Increased Use of Porch or Backyard Nature during COVID-19 Associated with Lower Stress and Better Symptom Experience among Breast Cancer Patients

Contact with nature has been used to promote both physical and mental health, and is increasingly used among cancer patients. However, the COVID-19 pandemic created new challenges in both access to nature in public spaces and in cancer care. The purpose of our study was to evaluate the change in active and passive use of nature, places of engaging with nature and associations of nature contact with respect to improvements to perceived stress and symptom experience among breast cancer patients during the pandemic. We conducted a cross-sectional survey of people diagnosed with breast cancer using ResearchMatch (n = 56) in July 2020 (the first wave of COVID-19). In this US-based, predominantly white, affluent, highly educated, female sample, we found that, on average, participants were first diagnosed with breast cancer at 54 years old and at stage 2 or 3. Eighteen percent of participants experienced disruptions in their cancer care due to the pandemic. As expected, activities in public places significantly decreased as well, including use of parks/trails and botanical gardens. In contrast, spending time near home, on the porch or in the backyard significantly increased. Also observed were significant increases in indoor activities involving passive nature contact, such as watching birds through a window, listening to birdsong, and smelling rain or plants. Decreased usage of parks/trails was significantly associated with higher stress (Coef = −2.30, p = 0.030) and increased usage of the backyard/porch was significantly associated with lower stress (Coef = −2.69, p = 0.032), lower symptom distress (Coef = −0.80, p = 0.063) and lower symptom severity (Coef = −0.52, p = 0.009). The most commonly reported alternatives to outdoor engagement with nature were watching nature through a window (84%), followed by looking at images of nature (71%), and listening to nature through a window (66%). The least commonly enjoyed alternative was virtual reality of nature scenes (25%). While outdoor contact with nature away from home decreased, participants still found ways to experience the restorative benefits of nature in and around their home. Of special interest in planning interventions was the fact that actual or real nature was preferred over that experienced through technology. This could be an artifact of our sample, or could represent a desire to be in touch with the “real world” during a health crisis. Nature contact may represent a flexible strategy to decrease stress and improve symptom experience among patients with cancer, particularly during public health crises or disruptions to cancer care.

Nature Contact in the Carceral Workplace: Greenspace and Staff Sickness Absence in Prisons in England and Wales

This paper demonstrates for the first time that prisons with a higher proportion of natural vegetation within their perimeter have lower levels of staff sickness absence. It makes three significant contributions. First, it extends studies of workplace nature contact into the un-researched carceral context. Second, whereas previous workplace nature contact studies have largely utilized single-site surveys, it presents national-level, statistically robust analysis. Third, it brings a novel new perspective to studies of sickness absence within correctional workforces, by considering the effect of the physical environment. Econometric estimations presented in the paper confirm lower levels of staff sick-leave in prisons with more greenspace. This relationship persists when we control for prison size, security level, age, level of crowding, levels of self-harm and violence among prisoners, and assaults against staff. The findings are significant in demonstrating the benefits of nature contact in workplaces in general, and carceral environments in particular. Importantly, this has the potential to influence future prison design.

Measuring Nature Contact: A Narrative Review

While many studies suggest evidence for the health benefits of nature, there is currently no standardized method to measure time spent in nature or nature contact, nor agreement on how best to define nature contact in research. The purpose of this review is to summarize how nature contact has been measured in recent health research and provide insight into current metrics of exposure to nature at individual and population scales. The most common methods include surrounding greenness, questionnaires, and global positioning systems (GPS) tracking. Several national-level surveys exist, though these are limited by their cross-sectional design, often measuring only a single component of time spent in nature, and poor links to measures of health. In future research, exposure assessment combining the quantifying (e.g., time spent in nature and frequency of visits to nature) and qualifying (e.g., greenness by the normalized difference of vegetation index (NDVI) and ratings on perception by individuals) aspects of current methods and leveraging innovative methods (e.g., experience sampling methods, ecological momentary assessment) will provide a more comprehensive understanding of the health effects of nature exposure and inform health policy and urban planning.

Affective Benefits of Nature Contact: The Role of Rumination

Mounting evidence shows that nature contact is associated with affective benefits. However, the psychological mechanisms responsible for these effects are not well understood. In this study, we examined whether more time spent in nature was associated with higher levels of positive affect in general, and lower levels of negative affect and rumination in general. We also conducted a cross-sectional mediation analysis to examine whether rumination mediated the association of nature contact with affect. Participants (N = 617) reported their average time spent in nature each week, as well as their general levels of positive and negative affect, and the degree to which they typically engaged in rumination in daily life. We then used structural equation modeling to test our hypotheses. Our results support the hypothesis that nature contact is associated with general levels of affect, and that rumination mediates this association for negative affect, and marginally mediates this association for positive affect.

The Relationship between Nature Deprivation and Individual Wellbeing across Urban Gradients under COVID-19

Lockdown aiming at slowing COVID-19 transmission has altered nature accessibility patterns, creating quasi-experimental conditions to assess if retracted nature contact and perceived nature deprivation influence physical and emotional wellbeing. We measure through on-line survey methods (n = 529) how pandemic mandates limiting personal movement and outdoor nature access within the United States affect self-assessed nature exposure, perceived nature deprivation, and subsequent flourishing as measured by the Harvard Flourishing Index. Results indicate that perceived nature deprivation strongly associates with local nature contact, time in nature, and access to municipal nature during the pandemic, after controlling for lockdown mandates, job status, household composition, and sociodemographic variables. Our hypothesis is that individuals with strong perceived nature deprivation under COVID-19 leads to diminished wellbeing proved true. Interaction models of flourishing showed positive modification of nature affinity with age and qualitative modification of nature deprivation with race. Our results demonstrate the potential of local nature contact to support individual wellbeing in a background context of emotional distress and social isolation, important in guiding public health policies beyond pandemics.

The Relationship between Nature Deprivation and Individual Wellbeing across Urban Gradients under COVID-19

Shelter-in-place aimed at slowing COVID-19 transmission has altered nature accessibility patterns, creating quasi-experimental conditions to assess if retracted nature contact and perceived nature deprivation influences physical and emotional wellbeing. We measure through survey methods how pandemic mandates limiting personal movement and outdoor nature access effect self-assessed nature exposure, perceived nature deprivation, and subsequent flourishing as measured by the Harvard Flourishing Index. Results indicate that perceived nature deprivation strongly associates with neighborhood nature contact, time in nature and access to municipal nature during the pandemic, after controlling for shelter-in-place mandates, job status, household composition, and sociodemographic variables. Our hypothesis that individuals with strong perceived nature deprivation under COVID-19 leads to diminished wellbeing proved true. Interaction models of flourishing showed positive modification of nature affinity with age and qualitative modification of nature deprivation with race. Our results demonstrate the potential of local nature contact to support individual wellbeing in a background context of emotional distress and social isolation, important in guiding public health policies beyond pandemics.