Front. Public HealthFrontiers in Public HealthFront. Public Health2296-2565Frontiers Media S.A.10.3389/fpubh.2024.1265682Public HealthOriginal ResearchPerceived urban green spaces and youth mental health in the post-COVID-19 eraMollaesmaeiliMahsaHakimianPantea*LakAzadehFaculty of Architecture and Urban Planning, Shahid Beheshti University, Tehran, Iran
Edited by: Maj Britt Dahl Nielsen, University of Southern Denmark, Denmark
Reviewed by: Kyle D. Buck, United States Environmental Protection Agency (EPA), United States; Xinlei Deng, National Institute of Environmental Health Sciences (NIH), United States; Amir Raza, University of Arizona, United States
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Introduction
The urban green space (UGS) is one of the most significant urban spaces with unique visual and social features, including pleasant air, low noise, and vitality, making it a recreational place for citizens, especially the youth. According to previous studies, perceived green space and the interaction with it is associated with mental health and lower symptoms of anxiety and depression. Although the presence of urban and blue-green spaces in Isfahan has a long history, the UGSs have been out of reach, causing a significant impact on youth mental health due to the spread of COVID-19 and the forcing of the Iranian government to severe and long-term lockdown. This study investigates the relationship between the long-term isolation of youth and being away from UGSs on their mental health in Isfahan city.
Methods
In September 2022, the youth (n = 273) in 12 neighborhoods with similar socio-economic status were asked to answer the online questionnaire. To investigate the correlation between perceived UGS and the mental health of the youth, Structural Equation Modeling (SEM) is done.
Results
The results show that the perceived UGSs negatively relate to the youth’s fear of the reoccurrence of COVID-19 infection, anxiety, and depression. Moreover, the model shows that perceived UGS has an inverse correlation with anxiety (β = −0.24, p = 0.00), and no meaningful correlation exists with depression.
Discussion
These results point to a practical solution for designing UDGs in residential areas for youth according to their benefits for mental health during the epidemic era.
The spread of COVID-19 unexpectedly changed the routines, habits, and types of youth activities (3), causing highly noticeable consideration in densely populated cities and especially metropolises. During this period, quarantine and social distancing, two methods of dealing with the pandemic, led to social isolation, a high risk of depression, inactivity, and limited access to essential services (4).
However, many studies have found that exposure to Urban Green Spaces (UGSs) is associated with mental relaxation and improves mental health in youth (5–10). Kaplans” Attention Restoration Theory (11) and Ulrich” ‘s Psycho-evolutionary Model (12) were pioneering research investigating nature” ‘s effects on humans” physical and mental health. Many studies have recently investigated how UGSs significantly affect youth mental health (13–15).
Before the spread of COVID-19, UGSs, such as parks, have provided residents with a very high quality of life (3, 16), improving mental health and reducing depression and anxiety (17–19). Unfortunately, during the COVID-19 outbreak, social distancing prevented people from visiting UGSs and engaging in recreational activities (20). The policy of “stay at home” and confinement led to the isolation of millions of people all over the world (21–23), particularly the youth (3, 24). (20).
In the last few decades, the expansion of urbanization by reducing the connection between people and nature has unintentionally led to an increase in the risk of ‘citizens’ mental disorders (25–27). Moreover, most city residents are youth, and more than 80% of mental disorders occur before age 26 (13, 28). In 2019, one in every eight people were living with a mental disorder, with anxiety and depressive disorders the most common (29). In 2020, initial estimates showed a 26 and 28% increase, respectively, for anxiety and major depressive disorders in just 1 year (29). Nevertheless, people became more prone to show different degrees of stress and depression during COVID-19 (30–32) and the paucity of people’s interaction with UGSs based on the fear of COVID-19 infection (33–35) exacerbated their mental status.
During COVID-19, citizens had to use private open green spaces inside their residences (23, 30) due to the prohibition of using parks and playgrounds (36). In the post-COVID-19 era, the youth in urban areas have found the opportunity to interact with each other in UGSs and perform their daily activities without restrictions. However, few studies in the literature investigated the role of UGSs in the youth’s mental health after COVID-19, particularly in arid regions where the scares UGS is a challenge.
Therefore, this study aims to examine the relationship between UGSs and anxiety and depression among the youth in Isfahan, one of the megacities in Iran with the prominent feature of blue space, Zayandeh Rood, in the post-COVID-19 era. Accordingly, after developing the conceptual framework, we tried not only to identify the relationship between perceived UGSs in neighborhoods and the mental health of Isfahani youth but also to understand the relationships between the perceived aesthetic of UGSs, perceived pollution (air and noise), and fear of COVID-19 infection, as factors mediating this relationship with the structural equation model.
Theoretical framework
The United Nations defines youth as adolescents between 15 and 24 years old (37). According to Marketta Kyttä, the priority of children and youth-friendly cities is their freedom and independence (38). However, to reduce the risk of infection during COVID-19, the youth, like others, have been forced to stay at home, being highly susceptible to anxiety and depression at both immediate and long-term levels (13).
The main features of UGSs are their social environment and aesthetic aspects, which encourage people to visit them. Many studies point out that exposure to UGSs positively relates to the youths’ psychological well-being (11, 39). In addition, perceived aesthetics in UGSs plays an essential role in attending, performing activities, and socializing with others (40–42). Driskell (43) believes that the presence of green areas, contact with nature, clean air, and the absence of garbage are some physical characteristics of a good place for children and youth. In addition, physical access to UGSs is directly associated with the youth’s mental health (44, 45). Many local authorities have developed policy plans, including environmental education classes and adding outdoor games to the curriculum to improve the mental health of their children and youth (46).
While air pollution and noise are two influential factors in the youth’s mental health (15, 47, 48), UGSs can potentially reduce the effect of these harmful factors (17), (49–51). Although perceived air and noise pollution are most closely related to the pollution calculated by meteorological stations, it is much more intense than the actual level of perception, demonstrating the effect of the personality, social, or physical dimensions of the respondent’s residence (52). However, perceived pollution is more related to the youth’s behavior than measured pollution (26).
Although visiting UGSs could be considered an effective way to improve mental health (44, 45), during COVID-19, using UGSs has been associated with problems. In this period, social networks and communication channels gave people quick access to the news, provoking fear of this disease, hopelessness, and uncertainty (14). During the pandemic, people worldwide experienced many fears related to COVID-19, including the fear of being in urban public spaces. Despite considering all the positive factors that may encourage the youth to visit UGSs, fear of COVID-19 infection and the possibility of death were some of the major factors that prevent them from being in UGSs (35).
