Dylan P. Cliff, Stewart A. Vella, Eme Eseme John, Xiaoqi Feng. The Relationship Between Green Space and Prosocial Behaviour Among Children and Adolescents: A Systematic Review. Frontiers in Psychology. 2020; 11 ():1.
Chicago/Turabian StyleI Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Eme Eseme John; Xiaoqi Feng. 2020. "The Relationship Between Green Space and Prosocial Behaviour Among Children and Adolescents: A Systematic Review." Frontiers in Psychology 11, no. : 1.
Studies from high income, mostly westernised countries tend to report health benefits from urban green spaces. Generalizability of this evidence for the 125 low and middle-income countries (LMICs) is debatable. This systematic review explored and synthesized the quality of green space-health studies reported from LMICs. Following PRISMA guidelines, 22 studies were found through a systematic search and after applying inclusion criteria by two researchers. Quantitative and qualitative synthesis of these studies included a study quality assessment using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The 22 studies were conducted in 11 LMICs and mostly of the cross-sectional design. Health outcomes include mental and physical health, wellbeing. Green space and health outcomes were mostly measured by the subjective tool, such as by the perception of the sample population; most reporting green space benefits except the study conducted on a slum population and two studies measured physical health outcomes. Only 14 studies adjusted different moderating variables in the quantitative analysis. Three studies explored mediation analyses and reported physical activity and perceived restorativeness of UGS to be the strongest potential pathways to better health. Lack of adherence to observation study design protocols resulted in the studies to have moderate to low quality. The enquiry on the potential health benefits of green space in LMICs is an important gap in knowledge. The evidence in the LMICs is limited by the quality of the studies. More research, especially longitudinal studies that make use of objective indicators of green space design, utilisation and health indicators in a wider range of LMICs is warranted.
Faysal Kabir Shuvo; Xiaoqi Feng; Selin Akaraci; Thomas Astell-Burt. Urban green space and health in low and middle-income countries: A critical review. Urban Forestry & Urban Greening 2020, 52, 126662 .
AMA StyleFaysal Kabir Shuvo, Xiaoqi Feng, Selin Akaraci, Thomas Astell-Burt. Urban green space and health in low and middle-income countries: A critical review. Urban Forestry & Urban Greening. 2020; 52 ():126662.
Chicago/Turabian StyleFaysal Kabir Shuvo; Xiaoqi Feng; Selin Akaraci; Thomas Astell-Burt. 2020. "Urban green space and health in low and middle-income countries: A critical review." Urban Forestry & Urban Greening 52, no. : 126662.
BackgroundConcerns about loss of greenspace with urbanisation motivate much research on nature and health; however, contingency of greenspace-health associations on the character of community change remains understudied.MethodsWith aggregate data from governmental sources for 1432 Swedish parishes, we used negative binomial regression to estimate incidence rate ratios (IRRs) for all-cause and cardiovascular disease (CVD) mortality during 2000–2008 in relation to percentage area (in 2000) of urban residential greenspace, urban parks and rural greenspace, looking across parishes with decrease, stability or increase in population density. We also assessed interactions between land use and population change.ResultsParishes with >1 decile increase in population density had lower incidence of all-cause (IRR=0.91, 95% CI 0.87 to 0.95) and CVD mortality (IRR=0.89, 95% CI 0.84 to 0.94) compared with parishes with stable populations. In stable parishes, all-cause mortality was lower with higher percentages of urban green (IRR=0.998, 95% CI 0.996 to 1.000) and rural green land uses (IRR=0.997, 95% CI 0.996 to 0.999). These results were inverted in densifying parishes; higher all-cause mortality attended higher initial percentages of urban (IRR=1.081, 95% CI 1.037 to 1.127) and rural greenspace (IRR=1.042, 95% CI 1.007 to 1.079) as measured in 2000. Similar associations held for CVD mortality.ConclusionsMore greenspace was associated with lower all-cause and CVD mortality in communities with relatively stable populations. In densifying communities, population growth per se may reduce mortality, but it may also entail harm through reductions in amount per capita and/or quality of greenspace.
