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Evidence to support nature contact and nature prescriptions to reduce loneliness is scant. A total of 2100 individuals took part in a survey conducted in Australia (n = 525, mean age = 34.1), India (n = 526, mean age = 29.5), Singapore (n = 523, mean age = 36.1), the UK (n = 526, mean age = 37.3), and the US (n = 525, mean age = 43.6) in 2022 (overall age range 18–89yrs). Multilevel logistic regressions adjusted for confounding indicated mean levels of overall loneliness tended to be higher in India (Odds Ratio [OR] 1.21, 95% Confidence Interval [95%CI] 0.90–1.62), Singapore (OR = 1.54, 95%CI = 1.15–2.07), the UK (OR = 1.26, 95%CI = 0.96–1.67) and the US (OR = 1.24, 95%CI = 0.94–1.64) compared with Australia. Notable differences were observed by loneliness type, for example, with lower odds of social loneliness (OR = 0.57, 95%CI = 0.41–0.79) and higher odds of emotional loneliness (OR = 1.57, 95%CI = 1.14–2.06) in India compared with Australia. Findings with regards to loneliness and nature contact varied between country. In general, social loneliness was lower in participants who visited natural surroundings regularly (OR = 0.81, 95%CI = 0.61–0.98) and spent two hours or more per week in nature (OR = 0.65, 95%CI = 0.49–0.81). Overall loneliness (OR = 1.98, 95%CI = 1.48–2.47) and emotional loneliness (OR = 2.84, 95%CI = 2.13–3.51) were substantially higher among those who felt having no-one to go with was a barrier to spending time in nature. Emotional loneliness was higher in those who had more time in nature (OR = 1.32, 95%CI = 0.94–1.75) or more frequent visits (OR = 1.24, 95%CI = 0.94–1.49), which may be indicative of selective processes by which some people who feel emotionally lonely seek meaningful sources of connection or solace in natural environments. In sum, these findings highlight potentially important contingencies in how people feel lonely in different countries, and the potential of contact with nature as a means to address this critical issue of modern times. Randomised trials of nature prescription interventions for loneliness co-designed with respect to contrasting cultural, economic, and climatic contexts are needed to ensure programs intended to reconnect people with nature are effective, equitable, and acceptable for everyone. • Study of nature contact, nature prescriptions and loneliness in five countries. • More nature contact was associated with less social loneliness. • More nature contact was associated with more emotional loneliness. • Nature prescriptions were not associated with loneliness. • Loneliness was higher in persons who had no-one to visit natural environments with. [ABSTRACT FROM AUTHOR]

Studies of associations between green space and overweight/obesity are often agnostic to green space type and potential contingencies by gender and household relocation. We investigated associations between total green space, tree canopy, and open grass within 1.6 km road network buffers, on body mass index (BMI) at baseline (n = 110,234; 2005–2009) and follow-up (n=50,672; 2012–2015) using data from the Sax's Institute's 45 and Up Study (NSW, Australia). Analyses considered potential non-linearities in these associations and the possibility for effect modification by gender and household relocation. Models were adjusted for age, couple status, region of birth, household income, employment status, educational attainment and housing status. Results revealed that 20 % or more tree canopy, compared to 0–10 % tree canopy was associated with lower BMI. Comparable findings were not observed for open grass or total green space. Nonlinear associations were observed, with a rapid decrease in odds of being overweight/obese at baseline with 20 % tree canopy, that became more stable by 30 % tree canopy. This non-linearity was stronger in females than males. By follow-up, associations indicated potential protective effects with 20 % or more tree canopy for overweight/obesity in females. Logistic regression models examined the odds of becoming a healthy weight at follow-up in overweight/obese individuals at baseline. Results indicated a potentially protective influence of tree canopy on overweight/obesity for people who did not move home (odds ratio (OR) = 1.06, 95 % confidence interval (CI) = 1.01–1.12), but not those who relocated (OR = 0.97, 95 % CI = 0.83–1.11). In sum, conserving and restoring urban tree canopy to at least 20% to 30% of nearby land-use may help to reduce levels of overweight and obesity in the community These benefits may be particularly potent for females and for people who are residentially stable. More open grass, or green space in general, may not have the same benefits for adult overweight/obesity as tree canopy. • Living nearby 30 % or more tree canopy reduces odds of overweight and obesity. • This association with tree canopy was stronger for females. • Tree canopy was negatively associated with overweight/obesity for non-movers. [ABSTRACT FROM AUTHOR]

Abstract Background Few studies have reported the association between greenspace and academic performance at school level. We examined associations between both residential and school greenspace and individual school grades in German adolescents. Methods German and maths grades from the latest school certificate, residential and school greenspace, and covariates were available for 1351 10 and 15 years old Munich children and 1078 Wesel children from two German birth cohorts – GINIplus and LISA. Residential and school greenspace was assessed by the Normalized Difference Vegetation Index (NDVI), tree cover, and (in Munich only) proportion of agricultural land, forest, and urban green space in 500-m and 1000-m circular buffers. Longitudinal associations between each exposure-outcome pair were assessed by logistic mixed effects models with person and school as random intercepts and adjusted for potential confounders. Results No associations were observed between any of the greenspace variables and grades in Wesel children. Several statistically significant associations were observed with German and maths grades in Munich children, however associations were inconsistent across sensitivity analyses. Conclusions There is no evidence of an association of higher greenspace at residence, school or combined with improved academic performance in German adolescents from the GINIplus and LISA longitudinal studies. Graphical abstract Image 1 Highlights • School greenspace was positively correlated with academic performance in ecological studies. • Our individual-level analysis included both residential and school greenspace and their combination. • We used data on individual German and maths grades in 10- and 15-year-olds. • No beneficial associations were observed in either of the two areas, Munich and Wesel. • The link is plausible and more studies with individual data should explore it. Higher residential or school greenspace does not appear to improve academic performance in 10- and 15-years old children from two study areas in Germany. [ABSTRACT FROM AUTHOR]

Cross-sectional studies of Alzheimer's disease tend to report higher risk in 'rural' areas. Multilevel longitudinal analysis of 261,669 participants in the Sax Institute's 45 and Up Study was conducted, tracking incidence of Alzheimer's disease defined by the first cholinesterase inhibitor prescription via linked records from the Department of Human Services in Australia. Alzheimer's disease was diagnosed in 3046 participants over 11 years. Adjusting for age, gender, education, income and area disadvantage, Alzheimer's disease risk was lower in 'outer regional and remote areas' (incident rate ratio 0.81, 95%CI 0.67-0.97) compared with 'major cities'. Further research on environmental factors is warranted. [ABSTRACT FROM AUTHOR]