While perceived aesthetics are one of the positive factors in increasing the presence of the youth and encouraging them to use UGSs, two factors, perceived pollution and fear of COVID-19 infection, are some inhibiting factors in this research. According to the role of UGSs in reducing air and noise pollution (53–55) as well as in improving youth mental health (56, 57), we aimed to examine the link between the perceived UGSs and the youth” mental health during the COVID-19 pandemic.
Based on the conceptual framework (Figure 1), our assumptions are as follows: (H1) To what extent are UGSs associated with youth mental health, specifically depression and anxiety, in the post-COVID-19 era? (H2) How do the perceived UGSs relate to the youth’s mental health through the three dependent variables of perceived aesthetics, perceived pollution (air and noise), and fear of COVID-19 infection?
Conceptual framework. The pathways between the core variables (perceived UGS, perceived pollution, perceived aesthetics, fear of COVID-19 infection, depression, and anxiety) and control variables (age and gender) are demonstrated.
Materials and methodsStudy design and participants
The cross-sectional research was conducted in September 2022. According to the Worldomenter website, when this research was conducted, it had been about a year since the worst peak of COVID-19 in September, and the risk of infecting and dying from COVID-19 has recently decreased worldwide (58). According to the Ministry of Health of Iran, we started our study after finishing the 7th peak in August 2022; people have returned to their regular routines.
Isfahan, a historic city, is known as the third most populated city in Iran. Zayandeh Rood River and the green public spaces and parks alongside this river are some of the most important landmarks in this city, creating a favorable green and blue space and significantly influencing the citizens’ mental health (Figures 2–4). Transferring the water of this river to gardens, agricultural lands, and neighborhoods through canals called Madi in the local language has developed green corridors in many city districts (59). As stated by the Isfahan municipality in 2021, the UGSs in the city are 28.17 square meters per capita (60).
Niasarm Madi (authors).
Farshadi Madi (authors).
Zayandeh Rood River.
The youth aged 15–24 at high school and undergraduate levels were asked to complete a self-reported questionnaire through Google Forms platform. As previous studies have stated, the socio-economic characteristics of the neighborhoods are related to residents’ mental health and their perception of UGS (61–63). In our study, this variable was controlled by selecting neighborhoods with similar socio-economic status. Based on the latest comprehensive plan (2017), Isfahan has 15 municipalities that have been divided into several neighborhoods. Based on the socio-economic data of the comprehensive plan (64), the questionnaire was distributed within 12 neighborhoods with similar socio-economic status across the city to cover the variety of participants. Therefore, the online questionnaire link was distributed to active youth groups within the designated neighborhoods through the social department of the Isfahan city municipality. Completing the online questionnaire proved instrumental, particularly in the post-COVID-19 era with insufficient vaccination coverage, as face-to-face interactions with youth in the neighborhoods were not feasible. By prioritizing the maintenance of social distance and opting for an online approach, we avoided potential biases in the data collection process. Figure 5 shows the location of the selected neighborhoods and Table 1 presents the socio-demographic characteristics of the residents of these neighborhoods.
The location of the selected neighborhoods in the study.
Socio-demographic status of the selected neighborhoods [source: (60, 64)].
Neighborhood number on the map
Region
Neighborhood name
Male
Female
Total population
Gender ratio*
Employed residents
Employment to population ratio (%)
Educated residents**
Educated residents to population ratio (%)
1
1
Khalja
2,764
3,034
5,798
91
1,674
29
2,107
36
2
3
Ahmad Abaad
3,191
3,180
6,370
100
1871
29
1,380
21
3
4
Hamedanian
4,520
4,504
9,024
100
2,482
27
1985
22
4
5
Hossein Abaad
6,627
7,352
13,979
90
3,840
27
5,397
39
5
6
Mosalla Masjed
4,123
4,470
8,593
92
2,324
27
2,756
32
6
7
Kaveh town
8,520
8,297
16,817
103
4,708
28
2,898
17
7
8
Razmandegah
4,502
4,486
8,987
100
2,744
30
2,191
24
8
9
Baharanchi
1742
1779
3,521
98
1,080
31
665
19
9
10
Mosalla
4,310
4,301
8,611
100
2,428
28
1,175
14
10
12
Malekshahr
17,367
18,149
35,516
96
10,626
30
9,152
26
11
13
Baghziyar
5,619
5,755
11,374
98
3,309
29
3,258
29
12
14
Shahpasand
6,473
6,206
12,679
104
3,582
28
2,296
18
*The number of males per 100 females.
**Residents with a high school diploma or higher degree.
A total of 273 questionnaires were collected. The Google Forms questionnaire could only be registered when all the items were completed, there was no missing data, and the exact number of incomplete submissions is unknown. The recommended sample size for structural equations, as per Kline (65), is 10–20 times the number of parameters. With 26 parameters in our research model, the acceptable sample limit is 260. Therefore, the 273 completed questionnaires collected align with the criteria, constituting an acceptable sample size for structural equations analysis. The Ethics Board of Iran University of Medical Sciences (IUMS) approved the project. Besides, informed consent was obtained from all subjects.
Instruments and measurements
Our study aims to discover the role of UGSs in the youth’s mental health and their attitude toward UGSs in the post-COVID-19 era. Therefore, a questionnaire containing 26 questions about UGSs and mental health was developed. Questions were designed using a conceptual framework extracted from the desk study. Ten academics and professionals approved this questionnaire’s face and content validity. The Cronbach’s alpha was 0.76, and ICC = 0.913. The final questionnaire consisted of six parts, described below:
Perceived UGSs in residential areas
Utilizing the approach employed in the study by Liu et al. (67), Yang et al. (68), and Li et al. (26), we measured people’s perception of UGS in the neighborhood to assess its correlation with mental health. Therefore, we asked the youth to answer, “How much urban green space (e.g., trees, plants, etc.) is in your neighborhood”?” Answers were given using a 5-point Likert scale, and the participants chose from 1 = very little to 5 = very much based on their experience.
Perceived pollution of UGSs
Based on the previous studies (26), the youth were asked to assess the perceived air and noise pollution in the UGSs based on a 5-point Likert scale: “How do you evaluate the level of noise pollution (e.g., honks, car engines, etc.) in the UGSs in the last month?” and “How do you evaluate the level of air pollution (smoke and dust) in the UGSs in the last month”?” (Cronbach α = 0.75). The mean score of the questions was used as the total score of this variable.
