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Abstract

Spending time in natural environments can benefit wellness and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last vii days and self-reported wellness and well-being. Participants (n = xix,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15–2015/16); weighted to be nationally representative. Weekly contact was categorised using lx min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last calendar week, the likelihood of reporting good health or high well-beingness became significantly greater with contact ≥120 mins (e.g. 120–179 mins: ORs [95%CIs]: Health = 1.59 [1.31–1.92]; Well-being = 1.23 [1.08–1.40]). Positive associations peaked between 200–300 mins per week with no further gain. The blueprint was consistent across primal groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a calendar week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical side by side pace in developing possible weekly nature exposure guidelines comparable to those for physical activity.

Introduction

A growing body of epidemiological testify indicates that greater exposure to, or 'contact with', natural environments (such as parks, woodlands and beaches) is associated with better health and well-beingness, at least amid populations in high income, largely urbanised, societies^one. While the quantity and quality of show varies across outcomes, living in greener urban areas is associated with lower probabilities of cardiovascular disease^two, obesity^three, diabetes^iv, asthma hospitalisation⁵, mental distress⁶, and ultimately mortality⁷, among adults; and lower risks of obesity⁸ and myopia^ix in children. Greater quantities of neighbourhood nature are also associated with better self-reported health^10,eleven,12, and subjective well-being¹³ in adults, and improved birth outcomes^fourteen, and cognitive development¹⁵, in children.

Yet, the amount of greenspace in one's neighbourhood (east.g. pct of land cover in a 1 km radius from the habitation), or the distance of ane's home to the nearest publically accessible dark-green space or park¹⁶ is only one way of assessing an private's level of nature exposure. An culling is to measure the amount of fourth dimension individuals actually spend exterior in natural environments^17,eighteen, sometimes referred to equally 'direct' exposure^xix. Both approaches are potentially informative. Residential proximity to nature may be related to health promoting factors such as reduced air and noise pollution (although the relationships are complex²⁰); and may as well provide 'indirect' exposure via views from the property²¹. Residential proximity is also generally positively related to 'direct' exposure; i.e. people in greener neighbourhoods tend to report visiting greenspace more often²². However many nature visits have place outside of the local neighbourhood²³. Moreover, such visits may recoup for a lack of nature in the neighbourhood²⁴. In other words, direct exposure, or more specifically in the current context, recreational time spent in natural environments per week, cannot accurately exist inferred from neighbourhood greenspace near the home.

Using data from a representative sample of the adult population of England, we aimed to better sympathise the relationships betwixt time spent in nature per week and self-reported health and subjective well-beingness. Our research builds directly on a minor number of studies that have started to look at like bug^{17,xviii,25,26}, and answers the call made in several recent reviews for more work in this expanse^27,28. Quantification of these 'exposure-response' relationships tin can contribute to the policy procedure, for example by providing prove upon which to base recommendations regarding the amount of fourth dimension required to be spent in nature per week to promote positive health and well-being outcomes. A similar process was used to support development of guidelines on the amount of recommended weekly physical activeness needed for health promotion and disease prevention²⁹.

The research advances previous work in three key ways. Offset, to engagement, researchers have examined direct nature exposure-response relationships using either a specific visit duration¹⁷, or nature visit frequency over a prolonged menstruation²⁶, or both independently^xviii. By multiplying the elapsing of a representative visit within the final week by the number of visits taken within the concluding week we were able to develop the first weekly exposure metric (i.e. minutes per calendar week) for nature exposure, similar to those used in other health promotion contexts (e.thousand. physical activeness²⁹). Second, by comparison the coefficients of other, well-established, predictors of health and well-being (eastward.grand. expanse impecuniousness) with those for average fourth dimension spent in nature per calendar week, we were able to assess the relative strength of any exposure-response relationship. Third, previous studies were constrained in their ability to look at the generalisability of relationships across dissimilar socio-demographic groups due to relatively modest, geographically constrained samples. In this study, the current, nationally representative sample enabled us to stratify, a priori, on socio-demographic characteristics, such as historic period^thirty, gender³¹, ethnicity³² and area deprivation³³, which appeared to moderate the nature-health association in previous studies²².

