Progress on changing human behaviour to meet the challenges of regional and global sustainability has been slow. Building on theory as well as small-scale survey and experimental evidence that exposure to nature may be associated with greater pro-environmentalism, the aim of the current study was to quantify relationships between exposure to nature (operationalised as neighbourhood greenspace, coastal proximity, and recreational nature visits) as well as appreciation of the natural world, and self-reported pro-environmental behaviour for the adult population of England. Using data from a nationally representative sample (N = 24,204), and controlling for potential confounders, a structural equation model was used to estimate relationships. Indirect effects of neighbourhood exposures via nature visits and nature appreciation were accounted for. We found positive relationships between both recreational nature visits and nature appreciation and pro-environmental behaviour across both the whole sample and key socio-demographic groups. The more individuals visited nature for recreation and the more they appreciated the natural world, the more pro-environmental behaviour they reported. Although rural and coastal dwellers tended to also be more pro-environmental on average, patterns were complex, potentially reflecting situational constraints and opportunities. Importantly, positive associations between pro-environmental behaviours and high neighbourhood greenspace and coastal proximity were present for both high and low socio-economic status households. Improving access to, and contact with, nature, e.g. through better urban planning, may be one approach for meeting sustainability targets.

The health risks of coastal areas have long been researched, but the potential benefits for health are only recently being explored. The present study compared the general health of Belgian citizens a) according to the EU's definition of coastal (50 km), and b) between eight more refined categories of residential proximity to the coast (250 km). Data was drawn from the Belgian Health Interview Survey (n = 60,939) and investigated using linear regression models and mediation analyses on several hypothesized mechanisms. Results indicated that populations living 50-100 km. Four commonly hypothesized mechanisms were considered but no indirect associations were found: scores for mental health, physical activity levels and social contacts were not higher at 0-5 km from the coast, and air pollution (PM10 concentrations) was lower at 0-5 km from the coast but not statistically associated with better health. Results are controlled for typical variables such as age, sex, income, neighbourhood levels of green and freshwater blue space, etc. The spatial urban-rural-nature mosaic at the Belgian coast and alternative explanations are discussed. The positive associations between the ocean and human health observed in this study encourage policy makers to manage coastal areas sustainably to maintain associated public health benefits into the future.

INTRODUCTION: Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined. METHODOLOGY AND ANALYSIS: the population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.

BACKGROUND AND OBJECTIVES: Having contact with nature can be beneficial for health and wellbeing, but many older adults face barriers with getting outdoors. We conducted a systematic review of quantitative studies on health and wellbeing impacts of indoor forms of nature (both real and simulated/artificial), for older adults in residential settings. RESEARCH DESIGN AND METHODS: Search terms relating to older adults and indoor nature were run in 13 scientific databases (MEDLINE, CINAHL, AgeLine, Environment Complete, AMED, PsychINFO, EMBASE, HMIC, PsychARTICLES, Global Health, Web of Knowledge, Dissertations and Theses Global, and ASSIA). We also pursued grey literature, global clinical trials registries, and a range of supplementary methods. RESULTS: of 6,131 articles screened against eligibility criteria, 26 studies were accepted into the review, and were quality-appraised using the Effective Public Health Practice Project (EPHPP) tool. The participants were 930 adults aged over 60. Nature interventions and health/wellbeing outcomes were heterogeneous, which necessitated a narrative synthesis. The evidence base was generally weak, with 18 of 26 studies having a high risk of bias. However, several higher-quality studies found indoor gardening and horticulture programs were effective for cognition, psychological wellbeing, social outcomes, and life satisfaction. DISCUSSION AND IMPLICATIONS: There is inconsistent evidence that indoor nature exposures are beneficial for older care residents. We expect that successful interventions were, at least partly, facilitating social interaction, supporting feelings of autonomy/control, and promoting skill development, that is, factors not necessarily associated with nature per se. Higher-quality studies with improved reporting standards are needed to further elucidate these mechanisms.

Contact with, and psychological connectedness to the natural world are both associated with various health and sustainability-related outcomes. To date, though, the evidence base has been fragmented. Using a representative sample of the adult population of England (N = 4,960), we investigated the relationships between three types of nature contact, psychological connectedness, health, subjective wellbeing and pro-environmental behaviours within a single study. We found that specific types of nature contact, as well as individual differences in nature connectedness, were differentially associated with aspects of health, well-being and pro-environmental behaviours. Living in a greener neighbourhood was, unrelated to any wellbeing or sustainability outcomes. By contrast, visiting nature ≥ once a week was positively associated with general health and household pro-environmental behaviours. Moreover, people who watched/listened to nature documentaries reported higher levels of both pro-environmental behaviours. Nature connectedness was positively related to eudaimonic wellbeing and both types of pro-environmental behaviour. Moreover, connectedness moderated key relationships between nature contact, wellbeing and pro-environmental behaviours. The complexity of our findings suggests that interventions increasing both contact with, and connection to nature, are likely to be needed in order to achieve synergistic improvements to human and planetary health.

Within the BlueHealth project, funded under the Horizon 2020 European Union research framework, a number of targeted experimental design interventions were used to test the effect and impact of planning and design on encouraging people to use various blue spaces. Complex interventions were implemented and evaluations before and after each were made using a set of tools which triangulate with each other—a site assessment tool, a behaviour observation tool, a questionnaire survey (including an economic evaluation) and qualitative interviews. The theoretical basis for the research is that of affordances, and the projects each involved modest changes to the landscape using the approach of “urban acupuncture” where a small intervention can potentially have an effect out of all proportion to the investment. This paper is a protocol paper and describes the research strategy and methodology in detail for one of the intervention sites, located in Plymouth in the UK. The aim is to present the methodology as a whole so as to act as (a) a reference framework for the results of all the projects which will be reported separately in a series of research articles once all the results are in and analysed and (b) a useful reference for other researchers wishing to carry out such complex projects and where a comprehensive presentation of the strategy and methodology is unavailable. We offer this protocol for reference, for critique and for inspiration to those following us.

We analysed the relationship between drug use and wellbeing using data from the Crime Survey for England and Wales. We focused on cannabis use, the most commonly used drug, but also controlled for use of other drugs, alcohol consumption and a range of potential confounds. Measuring life satisfaction on a 0–10 scale, linear models found that people who had never used cannabis had significantly higher scores than current users (0.54). Never having used other types of drugs was also associated with 0.37 extra life satisfaction points. Moderate alcohol use (1–2 days per week) was associated with higher life satisfaction than abstainers or more regular drinkers. Following the “life satisfaction approach”, we estimated the extra income that would be needed to compensate for the wellbeing loss associated with cannabis use. Accounting for income endogeneity, our results suggested that being a current cannabis user may cost an individual over £5600 per year, in terms of lost wellbeing, while being a current user of other drugs may cost approximately £4000 per year. While acknowledging possible reverse causality, we estimated the annual population cost of drug use may be as high as £10.7bn in terms of lost wellbeing.

Exposure to nature can strengthen an individual’s sense of connectedness (i.e. emotional/cognitive bonds to the natural world) and enhance psychological restoration (e.g. feeling relaxed/refreshed). To date, there have been few large studies looking at the role that type and quality of natural environments may have on these outcomes. The present study used data from a large survey in England (sample analyzed = 4,515), which asked participants to recall a recent visit to nature. After controlling for covariates, respondents recalled greater connectedness to nature and restoration following visits to rural and coastal locations compared with urban green space, and to sites of higher environmental quality (operationalized by protected/designated area status, for example, nature reserves). A series of structural equation analyses provided evidence for a bidirectional association between connectedness and restoration. Consideration of the psychological benefits associated with different types and quality of environment has implications for human health, environmental management, and conservation.

After adjusting for covariates, self-reported general health in England is higher among populations living closer to the coast, and the association is strongest amongst more deprived groups. We explored whether similar findings were present for mental health using cross-sectional data for urban adults in the Health Survey for England (2008-2012, N ≥25,963). For urban adults, living ≤1 km from the coast, in comparison to >50 km, was associated with better mental health as measured by the GHQ12. Stratification by household income revealed this was only amongst the lowest-earning households, and extended to ≤5 km. Our findings support the contention that, for urban adults, coastal settings may help to reduce health inequalities in England.

Encouraging the purchase of low-emission vehicles could reduce the environmental impact of growing global car ownership. To date, however, there is relatively little research into the degree to which environmental features, such as reduced CO2 emissions, are considered important when reflecting on car purchase decisions using large representative samples. This issue was explored using data from wave four (2013/14) of the UK Household Longitudinal Study, weighted to be representative of the UK population (N = 12,895). Principal components analysis identified three types of considerations during car purchase reflections: Utilitarian, Image-conscious and Environmental. Logistic and Ordinary Least Squares regressions identified attitudinal, behavioural and sociodemographic predictors of reporting environmental considerations during car purchase. Consideration of environmental factors during reflections on car purchases was more likely among those with higher climate change concerns and topic engagement, as well as self-reported pro-environmental behaviours more generally. Environmental considerations were also higher amongst women, older adults, non-white ethnic groups, urban residents and among individuals in Scotland (vs. London). Contrary to previous findings, richer and more educated respondents were less likely to consider environmental factors, with income positively related to image factors such as brand. Although our findings offer some support for the pro-environmental attitude–behaviour consistency hypothesis, they also highlight key non-attitudinal, sociodemographic factors underlying car purchase reflections that may help social-marketers and policy makers identify key audiences to more effectively promote low-emission vehicle purchases.

