title: Natural outdoor environments and mental and physical health: relationships and mechanisms.
abstract: BACKGROUND
  Evidence is growing for the beneficial impacts of natural outdoor environments on health. However, most of the evidence has focused on green spaces and little evidence is available on health benefits of blue spaces and about possible mediators and modifiers of such impacts. We investigated the association between natural outdoor environments (separately for green and blue spaces) and health (general and mental) and its possible mediators and modifiers.
  
  
  METHODS
  Cross-sectional data from adults interviewed in Catalonia (Spain) between 2010 and 2012 as part of the Catalonia Health Survey were used. The collected data included sociodemographic characteristics, self-perceived general health, mental health, physical activity and social support. Indicators of surrounding greenness and access to natural outdoor environments within 300 m of the residence and degree of urbanization were derived for residential addresses. Associations were estimated using logistic regression and negative binominal models.
  
  
  RESULTS
  Green spaces were associated with better self-perceived general health and better mental health, independent of degree of urbanization. The associations were more consistent for surrounding greenness than for access to green spaces. The results were consistent for different buffers, and when stratifying for socioeconomic status. Slightly stronger associations were found for women and residents of non-densely populated areas. No association was found between green spaces and social contacts and physical activity. The results for blue spaces were not conclusive.
  
  
  CONCLUSIONS
  Green spaces are associated with better general and mental health across strata of urbanization, socioeconomic status, and genders. Mechanisms other than physical activity or social support may explain these associations.
authors: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: mtriguero@creal.cat.
authors: Margarita
authors: M
authors: Triguero-Mas
authors: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: Payam
authors: P
authors: Dadvand
authors: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: Marta
authors: M
authors: Cirach
authors: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: David
authors: D
authors: Martínez
authors: Departament de Salut de la Generalitat de Catalunya, Barcelona, Spain.
authors: Antonia
authors: A
authors: Medina
authors: Institut d'Estadísitca de Catalunya, Barcelona, Spain.
authors: Anna
authors: A
authors: Mompart
authors: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: Xavier
authors: X
authors: Basagaña
authors: Vytauto Didžiojo Universitetas, Kaunas, Lithuania.
authors: Regina
authors: R
authors: Gražulevičienė
authors: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: Mark J
authors: MJ
authors: Nieuwenhuijsen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004777:Environment; D015444:Exercise; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D012944:Social Support; D012959:Socioeconomic Factors; D013030:Spain; D014507:Urbanization; D055815:Young Adult
keywords: Blue spaces; Green spaces; Medication; Mental health; Physical activity; Social support