Results

Models using duration categories

Descriptive data on the relationships between fourth dimension spent in nature in the last 7 days (in 60 min categories) and self-reported health (Good vs. poor) and subjective well-beingness (High vs. low) are presented in Table 1. Percentages per category are presented for both the estimation sample (n = xix,806), and for the sample weighted to be representative of the adult population of England. Similar details for all covariates can be plant in Appendix B, and relationships between our fundamental predictor, time in nature, and all other covariates in Appendix C.

Table 1 The frequency and percentage of respondents in each category of each predictor who reported good/very good health and loftier well-existence.

Full size table

The odds ratios (ORs) and 95% confidence intervals (CIs) for the survey weighted binomial logistic regressions predicting health and well-being are presented in Table two (total models in Appendix D). In the unadjusted models the odds ratios for reporting 'skilful' health and 'high' well-being were significantly higher for all nature contact ≥60 mins per calendar week compared to 0 mins. Contact of 1–59 mins per week was not associated with better outcomes than 0 mins, and there was too no linear increment above 60 mins; longer durations were not associated with better outcomes. In the adjusted models, significance simply emerged at the ≥120 mins per week category; and once again additional duration was not associated with improved outcomes. The human relationship appeared somewhat stronger for health than well-being (Fig. 1).

Tabular array 2 The odds ratios (OR) and 95% confidence intervals (CIs) of reporting good wellness and high well-beingness every bit a part of nature visit elapsing in the last 7 days.

Total size table

Sensitivity analysis

We conducted three types of sensitivity analysis. Showtime we explored exposure-response relationships using time spent in nature as a continuous variable, and outcomes modelled as binary variables using splines (Fig. two). The figures suggested relatively steady increases in the positive relationships for both health and well-being upwardly to around 120 mins, diminishing marginal returns from and then until around 200 mins per calendar week for wellness and 300 mins for well-being, and then a flattening out or even decrease thereon (though note the very large CIs > 400 mins). Although Fig. 2 should be treated with circumspection, due to hourly clustering (run across Methods, and Appendix A, Figure C), results broadly support the categorical analyses, with some suggestion that nature exposure beyond 120 mins a calendar week may have some additional benefits that did not emerge when health and wellbeing were treated as binary variables.

Second, we explored exposure-response relationships using fourth dimension spent in nature as a categorical variable and health and wellbeing modelled equally ordinal variables. Results were again very similar (Appendix E). The only slight alter was significance at the 60–119 min category for both outcomes, but this finding is not hands comparable to the binary logistic results for reasons explained in more than detail in Appendix E.

Our final sensitivity analysis modelled both time and well-being every bit continuous variables (Appendix Eastward, Figure D). Once again the results were very similar to the original model (Fig. 2b). Due to the inherently ordinal structure of the general wellness variable, we were unable to behave a comparable sensitivity model for health.

Contextualisation of results

To contextualise the magnitude of the human relationship between weekly nature contact and health and well-being, Fig. 3 presents the relevant ORs (CIs) alongside those for selected predictors including: neighbourhood greenspace and deprivation; concrete practise; individual SES; and relationship status (see Appendix D for details on all covariates). The figure highlights that 120–179 mins vs. 0 mins of nature contact per week was associated with: (a) a similar likelihood of reporting practiced health as, living in an area of low vs. high impecuniousness; meeting vs. non meeting physical activity guidelines, and (c) being in a high vs. low SES occupation. Although the clan between nature contact at this level and wellbeing was similar to that betwixt high vs. low: greenspace, impecuniousness and physical activity; it was less of import than SES and relationship status.