The potential of normative and feedback (financial vs. environmental) information in guiding pro-environmental decision-making behaviour was explored in a 2 × 2 (plus control) choice experiment. Using the context of home heating, 599 non-student participants from the UK general public were asked to choose between a standard heating system (a gas boiler) and a relatively more-energy efficient option (a heat pump). In line with evidence for the energy efficiency gap for sustainable innovations, there was low uptake of the heat pump (32.5%) in the control condition where no frame information was provided. Yet, in both conditions where normative information was provided, respondents were significantly more likely (vs. control) to choose the heat pump (financial + norm OR 3.63; 95% CIs 2.13,6.19; environmental + norm OR 3.09; 95% CIs 1.67,4.79), advancing understanding of normative social influence in the context of pro-environmental purchase behaviour. When normative information was not provided, only financial (OR 2.82; 95% CIs 1.67,4.79) but not environmental (OR 1.33; 95% CIs 0.78,2.26), feedback was associated with a significantly greater likelihood of heat pump choice. The main effect of normative information was replicated for behavioural intentions (though only for homeowners), but there was no norm-feedback interaction (regardless of homeownership). The implications for researchers looking to promote ‘green’ choice in the context of new technology adoption are discussed.

The promotion of physical activity through better urban design is one pathway by which health and well-being improvements can be achieved. This study aimed to quantify health and health-related economic impacts associated with physical activity in an urban riverside park regeneration project in Barcelona, Spain. We used data from Barcelona local authorities and metaanalysis assessing physical activity and health outcomes to develop and apply the “Blue Active Tool”. We estimated park user health impacts in terms of all-cause mortality, morbidity (ischemic heart disease; ischemic stroke; type 2 diabetes; cancers of the colon and breast; and dementia), disability-adjusted life years (DALYs) and health-related economic impacts. We estimated that 5753 adult users visited the riverside park daily and performed different types of physical activity (walking for leisure or to/from work, cycling, and running). Related to the physical activity conducted on the riverside park, we estimated an annual reduction of 7.3 deaths (95% CI: 5.4; 10.2), and 6.2 cases of diseases (95% CI: 2.0; 11.6). This corresponds to 11.9 DALYs (95% CI: 3.4; 20.5) and an annual health-economic impact of 23.4 million euros (95% CI: 17.2 million; 32.8 million). The urban regeneration intervention of this riverside park provides health and health-related economic benefits to the population using the infrastructure.

INTRODUCTION: Studies suggest that access and exposure to green-blue spaces (GBS) have beneficial impacts on mental health. However, the evidence base is limited with respect to longitudinal studies. The main aim of this longitudinal, population-wide, record-linked natural experiment, is to model the daily lived experience by linking GBS accessibility indices, residential GBS exposure and health data; to enable quantification of the impact of GBS on well-being and common mental health disorders, for a national population. METHODS AND ANALYSIS: This research will estimate the impact of neighbourhood GBS access, GBS exposure and visits to GBS on the risk of common mental health conditions and the opportunity for promoting subjective well-being (SWB); both key priorities for public health. We will use a Geographic Information System (GIS) to create quarterly household GBS accessibility indices and GBS exposure using digital map and satellite data for 1.4 million homes in Wales, UK (2008-2018). We will link the GBS accessibility indices and GBS exposures to individual-level mental health outcomes for 1.7 million people with general practitioner (GP) data and data from the National Survey for Wales (n=~12 000) on well-being in the Secure Anonymised Information Linkage (SAIL) Databank. We will examine if these associations are modified by multiple sociophysical variables, migration and socioeconomic disadvantage. Subgroup analyses will examine associations by different types of GBS. This longitudinal study will be augmented by cross-sectional research using survey data on self-reported visits to GBS and SWB. ETHICS AND DISSEMINATION: all data will be anonymised and linked within the privacy protecting SAIL Databank. We will be using anonymised data and therefore we are exempt from National Research Ethics Committee (NREC). An Information Governance Review Panel (IGRP) application (Project ID: 0562) to link these data has been approved.The research programme will be undertaken in close collaboration with public/patient involvement groups. A multistrategy programme of dissemination is planned with the academic community, policy-makers, practitioners and the public.

This paper presents a novel investigation of a conceptual model, proposing that increased nature exposure may be associated with lower cravings, through reductions in negative affect. A cross-sectional online survey (N = 149) provided an initial exploration of the relationships between various aspects of nature exposure, craving and negative affect. Access to gardens/allotments and residential views incorporating more than 25% greenspace were both associated with reductions in the strength and frequency of cravings. These associations were mediated, to varying degrees, by reductions in negative affect. This novel link could have implications for public health and environmental protection programmes.

A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

Cities are responding to their growing transportation demands in different ways. We interviewed city dwellers in two cities, Singapore and London, with highly developed transport infrastructure to understand individual transport decisions and experiences in the context of two different city cultures that support distinct transport policies. Compared to London, cars and other private transport are valued and priced beyond the reach of most in Singapore. Seventeen adults from London and sixteen from Singapore were interviewed and presented with an overview of the other city's transportation system to elicit their opinions on the differences and whether an alternate system could be applied in their city. Differences were observed in perceptions of, and beliefs concerning, private transport. In Singapore, cars served more than utilitarian purposes and were viewed as socially desirable status and success symbols. In London, car ownership and usage were viewed as a necessity due to a perceived lack of accessible, alternative transport. Both samples valued accessibility, affordability and comfort in relation to transport mode choice. There was also general acknowledgement and support for managing the car population and use in both cities, though how it should be done remains highly context-specific. Our findings suggest that public engagement and effective communication are important components when interventions and policies are introduced to better manage the car population and use in cities.

The potential benefits of aquatic environments for public health have been understudied in Asia. We investigated the relationships between blue space exposures and health outcomes among a sample of predominantly older adults in Hong Kong. Those with a view of blue space from the home were more likely to report good general health, while intentional exposure was linked to greater odds of high wellbeing. Visiting blue space regularly was more likely for those within a 10-15 min walk, and who believed visit locations had good facilities and wildlife present. Longer blue space visits, and those involving higher intensity activities, were associated with higher recalled wellbeing. Our evidence suggests that, at least for older citizens, Hong Kong's blue spaces could be an important public health resource.

Although the UK consumes a substantial amount of shellfish, most is imported (e.g. prawns), while locally harvested molluscs and crustaceans (e.g. mussels, crab) tend to be exported. This study aimed to investigate whether a low rate of local shellfish consumption in the UK is due to misunderstandings or knowledge gaps about the potential health and environmental risks and benefits of consumption. Following the Mental Models Approach, the present paper reveals: 1) qualitative results from 26 stakeholder/public interviews which identified 10 key misunderstandings and knowledge gaps, including incorrect beliefs about health risks and a lack of knowledge about the relative environmental benefits compared to other foods (key misunderstandings included some parts of a crab are poisonous if eaten, and the majority of UK shellfish is farmed), and 2) quantitative results from a survey (n = 1,433) that explored the degree to which these misunderstandings and knowledge gaps may influence consumption intentions in the wider UK population. Survey results suggested the number of misunderstandings and knowledge gaps significantly predicted shellfish consumption intentions even after controlling for demographics, food related values, and past consumption behaviour. Path analyses revealed their impact on intentions was partially mediated via Theory of Planned Behaviour variables. Results could inform information campaigns supporting consumers to make more informed decisions regarding a group of foods that are potentially both healthy and relatively environmentally friendly.

Increasingly, the potential short and long-term impacts of climate change on human health and wellbeing are being demonstrated. However, other environmental change factors, particularly relating to the natural environment, need to be taken into account to understand the totality of these interactions and impacts. This paper provides an overview of ongoing research in the Health Protection Research Unit (HPRU) on Environmental Change and Health, particularly around the positive and negative effects of the natural environment on human health and well-being and primarily within a UK context. In addition to exploring the potential increasing risks to human health from water-borne and vector-borne diseases and from exposure to aeroallergens such as pollen, this paper also demonstrates the potential opportunities and co-benefits to human physical and mental health from interacting with the natural environment. The involvement of a Health and Environment Public Engagement (HEPE) group as a public forum of "critical friends" has proven useful for prioritising and exploring some of this research; such public involvement is essential to minimise public health risks and maximise the benefits which are identified from this research into environmental change and human health. Research gaps are identified and recommendations made for future research into the risks, benefits and potential opportunities of climate and other environmental change on human and planetary health.

Human and environmental health are important globally. Reduced car use could improve human health by promoting physical activity and consequent decreases in carbon dioxide emissions would help achieve greenhouse gas emissions targets. The aim of this study was to explore how travellers evaluate seven transport choices. We compared the evaluative spaces of two distinct groups of transport users: predominantly non-car users and above-average mileage car users. The Repertory Grid technique was used to elicit 448 constructs from 15 non-car users and 15 high-mileage car users. Thematic analysis, content analysis, cluster analysis, analysis of means and principal component analysis were used to identify similarities and differences between the construct systems. Results revealed that non-car users and high-mileage car users apply broadly similar constructs to evaluate transport modes. They differ, however, in the structure of their construct systems. Both groups share constructs related to time and route flexibility. Effects on the environment and benefits of physical activity were important for non-car users but not for high-mileage car users. Non-car users view travel modes with greater differentiation, while high-mileage car users use a looser construal of travel modes. We discuss implications for future intervention design and ramifications for policy and practice.

Outdoor activities can be an important complement to classroom learning, especially for children/young people excluded, or at risk of exclusion, from mainstream schooling. The current research explored the impact of a 12-week surfing programme among such a group in the UK. Pre-post data on physiological health (heart rate (HR)/blood pressure), self-reported well-being (life and domain satisfaction), connectedness (e.g. to nature, school), environmental awareness (e.g. role of sand dunes) and teacher evaluations (e.g. behaviour) were collected. Results found significant drops in HR (suggesting improved fitness), increased satisfaction with appearance, more positive attitudes towards school and friendships, greater environmental awareness and more positive teacher evaluations, post-intervention. A lack of findings in other domains suggests these results were not due to participants simply conforming to demand characteristics. Overall, the results suggest that surfing interventions could have important benefits for vulnerable young people who struggle with mainstream schooling. The need for future research using control groups and longer term follow-up is discussed.

