The COVID-19 pandemic has had devastating consequences for health, social, and economic domains, but what has received far less focus is the effect on people’s relationship to vital ecological supports, including access to greenspace. We assessed patterns of greenspace use in relation to individual and environmental factors and their relationship with experiencing psychological symptoms under the pandemic. We conducted an online survey recruiting participants from social media for adults in Korea for September–December 2020. The survey collected data on demographics, patterns of using greenspace during the pandemic, and major depression (MD) and generalized anxiety disorder (GAD) symptoms. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 2-item (GAD-2) were applied to identify probable cases of MD and GAD. A logistic regression model assessed the association decreased visits to greenspace after the outbreak compared to 2019 and probable MD and GAD. Among the 322 survey participants, prevalence of probable MD and GAD were 19.3% and 14.9%, respectively. High rates of probable MD (23.3%) and GAD (19.4%) were found among persons currently having job-related and financial issues. Of the total participants, 64.9% reported decreased visits to greenspace after the COVID-19 outbreak. Persons with decreased visits to greenspace had 2.06 higher odds (95% CI: 0.91, 4.67, significant at p < 0.10) of probable MD at the time of the survey than persons whose visits to greenspace increased or did not change. Decreased visits to greenspace were not significantly associated with GAD (OR = 1.45, 95% CI: 0.63, 3.34). Findings suggest that barriers to greenspace use could deprive people of mental health benefits and affect mental health during pandemic; an alternative explanation is that those experiencing poor mental health may be less likely to visit greenspaces during pandemic. This implies the need of adequate interventions on greenspace uses under an outbreak especially focusing on how low-income populations may be more adversely affected by a pandemic and its policy responses.

To control the novel coronavirus disease (COVID-19) outbreak, state and local governments in the United States have implemented several mitigation efforts that resulted in lower emissions of traffic-related air pollutants. This study examined the impacts of COVID-19 mitigation measures on air pollution levels and the subsequent reductions in mortality for urban areas in 10 US states and the District of Columbia. We calculated changes in levels of particulate matter with aerodynamic diameter no larger than 2.5 μm (PM 2.5 ) during mitigation period versus the baseline period (pre-mitigation measure) using the difference-in-difference approach and the estimated avoided total and cause-specific mortality attributable to these changes in PM 2.5 by state and district. We found that PM 2.5 concentration during the mitigation period decreased for most states (except for 3 states) and the capital. Decreases of average PM 2.5 concentration ranged from 0.25 μg/m 3 (4.3%) in Maryland to 4.20 μg/m 3 (45.1%) in California. On average, PM 2.5 levels across 7 states and the capital reduced by 12.8%. We estimated that PM 2.5 reduction during the mitigation period lowered air pollution-related total and cause-specific deaths. An estimated 483 (95% CI: 307, 665) PM 2.5 -related deaths was avoided in the urban areas of California. Our findings have implications for the effects of mitigation efforts and provide insight into the mortality reductions can be achieved from reduced air pollution levels.

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Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas.

Human mobility is a significant factor for disease transmission. Little is known about how the environment influences mobility during a pandemic. The aim of this study was to investigate an effect of green space on mobility reductions during the early stage of the COVID-19 pandemic in Maryland and California, USA. For 230 minor civil divisions (MCD) in Maryland and 341 census county divisions (CCD) in California, we obtained mobility data from Facebook Data for Good aggregating information of people using the Facebook app on their mobile phones with location history active. The users’ movement between two locations was used to calculate the number of users that traveled into an MCD (or CCD) for each day in the daytime hours between 11 March and 26 April 2020. Each MCD’s (CCD’s) vegetation level was estimated as the average Enhanced Vegetation Index (EVI) level for 1 January through 31 March 2020. We calculated the number of state and local parks, food retail establishments, and hospitals for each MCD (CCD). Results showed that the daily percent changes in the number of travels declined during the study period. This mobility reduction was significantly lower in Maryland MCDs with state parks (p-value = 0.045), in California CCDs with local-scale parks (p-value = 0.048). EVI showed no association with mobility in both states. This finding has implications for the potential impacts of green space on mobility under an outbreak. Future studies are needed to explore these findings and to investigate changes in health effects of green space during a pandemic.

Given health threats of climate change, a comprehensive review of the impacts of ambient temperature and ar pollution on suicide is needed. We performed systematic literature review and meta-analysis of suicide risks associated with short-term exposure to ambient temperature and air pollution. Pubmed, Scopus, and Web of Science were searched for English-language publications using relevant keywords. Observational studies assessing risks of daily suicide and suicide attempts associated with temperature, particulate matter with aerodynamic diameter ≤10 μm (PM10) and ≤2.5 mm (PM2.5), ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) were included. Data extraction was independently performed in duplicate. Random-effect meta-analysis was applied to pool risk ratios (RRs) for increases in daily suicide per interquartile range (IQR) increase in exposure. Meta-regression analysis was applied to examine effect modification by income level based on gross national income (GNI) per capita, national suicide rates, and average level of exposure factors. In total 2274 articles were screened, with 18 studies meeting inclusion criteria for air pollution and 32 studies for temperature. RRs of suicide per 7.1 °C temperature was 1.09 (95% CI: 1.06, 1.13). RRs of suicide per IQR increase in PM2.5, PM10, and NO2 were 1.02 (95% CI: 1.00, 1.05), 1.01 (95% CI: 1.00, 1.03), and 1.03 (95% CI: 1.00, 1.07). O3, SO2, and CO were not associated with suicide. RR of suicide was significantly higher in higher-income than lower-income countries (1.09, 95% CI: 1.07, 1.11 and 1.20, 95% CI: 1.14, 1.26 per 7.1 °C increased temperature, respectively). Suicide risks associated with air pollution did not significantly differ by income level, national suicide rates, or average exposure levels. Research gaps were found for interactions between air pollution and temperature on suicide risks.

Although a few studies have identified positive association between green space and reduced mortality rate, the effect modification of green space for the impact of air pollution on health outcomes is under studied. We quantified whether green space modifies associations between short-term exposure to particulate matter (PM 10 , PM 2.5 ) and hospitalization across 364 urban U.S. counties for 2000-2013. Green space was measured by normalized difference vegetation index (NDVI). Daily number of hospital admissions for cardiovascular or respiratory diseases from Medicare enrollees (>65yrs) and air quality monitoring data for each county were used to assess risks, as percent change in hospitalization related to 10μg/m 3 increase in particulate matter. We computed an absolute change in county-specific relative risks explained by difference in countylevel NDVI. The study results found that the association between air pollution and health was less in areas with more green space. We estimated that an interquartile range increase in NDVI corresponds to a 1.68% (95% CI: 0.43, 2.91) decrease in the association between PM 10 and cardiovascular hospitalization and 10.40% (95% CI: 7.34, 13.34) decrease in the PM 10hospitalization association of acute myocardial infarction. For hospitalization associated with PM 2.5 , a 0.18% (95% CI: −0.39, 0.73) absolute decrease in relative risk was found for cardiovascular hospitalizations. In results stratified by age, younger age groups (65-74, 75-84yrs) had larger reductions for the PM 10 -hospitalization association with increase in NDVI than older populations (>85yrs) but not for the PM 2.5 -hospitalization association. These findings add evidence for health benefits of green space in diminishing the health impacts of particulate matters on hospitalizations for older populations in the U.S.