Terry Hartig; Thomas Astell-Burt; Zara Bergsten; Jan Amcoff; Richard Mitchell; Xiaoqi Feng. Associations between greenspace and mortality vary across contexts of community change: a longitudinal ecological study. Journal of Epidemiology and Community Health 2020, 74, 534 -540.
AMA StyleTerry Hartig, Thomas Astell-Burt, Zara Bergsten, Jan Amcoff, Richard Mitchell, Xiaoqi Feng. Associations between greenspace and mortality vary across contexts of community change: a longitudinal ecological study. Journal of Epidemiology and Community Health. 2020; 74 (6):534-540.
Chicago/Turabian StyleTerry Hartig; Thomas Astell-Burt; Zara Bergsten; Jan Amcoff; Richard Mitchell; Xiaoqi Feng. 2020. "Associations between greenspace and mortality vary across contexts of community change: a longitudinal ecological study." Journal of Epidemiology and Community Health 74, no. 6: 534-540.
The primary aim of this study was to describe the geography of serious mental illness (SMI)–type 2 diabetes comorbidity (T2D) in the Illawarra-Shoalhaven region of NSW, Australia. The Secondary objective was to determine the geographic concordance if any, between the comorbidity and the single diagnosis of SMI and diabetes. Spatial analytical techniques were applied to clinical data to explore the above objectives. The geographic variation in comorbidity was determined by Moran’s I at the global level and the local clusters of significance were determined by Local Moran’s I and spatial scan statistic. Choropleth hotspot maps and spatial scan statistics were generated to assess the geographic convergence of SMI, diabetes and their comorbidity. Additionally, we used bivariate LISA (Local Indicators of Spatial Association) and multivariate spatial scan to identify coincident areas with higher rates of both SMI and T2D. The study identified significant geographic variation in the distribution of SMI–T2D comorbidity in Illawarra Shoalhaven. Consistently higher burden of comorbidity was observed in some urban suburbs surrounding the major metropolitan city. Comparison of comorbidity hotspots with the hotspots of single diagnosis SMI and T2D further revealed a geographic concordance of high-risk areas again in the urban areas outside the major metropolitan city. The identified comorbidity hotspots in our study may serve as a basis for future prioritisation and targeted interventions. Further investigation is required to determine whether contextual environmental factors, such as neighbourhood socioeconomic disadvantage, may be explanatory. Ours is the first study to explore the geographic variations in the distribution of SMI and T2D comorbidity. Findings highlight the importance of considering the role of neighbourhood environments in influencing the T2D risk in people with SMI.
Ramya Walsan; Darren J. Mayne; Nagesh Pai; Xiaoqi Feng; Andrew Bonney. Exploring the geography of serious mental illness and type 2 diabetes comorbidity in Illawarra—Shoalhaven, Australia (2010 -2017). PLOS ONE 2019, 14, e0225992 .
AMA StyleRamya Walsan, Darren J. Mayne, Nagesh Pai, Xiaoqi Feng, Andrew Bonney. Exploring the geography of serious mental illness and type 2 diabetes comorbidity in Illawarra—Shoalhaven, Australia (2010 -2017). PLOS ONE. 2019; 14 (12):e0225992.
Chicago/Turabian StyleRamya Walsan; Darren J. Mayne; Nagesh Pai; Xiaoqi Feng; Andrew Bonney. 2019. "Exploring the geography of serious mental illness and type 2 diabetes comorbidity in Illawarra—Shoalhaven, Australia (2010 -2017)." PLOS ONE 14, no. 12: e0225992.