Although walking for leisure can support health, there has been little systematic attempt to consider how recreational walking is best promoted. In the UK, local authorities create promotional materials for walking networks, but little is known about whether they effectively encourage walking through persuasive messaging. Many of these materials pertain to walks in natural environments which evidence suggests are generally visited less frequently by physically inactive individuals. Consequently the present study explores whether and how recreational walking brochures use persuasive messages in their promotion of walks in natural environments. A coding taxonomy was developed to classify text in recreational walking brochures according to five behavioural content areas and 87 categories of potentially persuasive messages. Reliability of the taxonomy was ascertained and a quantitative content analysis was applied to 26 brochures collected from Devon, UK. Brochures often provided information about an advertised route, highlighted cultural and aesthetic points of interest, and provided directions. Brochures did not use many potentially effective messages. Text seldom prompted behaviour change or built confidence for walking. Social norm related information was rarely provided and there was a general lack of information on physical activity and its benefits for health and well-being. The limited range of message strategies used in recreational walking brochures may not optimally facilitate walking in natural environments for inactive people. Future research should examine the effects of theory-informed brochures on walking intentions and behaviour. The taxonomy could be adapted to suit different media and practices surrounding physical activity in natural environments.

Evidence supporting a positive association between neighbourhood greenspace and physical activity is equivocal. Using data from a large, nationally representative survey in England (n = 280,790), we found that while a positive relationship between the amount of neighbourhood greenspace and the odds of achieving recommended weekly physical activity existed for dog owners, no relationship was found for non-dog owners. The findings highlight the importance of neighbourhood greenspaces for supporting physical activity through dog walking in the UK context, but also raise the issue of how to encourage non-dog owners to use greenspaces in health-promoting ways. The results may also help to explain previously mixed findings in the international evidence base, and emphasise the need to adequately account for dog-ownership in future research exploring the relationship between greenspaces and physical activity.

Personal car use is increasing globally and is an important contributor to poor air quality and global greenhouse gas emissions. Although individuals have little direct control over some emission sources (e.g. heavy industry), they can modify their car use thereby reducing their own contribution. There have been many attempts to understand the psychology of personal car use and identify ways in which individuals might be encouraged to adopt more environmentally friendly travel modes. The aims of this study were (1) to review available psychological theories and models and their applications to understanding car use, (2) to assess the quality of empirical tests of relevant theories and (3) to develop an integrated conceptual overview of potentially modifiable antecedents that could inform future intervention design and further theoretical research. Fifteen psychological theories were identified from thirty-two unique studies but most theories were applied only once. Although two theories in particular (the Comprehensive Action Determination Model and Stage Model of Self-Regulated Behaviour Change) are both relatively comprehensive and have empirical support, our review suggests there are mechanisms of behavioural regulation relevant to car use that are not included in either theory. Integrating theories, we developed an integrative conceptual framework, referred to as the CAr USE (or CAUSE) framework of cognitive and emotional antecedents of car use. This framework is likely to be applicable to other ecologically-relevant behaviour patterns. Implications for research and practice are discussed.

Throughout evolutionary history, humans have developed strong reactions to animals and landscape features that have either aided or hindered survival and well-being. Exposure to natural environments provides many perceived and actual health benefits, including reduced mental fatigue, improved mood, and decreased stress and anxiety. Studies exploring humans’ responses to their surroundings, however, tend to focus on terrestrial environments. In contrast, fewer studies have focused on humans’ reactions to aquatic settings, or the biodiversity found within them. We provide an overview of the various health and well-being benefits associated with humans’ relationships with different aquatic settings and focus on one particular setting: simulated underwater environments (aquaria). We provide a review of aquaria-related studies, including emerging research on how different subaquatic species influence human health and well-being outcomes. Finally, we suggest ways in which the benefits of underwater biodiversity can be further researched.

Hypothesis: Stress and unusual events are associated with a higher likelihood of attacks and increased symptom severity in Menière's disease (MD). Background: MD is an unpredictable condition which severely impacts the quality of life of those affected. It is thought that unusual activity and stress may act as an attack trigger in MD, but research in this area has been limited to date. Methods: This was a longitudinal study conducted over two phases. A mobile phone application was used to collect daily data on Menière's attacks and individual symptoms (aural fullness, dizziness, hearing loss, and tinnitus), as well as prevalence of unusual events (phase I), and stress levels (phase II). There were 1,031 participants (730 women, mean age 46.0 yr) in phase I and 695 participants (484 women, mean age 47.7 yr) in phase II. Panel data regression analyses were employed to examine for associations between unusual events/stress and attacks/symptoms, including the study of 24 hours lead and lag effects. Results: Unusual events and higher stress levels were associated with higher odds of Menière's attacks and more severe symptoms. The odds of experiencing an attack were 2.94 (95% confidence interval [CI] 2.37, 3.65) with reporting of unusual events and increased by 1.24 (95% CI 1.20, 1.28) per unit increase in stress level. Twenty-four hour lead (OR 1.10 [95% CI 1.07, 1.14]) and lag (OR 1.10 [95% CI 1.06, 1.13]) effects on attacks were also found with increases in stress. Conclusion: This study provides the strongest evidence to date that stress and unusual events are associated with attacks and symptom exacerbation in MD. Improving our understanding of stress and unusual events as triggers in Menière's may reduce the uncertainty associated with this condition and lead to improved quality of life for affected individuals.

Virtual reality (VR) distraction has become increasingly available in health care contexts and is used in acute pain management. However, there has been no systematic exploration of the importance of the content of VR environments. Two studies tested how interacting with nature VR influenced experienced and recollected pain after 1 week. Study 1 (n = 85) used a laboratory pain task (cold pressor), whereas Study 2 (n = 70) was a randomized controlled trial with patients undergoing dental treatment. In Study 1, nature (coastal) VR reduced both experienced and recollected pain compared with no VR. In Study 2, nature (coastal) VR reduced experienced and recalled pain in dental patients, compared with urban VR and standard care. Together, these data show that nature can improve experience of health care procedures through the use of VR, and that the content of the VR matters: Coastal nature is better than urban.

People are often more satisfied with a choice (e.g. chocolates, pens) when the number of options in the choice set is "just right" (e.g. 10-12), neither too few (e.g. 2-4) nor too many (e.g. 30-40). We investigated this "Goldilocks effect" in the context of a placebo treatment. Participants reporting nonspecific complaints (e.g. headaches) chose one of Bach's 38 Flower Essences from a choice set of 2 (low choice), 12 (optimal choice), or 38 (full choice) options to use for a 2-week period. Replicating earlier findings in the novel context of a health-related choice, participants were initially more satisfied with the essence they selected when presented with 12 versus either 2 or 38 options. More importantly, self-reported symptoms were significantly lower 2 weeks later in the optimal (12) versus nonoptimal choice conditions (2 and 38). Because there is no known active ingredient in Bach's Flower Essences, we refer to this as the Goldilocks placebo effect. Supporting a counterfactual thinking account of the Goldilocks effect, and despite significantly fewer symptoms after 2 weeks, those in the optimal choice set condition were no longer significantly more satisfied with their choice at the end of testing. Implications for medical practice, especially patient choice, are discussed.

Research suggests that children living in areas with more greenspace may have better self-regulation, but to date no studies have investigated this capacity immediately following exposure to natural vs. urban environments. To explore this, two studies using between-subjects experimental designs were conducted. Participants, between eight and eleven years old, completed a delay of gratification task (as an indicator of self-regulation) before and after a short (3 min) video of either a natural or built environment or a control display. Potential cognitive and emotional mechanisms underpinning any self-regulation effects were explored using a selective attention task (Stroop test) and by monitoring mood (adapted Cantril’s ladder). Results were mixed. Supporting earlier work, post-test delay of gratification scores were significantly better after exposure to a natural than urban environment, however, compared to controls, it appeared that this effect was due to the depleting effect of the built condition, rather than any restorativeness of the natural condition. Although we also found a marginally significant increase in mood after exposure to the natural environment, this did not mediate the effects of environment on self-regulation.

Introduction Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe's coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with 'blue space' (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood. Aims and methods the BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas. Ethics and dissemination Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.

Risk communication is fundamental in ensuring people are equipped with the knowledge needed to navigate varied risks. One generally well-regarded framework for the development of such communications is the mental models approach to risk communication (MMARC). Developed during the 1990s, the MMARC has been applied to a range of health, technological, and environmental risks. However, as yet, we know of no attempt to collate and review articles that evaluated communications developed using the MMARC. This article took a first step at addressing this gap by conducting a scoping review that aimed to begin to explore the fidelity with which the approach has been applied, explore whether there appeared to be sufficient studies to warrant a future systematic review, and identify future research questions. Although the initial search found over 100 articles explicitly applying the MMARC, only 12 of these developed a risk-related communication that was tested against a control (and thus included in the current review). All studies reported a positive effect of the MMARC versus control communication for at least some of the outcome measures (knowledge being the most prevalent). However, there was wide variation between studies including type of control, outcomes assessed, and only five studies reported adopting a randomized design. The review highlights both the need for greater fidelity in the way future studies operationalize the MMARC approach, and suggests that a full-scale systematic review of the MMARC literature appears justified, especially given the possibility of a large gray literature in this area.