Generalisability of results

Table three shows results of analyses stratified on fundamental surface area and private level factors (see Appendix F for full details). For these analyses, nature contact was reconfigured into 3 elapsing levels reflecting: (a) 'no exposure' (0 minutes, ref); (b) 'low exposure', not associated with significantly greater likelihood of proficient health and high wellbeing (1–119 mins); and (c) 'high exposure', i.e. all durations associated with significantly higher likelihood of good health and loftier well-being combined (≥120 mins). Estimates from the models of wellness showed that the positive relationship found for 'high' but non 'low' exposure, compared to 'no exposure', in the overall model was consequent beyond those living in urban and rural, and high and low deprivation, areas. Information technology was also consequent for: both males/females; those above/below 65years quondam; those of high/low occupational social course; those with/without a long-term illness/disability; and for those who did vs. did not run across physical activeness recommendations. Stratification on neighbourhood greenspace suggested those in areas of loftier (but non low) greenspace besides had greater odds of good health if they spent any time in nature per week compared to 0 mins, perhaps reflecting the importance of indirect exposure among this cohort. Stratification on ethnicity showed the threshold was maintained amongst white British, but non 'other' respondents. Stratified models of well-being showed that 'high' simply non 'depression' exposure was associated with significantly greater odds of high wellbeing in all cases.

Table 3 The odds ratios (OR) and 95% conviction intervals (CIs) of reporting good health and high well-being as a part of the three primary categories of nature visit elapsing in the last 7 days, stratified on cardinal area and individual covariates.

Full size tabular array

Additional analyses found no differences in health and well-being as a function of how 'high' exposure was accomplished (a) one 120+ min visit; (b) two 60+ min visits; or (c) or three/more ≤ 40 min visits (see Appendix Thousand for details).

Word

Growing prove of a positive association betwixt contact with natural environments and health and well-being has led to calls for improved understanding of any exposure-response relationships^27,28. The aim of the current study was to assess these relationships with a measure based on direct exposure to natural environments, rather than residential proximity, using information from a large nationally representative sample in England. Exposure was defined in terms of the cocky-reported minutes spent in natural environments for recreation in the last seven days; and outcomes were self-reported health and subjective well-being.

Later a range of covariates had been taken into account, individuals who spent betwixt i and 119 mins in nature in the last week were no more likely to report proficient health or high well-beingness than those who reported 0 mins. However, individuals who reported spending ≥120 mins in nature last calendar week had consistently higher levels of both health and well-being than those who reported no exposure. Sensitivity analyses using splines to allow duration to be modelled every bit a continuous variable suggested that across 120 mins there were decreasing marginal returns until effectually 200–300 mins when the relationship flattened or even dropped. Nosotros tentatively suggest, therefore, that 120 mins contact with nature per week may reflect a kind of "threshold", below which there is insufficient contact to produce significant benefits to wellness and well-beingness, but above which such benefits become manifest.

In terms of magnitude, the association betwixt health, well-beingness and ≥120 mins spent in nature a calendar week, was similar to associations between health, well-being and: (a) living in an area of low vs. high deprivation; (b) being employed in a loftier vs. depression social course occupation; and (c) achieving vs. non achieving recommended levels of physical action in the last week. Given the widely stated importance of all these factors for health and well-being, we interpret the size of the nature relationship to be meaningful in terms of potential public health implications.

That the ≥120 mins "threshold" was present even for those who lived in low greenspace areas reflects the importance of measuring recreational nature contact straight when possible, rather than simply using residential proximity as a proxy for all types of nature exposure. People travel beyond their local neighbourhoods to access recreational nature experiences, and indeed in our ain data those who lived in the least light-green areas had college odds of spending ≥120 mins in nature than those living in greener neighbourhoods (Appendix C). Impoverished local opportunities need not be a bulwark to nature exposure^23,24. That the "threshold" was as well nowadays for those with long-term illnesses/disability, suggests that the positive overall association in the information was non simply due to healthier people visiting nature more than often.

One explanation for our findings might be that time spent in nature is a proxy for physical activity, and it is this which is driving the relationship, non nature contact per se. In England, for example, over three million adults achieve recommended action levels fully, or in part, in natural settings³⁴. Although: (a) we tried to control for this by including physical activeness over the terminal 7 days in our models; and (b) the threshold applied to individuals who did not see activity guidelines; we were unable to fully untangle these issues. Experimental research, yet, indicates that some benefits cannot be due solely to concrete activity. Research into shinrin-yoku (Japanese "forest bathing")³⁵, for instance, suggested that various psycho-physiological benefits can be gained from merely sitting passively in natural vs. urban settings. Moreover, physical activity conducted in nature may be more psychologically beneficial than in other locations³⁶, suggesting a complex interaction between the two which requires further research to fully understand²⁰.

