En i onmen al Resea ch 233 (2023) 116452
A ailable online 18 June 2023
0013-9351/© 2023 The Au ho s. Published by Else ie Inc. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-
nc-nd/4.0/).
P o ec i e e ec o es o a i e possibili ies on cogni i e unc ion and
men al heal h in child en and adolescen s: A scoping e iew including he
ole o physical ac i i y
Angel M. Dzhambo
a
,
b
,
c
,
1
,
*
, Pe e Le che
b
,
1
, Na alia Vincens
d
, Ke s in Pe sson Waye
d
,
Ma ia Kla e
e
, La isa Leis
e
, Thomas Lachmann
e
,
, Di k Sch eckenbe g
g
, Ch is in Belke
g
,
Go dana Ris o ska
h
, Ka ja M. Kanninen
i
, Dick Bo eldoo en
j
, Timo hy Van Ren e ghem
j
,
Sonja Je am
k
, Jenny Selande
l
, A zu A a
l
, Kim Whi e
m
, Jo di Jul ez
n
,
p
, Cha lo e Cla k
o
,
Ma ia Fo as e
p
,
q
,
,
s
, I ene an Kamp
m
a
Depa men o Hygiene, Facul y o Public Heal h, Medical Uni e si y o Plo di , Plo di , Bulga ia
b
Ins i u e o Highway Enginee ing and T anspo Planning, G az Uni e si y o Technology, G az, Aus ia
c
Resea ch G oup “Heal h and Quali y o Li e in a G een and Sus ainable En i onmen ”, SRIPD, Medical Uni e si y o Plo di , Plo di , Bulga ia
d
School o Public Heal h and Communi y Medicine, Ins i u e o Medicine, Go henbu g Uni e si y, Go henbu g, Sweden
e
Cogni i e and De elopmen al Psychology, Uni e si y o Kaise slau e n-Landau, Kaise slau e n, Ge many
Cen o de In es igaci´
on Neb ija en Cognici´
on, Facul ad de Lenguas y Educacion, Uni e sidad Neb ija, Mad id, Spain
g
Cen e o Applied Psychology, En i onmen al and Social Resea ch (ZEUS GmbH), Hagen, Ge many
h
Ins i u e o Public Heal h o he Republic o No h Macedonia, Skopje, Macedonia
i
A.I.Vi anen Ins i u e o Molecula Medicine, Uni e si y o Eas e n Finland, Kuopio, Finland
j
Depa men o In o ma ion Technology, Facul y o Enginee ing and A chi ec u e, Ghen Uni e si y, Ghen , Belgium
k
Na ional Ins i u e o Public Heal h, Ljubljana, Slo enia
l
Uni o Occupa ional Medicine, Ins i u e o En i onmen al Medicine, Ka olinska Ins i u e , S ockholm, Sweden
m
Na ional Ins i u e o Public Heal h and he En i onmen , Ne he lands
n
Ins i u d’In es igaci´
o Sani `
a ia Pe e Vi gili (IISPV), Clinical and Epidemiological Neu oscience G oup (Neu o`
Epia), Reus, Spain
o
Popula ion Heal h Resea ch Ins i u e, S Geo ge’s Uni e si y o London, London, Uni ed Kingdom
p
ISGlobal, Ba celona, Spain
q
Uni e si a Pompeu Fab a (UPF), Spain
CIBER Epidemiología y Salud Pública (CIBEREsp), Spain
s
PHAGEX Resea ch G oup, Blanque na School o Heal h Science, Uni e si a Ramon Llull (URL), Ba celona, Spain
ARTICLE INFO
Keywo ds:
Anxie y
A en ion
Cogni ion
Dep ession
G een space
Na u e
Res o a ion
Spo
ABSTRACT
Backg ound
The exposome app oach can be a powe ul ool o unde s anding he in e wining o social, physical, and
in e nal in luences ha shape men al heal h and cogni i e de elopmen h oughou childhood. To dis il con-
cep ual models o subsequen analyses, he EU- unded p ojec Ea ly En i onmen al quali y and Li e-cou se
men al heal h e ec s (Equal-Li e) has conduc ed li e a u e e iews on po en ial media o s linking he expo-
some o hese ou comes. We epo on a scoping e iew and a concep ual model o he ole o es o a i e pos-
sibili ies and physical ac i i y.