A type 2 diabetes (T2DM) diagnosis has been referred to as a "wake-up call", but subsequent behavioural change may be influenced by place of residence. Random effects within-between regressions were applied to 130,926 participants in the 45 and Up Study. T2DM diagnoses effected change in the odds of short sleeps and meeting vegetable and alcohol consumption guidelines, but not changes in physical activity. Each of these behaviours varied geographically and were patterned by area disadvantage and geographic remoteness. Impacts of T2DM diagnosis on behavioural change were not found to be geographically contingent, though analysis of specific environmental attributes is warranted. [ABSTRACT FROM AUTHOR]

Purpose The objectives of this study were to determine whether longitudinal changes in accelerometer-assessed moderate-to-vigorous physical activity (MVPA) were associated with changes in educational outcomes (i.e., academic performance and mathematics engagement) and to examine whether the association was nonlinear. Methods Longitudinal data were collected from 2,194 Australian adolescents (mean age = 13.40 years, standard deviation = .73) at two time points (Term 1, 2014, and Term 2, 2015). To measure the total MVPA, the adolescents wore an accelerometer for seven consecutive days. The participants responded to a questionnaire to measure mathematics engagement and completed a nationally administered numeracy test to assess academic performance. Results Latent change score models indicated that increases in MVPA had a positive quadratic association with National Assessment Program—Literacy and Numeracy (NAPLAN) scores in girls ( β  = .39, p  < .001) but not boys. In comparison, cross-sectional regression analyses indicated that MVPA had a positive quadratic association with NAPLAN scores in grade 7 ( β  = .92, p  = .04) boys and in grade 9 boys ( β  = .60, p  = .06), but not in girls. There was also a positive quadratic association between MVPA and school engagement in grade 9 boys ( β  = .77, p  = .03). Conclusions Cross-sectional evidence indicated that boys who were more physically active had better educational outcomes than their less active peers, and girls who increased their regular physical activity showed improvements in academic performance. All students need to increase their physical activity levels for health and educational benefits, without compromising the time spent on study and homework. [ABSTRACT FROM AUTHOR]

Background Evidence shows that the relationship between physical activity and mental wellbeing varies across different life domains. However, little is known about the reasons for such variation. We aimed to explore motivation as a potential underlying factor that may explain some of the variation, by qualitatively examining adolescents’ physical activity experiences and perceived affective outcomes during leisure-time, active travel, and physical education. Method We conducted computer-assisted-self-interviews with 144 adolescents ( M age = 14.42 years) about physical activity experiences they believed led to positive and negative affect. The participants were asked when the activities occurred, their reason for participation, and with whom they participated. Participants also responded to questions specifically about leisure-time, active travel, and physical education. Results Thematic analysis revealed that adolescents perceived leisure-time physical activity led to positive affect, because it was fun, increased self-esteem, and provided a sense of belonging. However, active travel was associated with positive affect among those who participated for enjoyment or health benefits, far more than those who participated because it was their only means of transportation. Similarly, those who believed physical education was fun, and experienced a sense of belonging, were more likely to report it led to positive affect, compared to those who participated in physical education because they were forced. Conclusions Compared to other life domains, more adolescents associate leisure-time physical activity with positive affect. However, promoting more autonomous motivation may enhance the effect of physical activity on wellbeing in other domains, such as active travel and physical education. [ABSTRACT FROM AUTHOR]

Food purchasing decisions are made within the context of the range of options available, yet most epidemiological studies focus upon single outlet types. Ratios of fast food outlets to supermarkets and green grocers were linked to addresses of 15,229 adults in the 45 and Up Study at baseline (2006-2008) and follow-up (2009-2010). Compared to having no fast food outlet but having healthy food outlets within 3.2km from home, multilevel growth curves revealed that relative exposure>25% fast food outlets were associated with 0.36-1.19kg/m2 higher BMI (p<0.05). These associations were consistent as people aged. No associations were observed for food outlets<0.8km. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine whether physical activity has a positive relationship with school engagement regardless of the presence or absence of a recess or lunch break before the classroom lesson.Design: Data were collected over three ten-week periods: January-April 2014 (Time 1), October-December 2014 (Time 2), and April-June 2015 (Time 3).Methods: A cohort of 2194 adolescents (mean age=13.40years, SD=.73) wore an accelerometer during the hour before a mathematics lesson and completed a questionnaire following the mathematics lesson to assess school engagement in that lesson.Results: Linear mixed models indicated that moderate-intensity activity before a mathematics lesson had a positive linear relationship with cognitive engagement (β=.40, p<.05). Recess breaks before a mathematics lesson had a negative relationship with overall, behavioural, emotional, and cognitive engagement (β=-.18, p<.01, β=-.19, p<.01, β=-.13, p=.03, and β=-.13, p=.04, respectively).Conclusions: Promoting moderate-intensity activity prior to mathematics lessons could improve students' cognitive engagement. Educators should be aware that students tend to demonstrate the lowest levels of school engagement after recess breaks. [ABSTRACT FROM AUTHOR]

There is a significant amount of evidence highlighting the health, wellbeing and social benefits of gardening during previous periods of crises. These benefits were also evident during the COVID-19 pandemic. This paper presents a narrative review exploring gardening during the early stages of the COVID-19 pandemic to understand the different forms of gardening that took place during this crisis and key elements of this activity. Research about gardening during the pandemic focused on food (in)security and disrupted food systems, the health and wellbeing benefits of gardening, and the social dimensions of gardening. We offer three vignettes of our own research to highlight key insights from local, national and international perspectives of gardening during the pandemic. The paper's conclusion outlines how researchers, policy makers and public health practitioners can harness what has been learned from gardening during the pandemic to ensure these benefits are more widely available and do not exacerbate already entrenched health inequalities in society. • Gardening during times of crisis offers significant public health benefits. • Social and health benefits associated with gardening were evident during COVID-19. • This paper explores literature on what gardening during COVID-19 looked like. • There is a need to strengthen the role of gardening in policy to be prepared for future crises. [ABSTRACT FROM AUTHOR]