The electric current results also suggested that it did not thing how the "threshold" was accomplished. This may be because individuals selected exposures to fit their personal preferences and circumstances. For instance, some may prefer long walks on the weekend in locations further from home; while others may prefer regular shorter visits to parks in the local area. To recommend the former type of person stops their long weekly visit in favour of several shorter trips or vice versa may be misguided.

Whilst this study deepens our understanding of the potential value of spending time outdoors in nature to wellness and well-existence, it is too early to make specific guidance due to several limitations. First, the data are observational and cross-sectional; and thus, however the same design holding for those with a long-term affliction/disability, we are unable to rule out the possibility that the clan is, at to the lowest degree in function, due to healthier, happier people spending more time in nature. Prospective longitudinal studies of the kind used to help develop physical action guidelines²⁹, and nature-based intervention studies are needed to improve sympathize causality. Cimprich and Ronis³⁷, for instance, institute that women recently diagnosed with chest cancer scored college on several attention tasks, compared to standard care controls, following a 5-calendar week period of spending 120 mins per week in 'natural restorative environments'. The authors argued that the 120 mins per week of nature exposure helped the women restore cognitive resources depleted by the stress of their diagnoses and early treatment. Although our sample was more heterogeneous, weekly nature exposure may work in a similar fashion by reducing generally high levels of stress³⁸. Like studies are needed to see how generalizable any potential "threshold" is beyond a range of situations, and to run into how long an private needs to maintain a certain amount of weekly exposure to reach health and well-being gains. Although effects on attentional processes were observed later on just 5 weeks in Cimprich and Ronis³⁷, wellness effects may need longer; and it is also of import to see whether different types of nature contact might confer different benefits.

We as well annotation that, although significant, time in nature explained relatively little variance in either health or wellbeing in these models based on cross-exclusive information (approx. 1% in unadjusted models in both cases). It will therefore be important to explore effect sizes in prospective/experimental studies to better understand the cost/benefit implications of whatsoever potentials interventions.

Some other limitation concerned our approximate of weekly exposure. As duration was asked nearly merely a single randomly selected visit in the final week, nosotros assumed that at the population level this was representative of all visits. Although rigorous collection protocols meant that the effects of a typical visit pick are likely to cancel out over a sample of nearly xx,000, nosotros recognise that accuracy at the individual level would exist improved if duration were asked about all visits in the concluding week. We also acknowledge that our data rely on self-reports and thus results needed to exist treated with caution. For case, self-reported elapsing is probable to be less authentic than measures obtained from geo-tracking individuals during specific visits³⁹, or over several days⁴⁰, and individuals may take been unsure almost, or reluctant to discuss, sure issues which were included every bit covariates (e.g. long standing illness/disability). Hereafter studies would ideally collate as much data via non self-report measures equally possible. We note, moreover, that dissimilar exposure to often invisible environmental factors such every bit air pollution, we can potentially 're-live' our experiences of the natural world in memory, for instance during periods of 'heed wandering', and derive benefits from these recollections independent of those experienced in situ ⁴¹. Thus, an exposure in this context may be considered equally the fourth dimension in situ plus all subsequent time spent thinking virtually the experience⁴². In short, we believe farther work is needed to remember more critically and creatively near what the term 'exposure' means in the current context.

Nosotros also remain cautious about whatsoever potential ≥120 mins "threshold". In function its emergence may exist a consequence of the clustering of duration responses around the hour mark and subsequent stratification, rather than annihilation materially different occurring at this level of exposure. The spline models, for instance, suggested a more nuanced pattern. Yet, this smoothing of the data was notwithstanding reliant on a highly non-normal distribution, suggesting that we need to be cautious about these analyses as well. Farther work is also needed to explore the 'peak' of returns at around 200–300 mins, to better understand why spending more time in nature is associated with little marginal gain. Thus, we encounter the tentative "threshold" and "elevation" discussed here more as a starting points for give-and-take and further investigation, than clearly established findings.