Losses in biodiversity and trends toward urbanisation have reduced people's contact with bio-diverse nature, yet the consequences for mental well-being are not well understood. Here, we demonstrate that greater plant and animal species richness in isolation causes an improvement in mental well-being. To do so, the present research experimentally manipulated species richness and assessed widely-used indicators of mental well-being. Participants viewed short videos of either high or low tree (Study 1) or bird (Study 2) species richness and reported on positive (i.e. vitality, positive affect) and negative (i.e. anxiety) indicators of mental well-being. Building on Study 1, Study 2 included an urban environment as a reference treatment and explored the role of giving participants information on the presented environment. We find that, in line with expectations, watching videos containing greater species richness consistently leads to higher mental well-being. We discuss findings in light of the importance of connecting people to biodiverse environments.

© 2017 Elsevier Ltd Background There is increasing policy interest in the potential for vegetation in urban areas to mitigate harmful effects of air pollution on respiratory health. We aimed to quantify relationships between tree and green space density and asthma-related hospitalisations, and explore how these varied with exposure to background air pollution concentrations. Methods Population standardised asthma hospitalisation rates (1997–2012) for 26,455 urban residential areas of England were merged with area-level data on vegetation and background air pollutant concentrations. We fitted negative binomial regression models using maximum likelihood estimation to obtain estimates of asthma-vegetation relationships at different levels of pollutant exposure. Results Green space and gardens were associated with reductions in asthma hospitalisation when pollutant exposures were lower but had no significant association when pollutant exposures were higher. In contrast, tree density was associated with reduced asthma hospitalisation when pollutant exposures were higher but had no significant association when pollutant exposures were lower. Conclusions We found differential effects of natural environments at high and low background pollutant concentrations. These findings can provide evidence for urban planning decisions which aim to leverage health co-benefits from environmental improvements.

Although the (perceived) biodiversity of a natural environment can influence people's actual, or predicted, restorative experiences, little is known about the generality of these effects or the importance of other aspects such as wildlife behaviour. The current research used an experimental approach (with photographs and videos of coastal scenes) to investigate these issues among a large heterogeneous UK sample (n=1,478). On average, coastal settings with higher perceived biodiversity were rated as offering greater restorative potential and were associated with higher willingness-to-visit. Men, and people with lower overall ratings, tended to be more sensitive to biodiversity levels, and older respondents believed coastal settings in general offered more restorative potential. Locations where a species was exhibiting High vs. Low fascination behaviours (e.g. murmurating vs. sleeping) were also rated more positively, highlighting the importance of wildlife behaviour on psychological outcomes, in addition to biodiversity. Implications for conservation and communication are discussed.

Despite growing interest in the relationships between natural environments and subjective wellbeing (SWB), previous studies have various methodological and theoretical limitations. Focusing on urban/peri-urban residents (n=7272) from a nationally representative survey of the English population, we explored the relationships between three types of exposure: i) ‘neighbourhood exposure’, ii) ‘visit frequency’, and iii) ‘specific visit’; and four components of SWB: i) evaluative, ii) eudaimonic, iii) positive experiential and iv) negative experiential. Controlling for area and individual level socio-demographics and other aspects of SWB, visit frequency was associated with eudaimonic wellbeing and a specific visit with positive experiential wellbeing. People who visited nature regularly felt their lives were more worthwhile, and those who visited nature yesterday were happier. The magnitude of the association between weekly nature visits and eudaimonic wellbeing was similar to that between eudaimonic wellbeing and life circumstances such as marital status. Findings are relevant for policies to protect and promote public access to natural environments.

Background a growing number of quantitative studies have investigated the potential benefits of outdoor blue spaces (lakes, rivers, sea, etc) and human health, but there is not yet a systematic review synthesizing this evidence. Objectives to systematically review the current quantitative evidence on human health and well-being benefits of outdoor blue spaces. Methods Following PRISMA guidelines for reporting systematic reviews and meta-analysis, observational and experimental quantitative studies focusing on both residential and non-residential outdoor blue space exposure were searched using specific keywords. Results in total 35 studies were included in the current systematic review, most of them being classified as of “good quality” (N = 22). The balance of evidence suggested a positive association between greater exposure to outdoor blue spaces and both benefits to mental health and well-being (N = 12 studies) and levels of physical activity (N = 13 studies). The evidence of an association between outdoor blue space exposure and general health (N = 6 studies), obesity (N = 8 studies) and cardiovascular (N = 4 studies) and related outcomes was less consistent. Conclusions Although encouraging, there remains relatively few studies and a large degree of heterogeneity in terms of study design, exposure metrics and outcome measures, making synthesis difficult. Further research is needed using longitudinal research and natural experiments, preferably across a broader range of countries, to better understand the causal associations between blue spaces, health and wellbeing.

Exposure to pollen can contribute to increased hospital admissions for asthma exacerbation. This study applied an ecological time series analysis to examine associations between atmospheric concentrations of different pollen types and the risk of hospitalization for asthma in London from 2005 to 2011. The analysis examined short-term associations between daily pollen counts and hospital admissions in the presence of seasonal and long-term patterns, and allowed for time lags between exposure and admission. Models were adjusted for temperature, precipitation, humidity, day of week, and air pollutants. Analyses revealed an association between daily counts (continuous) of grass pollen and adult hospital admissions for asthma in London, with a 4-5-day lag. When grass pollen concentrations were categorized into Met Office pollen 'alert' levels, 'very high' days (vs. 'low') were associated with increased admissions 2-5 days later, peaking at an incidence rate ratio of 1.46 (95%, CI 1.20-1.78) at 3 days. Increased admissions were also associated with 'high' versus 'low' pollen days at a 3-day lag. Results from tree pollen models were inconclusive and likely to have been affected by the shorter pollen seasons and consequent limited number of observation days with higher tree pollen concentrations. Future reductions in asthma hospitalizations may be achieved by better understanding of environmental risks, informing improved alert systems and supporting patients to take preventive measures.

The rise in greenhouse gas emissions from air travel could be reduced by individuals voluntarily abstaining from, or reducing, flights for leisure and recreational purposes. In theory, we might expect that people with pro-environmental value orientations and concerns about the risks of climate change, and those who engage in more pro-environmental household behaviours, would also be more likely to abstain from such voluntary air travel, or at least to fly less far. Analysis of two large datasets from the United Kingdom, weighted to be representative of the whole population, tested these associations. Using zero-inflated Poisson regression models, we found that, after accounting for potential confounders, there was no association between individuals’ environmental attitudes, concern over climate change, or their routine pro-environmental household behaviours, and either their propensity to take non-work related flights, or the distances flown by those who do so. These findings contrasted with those for pro-environmental household behaviours, where associations with environmental attitudes and concern were observed. Our results offer little encouragement for policies aiming to reduce discretionary air travel through pro-environmental advocacy, or through ‘spill-over’ from interventions to improve environmental impacts of household routines.

Attention Restoration Theory (ART) suggests the ability to concentrate may be restored by exposure to natural environments. Although widely cited, it is unclear as to the quantity of empirical evidence that supports this. A systematic review regarding the impact of exposure to natural environments on attention was conducted. Seven electronic databases were searched. Studies were included if (1) they were natural experiments, randomized investigations, or recorded “before and after” measurements; (2) compared natural and nonnatural/other settings; and (3) used objective measures of attention. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by another. Where possible, random effects meta-analysis was used to pool effect sizes. Thirty-one studies were included. Meta-analyses provided some support for ART, with significant positive effects of exposure to natural environments for three measures (Digit Span Forward, Digit Span Backward, and Trail Making Test B). The remaining 10 meta-analyses did not show marked beneficial effects. Meta-analysis was limited by small numbers of investigations, small samples, heterogeneity in reporting of study quality indicators, and heterogeneity of outcomes. This review highlights the diversity of evidence around ART in terms of populations, study design, and outcomes. There is uncertainty regarding which aspects of attention may be affected by exposure to natural environments.

Objectives: to explore the relationships between commute mode, neighbourhood public transport connectivity and subjective wellbeing. Method: the study used data on 3630 commuters in London from wave two of Understanding Society (2010/11). Multivariate linear regressions were used to investigate how commute mode and neighbourhood public transport connectivity were associated with subjective wellbeing for all London commuters and for public transport commuters only. Subjective wellbeing was operationalized in terms of both a positive expression (life satisfaction measured by a global single-item question) and a more negative expression (mental distress measured by the General Health Questionnaire). Logistic regression was also used to explore the predictors of public transport over non-public transport commutes. Results: After accounting for potentially-confounding area-level and individual-level socioeconomic and commute-related variables, only walking commutes (but not other modes) were associated with significantly higher life satisfaction than car use but not with lower mental distress, compared to driving. While better public transport connectivity was associated with significantly lower mental distress in general, train users with better connectivity had higher levels of mental distress. Moreover, connectivity was unrelated to likelihood of using public transport for commuting. Instead, public transport commutes were more likely amongst younger commuters who made longer distance commutes and had comparatively fewer children and cars within the household. Conclusion: the findings highlight the heterogeneity of relationships between commute mode, public transport connectivity and subjective wellbeing and have implications for intervention strategies and policies designed to promote commuting behaviour change.

Childhood obesity is one of the 21st century's most serious global health challenges. Research suggests that better access to 'greenspace' (e.g. parks) may encourage physical activity and reduce the risk of obesity amongst children. We extend earlier work by considering childhood obesity in relation to proximity to the coast, using data from England's National Child Measurement Programme. Results suggest that although the overall prevalence of childhood obesity is slightly lower at the coast (-0.68% points comparing 20 km, p

Exposure to natural environments can have calming and stress-reducing effects on humans. Moreover, previous studies suggest that these benefits may be greater in areas with higher species richness. Our study took advantage of a “natural experiment” to examine people’s behavioral, physiological, and psychological reactions to increases in levels of marine biota in a large aquarium exhibit during three stages of restocking: Unstocked, Partially stocked, and Fully stocked. We found that increased biota levels were associated with longer spontaneous viewing of the exhibit, greater reductions in heart rate, greater increases in self-reported mood, and higher interest. We suggest that higher biota levels, even in managed settings, may be associated with important well-being and health benefits, particularly for individuals not able to access the natural analogues of managed environments.