Urban tree canopy is associated with lower dementia risk, but no mediation analysis has been attempted to reveal potential mechanisms. We examined 3,639 dementia diagnoses in 109,688 participants of the Sax Institute's 45 and Up Study. Adjusted models indicated ≥20% tree canopy lowered the odds of developing dementia by 14% over 11 years (Odds Ratio = 0.86, 95%CI = 0.79–0.93). Association between tree canopy and dementia was partially mediated by physical activity (4.5%) and absences of psychological distress (5.7%), social support (2.9%), sleep duration (2.3%) and diabetes (1.8%). Social loneliness and absence of heart disease or hypertension did not mediate the tree canopy-dementia association. • First causal mediation study on nearby tree canopy and dementia. • Mediation was observed via capacity building and restoring pathways. • Physical activity mediated 4.5% of the association. • Absence of psychological distress mediated 5.7% of the association. • Social support, sleep, and diabetes mediated 1.8%–2.9%. [ABSTRACT FROM AUTHOR]

Introduction: There are few studies on the potential benefits of green space quantity and quality for child well-being. The authors hypothesized that more and better quality residential green space would be favorable for well-being and that these associations could be subject to effect modification across childhood.Method: Multilevel linear regression adjusted for demographic and socioeconomic confounders was used to track change in well-being (Strengths and Difficulties Questionnaire Total Difficulties Score and "internalizing" and "externalizing" subscales) across five separate occasions among a cohort of 4,968 Australian children aged 4-5 years beginning in 2004. Well-being was assessed with respect to objectively measured green space quantity and parent-reported green space quality, with interaction terms fitted with age to assess for potential effect modification. Data were analyzed in 2015.Results: Non-linear dose-response associations were observed for favorable well-being in relation to larger quantities of green space and also green space judged to be higher in quality. Favorable perceptions of green space quality were associated with larger quantities of green space regardless of neighborhood socioeconomic circumstances. Benefits for well-being appeared to top out at 21%-40% green space coverage and were reasonably consistent across childhood. Inequality in well-being (especially the internalizing subscale) emerged as children aged in relation to green space quality.Conclusions: Approximately 21%-40% of residential land-use allocated to green space may be an optimal amount for promoting child well-being, but the quality of this green space increases in importance as children age. [ABSTRACT FROM AUTHOR]

Summary Aims Hyperhomocysteinemia (HHcy) is known to increase the risk of many diseases. Factors influencing HHcy in healthy and hypertensive subjects remain under-researched. Methods A large population-based study was conducted in 60 communities from Shenzhen, China. Responses to standardized questions on lifestyle factors and blood samples were collected from all participants after a 12-h overnight fast. Multiple linear and multivariate logistic regressions were used to explore risk factors for HHcy. Results were then compared to those from a systematic review of English-language articles listed in Pubmed, EBSCOhost, Web of Science, Embase and Cochrane libraries that investigated HHcy risk factors in healthy and hypertensive subjects. Results A total of 1586 healthy (Male/Female = 642/944) and 5935 hypertensive subjects (Male/Female = 2928/3007) participated in our population-based study. In logistic regression analyses, age, BMI and creatinine (Cr) were risk factors, while being female, fruit intake and physical activity were protective factors for HHcy in healthy subjects. In hypertensive subjects, seven [age, smoking, salt intake, systolic blood pressure (SBP), uric acid, triglycerides (TG), and Cr] and four [female, fruit intake, total cholesterol (TC), and glucose] factors were associated with higher and lower HHcy respectively. The review of 71 studies revealed that potential risk factors for Hcy included nutritional, physiologic, lifestyle habits, ethnicity, genetics, interactions between gene–environment, gene–gene, gene–nutritional, environment–environment, nutritional–nutritional. Conclusion Our study indicates the potential importance of increasing folic acid and vitamin B supplementation, daily fruit and vegetable intake, regular exercise and refraining from tobacco smoking and alcohol consumption as preventive strategies for Hcy. [ABSTRACT FROM AUTHOR]

Several recent studies have suggested that people in socioeconomically disadvantaged circumstances may benefit more from local green space ('equigenesis'). This study provides a test of this hypothesis in children aged 0-13 years old. Results from multilevel models suggest the odds of sub-optimal general health were 14% lower among children in areas containing >21.5% green space compared to those with <10%. Higher parent-reported quality green space was associated with 18% lower odds of sub-optimal child health. However, no effect modification of the association between child health and area disadvantage across strata of green space quantity or quality was observed. [ABSTRACT FROM AUTHOR]

There is increasing awareness for beneficial health effects of green space surrounding the home, but the underlying mechanisms are not yet fully understood and challenging to study given the correlation with other exposures. Here, the association of residential greenness and vitamin D including a gene-environment interaction is investigated. 25-hydroxyvitamin D (25(OH)D) was measured by electrochemiluminescence at ages 10 and 15 years in participants of two German birth cohorts GINIplus and LISA. Greenness was measured using the Landsat-derived Normalized Difference Vegetation Index (NDVI) in a 500 m buffer surrounding the home. Linear and logistic regression models were applied at both time points adjusted for several covariates (N 10Y = 2,504, N 15Y = 2,613). In additional analyses vitamin D-related genes, physical activity, time spent outdoors, supplements, and measurement season were investigated as potential confounders or effect modifiers. A 1.5-SD increase in NDVI was significantly associated with increased 25(OH)D values at ages 10 and 15 years (β 10y = 2.41 nmol/l, p=<0.01; β 15y = 2.03 nmol/l, p = 0.02). In stratified analyses, the associations were not seen in participants spending more than 5 h/day outside in summer, having a high physical activity level, taking supplements, or being examined during the winter season. In a subset (n = 1,732) with genetic data, a significant gene-environment interaction of NDVI with CYP2R1 , an upstream gene in 25(OH)D synthesis, was observed at age 10 years. When investigating 25(OH)D sufficiency, defined as values above 50 nmol/l, a 1.5-SD increase in NDVI was associated with significantly higher odds of having sufficient 25 (OH)D levels at age 10 years (OR = 1.48, 1.19–1.83). In conclusion, robust associations between residential greenness and 25 (OH)D levels were observed in children and adolescents independent of other confounders and additionally supported by the presence of a gene-environment interaction. Effects of NDVI were stronger in those having lower vitamin D levels at age 10 years due to their covariate profile or genetically lower 25(OH)D synthesis. [Display omitted] • NDVI is robustly associated with 25(OH)D in children and adolescents. • Gene × Environment interaction present for CYP2R1. • Sub-group analyses reveal differences depending on covariate profile. [ABSTRACT FROM AUTHOR]