Finally, our results say piffling about exposure 'quality'. Research considering the quality of the natural environment in terms of plant and/or animal species richness suggests that experiences may be better in more biodiverse settings^25,43. Contact with nature is more just a circuitous multi-sensory experience, to varying degrees personal histories and meanings, longstanding cultural practices, and a sense of place play some function in the benefits realised^44,45,46, factors which may business relationship for why we did non find the same blueprint for health individuals not identifying as White British. In the current research, for instance, exposure estimates relied upon visits undertaken voluntarily, presumably because they had features important to those individuals⁴⁷ and these furnishings may non exist institute if individuals were to regularly spend 120 mins a calendar week in a natural environs of less personal relevance (e.1000. those who cocky-identified equally 'White European'). Our estimates too explicitly excluded fourth dimension spent in one's own garden which can exist an important form of meaningful nature contact for many people⁴⁸. All of these bug will need greater consideration in futurity research.

To conclude, although this research suggests that spending ≥120 mins a calendar week in nature may be an important "threshold" for health and well-being beyond a broad range of the developed population in England, nosotros believe that more prospective cohort, longitudinal, and experimental studies are required earlier any clear conclusions can be fatigued. In addition to improving the duration-exposure estimates used here, more enquiry is also needed to empathise the impact of different activities undertaken, equally well as the outcome of environmental quality and personal meaning. Nonetheless, we come across our findings equally an important starting signal for discussions effectually providing simple, evidence-based recommendations virtually the amount of fourth dimension spent in natural settings that could upshot in meaningful promotion of health and well-being.

Methods

Participants & procedure

Participants were drawn from Waves half dozen and vii (2014–2015/2015–2016) of the Monitor of Engagement with the Natural Environment (MENE) survey (the only Waves where our key outcomes were consistently measured). The survey, which is role of the UK government's National Statistics, is echo cross-exclusive (unlike people take office in each moving ridge), and is conducted across the whole of England and throughout the year (approx. 4,000 people per week) to reduce potential geographical and seasonal biases⁴⁹. As function of the Uk'south official statistics, sampling protocols are all-encompassing, to ensure as representative a sample of the adult English population as possible. Total details tin be plant in the almanac MENE Technical Reports⁴⁹ with key features including: (a) "a computerised sampling system which integrates the Post Role Accost file with the 2001 Census small area information at output area level. This enables replicated waves of multi-stage stratified samples"; (b) "the areas within each Standard Region are stratified into population density bands and inside ring, in descending order past percentage of the population in socio-economic Course I and Ii"; (c) "[in guild to] maximise the statistical accuracy of the sampling, sequential waves of fieldwork are allocated systematically across the sampling frame to ensure maximum geographical dispersion"; (d) "to ensure a balanced sample of adults within the effective contacted addresses, a quota is gear up past sex (male, female housewife, female not-housewife); within the female housewife quota, presence of children and working status and within the male quota, working status"; and (e) "the survey information is weighted to ensure that the sample is representative of the Uk population in terms of the standard demographic characteristics" (ref.⁴⁹, p.v). Data is collected using in-abode confront-to-face interviews with responses recorded using Reckoner Assisted Personal Interviewing (CAPI) software.

Although the total sample for these years was due north = 91,190, the health and well-being questions were just asked in every fourth sampling week (i.e. monthly, rather than weekly) resulting in a reduced sample of n = twenty,264. In order to account for whatsoever residual biases in sampling at this monthly level, special 'calendar month' survey weights are included in the information set. These were applied in the current analysis to ensure that results remained generalisable to the entire adult population of England. All data were anonymised by Natural England and are publically attainable at: http://publications.naturalengland.org.united kingdom/publication/2248731?category=47018. Ethical approving was non required for this secondary assay of publically available National Statistics.