Background Building on evidence that natural environments (e.g. parks, woodlands, beaches) are key locations for physical activity, we estimated the total annual amount of adult recreational physical activity in England's natural environments, and assessed implications for population health. Methods a cross-sectional analysis of six waves (2009/10–2014/5) of the nationally representative, Monitor of Engagement with the Natural Environment survey (n = 280,790). The survey uses a weekly quota sample, and population weights, to estimate nature visit frequency across England, and provides details on a single, randomly selected visit (n = 112,422), including: a) duration; b) activity; and c) environment type. Results Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one ‘active visit’ (i.e. ≥ 30 min, ≥ 3 METs) to natural environments in the previous week, resulting in 1.23 billion (1.14, 1.32) ‘active visits’ annually. An estimated 3.20 million (3.05, 3.35) of these also reported meeting recommended physical activity guidelines (i.e. ≥ 5 × 30 min a week) fully, or in part, through such visits. Active visits by this group were associated with an estimated 109,164 (101,736, 116,592) Quality Adjusted Life Years (QALYs) annually. Assuming the social value of a QALY to be £20,000, the annual value of these visits was approximately £2.18 billion (£2.03, £2.33). Results for walking were replicated using WHO's Health Economic Assessment Tool. Conclusions Natural environments provide the context for a large proportion of England's recreational physical activity and highlight the need to protect and manage such environments for health purposes.

Contrary to economic theory, psychological research has demonstrated increased choice can undermine satisfaction. When and why this 'excess choice effect' (ECE) occurs remains unclear. Building on theories of counterfactual thinking we argue the ECE is more likely to occur when people experience counterfactual thought or emotion and that a key trigger is a negative versus positive task outcome. Participants either selected a drink (Experiment 1) or chocolate (Experiment 2) from a limited (6) versus extensive (24) selection (Experiment 1) or were given no choice versus extensive (24) choice (Experiment 2). In both experiments, however, the choice was illusory: Half the participants tasted a 'good' flavour, half a 'bad' flavour. As predicted, extensive choice was only detrimental to satisfaction when participants tasted the 'bad' drink or chocolate, and this was mediated by the experience of counterfactual thought (Experiment 1) or emotion (Experiment 2). When outcomes were positive, participants were similarly satisfied with limited versus extensive and no choice versus extensive choice. Implications for our theoretical understanding of the ECE and for the construction of choice architectures aimed at promoting individual satisfaction and well-being are discussed. Copyright

Contrary to economic theory, psychological research has demonstrated increased choice can undermine satisfaction. When and why this 'excess choice effect' (ECE) occurs remains unclear. Building on theories of counterfactual thinking we argue the ECE is more likely to occur when people experience counterfactual thought or emotion and that a key trigger is a negative versus positive task outcome. Participants either selected a drink (Experiment 1) or chocolate (Experiment 2) from a limited (6) versus extensive (24) selection (Experiment 1) or were given no choice versus extensive (24) choice (Experiment 2). In both experiments, however, the choice was illusory: Half the participants tasted a 'good' flavour, half a 'bad' flavour. As predicted, extensive choice was only detrimental to satisfaction when participants tasted the 'bad' drink or chocolate, and this was mediated by the experience of counterfactual thought (Experiment 1) or emotion (Experiment 2). When outcomes were positive, participants were similarly satisfied with limited versus extensive and no choice versus extensive choice. Implications for our theoretical understanding of the ECE and for the construction of choice architectures aimed at promoting individual satisfaction and well-being are discussed.

© 2016 John Wiley & Sons A/S.Objectives: This study explored a promising theoretical model to explain dental patients' experiences and planning behavior for future appointments. The model predicts that patients pass through a 'psychological cycle' when undergoing a course of dental care: past appointment experiences influence their anticipations for future dental visits, which in turn affect behavioral intentions to attend appointments. Methods: Variables representing the hypothesized model stages and other potentially relevant context variables (dental anxiety, subjective oral health ratings, general anxiety, stress) were assessed by means of a cross-sectional online survey (n = 311). Multiple regression analyses were calculated to estimate the model's fit while controlling for potentially confounding factors. Results: Consistent with the hypothesized cycle, recollections of past appointment experiences influenced behavioral intentions to attend future appointments. This association was mediated by evaluations of prior visits and expectations for future appointments. The variables included within this model explained 42% of the variance in attendance intentions when controlling for the potential moderating effects of context variables. Conclusions: the findings highlight the contribution of cognitive factors, such as evaluations and expectations, to patients' attendance intentions. This knowledge could help find ways to improve treatment expectations to foster better dental service utilization.

BACKGROUND: Many studies suggest that exposure to natural environments ('greenspace') enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that "greenspace" is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents. METHODS: This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics. RESULTS: Positive associations were observed between good health prevalence and the density of the greenspace types, "broadleaf woodland", "arable and horticulture", "improved grassland", "saltwater" and "coastal", after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of "saltwater". Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators. CONCLUSIONS: the findings indicate that the type, quality and context of 'greenspace' should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.

INTRODUCTION: There is evidence that populations living close to the coast have improved health and wellbeing. Coastal environments are linked to promotion of physical activity through provision of safe, opportune, aesthetic and accessible spaces for recreation. Exposure to coastal environments may also reduce stress and induce positive mood. We hypothesised that coastal climate may influence the vitamin D status of residents and thus partly explain benefits to health. MATERIALS AND METHODS: Ecological and cross-sectional analyses were designed to elucidate the connection between coastal residence and vitamin D status. We divided residential data, from developed land use areas and the Lower Super Output Areas or Data Zones (Scotland) of the 1958 Birth Cohort participants, into the following coastal bands:

Physical inactivity poses a significant challenge to physical and mental health. Environmental approaches to tackle physical inactivity have identified natural environments as potentially important public health resources. Despite this, little is known about characteristics of the activity involved when individuals visit different types of natural environment. Using Natural England's Monitor of Engagement with the Natural Environment Survey, we examined 71,603 English respondents' recreational visits to natural environments in the past week. Specifically, we examined the intensity of the activities they undertook on the visits (METs), the duration of their visit, and the associated total energy expenditure (MET minutes). Visits to countryside and urban greenspace environments were associated with more intense activities than visits to coastal environments. However, visits to coastal environments were associated with the most energy expenditure overall due to their relatively long duration. Results differed by the urbanity or rurality of the respondent's residence and also how far respondents travelled to their destination. Knowledge of what types of natural environment afford the highest volumes and intensities of physical activity could inform landscape architecture and exercise prescriptions. Isolating activity-supporting characteristics of natural environments that can be translated into urban design is important in providing physical activity opportunities for those less able to access expansive environments.

Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has never been more pressing. Conceptual models can facilitate this by providing theoretical frameworks and supporting stakeholder engagement process simplifications for inherently complex situations involving environment and human health and well-being. They can be tools to think with, to engage, to communicate and to help navigate in a sea of complexity. We believe models such as eDPSEEA can help frame many of the issues which have become the challenges of the new public health era and can provide the essential platforms necessary for progress.

OBJECTIVE: to explore the potential value of obtaining momentary, instead of retrospective, accounts of the description and valuation of a person's own health-related quality of life (HRQOL). METHODS: Momentary HRQOL was examined with the experience sampling method (ESM) in 139 participants from four different samples. The ESM consists of a so-called beep questionnaire that was administered 10 times a day by an electronic device. Feasibility was determined by assessing willingness to participate in the study and by analyzing the percentage of dropouts and the number of completed beep questionnaires. Multilevel analysis was used to investigate the relation between momentary HRQOL and momentary feelings and symptoms. The relation between momentary outcomes and the EuroQol visual analogue scale was investigated with a multiple regression model. RESULTS: the overall participation rate was low, but there were no dropouts and the number of completed beeps was comparable to that in other studies. Multilevel analysis showed that feelings and symptoms were significant predictors of momentary HRQOL. The strength of these relations differed among three patient groups and a population-based sample. The EuroQol visual analogue scale was not predicted by momentary feelings and symptoms. CONCLUSIONS: We can conclude that the use of the ESM to measure accounts of the momentary experience of health in different populations is feasible. Retrospective measures may provide a biased account of the impact of health problems in the daily lives of people who are affected. Moreover, the bias may be different in different conditions.

HYPOTHESIS: Ménière's disease significantly impacts on an individual's mental health and subjective well-being (SWB). BACKGROUND: Ménière's disease is an unpredictable illness that impacts on mental health. The symptom triad of vertigo, tinnitus, and hearing loss all contribute to the disabling nature of the condition. To date, limited research has investigated the mental health and SWB impact of Ménière's disease. METHODS: We investigated the mental health and SWB of 1,376 Ménière's sufferers in the UK Biobank and compared this to over 500,000 controls. Participants in the Biobank were asked 38 questions pertaining to mental health and SWB. We utilized crude and adjusted linear and logistic regression to investigate the association between Ménière's and mental health and SWB. We also investigated how mental health and SWB might be related to length of diagnosis to see whether people might adapt to Ménière's over time. RESULTS: Ménière's was associated with increased frequency of depression, tiredness, tenseness, and unenthusiasm in the 2 weeks before recruitment. Ménière's was associated with longer periods of depression than controls (10.2 wk [95% CI: 5.2-15.2 wk]). Reduced health satisfaction was associated with Ménière's, but in other aspects of life (general happiness, work, family, friends, financial), individuals with Ménière's were as happy as controls. Mental health and SWB in individuals diagnosed for longer was better than in those who were recently diagnosed suggesting at least partial adaptation. DISCUSSION: This is the largest population study investigating the mental health impact of Ménière's. Our findings suggest that Ménière's adversely impacts on mental health, an individual's emotional state, and their life satisfaction. However, our findings raise the importance of supporting social relations for people with Ménière's and that although a cure is not currently available, we can still learn much about the adaptation strategies developed by long-term sufferers to help individuals with new diagnoses.