Research on the health benefits of people's long-term exposure to green space is lacking. Addressing this emerging topic, this study uncovers the association of green space types with a person's healthy ageing score (HAS). We investigated the association with HAS by continuous exposure to various green space types for two years. Green space types include tree canopy, low-lying vegetation and open grass percentage within 1.6-km road network distance buffers at baseline and second follow-up. Healthy ageing outcomes included functional capacity, resilience and HAS while accounting for relocation. This is a longitudinal study of a cohort of 22,715 New South Wales residents aged over 45 who participated in the Sax Institute's 45 and Up Study living in Sydney, Wollongong and Newcastle. Longitudinal models of healthy ageing on green space types were fit with controls for socioeconomic confounders. Women who did not relocate were associated with a lower functional capacity (β; 95%CI: −0.10; −0.15,−0.05) and higher resilience (0.11; 0.08, 0.14) compared to those who relocated. Apart from age, personal characteristics did not explain the variation in healthy ageing outcomes for participants who moved. For participants who did not relocate, 30% grass cover was associated with decreased functional capacity (−0.22; −0.41,−0.04) and HAS (−0.31; −0.56,−0.05). Also, 5–9% low-lying vegetation was associated with a decline in functional capacity (−0.09; −0.15, −0.03) and HAS (−0.09; −0.17, −0.01) of participants who stayed but improved resilience (0.28; 0.01, 0.55) of participants who relocated. Green space comprising over 30% tree cover appeared most beneficial for functional capacity (0.42; 0.31, 0.53), resilience (0.19; 0.13, 0.25) and HAS (0.60; 0.45, 0.75). For participants who relocated, over 30% tree canopy was associated with improved functional capacity (0.33; 0.54, 0.62) but not resilience or their HAS. Increased neighbourhood tree canopy supports healthy ageing. Older people should be supported to live in-home or move into nearby residential care and maintain regular contact with green spaces and trees, to maximise potential benefits for health and wellbeing. [ABSTRACT FROM AUTHOR]

Reductions in body mass index and reduced overweight/obesity risk among participants in the 45 and Up Study diagnosed with type 2 diabetes mellitus (T2DM) were relatively large in rural areas compared to those in urban environs. Further research is needed to explain why where people reside influences optimal management of T2DM. [ABSTRACT FROM AUTHOR]

Growing number of evidence have reported that exposure to air pollution was associated with unfavourable birth outcomes while increased exposure to green spaces was associated with better birth outcomes. However, the effect of interactions between air pollution and green spaces on pregnancy outcomes remain unclear. Using the data on all the live births recorded in Sydney between 2016 January and 2017 December, we built up multilevel linear and logistic regression models with random intercepts for statistical area level 2 (SA2) to examine the association between residential levels of air pollution (NO2, PM2.5, SO2 and O3) and pregnancy outcomes including birthweight, low birthweight, and preterm birth. This was followed by assessment of potential effect modification by green space quantity by fitting 2-way interaction term between each air pollutants and green space quantity separately. Furthermore, building on the 2-way interaction term, we explored 3-way interactions by adding area level socio-economic status and population density. Higher levels of PM2.5, NO2 and SO2 were statistically significantly associated with decrease in birthweights (p < 0.05) in the adjusted models. We observed statistically significantly association between the lower risks of preterm birth and higher levels of NO2 in the adjusted models (p < 0.05). However, none of the other air pollutants were statistically significantly associated with the odds of low birthweight and preterm birth. In the adjusted models, green space quantity was statistically significantly associated with reduced odds of preterm birth (p < 0.05). The results for birthweights were in the same direction (p < 0.05) however, some of these associations did not remain statistically significant after adjusting the models for air pollution. In general, no associations were found for low birthweight. Statistically significant 2-way interactions between green space quantity and NO2, PM2.5 and SO2 levels indicated that association between moderate levels of NO2, PM2.5 and birthweight weakened in the greener areas (>20 %) especially in the affluent and densely populated areas while the effect of SO2 did not differ consistently across green space levels with benefit of exposure to the greenest areas (>40 %) was evident, yet not statistically significant. Our findings suggest that increasing green spaces in cities may help supporting a healthy start in life by decreasing harms of moderate levels of air pollution. Replication in different contexts and consideration of potentially contrasting results with different types of green space is warranted. [Display omitted] [ABSTRACT FROM AUTHOR]

Identifying ‘neighbourhood effects’ to support widespread beliefs that where we live matters for our health remains a major challenge due to the reliance upon observational data. In this study we reassess the issue of local crime rates and psychological distress by applying unobserved (‘fixed’) effects models to a sample of participants who remain in the same neighbourhoods throughout the study. Baseline data was extracted from the 45 and Up Study between 2006 and 2008 and followed up as part of the Social Economic and Environmental Factors (SEEF) Study between 2009 and 2010. Kessler 10 scores were recorded for 25,545 men and 29,299 women reported valid outcomes. Annual crime rates per 1000 (including non-domestic violence, malicious damage, break and enter, and stealing, theft and robbery) from 2006 to 2010 inclusive were linked to the person-level data. Change in exposure to crime among participants in this study, therefore, occurs as a result of a change in the local crime rate, rather than a process of neighbourhood selection. Gender stratified unobserved effects logistic regression adjusting for sources of time-varying confounding (age, income, employment, couple status and physical functioning) indicated that an increase in the risk of experiencing psychological distress was generally associated with an increase in the level of neighbourhood crime. Effect sizes were particularly high for women, especially for an increase in malicious damage (Odds Ratio Tertile 3 vs Tertile 1 2.40, 95% Confidence Interval 1.88, 3.05), which may indicate that damage to local built environment is an important pathway linking neighbourhood crime with psychological distress. No statistically significant association was detected for an increase in non-domestic violence, although the effect was in the hypothesised direction. In summary, the application of unobserved effects models to analyse data that takes into account the temporally dynamic characteristics of where people live warrants further investigation. [ABSTRACT FROM AUTHOR]

Equivocal findings on crime as a deterrent for physical activity may be due to effects of geographic scale on exposure measurement. To investigate this hypothesis, physical activity was measured in 203,883 Australians and linked to standardised crime counts within small (‘Census Collection Districts’; approx. 330 residents) and larger areas (‘Statistical Local Areas’; approx. 32,000 residents). A median rate ratio of 2.26 indicated substantive geographic variation in moderate-to-vigorous physical activity (MVPA). Adjusting for confounders, multilevel negative binomial regression reported lower MVPA with more crime consistently in small, but not in larger areas. Reducing small pockets of local crime may encourage more physically active lifestyles. [ABSTRACT FROM AUTHOR]