Me hods
Pee - e iewed s udies published since he yea 2000 in English, on he associa ion be ween he exposome and
men al heal h/cogni ion in child en/adolescen s, and quan i a i ely in es iga ing es o a ion/ es o a i e quali y
as a media ing a iable we e conside ed. Da abase sea ches we e las upda ed in Decembe 2022. We used an
uns uc u ed expe -d i en app oach o ill in gaps in he e iewed li e a u e.
Resul s
* Co esponding au ho . Depa men o Hygiene, Facul y o Public Heal h, Medical Uni e si y o Plo di , 15A Vassil Ap ilo Bl d., 4000, Plo di , Bulga ia.
E-mail add esses: [email p o ec ed], [email p o ec ed], [email p o ec ed] (A.M. Dzhambo ).
1
These wo au ho s con ibu ed equally.
Con en s lis s a ailable a ScienceDi ec
En i onmen al Resea ch
jou nal homepage: www.else ie .com/loca e/en es
h ps://doi.o g/10.1016/j.en es.2023.116452
Recei ed 19 Decembe 2022; Recei ed in e ised o m 15 Ap il 2023; Accep ed 16 June 2023
En i onmen al Resea ch 233 (2023) 116452
2
Fi e eco ds o h ee dis inc s udies we e iden i ied, indica ing a sca ci y o empi ical e idence in his newly
de eloping esea ch a ea. No only we e hese s udies ew in numbe s, bu also c oss-sec ional, lending only
en a i e suppo o he idea ha pe cei ed es o a i e quali y o adolescen ’s li ing en i onmen migh media e
he associa ion be ween g eenspace and men al heal h. Physical ac i i y eme ged as a media o leading o be e
psychological ou comes in es o a i e en i onmen s. We p o ide a c i ical discussion o po en ial ca ea s when
in es iga ing he es o a ion mechanism in child en and p opose a hie a chical model including es o a ion,
physical ac i i y, and ela ional dynamics be ween child en and hei en i onmen , including social con ex , as
well as es o a i e en i onmen s o he han na u e.
Conclusions
I is jus i ied o u he explo e he ole o es o a ion and physical ac i i y as media o s in he associa ion
be ween ea ly-li e exposome and men al heal h/cogni i e de elopmen . I is impo an o conside he child
pe spec i e and speci ic me hodological ca ea s. Gi en he e ol ing concep ual de ini ions/ope a ionaliza ions,
Equal-Li e will a emp o ill in a c i ical gap in he li e a u e.
1. In oduc ion
1.1. Exposome pe spec i e on child men al heal h and cogni ion
The e is inc easing e idence ha men al heal h and cogni i e unc-
ioning a e he esul o a complex in e play be ween gene ic, psycho-
logical, en i onmen al, social, and o he ac o s and expe iences
(Ven iglio e al., 2021; Ba ch, 2022; Deguen e al., 2022; Lachmann and
Be gs ¨
om, 2023). Many men al heal h and cogni i e p oblems in
adul hood can be aced back o ea ly de elopmen al s ages when he
indi idual is mo e ulne able o en i onmen al and social ad e si ies
(Mul aney e al., 2021). Some o hese ea ly ad e si ies can lead o
epigene ic changes which inc ease he gene al isk o diseases ia age
accele a ion (de P ado-Be e al., 2021) o a e speci ically ela ed o
adul men al heal h p oblems (N¨
o hling e al., 2020; Alameda e al.,
2022). In gene al, child en wi h symp oms o men al ill-heal h ha e
shown poo e academic pe o mance, quali y o li e, and social and
men al unc ioning in la e li e (Luby e al., 2017; Copeland e al., 2021),
c ea ing a icious ci cle, ha is s ill insu icien ly unde s ood. No ably,
anxie y, a en ion de ici hype ac i i y diso de , conduc and dep ession
diso de s a e among he mos p e alen in child en (Ba ican e al.,
2022). Diagnosing hese diso de s a a young age is challenging and
al eady du ing la e adolescence and adul hood hey cause conside able
social and economic losses (GBD 2019 Men al Diso de s Collabo a o s,
2022).