Based on the Isfahan municipality, it has been reported that there were about 23 days of healthy air (51–100 AQI) and 8 days of unhealthy air for sensitive groups (101–150 AQI) in September 2022 (66). In summary, air pollution in September was minimal and did not adversely impact individuals’ perceptions while completing the questionnaire. Typically, air pollution in Iran’s metropolises, including Isfahan, tends to escalate toward the end of November and persists through December (67).
Perceived aesthetics of UGSs
To assess individuals’ perception of the aesthetics of spaces, we employed the questions from the adapted version (68) of the NEWS questionnaire (69). These questions measure people’s perceptions of the environment’s aesthetics while walking. We asked the participants to express their perceptions about the attractiveness and aesthetics of UGSs. “Do you consider UGSs near your residence well-designed, clean, well-maintained, and furnished?.” “In this area, are there any historic and attractive buildings with appropriate or considerable architecture?” In this area, are there any attractive landscapes (e.g., natural greenness, the presence of water in any forms, views of the mountains or other natural landscapes”)?” and “How do you rate the beauty of UGSs near your residence”?” The youth answered these questions using the 5-point Likert scale, and the Cronbach α was 0.77. We used the mean score of the questions as the total score of this variable.
Fear of COVID-19 infection
Due to the high mortality rates of COVID-19 globally, many people have suffered from the fear of COVID-19 transmission outside their homes. We formulated three questions assessing individuals’ fear of being in open spaces and contracting COVID-19 using The Fear of COVID-19 Scale (FCV-19S) questionnaire (70). Therefore, we asked the following three questions to find the relation between perceiving the UGS of the neighborhood and the fear of COVID-19 infection. “To what extent are you afraid of getting infected with COVID-19 in crowded spaces in UGSs, such as playgrounds, around fountains, bridges, sitting areas, and public toilets?” “When you think about COVID-19, do you feel an increase in your heart rate, insomnia, or any mental disorders?” and “How much does the possibility of reoccurrence of high infection of COVID-19 make you uneasy?” Answers are categorized from 1 = very little to 5 = very much. Cronbach α is calculated at 0.77. We used the mean score of the questions as the total score of this variable.
Feeling anxiety
The Generalized Anxiety Disorder 7-item scale (GAD-7) was used to assess the anxiety level of the participants (74). In seven questions, the youth were asked to state how much they suffered from anxiety symptoms in the past 2 weeks using UGSs. The answers were based on a 4-point Likert scale (0 = not at all to 3 = nearly every day). The total score indicated the respondents’ anxiety level (0–4 = minimal anxiety, 5–9 = mild anxiety, 10–14 moderately severe anxiety, and 15–19 = severe anxiety). There was a high reliability of Cronbach α estimated at 0.82.
Feeling depression
The 9-item Patient Health Questionnaire (PHQ-9) was used to assess the level of depression of the participants (71). In these nine questions, the symptoms of depression, lack of pleasure, hopelessness, sleep problems, fatigue, changes in appetite, and thoughts of suicide in the youth were measured, and they were asked to answer the questions based on a 4-point Likert scale (0 = not at all to 4 = almost every day). The scores were considered in five categories: 0–4 = minimal depression, 5–9 = mild depression, 14–10 = moderate depression, 15–19 = moderately severe depression, and 20–27 = severe depression with Cronbach α = 0.85.
Data analysis
In our study, Spearman’s Rank-Order Correlation (72) was done to examine the association between the variables, including perceived UGSs, perceived pollution, perceived aesthetics, fear of COVID-19 infection, and mental disorders (anxiety and depression) as well as age and gender of the participants. Data analysis was done with IBM SPSS Statistics software, version 26. If the correlation between the variables is strong, it is closer to +1 or − 1, and if two variables are independent, this number is closer to zero (73).
The structural equation model was employed to examine the hypothesized pathways in the conceptual framework presented in Figure 1 to analyze the relationship between perceived UGSs and youth mental health. A multivariate analysis method includes several dependent and independent variables in a single model and two categories of latent and observed variables (65). Perceived UGS was considered an independent variable, and others were dependent. Depression and anxiety were considered dependent variables obtained through the standardized questionnaires of GAD-7 and PHQ-9. Perceived pollution is a latent variable with two observed variables: air pollution and noise. Perceived aesthetics and fear of COVID-19 infection are the other observed variables in this model. As illustrated in Figure 1, demographic characteristics, including age and gender, were considered control variables in this model as relative quantitative and nominal qualitative variables, respectively.
ResultsCharacteristics of the participants
Two hundred and seventy-three youths between 15 and 24 years old in Isfahan were asked to answer the questionnaire. Table 2 displays that the mean age was 20.22, and about 52% of the participants were female. Also, 15 and 17.6% of the participants reported symptoms of moderate anxiety and moderate depression, respectively.
Characteristics of the participants (n = 273).
Variable
Category
Mean (S.D.)
Percentage (n)
Gender
Male
45.8% (125)
Female
54.2% (148)
Age (year)
20.22 (2.9)
15–18 (Highschool student)
30.8% (84)
19–24 (University student)
69.2% (189)
Perceived UGS
Little
11.4% (31)
A little
7.3% (20)
Moderate
12.5% (34)
Much
32.2% (88)
Very much
36.6% (100)
Perceived pollution
Little
12.5% (34)
A little
50.5% (138)
Moderate
18.3% (50)
Much
11.7% (32)
Very much
7.0% (19)
Perceived aesthetic
Little
1.5% (4)
A little
14.3% (39)
Moderate
24.2% (66)
Much
43.2% (118)
Very much
16.8% (46)
Fear of COVID-19 infection
Little
15.8% (43)
A little
44% (120)
Moderate
24.5% (67)
Much
11.7% (32)
Very much
4.0% (11)
Anxiety
–
7.43% (3.69)
Minimal anxiety
24.5% (67)
Mild anxiety
53.1% (145)
Moderate anxiety
15.0% (41)
Severe anxiety
7.3% (20)
Depression
–
8.02% (4.61)
Minimal depression
28.2% (77)
Mild depression
45.1% (123)
Moderate depression
17.2% (47)
Moderately severe depression
7% (19)
Severe depression
2.6% (7)
Correlation between variables
Table 3 displays that “anxiety” and “depression” were positively correlated with perceived noise, air pollution, and fear of COVID-19 infection. However, these two variables had a negative correlation with perceived UGSs. While there is no significant correlation between anxiety and gender in this statistical population, female youths have reported lower levels of depression than male youths.
Spearman’s rank correlation coefficient.