Accumulating exposure to quality green space over time is posited to influence child health, yet longitudinal studies are scarce. This study aimed to examine the associations between trajectories of perceived green space quality and child health-related outcomes. We used data from 1874 childrenin the B-cohort of the Longitudinal Study of Australian Children who participated in the Child Health Checkpoint module at 11–12 years. Data on caregiver perceived green space quality measured biennially was assessed using discrete trajectory mixture models to group children by contrasting distributions in green space quality over time. Examination of associations between trajectory groups of perceived green space quality and child biomarkers (i.e., albumin-to-creatinine ratio, total, cholesterol, total triglycerides, and glucose), physical health and behavioural assessments (i.e., anthropometric measurements, blood pressure, sedentary behaviour, physical activity, sleep, aerobic work capacity, and general wellbeing), and health care use were assessed using multilevel models, adjusted for sociodemographic variables. Four perceived green space quality trajectories were identified: "decreasing quality from high to moderate"; "increasing quality from low to high"; "consistently high quality"; "consistently low quality". Compared with consistently low levels of quality green space, adjusted models indicated consistently high-quality green space was associated with lower total triglycerides (β −0.13; 95%CI -0.25, −0.01). Lower odds of hospital admission was observed among children who accumulated quality green space over time (OR 0.45; 95%CI 0.23, 0.87). These associations were observed in boys only in sex-stratified analyses. Moreover, boys accumulating quality green space through time tended to have lower diastolic blood pressure (β −2.76; 95%CI -5.17, −0.35) and girls who experienced loss in quality green space tended to have a higher percentage of body fat (β 2.81; 95%CI 0.43, 5.20). Accumulating quality green space over time is important for various aspects of child health, with contrasting benefits by sex. [Display omitted] • Four trajectory groups were developed for childhood exposure to green space quality. • Consistently high-quality green space was associated with lower total triglycerides. • Accumulated quality green space decreased the odds of hospital admission. • Boys accumulating quality green space tended to have lower diastolic blood pressure. • Girls with loss in quality green space tended to have a higher body fat percent. [ABSTRACT FROM AUTHOR]

We investigated whether ethnic and country of birth differences in adult Body Mass Index (BMI) were associated with differences in diet, physical activity and ethnic density (the percentage of an ethnic group within the neighbourhood environment). A sample of 214,807 adults living in Australia was extracted from the 45 and Up Study. Analyses comprised multilevel modelling of BMI for 38 ethnic and country of birth groups. Physical activity was ascertained using the Active Australia Survey. Dietary measures included self-reported consumption of fruit, vegetables, meat and cheese. Ethnic density was objectively measured using 2006 Australian Census data. Possible confounders included age, gender, household income, educational qualifications, economic status, couple status, language, duration of residence, neighbourhood affluence and remoteness. Compared to Australian-born Australians (age-gender adjusted mean BMI = 27.1, 95%CI 27.1, 27.2), overseas-born groups often had lower mean BMI, especially the Chinese born in China (23.2, 23.0, 23.4). Exceptions included the Italians (BMI = 28.1), Greeks (28.5), Maltese (27.6), Lebanese (28.4) and Croatians (27.8) born in their ethnic-country of origin. Regardless of birthplace, BMI was lower for the English, Scottish, and Chinese, but higher for Italians and Greeks. Some ethnic differences reflected the ‘healthy migrant’ hypothesis, whereas others did not. These differences were only partially attenuated by controls for portions of fruit and vegetables, meat and cheese, frequency of participation in physical activity, and other explanatory variables. Ethnic density was associated with lower BMI for the English and Irish ( p < 0.05), regardless of whether they were born in the UK, Ireland, or Australia. Ethnic differences in adult weight status in Australia do not appear to be fully explained by conventional risk factors. For some groups, but not all, living among others of the same ethnic group may proxy unmeasured health-promoting factors and these contexts, along with other factors that harm health (e.g. racial discrimination) warrant further investigation. [ABSTRACT FROM AUTHOR]

Abstract: Recent studies suggest that stress can amplify the harm of air pollution. We examined whether experience of racism and exposure to particulate matter with an aerodynamic diameter of less than 2.5µm and 10µm (PM2.5 and PM10) had a synergistic influence on ethnic differences in asthma and lung function across adolescence. Analyses using multilevel models showed lower forced expiratory volume (FEV1), forced vital capacity (FVC) and lower rates of asthma among some ethnic minorities compared to Whites, but higher exposure to PM2.5, PM10 and racism. Racism appeared to amplify the relationship between asthma and air pollution for all ethnic groups, but did not explain ethnic differences in respiratory health. [Copyright &y& Elsevier]

Abstract: Little is known about why many people diagnosed with hepatitis C virus (HCV) infection fail to reach and stay within specialist care services. We used a Geographic Information System and logit regression to investigate whether travel-time to a specialist centre was associated with an increased likelihood of non-referral, non-attendance and loss to follow-up among persons diagnosed with HCV between 1991 and 2003 in Tayside, Scotland (UK). Information was available on referral to, and utilisation of, the single HCV specialist centre in Tayside between 1991 and 2006. Longer travel-time to a specialist centre was associated with an increased likelihood of non-referral to a specialist centre following diagnosis (Odds Ratio: 1.25, 95% Confidence Interval: 1.09, 1.44). Patients living further from an HCV specialist centre were less likely to be referred to it for treatment that could cure their HCV infection. Neither a history of intravenous drug use (IDU), nor area deprivation predicted non-referral. Subsequent to referral, travel-time to a specialist centre was not associated with either non-attendance (0.83 (0.56, 1.21)) or loss to follow-up (0.98 (0.78, 1.22)), although a history of IDU was a strong predictor of both non-attendance and loss to follow-up. Non-attendance was less likely among older patients, while loss to follow-up was more common among those living in deprived areas. Once referred, patients appear able to cope with stress and financial cost of long and frequent journeys to hospital. However, as rates of referral improve from more geographically remote areas, long travel-times to an HCV specialist centre may become an important factor determining future utilisation. [Copyright &y& Elsevier]