The o ali y o exposu es (de imen al o bene icial) o e a comple e
li e ime is bes cap u ed by he concep o exposome, ini ially desc ibed
by Wild (2005). This umb ella e m can be di ided in o se e al
non-gene ic ca ego ies, in e nal and ex e nal, which is u he sub-
di ided in o physical and social speci ic ex e nal, and gene al ex e nal
exposomes ( an Kamp e al., 2021). The exposome app oach can be a
powe ul ool o concep ualizing and unde s anding he in e wining
and cumula i e e ec o social, physical, and in e nal in luences (Vineis
and Ba ouki, 2022) ha shape men al heal h and cogni i e de elopmen
ac oss di e en con ex s and mic oen i onmen s (e.g., home, public
ou doo spaces, school) h oughou childhood. O no e, he e ec s o
di e en exposome componen s may a y in salience and s eng h
ac oss c i ical/sensi i e de elopmen al windows. Howe e , he expo-
some e ec s on men al heal h and cogni ion in child en and adolescen s
ha e been less s udied and we e p edominan ly ocused on chemical,
biological and physical exposu es (e.g., Jedynak e al., 2021; Vineis and
Ba ouki, 2022). Fu he mo e, he obse ed e ec s a y subs an ially, as
only selec ed exposome ac o s o ime windows we e included and
speci ic ela ionships among hese ac o s and he social exposome
(Deguen e al., 2022) we e a ely explo ed especially wi h espec o
men al heal h (c . Muelle e al., 2019; Mai e e al., 2021) and cogni ion
s udies (c . Jul ez e al., 2021; Bin e e al., 2022).
The EU- unded p ojec Ea ly En i onmen al quali y and li e-cou se
men al heal h e ec s (Equal-Li e) employs he exposome amewo k in
an in eg a ed s udy o he b oade de e minan s o child en’s
de elopmen and li e cou se men al heal h (Van Kamp e al., 2021).
Equal-Li e is pa o he Eu opean Human Exposome Ne wo k (h p
s://www.humanexposome.eu/; Ve meulen & Dillne , 2021). Apa
om a non- a ge ed machine lea ning app oach, Equal-Li e elies on a
se o heo y-based ques ions o mula ed based on exis ing e idence, in
o de o explo e he impac o mul i-modal exposu es (i.e., exposu es
in e ac ing o media ing each o he ) on child en’s men al heal h and
cogni ion. To ha end, da ase s ac oss Eu ope a e used. Equal-Li e builds
on he o iginal exposome concep (Wild, 2005, 2012) by u he
s essing he ole o social in luences, delinea ing hem as a subdomain
o he ex e nal exposome (Gudi-Minde mann e al., 2023 manusc ip
submi ed o his issue). Cen al o ou esea ch endea ou is he un-
de s anding o pu a i e pa hways (i.e., media o s) unde lying bene icial
and ha m ul men al heal h e ec s o he child exposome.
A media o is an in e ening ac o , which is in luenced by an
exposu e, which p ecedes i in ime, and in u n leads o an ou come,
which ollows in ime (Vande Weele, 2016). In addi ion, concep ual
ime-o de ing o hese is equi ed (i.e., “ he media o mus e e o a
causal condi ion ha eme ges p io o he c i e ion ou come bu no
p io o he p edic o ”), e en when dealing wi h c oss-sec ional da a
(Ta e, 2015). The p ocess o media ion hen e e s o a ela ionship
be ween exposu e, media o , and ou come, whe e he media o ac-
coun s o he e ec o he exposu e on he ou come ei he in pa
(pa ial media ion) o comple ely ( ull media ion). Add essing hypo h-
eses abou media ing p ocesses is possible using eg ession-based s a-
is ical ools in an explo a o y o con i ma o y ashion o conduc
media ion and mode a ion analyses. Howe e , in addi ion o he
ma hema ical and me hodological a en ion, hese equi e se ious
heo e ical and concep ual conside a ion (Fiedle e al., 2018).
To dis il concep ual models ha will in o m subsequen empi ical
analyses, Equal-Li e has conduc ed e iews o he li e a u e on selec ed
po en ial media o s (s ess/ es o a ion, sleep, and coping/sel -
egula ion) belie ed o link he exposome o child en’s men al heal h
(including well-being and quali y o li e cons uc s) and cogni ion in
di e en de elopmen al phases. Ou ocus he e is on he p ocess o
es o a ion and es o a i e possibili ies, which can be seen as a con-
cep ual ocal poin in a causal model whe e mul iple pa hways s a ing
om he exposome con e ge o gene a e childhood heal h bene i s
(Dzhambo e al., 2018b).