Growing evidence suggests an association between access to urban greenspace and mental health and wellbeing. Street trees may be an important facet of everyday exposure to nature in urban environments, but there is little evidence regarding their role in influencing population mental health. In this brief report, we raise the issue of street trees in the nature-health nexus, and use secondary data sources to examine the association between the density of street trees (trees/km street) in London boroughs and rates of antidepressant prescribing. After adjustment for potential confounders, and allowing for unmeasured area-effects using Bayesian mixed effects models, we find an inverse association, with a decrease of 1.18 prescriptions per thousand population per unit increase in trees per km of street (95% credible interval 0.00, 2.45). This study suggests that street trees may be a positive urban asset to decrease the risk of negative mental health outcomes.

The current study examined potential psycho-physiological benefits from exercising in simulated natural environments among a sample of post-menopausal women using a laboratory based protocol. Participants cycled on a stationary exercise bike for 15 min while facing either a blank wall (Control) or while watching one of three videos: Urban (Grey), Countryside (Green), Coast (Blue). Blood pressure, heart rate and affective responses were measured pre-post. Heart rate, affect, perceived exertion and time perception were also measured at 5, 10 and 15 min during exercise. Experience evaluation was measured at the end. Replicating most earlier findings, affective, but not physiological, outcomes were more positive for exercise in the simulated Green and, for the first time, Blue environment, compared to Control. Moreover, only the simulated Blue environment was associated with shorter perceived exercise duration than Control and participants were most willing to repeat exercise in the Blue setting. The current research extended earlier work by exploring the effects of "blue exercise" and by using a demographic with relatively low average levels of physical activity. That this sample of postmenopausal women were most willing to repeat a bout of exercise in a simulated Blue environment may be important for physical activity promotion in this cohort.

Exposure to green space is associated with a variety of positive health states. Research to date has focused primarily on 'generic' green space in urban areas, where green space is relatively scarce and where it is dominated by playing fields and parks. The current research adds to our understanding with an examination of relationships between different types of green space and mental health in rural areas in England (approximate rural population = 4 million). The aggregate land cover classes of Land Cover Map 2007 were linked to rural residential areas (Lower-level Super Output Areas) and then linked to rural participants (n=2020) in the 18-year longitudinal British Household Panel Survey. Random effects regression of mental health (as measured by GHQ12 scores) against land cover enabled effects to be simultaneously estimated from both mean between-individual differences and from within-individual differences over time. The nine natural land cover classes (Broadleaved woodland; Coniferous woodland; Arable; Improved grassland; Semi-natural grassland; Mountain, heath and bog; Saltwater; Freshwater; Coastal) were not significantly associated with differences in mental health between individuals. However, significant relationships were observed between some types of land cover and within-individual change in mental health amongst individuals who relocated during the 18 annual waves of the panel. These findings indicate the presence of important health related ecosystem services from different land cover types that have not previously been investigated and which help more effective spatial planning and land use management.

BACKGROUND: Dental anxiety and anxiety-related avoidance of dental care create significant problems for patients and the dental profession. Distraction interventions are used in daily medical practice to help patients cope with unpleasant procedures. There is evidence that exposure to natural scenery is beneficial for patients and that the use of virtual reality (VR) distraction is more effective than other distraction interventions, such as watching television. The main aim of this randomized controlled trial is to determine whether the use of VR during dental treatment can improve the overall dental experience and recollections of treatment for patients, breaking the negative cycle of memories of anxiety leading to further anxiety, and avoidance of future dental appointments. Additionally, the aim is to test whether VR benefits dental patients with all levels of dental anxiety or whether it could be especially beneficial for patients suffering from higher levels of dental anxiety. The third aim is to test whether the content of the VR distraction can make a difference for its effectiveness by comparing two types of virtual environments, a natural environment and an urban environment. METHODS/DESIGN: the effectiveness of VR distraction will be examined in patients 18 years or older who are scheduled to undergo dental treatment for fillings and/or extractions, with a maximum length of 30 minutes. Patients will be randomly allocated into one of three groups. The first group will be exposed to a VR of a natural environment. The second group will be exposed to a VR of an urban environment. A third group consists of patients who receive standard care (control group). Primary outcomes relate to patients' memories of the dental treatment one week after treatment: (a) remembered pain, (b) intrusive thoughts and (c) vividness of memories. Other measures of interest are the dental experience, the treatment experience and the VR experience. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41442806.

Dental anxiety creates significant problems for both patients and the dental profession. Some distraction interventions are already used by healthcare professionals to help patients cope with unpleasant procedures. The present study is novel because it a) builds on evidence that natural scenery is beneficial for patients, and b) uses a Virtual Reality (VR) representation of nature to distract participants. Extending previous work that has investigated pain and anxiety during treatment, c) we also consider the longer term effects in terms of more positive memories of the treatment, building on a cognitive theory of memory (Elaborated Intrusions). Participants (n = 69) took part in a simulated dental experience and were randomly assigned to one of three VR conditions (active vs. passive vs. control). In addition, participants were distinguished into high and low dentally anxious according to a median split resulting in a 362 between-subjects design. VR distraction in a simulated dental context affected memories a week later. The VR distraction had effects not only on concurrent experiences, such as perceived control, but longitudinally upon the vividness of memories after the dental experience had ended. Participants with higher dental anxiety (for whom the dental procedures were presumably more aversive) showed a greater reduction in memory vividness than lower dental-anxiety participants. This study thus suggests that VR distractions can be considered as a relevant intervention for cycles of care in which people's previous experiences affect their behaviour for future events. © 2014 Tanja-Dijkstra et al.

Despite growing evidence of public health benefits from urban green space there has been little longitudinal analysis. This study used panel data to explore three different hypotheses about how moving to greener or less green areas may affect mental health over time. The samples were participants in the British Household Panel Survey with mental health data (General Health Questionnaire scores) for five consecutive years, and who relocated to a different residential area between the second and third years (n = 1064; observations = 5320). Fixed-effects analyses controlled for time-invariant individual level heterogeneity and other area and individual level effects. Compared to premove mental health scores, individuals who moved to greener areas (n = 594) had significantly better mental health in all three postmove years (P =. 015; P =. 016; P =. 008), supporting a "shifting baseline" hypothesis. Individuals who moved to less green areas (n = 470) showed significantly worse mental health in the year preceding the move (P =. 031) but returned to baseline in the postmove years. Moving to greener urban areas was associated with sustained mental health improvements, suggesting that environmental policies to increase urban green space may have sustainable public health benefits.

The European Marine Board recently published a position paper on linking oceans and human health as a strategic research priority for Europe. With this position paper as a reference, the March 2014 Cornwall Oceans and Human Health Workshop brought together key scientists, policy makers, funders, business, and non governmental organisations from Europe and the US to review the recent interdisciplinary and cutting edge research in oceans and human health specifically the growing evidence of the impacts of oceans and seas on human health and wellbeing (and the effects of humans on the oceans). These impacts are a complex mixture of negative influences (e.g. from climate change and extreme weather to harmful algal blooms and chemical pollution) and beneficial factors (e.g. from natural products including seafood to marine renewable energy and wellbeing from interactions with coastal environments). Integrated approaches across disciplines, institutions, and nations in science and policy are needed to protect both the oceans and human health and wellbeing now and in the future.

Analysis of English census data revealed a positive association between self-reported health and living near the coast. However that analysis was based on cross-sectional data and was unable to control for potential selection effects (e.g. generally healthier, personality types moving to coastal locations). In the current study we have used English panel data to explore the relationship between the proximity to the coast and indicators of generic and mental health for the same individuals over time. This allowed us to control for both time-invariant factors such as personality and compare the strength of any relationship to that of other relationships (e.g. employment vs. unemployment). In support of cross-sectional analysis, individuals reported significantly better general health and mental health when living nearer the coast, controlling for both individual (e.g. employment status) and area (e.g. green space) level factors. No coastal effect on life satisfaction was found. Although individual level coastal proximity effects for general health and mental health were small, their cumulative impact at the community level may be meaningful for policy makers.

In this article, we analyze the relationship between positive psychology and peace psychology. We discuss how positive emotions, engagement, meaning, personal well-being, and resilience may impact peace at different levels, ranging from the personal and interpersonal to community, national, and global peace. First, we argue that an individual's positive experiences, personal well-being, and personal resilience, as defined in current positive psychology, may in fact contribute to personal and interpersonal peace but can also entail detrimental consequences for other individuals, communities, and nations. Second, we describe how peace psychology contains traces of positive psychology, especially with its focus on the pursuit of social justice. Third, reviewing and extending the concept of community resilience, we outline directions for further conceptual and empirical work in positive psychology inspired by peace psychology. Such work would do well to transcend positive psychology's current bias toward individualism and nationalism and to conceptualize well-being and resilience at the level of the "global community." This extended "positive peace psychology" perspective would have important implications for our understanding of how to overcome oppression and work toward global peace.