ObjectivesTo investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China.DesignMultilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015.SettingAll 31 provinces in China, not including Hong Kong, Macao or Taiwan.Participants96 466 ≥ 18 years old (women=54.3%).ExposuresPerson-level educational attainment and mean years of education in counties.OutcomeAL was measured using clinical guidelines for nine biomarkers: body mass index; waist circumference; systolic blood pressure; diastolic blood pressure; fasting blood glucose; total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol.ResultsMultilevel logistic regressions adjusted for sex, age, marital status, person-level education, county mean years of education and urban/rural reported ORs of 1.22 (95% CI 1.08 to 1.38) for 5-year all-cause mortality (n=3284) and 1.20 (1.04–1.37) for deaths from non-communicable diseases (n=2891) among people in AL quintile 5 (high) compared with quintile 1 (low). The median rate ratio estimated from unadjusted multilevel negative binomial regression showed AL clustered geographically (province=1.14; county=1.12; town=1.11; village=1.14). After adjusting for aforementioned confounders, AL remained higher with age (rate ratio 1.02, 95% CI 1.02 to 1.02), higher in women compared with men (1.17, 1.15 to 1.19), lower among singletons (0.83, 0.81 to 0.85) and widowers (0.96, 0.94 to 0.98). AL was lower among people with university-level compared with no education (0.92, 0.89 to 0.96), but higher in counties with higher mean education years (1.03, 1.01 to 1.05). A two-way interaction suggested AL was higher (1.04, 1.02 to 1.06) among those with university-level compared with no education within counties with higher mean years of education. Similar results were observed for alternative constructions of AL using 75th and 80th percentile cut-points.ConclusionsAL in China is patterned geographically. The degree of association between AL and person-level education seems to be dependent on area-level education, which may be a proxy for other contextual factors that warrant investigation.
Fan Mao; Thomas Astell-Burt; Xiaoqi Feng; Yunning Liu; Jianqun Dong; Shiwei Liu; Lijun Wang; Yingying Jiang; Wenlan Dong; Maigeng Zhou; Limin Wang. Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study. BMJ Open 2019, 9, e031366 .
AMA StyleFan Mao, Thomas Astell-Burt, Xiaoqi Feng, Yunning Liu, Jianqun Dong, Shiwei Liu, Lijun Wang, Yingying Jiang, Wenlan Dong, Maigeng Zhou, Limin Wang. Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study. BMJ Open. 2019; 9 (11):e031366.
Chicago/Turabian StyleFan Mao; Thomas Astell-Burt; Xiaoqi Feng; Yunning Liu; Jianqun Dong; Shiwei Liu; Lijun Wang; Yingying Jiang; Wenlan Dong; Maigeng Zhou; Limin Wang. 2019. "Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study." BMJ Open 9, no. 11: e031366.
Background Cross-sectional studies suggest that more green space may lower the odds of prevalent diabetes, hypertension and cardiovascular diseases (CVD) in cities. We assess if these results are replicable for tree canopy exposure and then extend the study longitudinally to examine incident cardiometabolic outcomes. Methods The study was set in the Australian cities of Sydney, Wollongong and Newcastle. Total green space and tree canopy as percentages of landcover within 1.6 km (1 mile) from home were linked to a residentially stable sample of 46 786 participants in the Sax Institute’s 45 and Up Study (baseline 2006–09; follow-up 2012–15). Separate multilevel models were used to investigate whether the odds of prevalent and incident doctor-diagnosed diabetes, hypertension and CVD were associated with total green space and tree canopy provision, adjusting for age, sex, income, education, employment and couple status. Results Lower odds of prevalent diabetes were observed with 1% increases in total green space [odds ratio (OR) 0.993, 95% confidence interval (CI) 0.988 to 0.998] and tree canopy (0.984, 0.978 to 0.989). Lower odds of prevalent CVD were found with a 1% increase in tree canopy only (0.996, 0.993 to 0.999). Lower odds of incident diabetes (0.988, 0.981 to 0.994), hypertension (0.993, 0.989 to 0.997) and CVD (0.993, 0.988 to 0.998) were associated with a 1% increase in tree canopy, but not total green space. At ≥30% compared with 0–9% tree canopy, there were lower odds of incident diabetes (0.687, 0.547 to 0.855), hypertension (0.828, 0.719 to 0.952) and CVD (0.782, 0.652 to 0.935). However, ≥30% compared with 0–4% total green space was associated with lower odds of prevalent diabetes only (0.695, 0.512 to 0.962). Conclusions Restoring local tree canopy in neighbourhoods may help to prevent the incidence of cardiometabolic diseases.
Thomas Astell-Burt; Xiaoqi Feng. Urban green space, tree canopy and prevention of cardiometabolic diseases: a multilevel longitudinal study of 46 786 Australians. International Journal of Epidemiology 2019, 49, 926 -933.