Item
1
2
3
4
5
6
7
8
1. Gender (male = 1)
1.0
2. Age
−0.005
1.0
3. Perceived fear of COVID-19 infection
−0.147*
0.042
1.0
4. Perceived UGS
0.11
−0.02
−0.336**
1.0
5. Perceived noise
−0.066
0.021
0.256**
−0.515**
1.0
6. Perceived air pollution
−0.056
0.112
0.272**
−0.559**
0.516**
1.0
7. Anxiety
−0.103
0.043
0.336**
−0.655**
0.555**
0.539**
1.0
8. Depression
−0.174**
−0.034
0.345**
−0.562**
0.476**
0.526**
0.614**
1.0
*, p < 0.05; **, 0.01.
Results of the SEM analysis
Based on the theoretical background and bivariate correlation, pathways between variables were proposed and analyzed in IBM SPSS Amos 24 software. The model fit indices published by West et al. were used to check the goodness of fit. Goodness-of-fit index (GFI) >0.95; standardized root mean square residual (RMSEA)<0.8; comparative fit index [(CFI) >0.95] (74) and discrepancy divided by degree of freedom ((CMIN/DF) ≤3) were considered good indicators (65). In the M0 model, we checked the confirmatory factor analysis model based on model fit indices and removed the pathways whose p-value of regression weights was insignificant. Then, in the M1 model, we added demographic characteristics, including age and gender to the model. Finally, we employed the structural equation model in the M2 model using the reduced model to demonstrate the regression paths between the exogenous variable, perceived UGSs, and other endogenous variables, including perceived pollution, perceived aesthetics, fear of COVID-19 infection, anxiety, and depression (CMIN/DF = 1.94, GFI = 0.97, CFI = 0.98, RMSEA = 0.06).
In the final SEM model, although there was no significant direct pathway between perceived UGSs and depression (β = 0.12, p = 0.304), all other pathways between the variables were shown to be significant (65). Despite a significant direct pathway between depression and gender (β = −0.12, P = -0.043) and fear of COVID-19 infection with age (β = −0.079, p = 0.031), these pathways were relatively deemed weak. Moreover, the correlations between fear of COVID-19 infection and depression (β = 0.126) and anxiety (β = 0.091) were weak (Figure 6).
Final structural equation model (M2) with standard regression weight (β). *, p< 0.05; **, p<0.01; ***, p = 0.00.
Table 4 illustrates that perceived UGSs (as the independent variable) had a significant total effect on other variables in our study, demonstrating the direct and indirect impacts of perceived UGSs on the youth’s mental health. The total effect of perceived UGS on perceived pollution, perceived aesthetics, and fear of COVID-19 infection was utterly from the direct effect. Inversely, the total effect on depression is entirely from the indirect effect. The total effect of perceived UGSs on anxiety mainly resulted from the indirect effect.
The standardized total, direct, and indirect effects of perceived UGSs on the core variables.
Variable
Total β (95% CI)
p value
Direct β (95% CI)
p value
Indirect β (95% CI)
p value
Perceived pollution
−0.83 (−0.89, −0.77)
0.003
−0.86 (−0.89, −0.77)
0.003
–
–
Perceived aesthetics
0.71 (0.65, 0.77)
0.005
0.71 (0.65, 0.77)
0.005
–
–
Fear of COVID-19 infection
−0.38 (−0.5, −0.26)
0.004
−0.38 (−0.5, −0.26)
0.004
–
–
Anxiety
−0.82 (−0.86, −0.78)
0.004
−0.24 (−0.38, −0.05)
0.14
−0.58 (−0.78, −0.45)
0.003
Depression
−0.69 (−0.74, −0.63)
0.005
–
–
−0.69 (−0.74, −0.63)
0.005
Discussion
This study examines the relationship between perceived UGSs, potential mediators, and the mental health of the youth (15–24 years old) in Isfahan City in the post-COVID-19 era. The results demonstrate that perceived UGSs are associated with youth anxiety through a direct adverse pathway. Therefore, it can be concluded that the youth exposed to UGSs have experienced better mental health conditions than their peers, emphasizing the role of UGSs in improving the youth’s mental health, as mentioned in previous studies (75–78).
Yet, the pandemic has significantly affected daily habits and behaviors in urban spaces worldwide (3) due to social distancing and quarantine. Thus, there was a global limitation for the youth’s access to UGSs for physical and social activities, directly and indirectly affecting their mental health (20). Although in the post-COVID-19 era, the youth’s access to UGSs seems unchecked, the fear of COVID-19 infection can still be considered a hindrance factor. However, in a longitudinal study, the researchers found that the worries about social distancing and COVID-19 infection decreased in the second and third waves compared to the first one in the U.K. (79). In another study, 46.8% of respondents claimed that fear of infection is the second reason after governmental restrictions prevent them from visiting UGSs (78). Based on the SEM analysis of our study, fear of infectious disease has a significant direct pathway to depression in the youth, although they have been started using UGSs. Similarly, in a study investigating the role of inside and outside greenery in depression in Shanghai, the researchers pointed out that UGSs are directly associated with less fear of COVID-19 infection and fewer symptoms of depression (80) in the post-COVID-19 era.
In our study, some participants reported moderate to severe levels of anxiety and depression, which is in agreement with the research (23) conducted after the pandemic. In a study conducted on 332 students in the city of Plovdiv, Bulgaria, around 34.7% of the youth suffered from depression (PHQ ≥ 10), and 21.7% of them suffered from anxiety (GAD≥10) as well. Meanwhile, in our research, these numbers show 26.8 and 22.3%, respectively. Accordingly, it might be concluded that although COVID-19 infection and mortality have globally decreased significantly, the symptoms of anxiety and depression are still common among the youth.
Based on our findings, perceived pollution is associated with the youth’s mental health. Reducing pollution could help heal mental health disorders (81), while UGSs can reduce air pollution and noise (55) by absorbing air pollutants (82), acting as a buffer (54). Our study confirms that pollution is negatively associated with perceived UGSs and positively associated with anxiety and depression. These findings contribute to understanding the factors establishing a connection between UGSs and mental health. Similarly, other studies have found that pollution mediates between UGSs and mental health (15, 26, 51, 57).
According to some studies (83, 84), environmental qualities help more visits to UGSs, and even during the pandemic, the importance of environmental qualities for youth activities in UGSs has been significant (55). The perceived aesthetic mediator is considered a critical quality for likable UGSs. Our results also show that perceived aesthetics can make a connection between using UGSs and decreasing anxiety. Consistently, previous studies also investigated that this mediator links UGSs to psychological well-being (9). For example, research in 2020 on three Chinese cities shows that improving landscape characteristics, including water, trees, and microclimate, can positively affect mental health (85).