Exposure to natural environments can help restore depleted emotional and cognitive resources. However, investigation of the relative impacts of different natural environments among large samples is limited. Using data from 4255 respondents drawn from Natural England's Monitoring Engagement with the Natural Environment survey (2009-2011), we investigated feelings of restoration (calm, relaxed, revitalized and refreshed) recalled by individuals after visits to different natural environments within the last week. Controlling for demographic and visit characteristics we found that of the broad environmental categories, coastal visits were associated with the most restoration and town and urban parks with the least. In terms of specific environmental types two "green space" locations (woodlands/forests and hills/moorland/mountains) were associated with levels of restoration comparable to coastal locations. Urban playing fields were associated with the least restoration. Restoration was positively associated with visit duration (a potential dose-response effect), and visits with children were associated with less restoration than visits alone. There was little evidence that different activities (e.g. walking, exercising) were associated with differences in restoration. The data may improve our understanding of the "cultural eco-system services" provided by different natural environments and help decision makers keen to invest scare resources in those environments most associated with psychological benefits. © 2013 Elsevier Ltd.

People generally seek out positive moods and avoid negative moods; however, it is unclear which motivation is more pronounced. Two studies addressed this issue by developing a value-based ranking of emotions based on the willingness to pay (WTP) approach. The approach utilizes money's cardinal properties and assumes opportunity costs as with everyday purchases. In Study 1 British participants indicated they would be willing to pay more to experience positive than to avoid negative emotions. In Study 2 this positivity bias was replicated with another sample of British participants. However, Hong Kong Chinese participants did not show such a preference, and were willing to pay significantly less to experience positive emotions but more to avoid negative emotions when compared with British participants. Experiencing Love was given the highest WTP judgment in all samples. Thus, some emotions are universally valued, whereas preferences for others differ across cultural groups, perhaps shaped by norms. Implications concerning valuations of psychological states for policy purposes are discussed. © 2012 the Author(s).

People often prefer inferior options in the present even when options in the future are more lucrative. Five studies investigated whether decision making could be improved by manipulating construal level and psychological distance. In Studies 1a, 1b, and 2, temporal discounting was reduced when future rewards (trips to Paris) were construed at a relatively concrete level, thus inducing a similar level of construal to present rewards. By contrast, Studies 3 and 4 reduced temporal discounting by making present financial rewards more psychologically distant via a social proximity manipulation, and thus linked to a similar high level of construal as future rewards. These results suggest that people prefer the more lucrative option when comparing two intertemporal choices that are construed on a similar level instead of on a different level. Thus, changes in construal level and mental representations can be used to promote more desirable choices in economic decision making. © 2013 by the Society for Personality and Social Psychology, Inc.

Studies using the Ultimatum Game have shown that participants reject unfair offers extended by another person although this incurs a financial cost. Previous research suggests that one possible explanation for this apparently selfdefeating response is that unfair offers involve strong negative responses that decrease the chances of responders accepting offers that would objectively constitute a net profit. We tested the hypothesis that one way of reducing responders' rejections of unfair offers is through increased psychological distance, so that participants move away from the concrete feeling of being unfairly treated. Social distance was manipulated by having participants play the Ultimatum Game either for themselves, or for another person. Compared to deciding for one's self or a close social contact, participants showed less sensitivity to fairness when deciding for a stranger, as indicated by fewer rejected unfair offers. We suggest that social distance helps people move beyond immediate fairness concerns in the Ultimatum Game. © 2013. The authors license this article under the terms of the Creative Commons Attribution 3.0 License.

This study explores the neglected issue of how families engage with beach environments in their local areas and use them in health promoting ways. Fifteen families with children aged 8-11 years living in coastal regions in Southwest England participated in individual semi-structured interviews. The findings indicate that beaches encouraged families to be physically active. Although families valued the opportunities for physical activity and active play afforded by beaches, the key health benefits emphasised were psychological, including experiencing fun, stress relief and engagement with nature. Increased social and family interaction was also highlighted as benefits. Despite perceiving health benefits, not all families regularly visited the beach. Barriers to visits included parents having limited time, cost of parking, lack of car access and cold weather. Parents played a key role in enabling visits by choosing to share these environments with their children. The social dimension of visits also encouraged families to make regular trips. The findings support the use of beach environments to promote families' health and wellbeing and positive relationships with nature.

The oceans are crucial for human survival, yet they are under serious threat from humans, for example through overfishing and poor waste management. We investigated two questions. First, does a leisure visit to an aquarium improve visitor attitudes and intentions towards marine sustainability, specifically regarding overfishing and pollution? Second, does an information booklet handed out in addition to the visit have additional measurable impact? Aquarium visitors (n = 104) completed a questionnaire on marine sustainability attitudes and behavioral intentions before and after their visit. Half of the visitors also were given informational materials that offered behavioral solutions to the problem of overfishing. The aquarium visit significantly improved visitors' overall attitudes and intentions. The information booklet additionally improved intentions significantly, but not attitudes. These findings show that a visit to an aquarium can help individuals develop what we term a marine mindset, a state of readiness to address marine sustainability issues. Implications, limitations, and ideas for further research are discussed. © 2013 Copyright Taylor and Francis Group, LLC.

Urbanization is a potential threat to mental health and well-being. Cross-sectional evidence suggests that living closer to urban green spaces, such as parks, is associated with lower mental distress. However, earlier research was unable to control for time-invariant heterogeneity (e.g. personality) and focused on indicators of poor psychological health. The current research advances the field by using panel data from over 10,000 individuals to explore the relation between urban green space and well-being (indexed by ratings of life satisfaction) and between urban green space and mental distress (indexed by General Health Questionnaire scores) for the same people over time. Controlling for individual and regional covariates, we found that, on average, individuals have both lower mental distress and higher well-being when living in urban areas with more green space. Although effects at the individual level were small, the potential cumulative benefit at the community level highlights the importance of policies to protect and promote urban green spaces for well-being.

An intensive program of 40years of research has produced various conceptual cognitive and affective approaches to environmental risk perception. In this short review of the most relevant conceptual approaches, appraisal theory is presented as a useful means of integrating cognitive and affective approaches to risk perception. Appraisal theory offers an opportunity to advance our understanding of how environmental risk perception operates in an emotion-specific manner and enables identification of new research directions. Although within other conceptual approaches there are still open research questions, the potential for examining environmental risk perception within appraisal theory has not yet been fully explored. Reviewing current appraisal theoretical models, seven research questions are suggested to structure future research on environmental risk perception. © 2012 Copyright Taylor and Francis Group, LLC.

It is often assumed that spending time by the coast leads to better health and wellbeing, but there is strikingly little evidence regarding specific effects or mechanisms to support such a view. We analysed small-area census data for the population of England, which indicate that good health is more prevalent the closer one lives to the coast. We also found that, consistent with similar analyses of greenspace accessibility, the positive effects of coastal proximity may be greater amongst more socio-economically deprived communities. We hypothesise that these effects may be due to opportunities for stress reduction and increased physical activity. © 2012 Elsevier Ltd.

Understanding how people interpret risks and choose actions based on their interpretations is vital to any strategy for disaster reduction. We review relevant literature with the aim of developing a conceptual framework to guide future research in this area. We stress that risks in the context of natural hazards always involve interactions between natural (physical) and human (behavioural) factors. Decision-making under conditions of uncertainty is inadequately described by traditional models of 'rational choice'. Instead, attention needs to be paid to how people's interpretations of risks are shaped by their own experience, personal feelings and values, cultural beliefs and interpersonal and societal dynamics. Furthermore, access to information and capacity for self-protection are typically distributed unevenly within populations. Hence trust is a critical moderator of the effectiveness of any policy for risk communication and public engagement. © 2012 Elsevier Ltd.

BACKGROUND: Patient trust in medical decision makers is a crucial facilitator of effective health care. Greater patient involvement in decision making requires improved understanding of how such trust is built, maintained, and lost in medical contexts. OBJECTIVE: the study investigates how trust in clinicians is affected by the 4 main diagnostic outcomes proposed by signal detection theory: true positives, true negatives, false positives, and false negatives. Cognitive appraisals of, and affective reactions to, the decisions were measured to investigate the psychological mechanisms underpinning effects on trust. DESIGN: Members of an Internet research panel (N = 1162) participated in a between-participant experimental study using hypothetical cancer diagnosis scenarios. RESULTS: Overall, correct diagnoses bolstered trust as much as incorrect ones undermined it. Consistent with recent findings in other decision-making domains, trust was not as precarious as generally believed. The influence of decisions and outcomes on trust was mediated through cognitive assessments and affective responses in line with current appraisal theories in psychology. Prior levels of trust in clinicians affected sympathy for doctors, highlighting the role that trust plays in responding to new information. CONCLUSIONS: Trust in (hypothetical) clinicians is sensitive to information about their past diagnostic performance. Greater understanding of the cognitive and affective mechanisms by which this occurs may help maintain current high levels of trust. Further research is needed to examine whether findings generalize to real medical decision-making contexts. Clinicians may want to consider the impact their diagnoses have on trust alongside medical and financial considerations.

Excess choice has previously been shown to have detrimental effects on decisions about consumer products. As the number of options increases, people are more likely to put off making an active choice (i.e. defer) and show less satisfaction with any purchase actually made. We extend this line of enquiry to choosing a charitable organisation to volunteer for. The issue is important because the number of voluntary organisations is enormous and the impact of such a decision may be greater than for consumer decisions in terms of time commitment and benefits to the volunteer and society. Study 1 asked students to examine a real volunteering website and record how many organisations they considered, decision difficulty and whether or not they would like to sign up for a chosen organisation or prefer to defer a decision. Study 2 presented either a relatively small (10) or large (30) choice set of hypothetical organisations and measured deferment likelihood and decision difficulty. In both studies the more options considered, the greater the likelihood to defer. This effect was mediated by decision difficulty. This research is the first to find that detrimental effects of excess choice extend to volunteering. Implications for volunteer recruitment are discussed.