AMA StyleThomas Astell-Burt, Xiaoqi Feng. Urban green space, tree canopy and prevention of cardiometabolic diseases: a multilevel longitudinal study of 46 786 Australians. International Journal of Epidemiology. 2019; 49 (3):926-933.
Chicago/Turabian StyleThomas Astell-Burt; Xiaoqi Feng. 2019. "Urban green space, tree canopy and prevention of cardiometabolic diseases: a multilevel longitudinal study of 46 786 Australians." International Journal of Epidemiology 49, no. 3: 926-933.
Background: This study examined the associations between environmental characteristics of early childhood education and care (ECEC) centers and 1-year change in toddlers’ physical activity and sedentary behavior while at the centers. Methods: Data from 292 toddlers from the GET-UP! study were analyzed. Environmental characteristics of ECEC centers were rated using the Infant/Toddler Environment Rating Scale-revised edition at baseline. Children’s physical activity and sedentary behavior in the centers were assessed using activPAL devices, at baseline and at 1-year follow-up. Linear mixed models were performed to examine the associations between the environmental characteristics and change in the proportion of time spent in physical activity and sedentary behavior. Results: Compared with baseline, children spent a higher proportion of time in sedentary behavior (sitting) but a lower proportion of time in standing and physical activity (stepping) while at ECEC centers, at 1-year follow-up. The environmental characteristics “interaction” (B = −1.39; P = .01) and “program structure” (B = −1.15; P = .04) were negatively associated with change in the proportion of time spent in physical activity. Conclusion: Better “interaction” and “program structure” may preclude children’s physical activity from declining over time and may be considered important features to target in future interventions in ECEC centers aiming at promoting active lifestyles.
Zhiguang Zhang; Eduarda Sousa-Sá; João R. Pereira; Anthony D. Okely; Xiaoqi Feng; Rute Santos. The Associations Between Environmental Characteristics of Early Childhood Education and Care Centers and 1-Year Change in Toddlers’ Physical Activity and Sedentary Behavior. Journal of Physical Activity and Health 2019, 16, 1000 -1006.
AMA StyleZhiguang Zhang, Eduarda Sousa-Sá, João R. Pereira, Anthony D. Okely, Xiaoqi Feng, Rute Santos. The Associations Between Environmental Characteristics of Early Childhood Education and Care Centers and 1-Year Change in Toddlers’ Physical Activity and Sedentary Behavior. Journal of Physical Activity and Health. 2019; 16 (11):1000-1006.
Chicago/Turabian StyleZhiguang Zhang; Eduarda Sousa-Sá; João R. Pereira; Anthony D. Okely; Xiaoqi Feng; Rute Santos. 2019. "The Associations Between Environmental Characteristics of Early Childhood Education and Care Centers and 1-Year Change in Toddlers’ Physical Activity and Sedentary Behavior." Journal of Physical Activity and Health 16, no. 11: 1000-1006.