Moreover, in disagreement with another study (26), we could not find any significant direct pathway between perceived UGSs and depression. This variable is related to UGSs through indirect pathways. Additionally, our results show a significant direct pathway between anxiety and UGS quality. These unusual results, as mentioned above, can be justified by the mental health status of the participants, who were not depressed but suffered from fear of being infected in public places (86).
Finally, our results revealed the significant direct association pathways between UGSs and other mediators, including perceived pollution, perceived aesthetics, and fear of infectious disease, emphasizing the role of UGSs on youth mental health. In line with the research conducted by John Newton in Australia, he found anxiety caused by fear of death felt by 22% of the respondents due to COVID-19 (87). Besides, the two mediators of perceived pollution and aesthetics showed a robust association (β = 0.714) (65) between perceived UGSs and youth mental health with a higher regression coefficient than the fear of being infected. Therefore, as depicted in Figure 6, it can be concluded that the connection between perceived Urban Green Space (UGS) and mental health is mediated by the perceived aesthetic of UGS. Prior research findings have consistently highlighted the significance of UGS features such as beauty, naturalness, cleanliness, well-maintenance, and attractive landscapes and buildings in influencing people’s mental health (63, 88, 89).
A limitation in arid regions is the less availability of UGSs. Isfahan, situated on the periphery of Iran’s central desert and characterized by an arid climate, faces challenges in providing adequate UGSs. This study underscores the significance of UGSs in arid climates, particularly during the COVID-19 pandemic. During this period, with social distancing measures and widespread quarantine, neighborhood UGSs emerged as vital for enhancing mental health and averting the exacerbation of conditions like depression and anxiety among residents. This consideration, supported by prior studies in similar climates, underlines the significance of UGS in future research within such regions.
Recent research in Saudi cities with arid climates indicates that, despite a decline in park visitors during the COVID-19 pandemic, urban parks remain crucial for people’s mental health and well-being. Emphasizing the importance of these parks’ quality and quantity is underscored (93). Kim and Coseo’s study in Phoenix, Arizona, underscores the vital role of urban parks as green infrastructure in mitigating air pollution and promoting public health (90). A study in Greece, characterized by a predominantly dry climate, examines public perception regarding the importance of urban green space (91). Akbar et al.’s research in Yazd, an arid region in Iran, explores the influence of large green spaces on public perception, highlighting the absence of green space as a significant barrier to Urban Green Spaces (UGS). The study also addresses the impact of UGS proximity, the presence of water, and green elements on changing people’s moods (96). In Birjand, a study amid the COVID-19 pandemic revealed a shift in green space usage. Public park visits decreased due to government restrictions, but private green spaces like yards and gardens saw increased activity. The findings underscore the importance of enhancing the quality and quantity of green space in arid cities, emphasizing positive impacts on the relationship with nature, mental health, and recreational opportunities during a pandemic (92).
However, there are still some limitations in our study. The first limitation is the restricted understanding of resident’s interaction with UGSs. Unlike many other studies exploring the correlation between UGS interaction and mental health (93), this research focuses on resident’s perceptions of UGSs in neighborhoods.
Bias is considered another limitation of our study in data collection with a self-administrated questionnaire because of the problem of underestimating the questions among participants. Yet, at the beginning of the questionnaire, we described the study for the respondents and categorized anxiety and depression questions with a specific title the youth may underreport due to the stigma, fear, and possibility of labeling that such topics have among the people (3). Also, this research is cross-sectional, and we could not investigate the role of time in our target group. Finally, the average statistical population may not be generalizable to all youth. The SEM model may also lack sufficient power to detect other potentially essential pathways.
Certainly, subjective research is not without its limitations, Numerous studies emphasize the importance of investigating research related to the environment, its connection with humans, and its impact on health from both objective and subjective perspectives (94–96). This dual approach is advocated to enhance the depth of research in this domain. Therefore, a comprehensive exploration of this field requires an examination of not only the subjective dimension but also the objective one. By incorporating both perspectives, researchers can provide a more holistic understanding of the complexities inherent in the relationship between the environment and human health.
Conclusion
This study investigates the relationship between perceived UGSs and youth mental health in Isfahan based on a conceptual framework demonstrating the relationship between different variables through the mediators of perceived pollution, perceived beauty, and fear of COVID-19 infection in the post-COVID-19 era. The youth with more opportunities to be exposed to more UGSs generally had better mental health and fewer symptoms of depression and anxiety. The structural equation model shows the potential pathways between UGSs and mental health among the youth. Less pollution, better environmental conditions, and less fear of COVID-19 infection can help decrease anxiety and depression symptoms. Since this research was cross-sectional, future studies can be longitudinal to determine whether the UGSs can reduce the symptoms of anxiety and depression caused by COVID-19 over time. Due to the nature of our cross-sectional data, a causal relationship between the analyzed variables could not be proven; nonetheless, our model suggests that improved UGS quality, such as less noise and air pollution, can boost mental health. Future urban public design projects should improve environmental qualities to safeguard urban residential spaces and opportunities for UGSs for physical and recreational activities for all citizens.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved by the Shahid Beheshti University of Medical Sciences. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2024.1265682/full#supplementary-material