1.2. Concep o es o a ion
Responding o an excess o demands ela i e o he esou ces needed
o cope wi h hose demands is axing and, in u n, deple es adap i e
esou ces, which equi e pe iodic es o a ion ( on Linde n e al., 2017).
In o he wo ds, es o a ion can be de ined as a p ocess h ough which
adap i e capaci ies diminished in ongoing e o s o mee adap i e de-
mands a e enewed, eco e ed, o e-es ablished (Ha ig, 2004). Thus,
he es o a ion pe spec i e necessa ily complemen s and ansac s wi h
he s ess and coping pe spec i es in human adap a ion p ocesses o he
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
3
en i onmen . Impo an ly, es o a ion is ca ied by pe son-en i onmen
ansac ions and is no an au oma ic ou come o objec i e exposu e o
simply being in a pa icula en i onmen du ing ime one migh ha e
a ailable o es o a ion ( on Linde n e al., 2017). En i onmen ’s
es o a i e quali y depends on i s po en ial o bo h pe mi and p omo e
es o a ion, depending on con ex ual ac o s and indi idual di e ences
(Ha ig, 2004, 2021).
Two in luen ial heo ies ha e p oposed psychological mechanisms
by which na u e expe ience can p o ide es o a i e bene i s: he
Kaplan’s (Kaplan and Kaplan, 1989; Kaplan, 1995) a en ion es o a ion
heo y (ART) and Ul ich’s psycho-e olu iona y heo y, usually e e ed
o as s ess eco e y heo y o s ess educ ion heo y (SRT; Ul ich,
1979; Ul ich e al., 1991). Bo h heo ies supplemen each o he – he
SRT is mo e ocused on eco e y om psycho-physiological s ess, while
ART deals wi h eco e y om di ec ed a en ion a igue (men al a-
igue). To be es o a i e, SRT equi es an en i onmen wi hou uncon-
ollable h ea , wi h mode a e le els o complexi y, wi h he pe cep ion
o na u al con en o o he isual s imuli o educe psychophysiological
a ousal and induce posi i e a ec . In ART, he pe cep ion o being away
om hassles and ou ines o expe ienced ascina ion (e.g., in na u e),
among o he pe cep ual ace s, gi es es o neu ocogni i e p ocesses
in ol ed in sus aining di ec ed a en ion, and hus imp o es cogni i e
abili ies (Ha ig, 2021). This does no necessa ily equi e he pe son o
be in na u e alone (Ko pela and S aa s, 2020; Ha ig, 2021). I can be he
expe ience o social suppo /cohesion o walking wi h iends, which
Ha ig (2021) is aming as “ es o a ion o ela ional esou ces” o he
psychological dis ance o eelings o “being away” h ough physical
exe cise. A ecen heo e ical wo k has emphasized he ole o o se ing
loneliness h ough na u e con ac as a pa hway o be e heal h
(As ell-Bu e al., 2022).
Rega dless o which esou ce has become deple ed, a p econdi ion
o i s es o a ion is ha he gi en socio-physical en i onmen will
suppo ha es o a i e p ocess and educe s ess and cogni i e load
(Haw ho ne e al., 2019; S e enson e al., 2019). No ably, he p esence
o posi i e ea u es is he basic equi emen o a “ es o a i e en i on-
men ”, which no only a o ds oppo uni ies o es o a ion, bu also
encou ages ac i i ies and expe iences leading o es o a ion (Ha ig,
2021). Ano he impo an aspec is ha an en i onmen o high
es o a i e quali y can a o d oppo uni ies o acqui e new adap i e
esou ces (i.e., ins o a ion) and in u n suppo men al heal h/di ec ed
a en ion es o a ion and os e heal h in gene al (Ma ke ych e al.,
2017). Fo example, he likelihood o playing, engaging in o he ou doo
physical ac i i ies, o simply hanging ou wi h iends is de e mined by
cha ac e is ics o he buil en i onmen (No dbø e al., 2020a). Recen
e idence suppo s a ole o es o a ion in he mechanisms behind men al
heal h and cogni i e de elopmen o child en and adolescen s (Be o
e al., 2015; Collado and S aa s, 2016; Amicone e al., 2018). Howe e ,
conside a ion o he child pe spec i e and how child expe iences and
es o a ion needs may di e om hose o adul s is s ill less well un-
de s ood (Collado and S aa s, 2016).