The self-perception of weight and weight loss attempts might promote weight loss and maintenance. To examine trends in current measured body mass index (BMI) and weight, self-reported weight, self-perceived weight status, weight loss attempts, and weight loss strategies among adults in the United States. This national cross-sectional study used data from continuous National Health and Nutrition Examination Survey (NHANES) data sets (1999-2000 to 2015-2016). Participants were US residents older than 20 years. Data were analyzed from January 2018 to December 2018. Current measured BMI and weight, self-reported weight, self-perceived weight status, weight loss attempts, and applied weight loss strategies. Adjusted, self-reported, prior-year weight was calculated using correction equations that considered age, sex, race/ethnicity, and quartile of self-reported prior-year weight. Data were collected from 48 026 participants (19 792 [41.2%] aged 40-64 years; 24 255 [50.5%] women; 21 725 [45.2%] white) through 9 surveys from 1999-2000 to 2015-2016. Increasing trends were observed in current measured BMI (difference, 1.20; 95% CI, 0.92-1.47; P for trend < .001), current measured weight (difference 2.77 kg; 95% CI, 1.92-3.61 kg; P for trend < .001), adjusted, self-reported, prior-year weight (difference, 2.36 kg; 95% CI, 1.52-3.21 kg; P for trend < .001), and the difference between measured and adjusted self-reported weight (difference 0.70 kg; 95% CI, 0.34-1.07 kg; P for trend < .001). During this period, the proportion of overall participants who had attempted to lose weight increased from 34.3% to 42.2% (difference, 8.0%; 95% CI, 4.1%-10.5%; P for trend < .001). The most commonly reported weight loss strategies with the most rapidly increasing prevalence during the study period were reduced food consumption (21.2%-31.9%; difference, 11.1%; 95% CI, 8.2%-13.3%; P for trend < .001), exercise (18.2%-31.5%; difference, 14.4%; 95% CI, 11.3%-16.9%; P for trend < .001), and frequent water intake (0.2%-26.3%; difference, 26.2%; 95% CI, 24.1%-29.0%; P for trend < .001). Between 2005-2006 and 2015-2016, increases were also observed for the reported consumption of more fruits, vegetables, and salads (0.1%-29.4%; difference, 30.3%; 95% CI, 28.1%-31.2%; P for trend < .001), changing eating habits (0.3%-20.5%; difference, 20.2%; 95% CI, 19.1%-22.3%; P for trend < .001), and the consumption of less sugar, candy, and sweets (0.2%-20.9%; difference, 21.7%; 95% CI, 19.3%-22.6%; P for trend < .001). In this cross-sectional study, our data indicated an increasing trend in the proportion of participants who attempted to lose weight and a parallel increasing trend in current measured BMI and weight among adults in the United States.
Liyuan Han; Dingyun You; Fangfang Zeng; Xiaoqi Feng; Thomas Astell-Burt; Shiwei Duan; Lu Qi. Trends in Self-perceived Weight Status, Weight Loss Attempts, and Weight Loss Strategies Among Adults in the United States, 1999-2016. JAMA Network Open 2019, 2, e1915219 -e1915219.
AMA StyleLiyuan Han, Dingyun You, Fangfang Zeng, Xiaoqi Feng, Thomas Astell-Burt, Shiwei Duan, Lu Qi. Trends in Self-perceived Weight Status, Weight Loss Attempts, and Weight Loss Strategies Among Adults in the United States, 1999-2016. JAMA Network Open. 2019; 2 (11):e1915219-e1915219.
Chicago/Turabian StyleLiyuan Han; Dingyun You; Fangfang Zeng; Xiaoqi Feng; Thomas Astell-Burt; Shiwei Duan; Lu Qi. 2019. "Trends in Self-perceived Weight Status, Weight Loss Attempts, and Weight Loss Strategies Among Adults in the United States, 1999-2016." JAMA Network Open 2, no. 11: e1915219-e1915219.
Cities are constantly evolving and so are the living conditions within and between them. Rapid urbanization and the ever-growing need for housing have turned large areas of many cities into concrete landscapes that lack greenery. Green infrastructure can support human health, provide socio-economic and environmental benefits, and bring color to an otherwise grey urban landscape. Sometimes, benefits come with downsides in relation to its impact on air quality and human health, requiring suitable data and guidelines to implement effective greening strategies. Air pollution and human health, as well as green infrastructure and human health, are often studied together. Linking green infrastructure with air quality and human health together is a unique aspect of this article. A holistic understanding of these links is key to enabling policymakers and urban planners to make informed decisions. By critically evaluating the link between green infrastructure and human health via air pollution mitigation, we also discuss if our existing understanding of such interventions is sufficient to inform their uptake in practice. Natural science and epidemiology approach the topic of green infrastructure and human health very differently. The pathways linking health benefits to pollution reduction by urban vegetation remain unclear and the mode of green infrastructure deployment is critical to avoid unintended consequences. Strategic deployment of green infrastructure may reduce downwind pollution exposure. However, the development of bespoke design guidelines is vital to promote and optimize greening benefits, and measuring green infrastructure's socio-economic and health benefits are key for their uptake. Greening cities to mitigate pollution effects is on the rise and these need to be matched by scientific evidence and appropriate guidelines. We conclude that urban vegetation can facilitate broad health benefits, but there is little empirical evidence linking these benefits to air pollution reduction by urban vegetation, and appreciable efforts are needed to establish the underlying policies, design and engineering guidelines governing its deployment.