Abstract: Recent work in France has suggested that poor geographic access to primary healthcare may have a negative influence upon detection rates of the hepatitis C virus. Topography and poor infrastructure can exacerbate geographic remoteness, while the stigma surrounding hepatitis C and intravenous drug use may also discourage healthcare-seeking behaviour in rural communities with limited choice of general practitioner. No similar study has been conducted in the UK, where detection rates of hepatitis C are also low. Moreover, the previous French findings did not adjust for the uneven spatial distribution of HCV prevalence and associated risk factors, which raises the possibility that the reported travel-time associations were a reflection of greater hepatitis C prevalence in urban areas (where the travel-times to primary healthcare are short) and not an effect of geographic access to primary healthcare. Using geographic information systems, Poisson regression and a dataset from Tayside (Scotland), we explored whether lower rates of hepatitis C detection were associated with higher travel-times to primary healthcare. We tested whether any travel-time effects remained once the models were adjusted for deprivation, by controlling for the spatial variation of some of the known risk factors of hepatitis C infection. Separate models were calculated according to patient history of opiate substitution therapy to take account of people likely to have been infected through intravenous drug use. Rates of detected hepatitis C were highest among males aged between 25 and 39 years. A statistically significant travel-time-decay effect was observed, though with notable attenuation for all patients after adjusting for deprivation. Further modelling identified a travel-time effect only for those who had received opiate substitution therapy. The absence of a similar effect in the non-opiate substitution therapy group indicates that selection effects, not causation, are the most likely explanation for the initial travel-time-decay effects. Thus, future studies of hepatitis C detection and geographic access to primary healthcare will need to consider ways of controlling for the uneven spatial distribution of HCV prevalence and associated risk factors beyond ecological measures of socioeconomic deprivation. [Copyright &y& Elsevier]

Background: A large multicentre European study reported later onset of menopause among women residing in greener areas. This influence on the timing of a reproductive event like menopause, raises the question whether similar associations can be observed with timing of menarche. We investigated whether exposure to residential green space was related to the age at menarche in German and Australian adolescent girls.Methods: The analytic samples comprised of 1706 German and 1474 Australian adolescent girls. Percentage of green space was calculated in 1000 m buffers around a residential address or its surrogate at the previous follow-up. Mixed effects Cox proportional hazard models were used to explore the associations. The survival object was the occurrence of menarche at the time of follow-up (15-year follow-up of the German cohorts and the study wave at 14-15 years in the Australian cohort) and number of years since baseline (10-year follow-up in the German cohort and the study wave at 10-11 years in the Australian cohort). Participants who did not reach menarche were included as censored observations.Results: A greener residence was not associated with the age at menarche. Null findings were consistent in the general population and in analyses stratified by socioeconomic status or urbanicity in both countries. Urban residents were more likely to have earlier menarche, and this association was consistent across Germany and Australia.Conclusion: The results of our analysis do not support the hypothesis that residing in places with more green space can influence timing of menarche. However, given the limitations of our study, researchers should not be discouraged to further explore environmental risk factors of early menarche. [ABSTRACT FROM AUTHOR]

While the evidence of mental health benefits from investing in green space accumulates, claims of reduced healthcare expenditure are rarely supported by evidence from analyses of actual healthcare data. Additionally, the question of 'who pays?' has been ignored. We addressed these gaps using person-level data in three Australian cities. 55,339 participants with a mean follow-up time of 4.97 years in the Sax Institute's 45 and Up Study (wave 2, collected 2012–2015) were linked to fee-for-service records of antidepressant prescriptions and talking therapy subsidised by the Australian Government (including data on per unit fee, state subsidy, and individual co-payment). Total green space, tree canopy and open grass within 1.6 km road network distances were linked to each participant. Multilevel logistic, negative binomial, and generalised linear models with gamma distribution adjusted for demographic and socioeconomic confounders were used to assess association between each green space variable and prescribing/referral and costs of antidepressants and talking therapy. Prescription of at least one course of antidepressants occurred for 20.01% (n = 11,071). Referral for at least one session of talking therapy occurred in 8.95% (n = 4954). 13,482 participants (24.4%) had either a prescription or a referral. A 10% increase in green space was associated with higher levels of antidepressant prescribing (e.g. incident rate ratio (IRR) = 1.06, 95%CI = 1.04–1.08). Tree canopy was not associated with antidepressant prescribing or referrals for talking therapy. Open grass was associated with higher odds (OR = 1.17, 95%CI = 1.13–1.20) and counts (IRR = 1.05, 95%CI = 1.02–1.08) of antidepressant prescriptions. Open grass was also associated with lower odds (OR = 0.87, 95%CI = 0.82–0.92) and counts (IRR = 0.93, 95%CI = 0.90–0.96) of talking therapy referrals. Open grass was associated with higher total and mean per-person levels of expenditure on antidepressant prescriptions. Although green space supports mental health, these unexpected results provide pause for reflection on whether greening strategies will always result in purported reductions in mental healthcare expenditure. • Open grass was associated with antidepressants prescribing. • Open grass was associated with higher mental healthcare costs. • Tree canopy was not associated with mental healthcare expenditure. [ABSTRACT FROM AUTHOR]

• House dwellers were more physically active if there was more green space and/or trees. • More green space was not associated with more physically active apartment dwellers. • More open grass was associated with lower proportions of vigorous physical activity. Association between green space and physical activity has ignored housing type, despite people in houses often having access to private green space, whereas their counterparts in apartments mostly do not. Thus, access to green space may have contrasting influences on outdoor leisure time and how much of it is spent doing the types of physical activity known to protect against chronic disease. Adjusted multilevel logistic and zero-truncated negative binomial regressions of the Sax Institute's 45 and Up Study baseline (2006–2009) tested associations between percentage green space, tree canopy, and open grass within 1.6 km of participants homes with: (i) time outdoors on weekdays or (ii) on weekends; (iii) minutes of moderate to vigorous physical activity (MVPA); and (iv) percentage of MVPA spent in vigorous activities (i.e. activities that make people puff and pant). A 10 % increase in total green space was marginally associated with higher odds of spending > 2 h outdoors during weekdays (OR = 1.02, 95 %CI = 1.00–1.04) and > 4 h during weekends (OR = 1.03, 1.01–1.05) for house-dwellers only. Levels of total MVPA tended to be higher with more green space (IRR = 1.01, 1.00–1.03) among people in houses, but not those in apartments. MVPA as > 30 % vigorous was higher for people in houses with 10 % more green space (OR = 1.03 (1.01–1.06), but not apartments. Similar results to total green space were found for 10 % increases in tree canopy, but not for open grass. Association between open grass and time outdoors on weekends was observed for house-dwellers only (OR = 1.03, 1.00–1.07). More open grass was associated were lower levels of MVPA among people in houses (IRR = 0.97 (0.95−0.99). More open grass was also associated with lower odds of > 30 % MVPA being vigorous among house-dwellers (OR = 0.96, 0.92−0.99) and apartment-dwellers (OR = 0.84, 0.75−0.94). Benefits of green space for physical activity tend to be observed among house-dwellers. The general absence of green space benefits for time outdoors and physical activity among apartment-dwellers warrants in-depth exploration. [ABSTRACT FROM AUTHOR]