Outcomes: Self-reported wellness & subjective well-being

Cocky-reported wellness (henceforth: health) was assessed using the single-particular: 'How is your wellness in full general?' (sometimes referred to every bit 'SF1'). Response options were: 'Very bad', 'Bad', 'Fair', 'Good' and 'Very good'. Responses are robustly associated with use of medical services⁵⁰ and mortality⁵¹; and crucially, for current purposes, neighbourhood greenspace¹³. Following earlier work we dichotomised responses into 'Good' ('Proficient/very skillful', weighted = 76.5%) and 'Not good' ('Fair/bad/very bad', 23.5%)⁵². Subjective well-existence (henceforth: well-being) was assessed using the 'Life Satisfaction' measure, one of the Great britain's national well-being measures⁵³: 'Overall how satisfied are you lot with life nowadays?' with responses ranging from 0 'Non at all' to 10 'Completely'. Again, following earlier studies nosotros dichotomised responses into 'High' (viii–ten, lx.2%) and Depression (0–7, 39.8%) well-being⁵⁴. Histograms of the (not-normal) distributions for both outcome variables are presented in Appendix A. Of note although the dichotomisation points were based on prior research, they are consistent with the current data; the l^th percentile for health was in the 'proficient' response and for wellbeing in '8'. Sensitivity analyses conducted on ordinal (both wellness and wellbeing) and linear (wellbeing only) variations of these variables are presented in Appendix E.

Exposure: Recreational nature contact in last 7 days

Recreational nature contact, or time spent in natural environments in the last week, was derived past multiplying the number of reported recreational visits per week by the length of a randomly selected visit in the last week. Participants were introduced to the survey equally follows: "I am going to ask you well-nigh occasions in the last calendar week when y'all spent your fourth dimension out of doors. By out of doors nosotros mean open spaces in and around towns and cities, including parks, canals and nature areas; the coast and beaches; and the countryside including farmland, woodland, hills and rivers. This could be anything from a few minutes to all mean solar day. Information technology may include time spent shut to your home or workplace, further afield or while on vacation in England. However this does not include: routine shopping trips or; time spent in your own garden." Then they were asked "how many times, if at all, did you brand this type of visit yesterday/on <Day> " for each of the previous seven days. Ninety-eight percentage of respondents reported ≤7 visits last week. The remaining ii% were capped at 7 visits to avoid dramatically skewing weekly elapsing estimates.

Later basic details of each visit (upwards to 3 per mean solar day) were recorded, a single visit was selected at random past the CAPI software, for the interviewer to inquire further questions well-nigh, including: "How long did this visit final altogether?" (Hours & Minutes). Due to random selection, fifty-fifty if the selected visit was not necessarily representative for whatsoever given private, the randomisation procedure should reduce potential bias at the population level at which our analyses were conducted. Weekly duration estimates were thus derived by multiplying the duration for this randomly selected visit past the number of stated visits in the last seven days (capped at 7). Following the approach of before exposure-response studies in the field (e.g. Shanahan et al., 2016), duration was categorised into 7 categories: 0 mins (n = 11,668); ane–59 mins (n = 355); sixty–119 mins (n = ane,113); 120–179 mins (n = 1,290); 180–239 mins (north = ane,014); 240–299 mins (northward = 882); ≥300 mins (n = 3,484). An alternative banding at xxx minutes was problematic considering of very low Ns for some bands (e.g. 1–29 mins, n = 85), reflecting the fact that weekly duration estimates amassed around the hr marks, e.g. 78% of the unweighted observations within the 120–179 mins band were precisely 120 mins (Run across Appendix A, Figure C for duration histogram). The highest ring was capped at ≥300 mins due to the large positive skew of the information.

Control variables

Wellness and well-being are associated with socio-demographic and environmental characteristics at both neighbourhood (east.g. expanse deprivation) and private (due east.g. relationship status) levels⁵⁵. Equally many of these variables may besides be related to nature exposure they were controlled for in the adjusted analyses.

Area level control variables

Expanse level covariate data was assigned on the spatial level of the Demography 2001 Lower-layer Super Output Areas (LSOAs) in which individuals lived. In that location were 32,482 LSOAs in England, each containing approximately 1,500 people within a mean physical area of 4km^two.