ReferencesMorenoCWykesTGalderisiSNordentoftMCrossleyNJonesN. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. (2020) 7:813–24. doi: 10.1016/S2215-0366(20)30307-2, PMID: 32682460PortegijsEKeskinenKETuomolaE-MHinrichsTSaajanahoMRantanenT. Older adults’ activity destinations before and during COVID-19 restrictions: from a variety of activities to mostly physical exercise close to home. Health Place. (2021) 68:102533. doi: 10.1016/j.healthplace.2021.102533, PMID: 33647634BilJSBuławaBŚwierzawskiJ. Mental health and the City in the post-COVID-19 era. Sustain For. (2021) 13:5733. doi: 10.3390/su13147533Sepúlveda-LoyolaWRodríguez-SánchezIPérez-RodríguezPGanzFTorralbaROliveiraDV. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. J Nutr Health Aging. (2020) 24:938–47. doi: 10.1007/s12603-020-1500-7, PMID: 33155618BowlerDEBuyung-AliLMKnightTMPullinAS. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. (2010) 10:456. doi: 10.1186/1471-2458-10-456, PMID: 20684754JamesPBanayRFHartJELadenF. A review of the health benefits of greenness. Curr Epidemiol Rep. (2015) 2:131–42. doi: 10.1007/s40471-015-0043-7HaluzaDSchönbauerRCervinkaR. Green perspectives for public health: a narrative review on the physiological effects of experiencing outdoor nature. Int J Environ Res Public Health. (2014) 11:5445–61. doi: 10.3390/ijerph110505445KondoMCFluehrJMMcKeonTBranasCC. Urban green space and its impact on human health. Int J Environ Res Public Health. (2018) 15:445. doi: 10.3390/ijerph15030445GubbelsJSKremersSPJDroomersMHoefnagelsCStronksKHosmanC. The impact of greenery on physical activity and mental health of adolescent and adult residents of deprived neighborhoods: a longitudinal study. Health Place. (2016) 40:153–60. doi: 10.1016/j.healthplace.2016.06.002, PMID: 27322564van den BergMvan PoppelMvan KampIAndrusaityteSBalsevicieneBCirachM. Visiting green space is associated with mental health and vitality: a cross-sectional study in four european cities. Health Place. (2016) 38:8–15. doi: 10.1016/j.healthplace.2016.01.003KaplanS. The restorative benefits of nature: toward an integrative framework. J Environ Psychol. (1995) 15:169–82. doi: 10.1016/0272-4944(95)90001-2UlrichRSSimonsRFLositoBDFioritoEMilesMAZelsonM. Stress recovery during exposure to natural and urban environments. J Environ Psychol. (1991) 11:201–30. doi: 10.1016/S0272-4944(05)80184-7PowerEHughesSCotterDCannonM. Youth mental health in the time of COVID-19. Ir J Psychol Med. (2020) 37:301–5. doi: 10.1017/ipm.2020.84, PMID: 32611470ReirizMDonoso-GonzálezMRodríguez-ExpósitoBUcedaSBeltrán-VelascoAI. Impact of COVID-19 confinement on mental health in youth and vulnerable populations: an Extensive Narrative Review. Sustainability. (2023) 15:3087. doi: 10.3390/su15043087DzhambovAHartigTMarkevychITilovBDimitrovaD. Urban residential greenspace and mental health in youth: different approaches to testing multiple pathways yield different conclusions. Environ Res. (2018) 160:47–59. doi: 10.1016/j.envres.2017.09.015, PMID: 28961469SharifiAKhavarian-GarmsirAR. The COVID-19 pandemic: impacts on cities and major lessons for urban planning, design, and management. Sci Total Environ. (2020) 749:142391. doi: 10.1016/j.scitotenv.2020.142391, PMID: 33370924BeyerKMMKaltenbachASzaboABogarSNietoFJMaleckiKM. Exposure to neighborhood green space and mental health: evidence from the survey of the health of Wisconsin. Int J Environ Res Public Health. (2014) 11:3453–72. doi: 10.3390/ijerph110303453BermanMGKrossEKrpanKMAskrenMKBursonADeldinPJ. Interacting with nature improves cognition and affect for individuals with depression. J Affect Disord. (2012) 140:300–5. doi: 10.1016/j.jad.2012.03.012, PMID: 22464936Faber TaylorAKuoFE. Children with attention deficits concentrate better after walk in the park. J Atten Disord. (2009) 12:402–9. doi: 10.1177/1087054708323000, PMID: 18725656SikorskaDWojnowska-HeciakMHeciakJBukowskaJŁaszkiewiczEHopkinsRJ. Rethinking urban green spaces for urban resilience. Do green spaces need adaptation to meet public post-covid expectations?Urban For Urban Green. (2023) 80:127838. doi: 10.1016/j.ufug.2023.127838SignorelliCScognamiglioTOdoneA. COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population. Acta Biomed. (2020) 91:175–9. doi: 10.23750/abm.v91i3-S.9511AmerioABrambillaAMorgantiAAgugliaABianchiDSantiF. COVID-19 lockdown: housing built Environment’s effects on mental health. Int J Environ Res Public Health. (2020) 17:5973. doi: 10.3390/ijerph17165973DzhambovAMLercherPBrowningMHEMStoyanovDPetrovaNNovakovS. Does greenery experienced indoors and outdoors provide an escape and support mental health during the COVID-19 quarantine?Environ Res. (2021) 196:110420. doi: 10.1016/j.envres.2020.110420, PMID: 33157110CampionJJavedASartoriusNMarmotM. Addressing the public mental health challenge of COVID-19. Lancet Psychiatry. (2020) 7:657–9. doi: 10.1016/S2215-0366(20)30240-6, PMID: 32531299GrantMBrownCCaiaffaWTCaponACorburnJCouttsC. Cities and health: an evolving global conversation. Cities Health. (2017) 1:1–9. doi: 10.1080/23748834.2017.1316025LiHBrowningMHEMDzhambovAMZhangGCaoY. Green space for mental health in the COVID-19 era: a pathway analysis in residential green space users. Land. (2022) 11:1128. doi: 10.3390/land11081128TurnerWRNakamuraTDinettiM. Global urbanization and the separation of humans from nature. Bioscience. (2004) 54:585–90. doi: 10.1641/0006-3568(2004)054[0585:GUATSO]2.0.CO;2CaspiAHoutsRMAmblerADaneseAElliottMLHaririA. Longitudinal assessment of mental health disorders and comorbidities across 4 decades among participants in the Dunedin birth cohort study. JAMA Netw Open. (2020) 3:–e203221. doi: 10.1001/jamanetworkopen.2020.3221, PMID: 32315069World Health Organization. Mental health and COVID-19: Early evidence of the pandemic’s impact: Scientific brief, 2 march 2022World Health Organization (2022).AsimFChaniPSShreeV. Impact of COVID-19 containment zone built-environments on students’ mental health and their coping mechanisms. Build Environ. (2021) 203:108107. doi: 10.1016/j.buildenv.2021.108107, PMID: 36567701BenkeCAutenriethLKAsselmannEPané-FarréCA. Lockdown, quarantine measures, and social distancing: associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. (2020) 293:113462. doi: 10.1016/j.psychres.2020.113462, PMID: 32987222BrooksSKWebsterRKSmithLEWoodlandLWesselySGreenbergN. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. (2020) 395:912–20. doi: 10.1016/S0140-6736(20)30460-8, PMID: 32112714UgoliniFMassettiLPearlmutterDSanesiG. Usage of urban green space and related feelings of deprivation during the COVID-19 lockdown: lessons learned from an Italian case study. Land Use Policy. (2021) 105:105437. doi: 10.1016/j.landusepol.2021.105437, PMID: 35431392UgoliniFMassettiLCalaza-MartínezPCariñanosPDobbsCOstoićSK. Effects of the COVID-19 pandemic on the use and perceptions of urban green space: an international exploratory study. Urban For Urban Green. (2020) 56:126888. doi: 10.1016/j.ufug.2020.126888, PMID: 33100944FabisiakBJankowskaAKłosR. Attitudes of polish seniors toward the use of public space during the first wave of the COVID-19 pandemic. Int J Environ Res Public Health. (2020) 17:8885. doi: 10.3390/ijerph17238885ShoariNEzzatiMBaumgartnerJMalacarneDFechtD. Accessibility and allocation of public parks and gardens during COVID-19 social distancing in England and Wales. medRxiv. 2020-05 (2020) doi: 10.1101/2020.05.11.20098269HorschelmannKvan BlerkL. Children, Youth and the City. London: Routledge (2013).WilliamsS.WrightH.Zu DohnaF., “Cities alive: designing for urban childhoods,” London: ARUP. (2017).WilsonEO. Biophilia In: Biophilia. Cambridge, MA: Harvard University Press (1984).ZhangJWPiffPKIyerRKolevaSKeltnerD. An occasion for unselfing: beautiful nature leads to prosociality. J Environ Psychol. (2014) 37:61–72. doi: 10.1016/j.jenvp.2013.11.008BallKBaumanALeslieEOwenN. Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults. Prev Med. (2001) 33:434–40. doi: 10.1006/pmed.2001.0912ZhangJWHowellRTIyerR. Engagement with natural beauty moderates the positive relation between connectedness with nature and psychological well-being. J Environ Psychol. (2014) 38:55–63. doi: 10.1016/j.jenvp.2013.12.013DriskellD. Creating better cities with children and youth: A manual for participation. London: Earthscan. (2002).HartigT. Green space, psychological restoration, and health inequality. Lancet. (2008) 372:1614–5. doi: 10.1016/S0140-6736(08)61669-4, PMID: 18994650MitchellRPophamF. Effect of exposure to natural environment on health inequalities: an observational population study. Lancet. (2008) 372:1655–60. doi: 10.1016/S0140-6736(08)61689-XWhiteH., (2008). “Connecting today’s kids with nature: a policy action plan,” National Wildlife Federation, Merrifield, VA. Available at: http://www.beoutthere.org (Accessed July 11, 2017).VentriglioABellomoAdi GioiaIdi SabatinoDFavaleDde BerardisD. Environmental pollution and mental health: a narrative review of literature. CNS Spectr. (2021) 26:51–61. doi: 10.1017/S1092852920001303, PMID: 32284087DimitrovaDDzhambovA. Is there an association between urban greenness and air pollution annoyance?Scripta Scientifica Salutis Publicae. (2016) 2:49–59. doi: 10.14748/sssp.v2i2.1796RoeJML. Restorative cities: urban design for mental health and wellbeing. London; New York: Bloomsbury Visual Arts (2021).DadvandPde NazelleAFiguerasFBasagañaXSuJAmolyE. Green space, health inequality and pregnancy. Environ Int. (2012) 40:110–5. doi: 10.1016/j.envint.2011.07.004YangMDijstMFaberJHelbichM. Using structural equation modeling to examine pathways between perceived residential green space and mental health among internal migrants in China. Environ Res. (2020) 183:109121. doi: 10.1016/j.envres.2020.109121PengMZhangHEvansRDZhongXYangK. Actual air pollution, environmental transparency, and the perception of air pollution in China. J Environ Dev. (2019) 28:78–105. doi: 10.1177/1070496518821713SuJGJerrettMde NazelleAWolchJ. Does exposure to air pollution in urban parks have socioeconomic, racial or ethnic gradients?Environ Res. (2011) 111:319–28. doi: 10.1016/j.envres.2011.01.002Van RenterghemTBotteldoorenD. View on outdoor vegetation reduces noise annoyance for dwellers near busy roads. Landsc Urban Plan. (2016) 148:203–15. doi: 10.1016/j.landurbplan.2015.12.018MarkevychISchoiererJHartigTChudnovskyAHystadPDzhambovAM. Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ Res. (2017) 158:301–17. doi: 10.1016/j.envres.2017.06.028, PMID: 28672128DzhambovAMMarkevychIHartigTTilovBArabadzhievZStoyanovD. Multiple pathways link urban green- and bluespace to mental health in young adults. Environ Res. (2018) 166:223–33. doi: 10.1016/j.envres.2018.06.004, PMID: 29890427DzhambovAMMarkevychITilovBArabadzhievZStoyanovDGatsevaP. Pathways linking residential noise and air pollution to mental ill-health in young adults. Environ Res. (2018) 166:458–65. doi: 10.1016/j.envres.2018.06.031“COVID - coronavirus statistics - Worldometer.” (2024)’ Available at: https://www.worldometers.info/coronavirus/country/iran/. (Accessed January 30, 2024).VaeztavakoliALakAYigitcanlarT. Blue and green spaces as therapeutic landscapes: health effects of urban Water Canal areas of Isfahan. Sustain For. (2018) 10:4010. doi: 10.3390/su10114010The I. Municipality, the statistical yearbook of Isfahan. (2021). Available at: https://plan.isfahan.ir/fa/statistics-contents (Accessed January 30, 2024).PoortingaW.BirdN.HallingbergB.PhillipsRWilliamsD. “The role of perceived public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak”, Landscape and Urban Planning. (2021). 