Past research on cannabis has been limited in scope to THC potencies lower than legally available and efforts to integrate the effects into models of driving performance have not been attempted to date. The purpose of this systematic review is to understand the implications for modeling driving performance and describe future research needs. The risk of motor vehicle crashes increases 2-fold after smoking marijuana. Driving during acute cannabis intoxication impairs concentration, reaction time, along with a variety of other necessary driving-related skills. Changes to legislation in North America and abroad have led to an increase in cannabis' popularity. This has given rise to more potent strains, with higher THC concentrations than ever before. There is also rising usage of novel ingestion methods other than smoking, such as oral cannabis products (e.g., brownies, infused drinks, candies), vaping, and topicals. The PRISMA guidelines were followed to perform a systematic search of the PubMed database for peer-reviewed literature. Search terms were combined with keywords for driving performance: driving, performance, impairment. Grey literature was also reviewed, including congressional reports, committee reports, and roadside surveys. There is a large discrepancy between the types of cannabis products sold and what is researched. Almost all studies that used inhalation as the mode of ingestion with cannabis that is around 6% THC. This pales in comparison to the more potent strains being sold today which can exceed 20%. Which is to say nothing of extracts, which can contain 60% or more THC. Experimental protocol is another gap in research that needs to be filled. Methodologies that involve naturalistic (real world) driving environments, smoked rather than vaporized cannabis, and non-lab certified products introduce uncontrollable variables. When considering the available literature and the implications of modeling the impacts of cannabis on driving performance, two critical areas emerge that require additional research: The first is the role of cannabis potency. Second is the route of administration. Does the lower peak THC level result in smaller impacts on performance? How long does potential impairment last along the longer time-course associated with different pharmacokinetic profiles. It is critical for modeling efforts to understand the answers to these questions, accurately model the effects on driver performance, and by extension understand the risk to the public. [ABSTRACT FROM AUTHOR]

Potential pathways linking green space quality to prosocial behaviour have not been investigated so far. This study aimed to examine 15 candidate mediators of the association between green space quality and prosocial behaviour across physical activity, social interaction, health-related quality of life (HRQOL), child and caregiver mental health. This study analysed data of 4969 children aged 4−5 years that were observed for 10 years (2004–2014), retrieved from the Longitudinal Study of Australian Children. Caregiver perceptions of the availability of good neighbourhood parks, play spaces, and playgrounds were used to evaluate green space quality. Prosocial behaviour was measured based on caregiver reports of the prosocial subscale from the Strengths and Difficulties Questionnaire. Causal mediation analysis was used to fit each candidate mediator in a single mediation model. Additional analyses were conducted to strengthen the findings by modelling green space quality, candidate mediators with child-reported prosocial behaviour. Findings from this study suggest weak evidence of physical activity mediation, with only physical activity enjoyment displaying moderate mediation consistency. Child social interaction and caregiver mental health showed low mediation consistency. In addition, moderate-to-high and low-to-high mediation consistency was found for child mental health and HRQOL indicators, respectively. Mediation by candidate mediators appeared to manifest more in late childhood. Mediation models using child-reported prosocial behaviour tended to show weaker mediation compared to caregiver-reported prosocial behaviour models. To conclude, green space quality may indirectly influence prosocial behaviour among children via several pathways. Improving the quality of neighbourhood green space may support physical activity enjoyment, social interaction, mental health among children, which in turn, may potentially foster the development of prosocial behaviour. [ABSTRACT FROM AUTHOR]

• Walking trails, group exercise venues were associated with increased green space visitation. • Fitness area was positively associated with cumulative green space visitation of 30 min or more a week. • Health knowledge promotion area was associated with greater odds of visiting green space at least 120 min per week. • Males, the elderly, and people with middle and high socioeconomic status were more likely to prefer to visit green space. With rapid urbanization globally, people in cities tend to have fewer opportunities to interact with nature. Some health-promoting green infrastructure may support increased visitation. To investigate associations between green space visitation and a range of health promoting green infrastructure. From November 2019 to January 2020, we conducted a population-based cross-sectional study in Shenzhen, China. Patients diagnosed with hypertension aged 35 years or older managed by community health centers for one year were recruited. A stratified multi-stage cluster random sampling method was applied to select a representative sample of 1 158 participants. A well-structured questionnaire was applied to obtain information. Participants were surveyed face-to-face (response rate 96.4 %; n = 1,116 participants) by trained interviewers. Binary logistic regression model was used to analyze the relationship between green space visitation and a range of health promoting green infrastructure. The rate of visiting green space was 87.5 % (976/1,116). The rate of visiting green space for at least 30 min per week was 85.5 % (954/1,116). The rate of visiting green space for at least 120 min per week was 78.2 % (873/1,116). Green space with walking trails [ OR (95 % CI): 2.322(1.501,3.591)], group exercise venue [ OR (95 % CI): 1.546(1.034,2.312)] mean higher odds of people with hypertension visiting green space. Green space with fitness area availability was positively associated with cumulative green space visitation of 30 min or more a week [ OR (95 % CI): 1.652(1.115,2.447)]. Health knowledge promotion area was associated with greater odds of visiting green space at least 120 min per week [ OR (95 % CI): 1.529(1.124,2.079)]. Walking trails, health knowledge promotion areas, fitness areas and group exercise venue are associated with higher levels of green space visitation at health-relevant cumulative durations. Our findings have significance for urban greening strategies that aim to maximize population health. [ABSTRACT FROM AUTHOR]