Neighbourhood greenspace

In social club to understand how much greenspace is in an individual'south neighbourhood, we derived an expanse density metric using the Generalised Land Utilize Database (GLUD)⁵⁶. The GLUD provides, for each LSOA in England, the area covered by greenspace and domestic gardens. These were summed and divided by the total LSOA surface area to provide the greenspace density metric. This metric was allocated to each individual in the sample, based on LSOA of residence. Following previous literature, individuals were assigned to one of v quintiles of greenspace based on this definition (ranging from least green to most greenish)³³. Rather than derive quintiles of greenspace from the current sample (i.e. split up the electric current sample into five equal parts based on the percentage of greenspace in their LSOA), we assigned individuals instead to one of five pre-determined greenspace quintiles based on the distribution of greenspace across all 32,482 LSOAs in England. Although this meant that we did not get exactly equal 20% shares of our current sample beyond greenspace quintiles (although due to the sampling protocol we were still very close to this, come across Appendix B) this approach immune inferences to be fabricated across the entire country, rather than merely to the electric current sample. In exploratory sensitivity analyses we divers greenspace every bit the GLUD category 'greenspace' only, with the GLUD category 'gardens' excluded. This produced very similar results, and so nosotros focused on the more than inclusive definition including both aspects. In further exploratory sensitivity analyses, we assigned individuals to 5 greenspace categories defined by equal ranges of greenspace coverage (e.yard. 0–twenty%, 21–40%, 41–60% etc.) rather than quintiles based on percentages of the population. This also produced very similar results, and so over again we decided to become with the most common approach. In subsequent analyses the least green quintile acted as the reference category.

Surface area impecuniousness

Each LSOA in England is assessed in terms of several parameters of impecuniousness, including unemployment and crime, levels of educational, income, health metrics, barriers to housing and services, and the living environment. A full Index of Multiple Deprivation (IMD) score is derived from these subdomains⁵⁷. Following previous studies⁵², we assigned individuals into deprivation quintiles based on the LSOA in which they lived. As with greenspace, the cut points for area impecuniousness quintiles were also based on all LSOAs in England, rather than those in the electric current sample, to allow inference to the population as a whole (most deprived quintile =ref).

Air pollution

An indicative measure of air pollution was operationalised as LSOA background PM₁₀ assigned to tertiles of all LSOAs in England (lowest particulate concentration =ref). PM10 concentrations, based on Pollution Climate Mapping (PCM) model simulations⁵⁸, were averaged over the period 2002–2012, and aggregated from one km foursquare resolution to LSOAs.

Private level controls

Individual level controls comparable to earlier studies in this area^{6,seven,12,13,15} included: sex (male =ref); age (categorised every bit 16–64 =ref; 65+); occupational social grade (AB (highest, east.g. managerial), C1, C2 and DE (everyman, e.g. unskilled labour, =ref) as a proxy for individual socio-economic status (SES); employment status (full-time, part-time, in didactics, retired, not working/unemployed =ref); relationship status (married/cohabiting; single/separated/divorced/widowed =ref); ethnicity (White British; other =ref); number of children in the household (≥ane vs. 0 =ref); and dog buying (Yes; No =ref).

2 further command variables were peculiarly important. First, the survey asked: 'Practise you take any long standing illness, wellness problem or disability that limits your daily activities or the kind of work yous tin can practice?' ('Restricted operation': Aye; No =ref). Including this variable, at least in role, controls for reverse causality. If similar associations between nature exposure and health and well-beingness are constitute for both those with and without restricted functioning, this would back up the notion that the associations are not merely due to healthier, more mobile people visiting nature more often.

Nosotros also controlled for the number of days per calendar week people reported engaging in physical activity >30 mins; in the current analysis dichotomised equally either meeting or not meeting guidelines of 150 mins per week (i.e. 5 days in the week with physical activity >30 mins). Some people achieve this guideline though physical activity in natural settings³⁵, thus, any association betwixt time spent in nature and health may simply be due to the physical action engaged in these settings. We believe this is non the case in the electric current context because the (rank order) correlation between weekly nature contact and the number of days a week an individual engaged in >30 mins of physical activity was just r_s = 0.27. Even so, by decision-making for weekly activity levels, modelled relationships between time in nature and health have less bias from this source, and, therefore, improved estimates of clan with nature exposure per se.