211:104092 doi: 10.1016/j.landurbplan.2021.104092Berdejo-EspinolaVSuárez-CastroAFAmanoTFieldingKSOhRRYFullerRA. Urban green space use during a time of stress: a case study during the COVID-19 pandemic in Brisbane, Australia. People Nat (Hoboken). (2021) 3:597–609. doi: 10.1002/pan3.10218, PMID: 34151197RobinsonJMBrindleyPCameronRMaccarthyDJorgensenA. Nature’s role in supporting health during the COVID-19 pandemic: a geospatial and socioecological study. mdpicom. (2021) 18. doi: 10.3390/ijerph18052227, PMID: 33668228Isfahan municipalityAtlas of Isfahan comprehensive plan. (2023). Available at: https://plan.isfahan.ir/sites/default/files/content_files/atlas/24228/atlas6.pdfKlineRB. Principles and practice of structural equation modeling. New York: Guilford publications (2023).The Department of Environmental Protection Agency of Isfahan province, “Isfahan air quality” [Online]. Available at: http://isfahan-doe.ir/page-default/fa/0/form/pId5 (Accessed December 10, 2023).Air Quality Control Company, “Air Pollution Monitoring System.” Available at: https://aqms.doe.ir/Home/AQI (Accessed December 10, 2023).HakimianPLakA. Adaptation and reliability of neighborhood environment walkability scale (NEWS) for Iran: a questionnaire for assessing environmental correlates of physical activity. Med J Islam Repub Iran. (2016) 30:427.SaelensBESallisJFBlackJBChenD. Neighborhood-based differences in physical activity: an environment scale evaluation. Am J Public Health. (2003) 93:1552–8. doi: 10.2105/AJPH.93.9.1552, PMID: 12948979AhorsuDKLinCYImaniVSaffariMGriffithsMDPakpourAH. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. (2022) 20:1537–45. doi: 10.1007/S11469-020-00270-8/TABLES/3, PMID: 32226353KroenkeKSpitzerRLWilliamsJBW. The PHQ-9. J Gen Intern Med. (2001) 16:606–13. doi: 10.1046/j.1525-1497.2001.016009606.xPuthM-TNeuhäuserMRuxtonGD. Effective use of Spearman’s and Kendall’s correlation coefficients for association between two measured traits. Anim Behav. (2015) 102:77–84. doi: 10.1016/j.anbehav.2015.01.010SloanL. Learn about Spearman’s rank-order correlation coefficient in SPSS with data from the general social survey (2012). London: SAGE Publications (2015).WestSGTaylorABWuW. Model fit and model selection in structural equation modeling. Handbook Struct Equat Model. (2012) 1:209–31.BustamanteGGuzmanVKobayashiLCFinlayJ. Mental health and well-being in times of COVID-19: a mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults. Health Place. (2022) 76:102813. doi: 10.1016/j.healthplace.2022.102813, PMID: 35623164HazlehurstMFMuqueethSWolfKLSimmonsCKroshusETandonPS. Park access and mental health among parents and children during the COVID-19 pandemic. BMC Public Health. (2022) 22:800. doi: 10.1186/s12889-022-13148-2ReidCERievesESCarlsonK. Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver. PLoS One. (2022) 17:e0263779. doi: 10.1371/journal.pone.0263779, PMID: 35235576NoszczykTGorzelanyJKukulska-KoziełAHernikJ. The impact of the COVID-19 pandemic on the importance of urban green spaces to the public. Land Use Policy. (2022) 113:105925. doi: 10.1016/j.landusepol.2021.105925, PMID: 34898794BurnettHOlsenJRMitchellR. Green space visits and barriers to visiting during the COVID-19 pandemic: a three-wave nationally representative cross-sectional study of UK adults. Land. (2022) 11:503. doi: 10.3390/land11040503ZhangJBrowningMHEMLiuJChengYZhaoBDadvandP. Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China. Build Environ. (2023) 227:109799. doi: 10.1016/j.buildenv.2022.109799, PMID: 36407014McCayLLaiL. “Urban design and mental health in Hong Kong: A city case study,” in J Urban Design Mental Health. (2018) 4:9. Available at: https://www.urbandesignmentalhealth.com/journal4-hk-case-study.html (Accessed January 30, 2024).Van RenterghemTForssénJAttenboroughKJeanPDefranceJHornikxM. Using natural means to reduce surface transport noise during propagation outdoors. Appl Acoust. (2015) 92:86–101. doi: 10.1016/j.apacoust.2015.01.004SchipperijnJEkholmOStigsdotterUKToftagerMBentsenPKamper-JørgensenF. Factors influencing the use of green space: results from a Danish national representative survey. Landsc Urban Plan. (2010) 95:130–7. doi: 10.1016/j.landurbplan.2009.12.010FongarCAamodtGRandrupTBSolfjeldI. Does perceived green space quality matter? Linking Norwegian adult perspectives on perceived quality to motivation and frequency of visits. Int J Environ Res Public Health. (2019) 16:2327. doi: 10.3390/ijerph16132327ChenCLuoWLiHZhangDKangNYangX. Impact of perception of green space for health promotion on willingness to use parks and actual use among young urban residents. Int J Environ Res Public Health. (2020) 17:5560. doi: 10.3390/ijerph17155560TabriziNLakAMoussaviASMR. Green space and the health of the older adult during pandemics: a narrative review on the experience of COVID-19. Front Public Health. (2023) 11:1218091. doi: 10.3389/fpubh.2023.1218091, PMID: 37601191Newton-JohnT.MenziesR.ChambersS.MenziesR. “Psychological Distress Associated with COVID-19: Estimations of Threat and the Relationship with Death Anxiety,” in SSRN Electronic Journal. (2020) doi: 10.2139/ssrn.3594629LauK.YungC.TanZ. “Usage and perception of urban green space of older adults in the high-density city of Hong Kong,” Urban Forestry & Urban Greening, (2021) 64:127251. doi: 10.1016/j.ufug.2021.127251KothenczGKolcsárRCabrera-BaronaPSzilassiP. “Urban green space perception and its contribution to well-being,” in International journal of environmental research and public health. (2017) 14:766. doi: 10.3390/ijerph14070766KimGCoseoP. Urban park systems to support sustainability: the role of urban park systems in hot arid urban climates. Forests. (2018) 9:439. doi: 10.3390/f9070439KolimenakisASolomouADProutsosNAvramidouEVKorakakiEKaretsosG. Public perceptions of the socioeconomic importance of urban green areas in the era of COVID-19: a case study of a Nationwide survey in Greece. Land. (2022) 11:2290. doi: 10.3390/land11122290KhalilnezhadMRUgoliniFMassettiL. Attitudes and behaviors toward the use of public and private green space during the covid-19 pandemic in Iran. Land. (2021) 10:1085. doi: 10.3390/LAND10101085/S1CollinsCHaaseDHeilandSKabischN. Urban green space interaction and wellbeing–investigating the experience of international students in Berlin during the first COVID-19 lockdown. Urban For Urban Green. (2022) 70:127543. doi: 10.1016/j.ufug.2022.127543, PMID: 35291447ZhangLZhouSKwanM-P. A comparative analysis of the impacts of objective versus subjective neighborhood environment on physical, mental, and social health. Health Place. (2019) 59:102170. doi: 10.1016/j.healthplace.2019.102170, PMID: 31422227Sealy–JeffersonSMesserLSlaughter-AceyJMisraDP. Inter-relationships between objective and subjective measures of the residential environment among urban African American women. Ann Epidemiol. (2017) 27:164–8. doi: 10.1016/j.annepidem.2016.12.003MaransRW. Understanding environmental quality through quality of life studies: the 2001 DAS and its use of subjective and objective indicators. Landsc Urban Plan. (2003) 65:73–83. doi: 10.1016/S0169-2046(02)00239-6