1.3. Aim and scope
We epo on a scoping e iew o he ole o es o a i e possibili ies
and physical ac i i y as pa hways om he exposome o men al heal h
and cogni ion in child en and adolescen s. We p esen a c i ical
app aisal o esea ch gaps in he exis ing li e a u e ha a e po en ially
ele an o Equal-Li e. O he scoping e iews in he se ies, which sha e
he same li e a u e sea ch s a egy, a e ocused on a concep ual ame-
wo k o he exosome pe spec i e in ela ion o men al heal h and
cogni i e de elopmen (Pe sson Waye e al., 2023a manusc ip in
p epa a ion/A) and on he pa hways – s ess (Belke e al., 2023 manu-
sc ip in p epa a ion), sleep (Pe sson Waye e al., 2023b, manusc ip in
p epa a ion/B), and coping/sel - egula ion (Leis e al., 2023 manu-
sc ip in p epa a ion/A) linking he exposome o men al heal h and
cogni i e de elopmen .
2. Me hods
2.1. O ganiza ion o he e iew and concep ual model building
The in en o his wo k was o gene a e a concep ual model o he
ela ionships be ween he exposome, es o a ion, and child/adolescen ’s
men al heal h/cogni ion. As building blocks o ha model, we le e -
aged exis ing empi ical e idence and heo e ically-indica ed pa hways
ha we e e alua ed as plausible enough o me i in es iga ion in Equal-
Li e, e en i no di ec e idence on hem was a ailable. In i s s uc u e,
he p esen wo k echoes he s uc u e o o he wo ks ha s a wi h a
sys ema ic e iew o he li e a u e, which la e eeds in o a la ge con-
cep ual mechanis ic model (As ell-Bu e al., 2022).
The model building in he cu en e iew wen h ough se e al
s ages, whe e empi ical esul s on he ole o es o a ion as a media o
linking di e en exposome domains o men al heal h/cogni ion se ed
as a ounda ion. Fi s , we conduc ed a scoping e iew o s udies ha
speci ically explo ed pa hways om he exposome o es o a ion and
hen o men al heal h/cogni ion (1 laye o e idence). Second, we d ew
on empi ical suppo ing e idence on pa ial associa ions, i.e., s udies
ha examined he cons i uen pa hways in a piecewise ashion (e.g.,
om exposome o es o a ion o om es o a ion o ou come). He e we
looked a single exposu es only, s ill add essing he mechanism ia
es o a ion, o ins ead o es o a ion explo ed media ion by ins o a ion
(e.g., ia physical ac i i y o social in e ac ion in a es o a i e se ing) (2
laye o e idence). Thus, while he scoping e iew ollowed a sys-
ema ic and s uc u ed app oach o e idence e ie al and syn hesis, in
he 2nd laye we adop ed a mo e uns uc u ed expe -d i en app oach
o ill in gaps in he scoping e iew li e a u e o add e idence ha
became a ailable a e he comple ion o he o mal li e a u e sea ches
o he scoping e iew. The inal model was de eloped h ough an
i e a i e p ocess.
2.2. Scoping e iew p o ocol
We had no p io in o ma ion on he ex en o he li e a u e on child
exposome, es o a ion, and heal h, bu we an icipa ed ha he body o
e idence would be he e ogeneous. We we e also mind ul ha he
ques ion we aimed o p oduce an answe o was a he b oadly de ined:
“Wha is he e idence on es o a ion ac ing as a media o linking he
exposome o childhood men al heal h/cogni ion?”. The e o e, a sys-
ema ic e iew amewo k was deemed oo es ic i e. Ra he han a
sys ema ic e iew, we employed a scoping e iew amewo k, which is
sui able o mapping he e ogeneous knowledge base on an unde s udied
subjec and iden i ying esea ch gaps, bu a he same ime sha es he
p inciples o anspa en and ep oducible epo ing essen ial o sys-
ema ic e iews (Pe e s e al., 2015). We ollowed he guidance o
conduc ing scoping e iews ou lined by A ksey and O’Malley (2005)
and Pe e s e al. (2015).
2.2.1. Eligibili y c i e ia
We employed s ic c i e ia o s udies o be included in he e iew
(Table 1). S udy eco ds had o be a ailable in English, s udy he asso-
cia ion be ween he exposome and child/adolescen men al heal h/
cogni ion, and quan i a i ely in es iga e es o a ion/ es o a i e quali y
as a media ing a iable. We did no include s udies, in which no speci ic
e o was made o e alua e media ion (i.e., s udies in which es o a ion
was me ely adjus ed o and ea ed as a con ounde ). Empi ical s udies
o obse a ional o expe imen al design we e eligible, bu e iews and
ecological s udies lacking indi idual-le el da a we e excluded.