Prashant Kumar; Angela Druckman; John Gallagher; Birgitta Gatersleben; Sarah Allison; Theodore S. Eisenman; Uy Hoang; Sarkawt Hama; Arvind Tiwari; Ashish Sharma; K.V. Abhijith; Deepti Adlakha; Aonghus McNabola; Thomas Astell-Burt; Xiaoqi Feng; Anne C. Skeldon; Simon de Lusignan; Lidia Morawska. The nexus between air pollution, green infrastructure and human health. Environment International 2019, 133, 105181 .
AMA StylePrashant Kumar, Angela Druckman, John Gallagher, Birgitta Gatersleben, Sarah Allison, Theodore S. Eisenman, Uy Hoang, Sarkawt Hama, Arvind Tiwari, Ashish Sharma, K.V. Abhijith, Deepti Adlakha, Aonghus McNabola, Thomas Astell-Burt, Xiaoqi Feng, Anne C. Skeldon, Simon de Lusignan, Lidia Morawska. The nexus between air pollution, green infrastructure and human health. Environment International. 2019; 133 ():105181.
Chicago/Turabian StylePrashant Kumar; Angela Druckman; John Gallagher; Birgitta Gatersleben; Sarah Allison; Theodore S. Eisenman; Uy Hoang; Sarkawt Hama; Arvind Tiwari; Ashish Sharma; K.V. Abhijith; Deepti Adlakha; Aonghus McNabola; Thomas Astell-Burt; Xiaoqi Feng; Anne C. Skeldon; Simon de Lusignan; Lidia Morawska. 2019. "The nexus between air pollution, green infrastructure and human health." Environment International 133, no. : 105181.
This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)-type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis considered 3816 individuals with an SMI living in the Illawarra and Shoalhaven regions of NSW, Australia, between 2010 and 2017. Multilevel logistic regression models accounting for suburb (neighbourhood) level clustering were used to assess the association between neighbourhood disadvantage and SMI -T2D comorbidity. Models were adjusted for age, sex, and country of birth. Compared with the most advantaged neighbourhoods, residents in the most disadvantaged neighbourhoods had 3.2 times greater odds of having SMI-T2D comorbidity even after controlling for confounding factors (OR 3.20, 95% CI 1.42-7.20). The analysis also revealed significant geographic variation in the distribution of SMI -T2D comorbidity in our sample (Median Odds Ratio = 1.35) Neighbourhood socioeconomic disadvantage accounted for approximately 17.3% of this geographic variation. These findings indicate a potentially important role for geographically targeted initiatives designed to enhance prevention and management of SMI-T2D comorbidity in disadvantaged communities.
Ramya Walsan; Darren J Mayne; Xiaoqi Feng; Nagesh Pai; Andrew Bonney. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. International Journal of Environmental Research and Public Health 2019, 16, 3905 .
AMA StyleRamya Walsan, Darren J Mayne, Xiaoqi Feng, Nagesh Pai, Andrew Bonney. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. International Journal of Environmental Research and Public Health. 2019; 16 (20):3905.
Chicago/Turabian StyleRamya Walsan; Darren J Mayne; Xiaoqi Feng; Nagesh Pai; Andrew Bonney. 2019. "Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness." International Journal of Environmental Research and Public Health 16, no. 20: 3905.
To investigate association between urban green space and prevalent and incident cases of insufficient sleep (<6 h sleep per day). This longitudinal study examined the odds of prevalent and incident insufficient sleep in relation to indicators of total green space, tree canopy, open grass and other low-lying vegetation in the Sax Institute's 45 and Up Study (baseline 2006–2009; follow-up 2012–2015). Association between green space within 1.6 km road distances and insufficient sleep among 38,982 participants living in Sydney, Wollongong or Newcastle were analysed using multilevel logistic regressions adjusted for confounding. Participants with more total green space had lower odds of prevalent insufficient sleep (e.g. ≥30% compared with 0-4% total green space odds ratio (OR) = 0.68, 95% credible interval (95%CI) = 0.53, 0.85). The odds of prevalent insufficient sleep were lower among participants with more tree canopy (e.g. ≥30% compared with 0-9% tree canopy OR = 0.78, 95%CI 0.69, 0.88). The odds of incident insufficient sleep were also lower with more tree canopy (e.g. ≥30% compared with 0-9% tree canopy OR = 0.87, 95%CI = 0.75, 0.99). There were no statistically significant associations between prevalent or incident insufficient sleep with open grass or other low-lying vegetation, nor incident sufficient sleep with total green space. Prioritising restoration and protection of urban tree canopy may help to promote population-wide prevention of insufficient sleep in middle-to-older aged adults.