Evidence affirms that green space has health benefits, but ethnic inequities in green space availability are under-researched. Percentages of parkland, tree canopy, and open grass within 1.6 km road network distance from home were linked to 110,233 participants in the Sax Institute's 45 and Up Study baseline survey living in the cities of Sydney, Newcastle and Wollongong. Participants were dichotomised as having insufficient quantity of each green space variable using <20 % vs > 20 % as a cut-point, based upon previous studies indicating evidence of health benefits above this threshold. Adjusted multilevel logistic regressions were used to examine odds of insufficient green space associated with country of birth, years lived in Australia, and whether a language other than English was spoken at home. Compared to participants born in Australia, those born in Italy, Lebanon, Vietnam, or China had higher odds of insufficient parkland. Migrants arriving in Australia after 1966 and those speaking a language other than English also had higher odds of insufficient parkland. In contrast, odds of insufficient tree canopy were lower among participants born in Germany, Italy, Lebanon, the Philippines, China, and India compared to those born in Australia. Odds of insufficient tree canopy were also lower for those who moved to Australia after 1966 or who spoke a non-English language at home. Odds of insufficient open grass were higher for participants born in China, migrants between 1996 and 2008, and those speaking a language other than English at home. In conclusion, different ways of measuring ethnicity and green space influenced the patterns observed. Implications for understanding ethnicity-related contingencies in greenspace-health associations requires study. [ABSTRACT FROM AUTHOR]

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. [Display omitted] • Living in greener areas was associated with healthier birth outcomes. • The association was stronger among babies of mothers who lived in affluent areas. • Stronger association was observed for babies of overseas born mothers. Living in greener neighbourhoods was associated with higher birthweight with stronger association among mothers lived in affluent areas and born overseas. [ABSTRACT FROM AUTHOR]

Associations between green space type and 9-year risk of incident cardiovascular disease (CVD) hospitalisations and deaths were analysed in 4166 people with type 2 diabetes in the Sax Institute's 45 and Up Study. Incidence of all-cause mortality, cardiovascular mortality, fatal or non-fatal CVD events and acute myocardial infarctions (AMI) were 14.67%, 7.23%, 47.36%, and 4.51%, respectively. After full adjustment, more tree canopy was associated with lower CVD mortality, lower fatal or non-fatal CVD events, and lower AMI risk. More open grass was associated with lower all-cause mortality, lower CVD mortality and lower fatal or non-fatal CVD events, but higher AMI risk. [ABSTRACT FROM AUTHOR]

Abstract: Background: Physical education (PE) lessons and leisure-time represent two important opportunities for adolescents to accumulate moderate-to-vigorous physical activity (MVPA). Purpose: Framed by self-determination theory, this study investigated how much of the observed variation in adolescent boys' MVPA levels (during PE and leisure-time) was explained by individual- and class-level motivation. Methods: Cross-sectional design. Adolescent boys (N = 61, M = 14.36 years, SD = .48 years) completed motivation questionnaires and wore an accelerometer during a PE lesson and across 7 consecutive days. Results: Self-determined motivation toward PE predicted MVPA during PE lessons (R 2 = .31). Self-determined motivation toward leisure-time physical activity was positively associated with MVPA during leisure-time (R 2 = .08). Conclusions: Findings support the tenets of self-determination theory and suggest that motivation may be an important correlate of adolescent boys' MVPA in PE lessons and during leisure-time. Also, results indicated that teachers' behavior may be an important determinant of MVPA in PE lessons, while individual motivation may be more important in leisure-time. [Copyright &y& Elsevier]

• Incidence of dementia was tracked over 11 years among 109,688 adults. • Prescription, hospitalisation and death data was used for triangulation. • Associations were tested with total green space, trees and open grass. • Lower prescription rates for dementia in disadvantaged communities. • More tree canopy, but not more open grass, lowered dementia risk. Urban greening is a climate change-related policy with considerable health benefits. But do these benefits extend to prevention of dementia and, if so, which types of green space matter? Multilevel discrete time-to-event cohort study of incident Alzheimer's disease over 11 years among a baseline recruited between January 1, 2006 and December 31, 2009 (the Sax Institute's 45 and Up Study). Sampled participants for this study (N=109,688) were aged 45 years or older with no record of dementia up to 6 years before baseline, living in the cities of Sydney, Wollongong and Newcastle, Australia. Exposures were percentage total green space, tree canopy and open grass within 1.6-km road network distance buffers at baseline. Outcomes were time-to-first anti-dementia medication prescription (Department of Human Services) or dementia detected during hospitalisation or death up to 31 December 2016 (up to 11 years follow-up). Outcomes were analysed in parallel to triangulate on associations with green space, while testing for bias due to potential under-prescribing of anti-dementia medications. Models were adjusted for baseline person-level factors and area-level socioeconomic disadvantage. Dementia detection varied by case ascertainment method. 1.55% (1,703/109,688) persons were detected using prescribed anti-dementia medications. 3.32% (3,639/109,688) persons were detected during hospitalisation or death via ICD-10 codes. Dementia incidence irrespective of outcome measurement was lower among females, younger participants, those living in couples, with higher qualifications and higher incomes. Dementia risk was lower with more tree canopy when the outcome was measured using hospital and death records (≥30% vs <10% tree canopy incidence hazard ratio (IHR) = 0.86, 95%CI 0.75, 0.99), after adjusting for person-level factors. The opposite association was observed when anti-dementia medications were used to detect dementia (≥30% vs <10% tree canopy IHR = 1.33, 95%CI 1.07, 1.66). Anti-dementia medication-based detection also indicated lower dementia risk with more open grass (≥20% vs <5% IHR = 0.83, 95%CI 0.67, 1.03). Anti-dementia medication prescribing was lower in the highest vs. lowest area-level disadvantage tertile (29.8% vs. 43.7%) among people diagnosed with dementia, indicating potential bias from geographic differences in prescribing practices. Adjusting for area-level disadvantage explained associations between tree canopy, open grass and dementia when detected by anti-dementia medication, but had negligible impact on negative (i.e. potentially protective) association between tree canopy and dementia detected by hospital and death records (≥30% vs <10% tree canopy hazard ratio 0.84, 95%CI 0.72, 0.99). Increasing urban tree canopy cover may help to reduce the risk of dementia. Replication in contrasting contexts and mediation studies to assess pathways are warranted. [ABSTRACT FROM AUTHOR]

Urban green space may help slow cognitive decline. We extend the investigation towards subjective memory and green space type using latent class analysis and multilevel models of 45,644 individuals in the Sax Institute's 45 and Up Study. Participants with more tree canopy relative to open grass within 1.6 km, compared to similar quantities of both types, tended to have more favourable odds of subjective memory complaints and self-rated excellent memory at baseline. Higher quantities of open grass relative to tree canopy did not afford similar levels of benefit. Socioeconomic factors explained associations between green space and cumulative incidence of memory-related outcomes. [ABSTRACT FROM AUTHOR]