Recent investigations into morality suggest that affective responses may precede moral judgments. The present study investigated, first, whether individuals show specific facial affect in response to moral behaviors and, second, whether the intensity of facial affect predicts subsequent moral judgments. Muscle activity relating to disgust (levator labii), anger (corrugator supercilii), and positive affect (zygomaticus major) was recorded while participants considered third-person statements describing good and bad behaviors across five foundations of morality (purity, fairness, harm, authority, and ingroup). Facial disgust was highest in response to purity violations, followed by fairness violations. In contrast, harm violations evoked anger expressions. Importantly, the extremity of subsequent moral judgments was predicted by facial affect, such that judgments about purity and fairness correlated with facial disgust, harm correlated with facial anger, and ingroup correlated with positive facial affect. These results demonstrate that individuals spontaneously exhibit domain-specific moral affect that allows inferences about their moral judgments. © the Author(s) 2011.

Although theorists have suggested that aquatic environments or "blue space" might have particular restorative potential, to date there is little systematic empirical research on this issue. Indeed the presence of water has, unintentionally, been a confounding factor in research comparing people's reactions to built and natural environments. Whereas aquatic features (rivers, lakes, coasts) are frequently present in visual stimuli representing natural environments they are rarely incorporated in stimuli portraying built environments. As many towns are, for good reason, located near water this is a potentially significant oversight. The current research collated a set of 120 photographs of natural and built scenes, half of which contained "aquatic" elements. Proportions of "aquatic"/"green"/"built" environments in each scene (e.g. 1/3rd, 2/3rds) were also standardised. Two studies investigated preferences (attractiveness, willingness to visit and willingness to pay for a hotel room with the view), affect and perceived restorativeness ratings for these photographs. As predicted, both natural and built scenes containing water were associated with higher preferences, greater positive affect and higher perceived restorativeness than those without water. Effect sizes were consistently large. Intriguingly, images of "built" environments containing water were generally rated just as positively as natural "green" space. We propose a number of avenues for further research including exploration of the mechanisms underlying these effects. © 2010 Elsevier Ltd.

Studies have investigated perceived own risk as a predictor of behavioural change, but only few have investigated perceived risk to others. However, many risks are distributed, affecting other people as much as the 'agents' of the behaviour in question. Further, research on health perceptions has focussed more on risk than benefit even though people generally choose to engage in behaviours because of benefits not risks. The present study investigated the acceptance of smoking restrictions in Germany, a country that at the time of conducting the research had few restrictions on smoking. Smokers (N = 147) rated the benefits and risks of smoking for themselves and others, and their attitudes towards smoking restrictions. We replicated comparative optimism and reality constraints concerning smoking risks. Additionally, we found that participants overestimated their own benefits compared to other smokers ('comparative utility'). Importantly, own benefits but risks to others best predicted the acceptance of smoking regulations. Moreover, smokers who intended to quit differed from those who did not intend to quit. These findings are potentially important for policy makers aiming to broaden acceptance of regulations for risky behaviours: it may be more effective to remind people they are putting others at risk rather than themselves. © 2010 Taylor & Francis.

The intuitive detection theorist (IDT) model of trust posits that trust in hazard managers stems from judgments about their performance on three criteria: their ability to discriminate safe from dangerous situations (discrimination ability); their tendency under uncertainty to assume danger is present (response bias); and their propensity to be open and honest with the public about events (communication bias). The current article tests the model's robustness using findings from three experiments and four surveys conducted by two different research teams. Study-specific analyses and an overall analysis of the seven studies combined confirm that all three of the IDT model's dimensions are important for trust, explaining on average 43% of trust variance. These effects occurred largely independently of hazard topic, research method, or investigator. Hypothesized interaction effects among the dimensions, based upon earlier studies, were weak and contradictory; this is the first known study of interactions among trust model variables.

Serious consideration is being given to the impact of private behavior and public policies on people's subjective well-being (SWB). A new approach to measuring well-being, the day reconstruction method (DRM), weights the affective component of daily activities by their duration in order to construct temporal aggregates. However, the DRM neglects the potentially important role of thoughts. By adapting this method to include thoughts as well as feelings, we provide perhaps the most comprehensive measure of SWB to date. We show that some activities relatively low in pleasure (e.g. work and time with children) are nonetheless thought of as rewarding and therefore contribute to overall SWB. Such information may be important to policymakers wishing to promote behaviors that are conducive to a broader conception of SWB.

The way in which a comparison is worded has systematic effects on its outcome. In self-other comparisons, the instruction "compare yourself with your peers" triggers greater self-positivity than does the reverse instruction, "compare your peers with yourself" (focus effect). But is the focus effect due to the inclusion of a generalized target? the authors extended the focus effect from comparisons with the average peer to comparisons with specific individuals (close friend or acquaintance). Participants displayed self-positivity when they compared themselves with a close friend but not when they compared a close friend with themselves. The present research is the first to demonstrate the focus effect in comparisons of self and specific individuals.

There is increasing interest in the "economics of happiness", reflected by the number of articles that are appearing in mainstream economics journals that consider subjective well-being (SWB) and its determinants. This paper provides a detailed review of this literature. It focuses on papers that have been published in economics journals since 1990, as well as some key reviews in psychology and important unpublished working papers. The evidence suggests that poor health, separation, unemployment and lack of social contact are all strongly negatively associated with SWB. However, the review highlights a range of problems in drawing firm conclusions about the causes of SWB; these include some contradictory evidence, concerns over the impact on the findings of potentially unobserved variables and the lack of certainty on the direction of causality. We should be able to address some of these problems as more panel data become available. © 2007 Elsevier B.V. All rights reserved.

Suicide attacks have raised the stakes for officers deciding whether or not to shoot a suspect ('Police Officer's Terrorist Dilemma'). Despite high-profile errors we know little about how trust in the police is affected by their response to the terrorist threat. Building on a conceptualisation of lay observers as intuitive signal detection theorists, a general population sample (N = 1153) were presented with scenarios manipulated in terms of suspect status (Armed/Unarmed), officer decision (Shoot/Not Shoot) and outcome severity (e.g. suspect armed with Bomb/Knife; police shoot suspect/suspect plus child bystander). Supporting predictions, people showed higher trust in officers who made correct decisions, reflecting good discrimination ability and who decided to shoot, reflecting an 'appropriate' response bias given the relative costs and benefits. This latter effect was moderated by (a) outcome severity, suggesting it did not simply reflect a preference for a particular type of action, and (b) preferences for a tough stance towards terrorism indexed by Right-Wing Authoritarianism (RWA). Despite loss of civilian life, failure to prevent minor terror attacks resulted in no loss of trust amongst people low in RWA, whereas among people high in RWA trust was positive when police erroneously shot an unarmed suspect. Relations to alternative definitions of trust and procedural justice research are discussed. Copyright © 2007 John Wiley & Sons, Ltd.

Although the issue of risk target (e.g. self, others, children) is widely acknowledged in risk perception research, its importance appears underappreciated. To date, most research has been satisfied with demonstrating comparative optimism, i.e. lower perceived risk for the self than others, and exploring its moderators, such as perceived controllability and personal exposure. Much less research has investigated how the issue of target may affect benefit perceptions or key outcomes such as stated preferences for hazard regulation. The current research investigated these issues using data from a public survey of attitudes toward mobile phone technology (N= 1,320). First, results demonstrated comparative optimism for this hazard, and also found moderating effects of both controllability and personal exposure. Second, there was evidence of comparative utility, i.e. users believed that the benefits from mobile phone technology are greater for the self than others. Third, and most important for policy, preferences for handset regulation were best predicted by perceptions of the risks to others but perceived benefits for the self. Results suggest a closer awareness of target can improve prediction of stated preferences for hazard regulation and that it would be profitable for future research to pay more attention to the issue of target for both risk and benefit perceptions.

Although a considerable amount of research has examined correlates of baseline public trust in risk managers, much less research has looked at marginal changes in public trust following specific events. Such research is important for identifying what kinds of events will lead to increases and decreases in public trust and thus for understanding how trust is built and lost. Using a taxonomy based upon signal detection theory (SDT), the current article presents two experimental studies examining marginal trust change following eight different types of events. Supporting predictions, cautious decisionmakers who accepted signs of danger (Hits and False Alarms) were more likely to be trusted than those who rejected them (All Clears and Misses). Moreover, transparency about an event was associated with higher levels of marginal trust than a lack of transparency in line with earlier findings. Contrary to predictions, however, trust was less affected by whether the decisions were correct (i.e. Hits and all Clears) or incorrect (i.e. False Alarms and Misses). This finding was primarily due to a "False Alarm Effect" whereby Open False Alarms led to positive increases in trust despite being incorrect assessments of risk. Results are explained in terms of a cue diagnosticity account of impression formation and suggest that a taxonomy of event types based on SDT may be useful in furthering our understanding of how public trust in risk managers is gained and lost.

Fifty people with diabetes attending a 'high risk' renal clinic were interviewed about their perceptions of diabetic nephropathy and other diabetes related complications. Despite the nigh risks involved many patients appeared relatively unconcerned with, or even unaware of, the severity of their condition. It is argued that lack of obvious symptoms associated with nephropathy can lead to ambiguity during consultations and greater opportunity for the use of a variety of risk attenuation strategies by the patient. It is recommended that medical staff become aware of these strategies in order to understand failures in self-management in the face of complications such as nephropathy.