Thomas Astell-Burt; Xiaoqi Feng. Does sleep grow on trees? A longitudinal study to investigate potential prevention of insufficient sleep with different types of urban green space. SSM - Population Health 2019, 10, 100497 .
AMA StyleThomas Astell-Burt, Xiaoqi Feng. Does sleep grow on trees? A longitudinal study to investigate potential prevention of insufficient sleep with different types of urban green space. SSM - Population Health. 2019; 10 ():100497.
Chicago/Turabian StyleThomas Astell-Burt; Xiaoqi Feng. 2019. "Does sleep grow on trees? A longitudinal study to investigate potential prevention of insufficient sleep with different types of urban green space." SSM - Population Health 10, no. : 100497.
The American Heart Association (AHA) proposed the Life’s Simple 7 (LS7) set of risk factors used to indicate cardiovascular health.1 The LS7 comprises 7 ideal metrics, including 3 ideal health factors: untreated systolic blood pressure (BP) less than 120 and diastolic BP less than 80 mm Hg, untreated total cholesterol level less than 200 mg/dL (to convert to millimoles per liter, multiply by 0.0259), and untreated fasting blood glucose concentration less than 100 mg/dL (to convert to millimoles per liter, multiply by 0.0555). The LS7 also includes 4 ideal health behaviors: not smoking, maintaining a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) less than 25, achievement of a goal physical activity level, and a diet meeting 4 to 5 target components (recommended consumption levels of fruits and vegetables, fish, fiber-rich whole grains, sodium, and sugar-sweetened beverages).1 In previous studies, adherence to the ideal LS7 metrics was found to be associated with decreased risks of cardiovascular disease (CVD),2 all-cause mortality,3 and cancer.4
Liyuan Han; Dingyun You; Wenjie Ma; Thomas Astell-Burt; Xiaoqi Feng; Shiwei Duan; Lu Qi. National Trends in American Heart Association Revised Life's Simple 7 Metrics Associated With Risk of Mortality Among US Adults. JAMA Network Open 2019, 2, e1913131 -e1913131.
AMA StyleLiyuan Han, Dingyun You, Wenjie Ma, Thomas Astell-Burt, Xiaoqi Feng, Shiwei Duan, Lu Qi. National Trends in American Heart Association Revised Life's Simple 7 Metrics Associated With Risk of Mortality Among US Adults. JAMA Network Open. 2019; 2 (10):e1913131-e1913131.
Chicago/Turabian StyleLiyuan Han; Dingyun You; Wenjie Ma; Thomas Astell-Burt; Xiaoqi Feng; Shiwei Duan; Lu Qi. 2019. "National Trends in American Heart Association Revised Life's Simple 7 Metrics Associated With Risk of Mortality Among US Adults." JAMA Network Open 2, no. 10: e1913131-e1913131.
Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. The study describes a range of CMRFs with different distributions in the study region. The results allow generation of hypotheses to test in future research concerning location specific population health approaches.
Renin Toms; Darren J. Mayne; Xiaoqi Feng; Andrew Bonney. Geographic variation in cardiometabolic risk distribution: A cross-sectional study of 256,525 adult residents in the Illawarra-Shoalhaven region of the NSW, Australia. PLOS ONE 2019, 14, e0223179 .
AMA StyleRenin Toms, Darren J. Mayne, Xiaoqi Feng, Andrew Bonney. Geographic variation in cardiometabolic risk distribution: A cross-sectional study of 256,525 adult residents in the Illawarra-Shoalhaven region of the NSW, Australia. PLOS ONE. 2019; 14 (10):e0223179.