Pa icipan s o any gende , na ionali y, and heal h s a us we e
eligible o inclusion, bu hey had o be unde o equal o he age o 21,
wi hin he age ange c i e ion o coho s in Equal-Li e. S udies ha
included di e en age g oups we e also included, i pa icipan s’ median
age was ≤21 yea s. Pa icipan s could be membe s o he gene al
popula ion o a speci ic subg oup.
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
4
We conside ed pape s dealing wi h mul iple, cumula i e, o com-
bined exposu es. We aimed o e ie e bo h s udies ha o mally s a ed
ha ing used he exposome amewo k, and s udies ha conside ed he
e ec o mul iple exposu es in he spi i o he exposome app oach, e en
i hey did no speci ically use pe inen e minology. A leas wo
physical exposu es (e.g., ai pollu ion and a ic noise) o a leas one
physical exposu e in combina ion wi h o he exposu es pe aining o he
social (e.g., social suppo ) o he in e nal exposomes (e.g., bioma ke s)
we e p e equisi es o including a s udy in he scoping e iew. Ou ocus
on physical exposu es was in luenced by a knowledge gap ega ding he
e ec s and po en ial mechanisms o cumula i e physical exposu es on
child en’s and adolescen s’ men al heal h and cogni ion, ei he in
connec ion o social exposu es o as in e ac ing physical exposu es ( an
Kamp e al., 2021). Fo u he de ails on his app oach, we e e o
Pe sson Waye e al. (2023a) (manusc ip in p epa a ion/A).
Ou comes o in e es a e lis ed in Table 1 and included measu es o
men al heal h, posi i e o nega i e a ec , ex e nalizing beha iou s o
in e nalizing symp oms, cogni i e unc ioning, and academic
pe o mance.
2.2.2. In o ma ion sou ces and sea ch s a egy
Elec onic sea ches o pee - e iewed s udies published since he yea
2000 we e pe o med in wo da abases, Scopus and PsycINFO. These
sea ches based on i le and abs ac we e conduc ed by lib a ians a he
Uni e si y o Go henbu g on June 17, 2020 and la e upda ed on
Oc obe 5, 2020. The sea ch s a egy was discussed wi hin he esea ch
eam and wi h he lib a ians. Gi en he ime gap be ween hese ini ial
sea ches and he comple ion o he e idence syn hesis, we upda ed he
sea ches one las ime jus p io o submission o his pape . The upda ed
sea ches we e ex ended om 2020 un il Decembe 1, 2022. The sea ch
e ms in each sea ch block, as well as he keywo d s ings used in he
la es sea ches a e shown in Table S1, Sec ion S1 and Sec ion S2. In
addi ion, we sea ched pape s based on he coho s and school s udies
included in Equal-Li e (h ps://www.equal-li e.eu/en), and e e ence
lis s o ele an e iew pape s and a icles. To augmen he lis o
included s udies, pe sonal lib a ies o expe s wi hin he conso ium and
sugges ed pape s om he Equal-Li e ad iso s we e sc eened.
To manage he e iew a he sc eening phase, we used Rayyan
(Ouzzani e al., 2016). The i s sc eening was based on i le and abs ac
only. Two e iewe s independen ly assessed each eco d agains he lis
o inclusion/exclusion c i e ia. S udy eco ds we e judged as ele an ,
no ele an , o po en ially ele an . Con lic s be ween he e iewe s
we e esol ed h ough consensus o by a hi d e iewe . Pape s deemed
ele an and po en ially ele an we e ad anced o he eligibili y phase,
in which a new pai o e iewe s assessed each ull ex . No ewo hy,
co-au ho s o he p esen e iew we e no in ol ed in sc eening o
assessing he eligibili y o hei own s udies iden i ied in he elec onic
sea ches.
2.2.3. Da a cha ing
In he eligibili y phase, e iewe s ex ac ed da a on he ollowing
s udy cha ac e is ics: s udy design, loca ion and pe iod, sampling
s a egy and sample size, exposu e de ini ion and assessmen , ou come
de ini ion and assessmen , media o de ini ion and assessmen , and
s a is ical analysis. These da a we e ex ac ed in a p e-designed o m by
one e iewe and e i ied by ano he e iewe .
