August 13 | 2018

Comparing the Normalized Difference Vegetation Index with the Google Street View Measure of Vegetation to Assess Associations between Greenness, Walkability, Recreational Physical Activity, and Health in Ottawa, Canada

Paul J. Villeneuve, Renate L. Ysseldyk, Ariel Root, Sarah Ambrose, Jason DiMuzio, Neerija Kumar, Monica Shehata, Min Xi, Evan Seed, Xiaojiang Li, Mahdi Shooshtari, and Daniel Rainham.

Int. J. Environ. Res. Public Health 201815(8),1719;


The manner in which features of the built environment, such as walkability and greenness, impact participation in recreational activities and health are complex. We analyzed survey data provided by 282 Ottawa adults in 2016. The survey collected information on participation in recreational physical activities by season, and whether these activities were performed within participants’ neighbourhoods. The SF-12 instrument was used to characterize their overall mental and physical health. Measures of active living environment, and the satellite derived Normalized Difference Vegetation Index (NDVI) and Google Street View (GSV) greenness indices were assigned to participants’ residential addresses. Logistic regression and least squares regression were used to characterize associations between these measures and recreational physical activity, and self-reported health. The NDVI was not associated with participation in recreational activities in either the winter or summer, or physical or mental health. In contrast, the GSV was positively associated with participation in recreational activities during the summer. Specifically, those in the highest quartile spent, on average, 5.4 more hours weekly on recreational physical activities relative to those in the lowest quartile (p = 0.01). Active living environments were associated with increased utilitarian walking, and reduced reliance on use of motor vehicles. Our findings provide support for the hypothesis that neighbourhood greenness may play an important role in promoting participation in recreational physical activity during the summer.

August 7 | 2018

Effect of Greening Vacant Land on Mental Health of Community-Dwelling Adults  A Cluster Randomized Trial

Eugenia C. South, MD, MS; Bernadette C. Hohl, PhD; Michelle C. Kondo, PhD; John M. MacDonald, PhD; Charles C. Branas, PhD.

JAMA Network Open. 2018;1(3):e180298.doi:10.1001/jamanetworkopen.2018.0298

And Invited Commentary doi:10.1001/jamanetworkopen.2018.0299


Importance Neighborhood physical conditions have been associated with mental illness and may partially explain persistent socioeconomic disparities in the prevalence of poor mental health.

Objective To evaluate whether interventions to green vacant urban land can improve self-reported mental health.

Design, Setting, and Participants This citywide cluster randomized trial examined 442 community-dwelling sampled adults living in Philadelphia, Pennsylvania, within 110 vacant lot clusters randomly assigned to 3 study groups. Participants were followed up for 18 months preintervention and postintervention. This trial was conducted from October 1, 2011, to November 30, 2014. Data were analyzed from July 1, 2015, to April 16, 2017.

Interventions  The greening intervention involved removing trash, grading the land, planting new grass and a small number of trees, installing a low wooden perimeter fence, and performing regular monthly maintenance. The trash cleanup intervention involved removal of trash, limited grass mowing where possible, and regular monthly maintenance. The control group received no intervention.

Main Outcomes and Measures Self-reported mental health measured by the Kessler-6 Psychological Distress Scale and the components of this scale.

Results  A total of 110 clusters containing 541 vacant lots were enrolled in the trial and randomly allocated to the following 1 of 3 study groups: the greening intervention (37 clusters [33.6%]), the trash cleanup intervention (36 clusters [32.7%]), or no intervention (37 clusters [33.6%]). Of the 442 participants, the mean (SD) age was 44.6 (15.1) years, 264 (59.7%) were female, and 194 (43.9%) had a family income less than $25 000. A total of 342 participants (77.4%) had follow-up data and were included in the analysis. Of these, 117 (34.2%) received the greening intervention, 107 (31.3%) the trash cleanup intervention, and 118 (34.5%) no intervention. Intention-to-treat analysis of the greening intervention compared with no intervention demonstrated a significant decrease in participants who were feeling depressed (−41.5%; 95% CI, −63.6% to −5.9%; P = .03) and worthless (−50.9%; 95% CI, −74.7% to −4.7%; P = .04), as well as a nonsignificant reduction in overall self-reported poor mental health (−62.8%; 95% CI, −86.2% to 0.4%; P = .051). For participants living in neighborhoods below the poverty line, the greening intervention demonstrated a significant decrease in feeling depressed (−68.7%; 95% CI, −86.5% to −27.5%; P = .007). Intention-to-treat analysis of those living near the trash cleanup intervention compared with no intervention showed no significant changes in self-reported poor mental health.

Conclusions and Relevance Among community-dwelling adults, self-reported feelings of depression and worthlessness were significantly decreased, and self-reported poor mental health was nonsignificantly reduced for those living near greened vacant land. The treatment of blighted physical environments, particularly in resource-limited urban settings, can be an important treatment for mental health problems alongside other patient-level treatments.