Chicago/Turabian StyleRenin Toms; Darren J. Mayne; Xiaoqi Feng; Andrew Bonney. 2019. "Geographic variation in cardiometabolic risk distribution: A cross-sectional study of 256,525 adult residents in the Illawarra-Shoalhaven region of the NSW, Australia." PLOS ONE 14, no. 10: e0223179.
What type of green space is associated with better mental health? In this cohort study of 46 786 adults older than 45 years, exposure to 30% or more tree canopy compared with 0% to 9% tree canopy was associated with 31% lower odds of incident psychological distress, whereas exposure to 30% or more grass was associated with 71% higher odds of prevalent psychological distress after adjusting for age, sex, income, economic status, couple status, and educational level. Similar results were found for self-rated fair to poor general health but not physician-diagnosed depression or anxiety. Investments specifically in tree canopy may provide more support for mental health. Recent studies indicate that living near more green space may support mental and general health and may also prevent depression. However, most studies are cross-sectional, and few have considered whether some types of green space matter more for mental health. To assess whether total green space or specific types of green space are associated with better mental health. This cohort study included a residentially stable, city-dwelling sample of 46 786 participants from Sydney, Wollongong, and Newcastle, Australia, in the baseline of the Sax Institute’s 45 and Up Study (data collected from January 1, 2006, to December 31, 2009). Follow-up was conducted from January 1, 2012, to December 31, 2015. Analyses were conducted in January 2019. Percentage of total green space, tree canopy, grass, and other low-lying vegetation measured within 1.6-km (1-mile) road network distance buffers around residential addresses at baseline. Three outcome variables were examined at baseline (prevalence) and follow-up (incidence without baseline affirmatives): (1) risk of psychological distress (10-item Kessler Psychological Distress Scale), (2) self-reported physician-diagnosed depression or anxiety, and (3) fair to poor self-rated general health. This study included 46 786 participants (mean [SD] age, 61.0 [10.2] years; 25 171 [53.8%] female). At baseline, 5.1% of 37 775 reported a high risk of psychological distress, 16.0% of 46 786 reported depression or anxiety, and 9.0% of 45 577 reported fair to poor self-rated health. An additional 3.3% of 32 991 experienced psychological distress incidence, 7.5% of 39 277 experienced depression or anxiety incidence, and 7.3% of 40 741 experienced fair to poor self-rated health incidence by follow-up (mean [SD] of 6.2 [1.62] years later). Odds ratios (ORs) adjusted for age, sex, income, economic status, couple status, and educational level indicated that exposures of 30% or more total green space (OR, 0.46; 95% CI, 0.29-0.69) and tree canopy specifically (OR, 0.69; 95% CI, 0.54-0.88) were associated with lower incidence of psychological distress. Exposure to tree canopy of 30% or more, compared with 0% to 9%, was also associated with lower incidence of fair to poor general health (OR, 0.67; 95% CI, 0.57-0.80). Exposure to grass of 30% or more, compared with 0% to 4%, was associated with higher odds of incident fair to poor general health (OR, 1.47; 95% CI, 1.12-1.91) and prevalent psychological distress (OR, 1.71; 95% CI, 1.25-2.28). Exposure to low-lying vegetation was not consistently associated with any outcome. No green space indicator was associated with prevalent or incident depression or anxiety. Protection and restoration of urban tree canopy specifically, rather than any urban greening, may be a good option for promotion of community mental health.
Thomas Astell-Burt; Xiaoqi Feng. Association of Urban Green Space With Mental Health and General Health Among Adults in Australia. JAMA Network Open 2019, 2, e198209 .
AMA StyleThomas Astell-Burt, Xiaoqi Feng. Association of Urban Green Space With Mental Health and General Health Among Adults in Australia. JAMA Network Open. 2019; 2 (7):e198209.
Chicago/Turabian StyleThomas Astell-Burt; Xiaoqi Feng. 2019. "Association of Urban Green Space With Mental Health and General Health Among Adults in Australia." JAMA Network Open 2, no. 7: e198209.