2.3. Suppo ing mechanis ic e idence
We used u he e idence on pa ial associa ions be ween exposome
o media o s and/o media o s o ou comes iden i ied a ea lie s ages o
he sc eening o he scoping e iew. Tha is, s udies om o he sou ces
and hose excluded om he scoping e iew because hey did no ul il
all inclusion c i e ia ha we e used o suppo speci ic associa ions
wi hin ou model. Fo example, i a s udy only looked a one exposu e,
such as ai pollu ion, i would be excluded om he scoping e iew, bu
could p o ide use ul in o ma ion o cons uc ing ou concep ual model.
Fu he , we pe o med a non-sys ema ic apid sea ch o s udies in
PubMed and Google Schola o e idence published a e he las upda e
o he scoping e iew. Physical ac i i y- ela ed e ms we e also used in
hese sea ches. We inco po a ed exis ing models and heo ies o
cons uc a concep ual model, which could la e in o m analyses in
Equal-Li e. The le el o de ail a his s age was limi ed o cons uc s
ela ed o es o a ion and ins o a ion (i.e., physical ac i i y, social
in e ac ion), while mo e dis al cons uc s ha lay close o o he me-
dia o s o in e es in Equal-Li e (s ess, sleep, coping and sel - egula ion)
will be co e ed in he o he e iews in his se ies.
2.4. Syn hesis o indings
S udy cha ac e is ics we e desc ibed in na a i e and abula ed. The
pa hways be ween exposome, es o a ion/ins o a ion, and men al
heal h/cogni ion we e g aphed.
3. Resul s
3.1. Sea ch esul s
Fig. 1 shows he s udy selec ion low cha . Elec onic sea ches and
expe sugges ions yielded 3429 hi s, o which 2996 we e le a e
emo ing duplica e eco ds. Following i le and abs ac sc eening, we
excluded addi ional 2738 eco ds on ele ance. O he 228 emaining
ull ex s we assessed o eligibili y, 223 we e excluded. Tha le us wi h
i e (pa ially o e lapping) s udy eco ds o h ee dis inc s udies (i.e.,
da ase s).
3.2. S udy cha ac e is ics
The cha ac e is ics o s udies included in he na a i e syn hesis a e
gi en in Table 2 (Dzhambo e al., 2017, 2018a, 2018b, 2018c;
Dzhambo , 2018). All i e epo s we e published by he same esea ch
Table 1
Inclusion and exclusion c i e ia used o sc een s udy eco ds in he scoping
e iew.
Inclusion c i e ia Exclusion c i e ia
Popula ion Humans, child en/adolescen s
(0–21 yea s) o a leas >50% o
pa icipan s ≤21 yea s old
Animal s udies, <50% o
pa icipan s <21 yea s old,
p egnan women
S udy
design
C oss-sec ional, case-con ol,
coho , case c osso e , (quasi-)
expe imen al, andomized
con olled ial
Re iews, ecological/a ea-le el
s udies
Exposu es Mul iple physical exposu es o a
leas wo exposu es pe aining o
di e en exposome domains, one
o which o he physical
exposome; objec i ely measu ed
and/o sel - epo ed
Single exposu es o mul iple
exposu es om only social o
in e nal exposome domain
Ou comes Child/adolescen men al heal h
and/o cogni ion and/o well-
being/quali y o li e; objec i ely
measu ed o sel - epo ed
(di e en han abo e; men al
heal h, posi i e o nega i e
a ec , ex e nalizing o
in e nalizing symp oms,
cogni i e unc ioning, and
academic pe o mance.
Only ma e nal ou comes,
pe cei ed gene al heal h,
physical heal h ou comes
Media o s Ac ual o pe cei ed es o a ion,
en i onmen al es o a i e
quali y/ es o a i eness;
objec i ely measu ed o sel -
epo ed
Res o a ion/ es o a i e quali y
only ea ed as a con ounde ,
bu no an in e media e
a iable; no o mal es o
in e p e a ion o media ion by
es o a ion/ es o a i e quali y
No e. Fo a de ailed lis o he indica o s and sea ch e ms, see Table S1.