Temporal controls

Due to the multi-year pooled nature of the data, year/moving ridge was also controlled for. Preliminary assay constitute no effect of the season in which the information were collected so this was excluded from final analyses.

Analysis strategy

Survey weighted binomial logistic regressions were used to predict the relative odds that an individual would have 'Proficient' health or 'High' well-existence as a part of weekly nature exposure in terms of duration categories per week. Model fit was provided past pseudo R²; here the more conservative Cox and Snell guess. The outcome binary variables were first regressed against the exposure elapsing categories to test direct relationships; adjusted models were and then specified to include the individual and area level control variables. Due to missing area level data for a small minority of participants (n = 456), our estimation samples for these adjusted models were n = nineteen,808. Preliminary assay found that the weighted descriptive proportions amidst this reduced estimation sample differed only negligibly from those amidst all bachelor observations in the wider MENE sample, suggesting our complete case assay approach did not distort the population representativeness of the estimation sample. The full due north = 20,264 sample was maintained for the unadjusted model to provide the near accurate, weighted representation of the data, every bit reducing unadjusted models to n = 19,808 produced practically identical results. Although our principal analyses used elapsing categories of weekly nature contact, an exploratory analysis used generalized additive models incorporating a penalized cubic regression spline of elapsing every bit a continuous variable (adjusting for the same set of covariates). This enabled us to produce a 'smoother' plot of the information. Analyses and plotting was done using R version 3.iv.1, using packages mgcv and visreg ⁵⁹.

To explore the generalisability of whatsoever pattern across different socio-demographic groups, we likewise a priori stratified the analyses on several area and individual covariates (as defined above) which have been found to be important in previous studies: (a) Urbanicity; (b) Neighbourhood greenspace; (c) Expanse deprivation; (d) Sexual practice; (e) Historic period; (f) Restricted performance; (thou) Individual socio-economic status (SES); (f) Ethnicity; and (thousand) Physical activity. In the case of the three multi-category predictors (area greenspace/deprivation, individual SES), binary classifications were derived for the stratified analyses to maintain robust sample sizes in each category. In the case of LSOA greenspace and impecuniousness binary splits were fabricated based on the median cutting-indicate for all LSOAs in England; SES was dichotomised by collapsing the social grade categories in the standard way, A/B/C1 vs. C2/D/East.

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Acknowledgements

This piece of work was supported past the National Constitute for Health Research Health Protection Enquiry Unit (NIHR HPRU) in Environmental Alter and Wellness at the London Schoolhouse of Hygiene and Tropical Medicine in partnership with Public Health England (PHE), and in collaboration with the University of Exeter, University College London, and the Met Function. The funders had no role in the study pattern, analysis, interpretation of information, or decision to submit the article for publication. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, or Public Health England. We would like thank an earlier reviewer and the editorial board team for suggestions on how to improve an earlier version of this manuscript.

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Affiliations

European Middle for Environment and Human Health, University of Exeter Medical Schoolhouse, Exeter, U.k.

Mathew P. White, Ian Alcock, James Grellier, Benedict W. Wheeler, Sara Fifty. Warber, Angie Bone, Michael H. Depledge & Lora E. Fleming
Institute for Housing and urban Research, Uppsala Academy, Box 514, SE-75120, Uppsala, Sweden

Terry Hartig
Section of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, The states

Sara L. Warber

Contributions

M.Westward. conceived of the report in discussion with T.H., M.D. and L.Due east.F.; M.W., I.A. and J.Yard. conducted the analyses; B.W., S.W. and A.B. fabricated additional analysis suggestions and provided text/references on specific sections. All authors contributed to the text of the manuscript and reviewed the last submission.

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Correspondence to Mathew P. White.

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White, M.P., Alcock, I., Grellier, J. et al. Spending at least 120 minutes a calendar week in nature is associated with good health and wellbeing. Sci Rep 9, 7730 (2019). https://doi.org/10.1038/s41598-019-44097-3

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Received: 08 May 2018
Accepted: 08 May 2019
Published: thirteen June 2019
DOI : https://doi.org/x.1038/s41598-019-44097-3

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