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
5
g oup and some o hem sha ed subjec s, lea ing us wi h only h ee
unique da ase s. Since hey epo ed on di e en mechanis ic pa hways,
we e ained hem in he e iew bu ook ca e no o double coun e i-
dence on he same pa hway when based on he same sample.
The s udies we e conduc ed in he ci y o Plo di , Bulga ia, whe e
con enience samples o uni e si y and high school s uden s we e su -
eyed c oss-sec ionally. Only one s udy was o panel design and
collec ed da a a wo ime poin s, he beginning and he end o he ac-
ademic yea (Dzhambo , 2018). The ou come in hese s udies was a
composi e o anxie y and dep ession symp oms measu ed wi h he
12-i em e sion o he Gene al Heal h Ques ionnai e (Goldbe g and
Blackwell, 1970). The main physical exposu es in es iga ed we e na -
u al ou doo en i onmen s and a ic emissions. Gene ally, mul iple
indica o s we e used o ope a ionalize g eenspace, including
sa elli e-de i ed ege a ion indices, a ailabili y o g eenspace land
use/co e , and dis ances o g een and blue spaces om pa icipan s’
esiden ial add ess. Long- e m a ic noise and ai pollu ion we e
measu ed mo e c udely wi h single indica o s (i.e., day-e ening-nigh
sound p essu e le els and ni ogen dioxide). Th ee o he s udies
ea ed ai pollu ion and noise no simply as co-exposu es, bu also as
media o s ha s ood on he pa h om g eenspace o men al heal h
(Dzhambo , 2018; Dzhambo e al., 2018a, 2018b). Fu he mo e,
objec i e measu es o hese physical exposu es we e supplemen ed wi h
pe cei ed measu es o g een and blue spaces, and annoyance by noise,
ai pollu ion and ib a ion ( o ming an en i onmen al annoyance scale),
which we e in u n assumed o ope a e as in e media e a iables leading
o men al heal h. Pe cei ed neighbou hood es o a i e quali y,
measu ed wi h i ems om he Pe cei ed Res o a i eness Scale (Ha ig
e al., 1997a, 1997b) ha cap u ed eelings o being away and ascina-
ion wi h he neighbou hood en i onmen , eme ged as a cen al medi-
a o . I was associa ed wi h mo e g eenspace, highe physical ac i i y
and social cohesion, and lowe pe cei ed noise and ai pollu ion. In u n,
hose media ing a iables led o be e men al heal h. In one s udy
(Dzhambo e al., 2018a), a ic noise ela ed o men al ill-heal h ia
Fig. 1. Flowcha o he pape selec ion p ocess o he scoping e iew.
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
6
Table 2
Summa y o indings in he scoping e iew.
S udy Design Popula ion Se ing Exposome Media o Ou come Analysis me hod Resul s
Physical Social
Dzhambo
e al.
(2018b)
C oss-
sec ional
S uden s (N
=720)
Median age:
21 ( ange
18–35 y s)
64.2%
emale
Residen ial
(Bulga ia)
G eenness
(NDVI, ee
co e ), G een
space land co e ,
Dis ance o g een
space, Pe cei ed
g eenness scale
Dis ance o
bluespace,
Pe cei ed
bluespace scale
Ai pollu ion
(NO
2
) and a ic
noise (L
day
)
concep ualised as
media o s in he
analysis
Pe cei ed
neighbou hood
social cohesion
concep ualised as
media o in he
analysis
Res o a ion
Pe cei ed
es o a i e
quali y o he
neighbou hood
Ins o a ion
Social cohesion,
Physical ac i i y
S ess
En i onmen al
annoyance
(noise, ai
pollu ion,
ib a ion)
O he s
Pe cei ed
neighbou hood
g een/blue
space, noise and
ai pollu ion
Gene al
men al
heal h
(GHQ-12)
S uc u al
equa ion
modelling
O he co a ia es
in SEM: sex, age,
e hnici y, mon h,
SES, popula ion
densi y,
se lemen ,
du a ion o
esidence, ime
spen a home,
s ess ul e en s
⁃ Highe g eenness
associa ed wi h
be e men al
heal h h ough
highe pe cei ed
g eenspace,
highe
es o a i e
quali y, and
subsequen ly
highe physical
ac i i y
⁃ Media ion also
ia lowe noise
exposu e and
highe pe cei ed
g eenspace, and
hen lowe
annoyance
⁃ Bluespace
associa ed wi h
highe pe cei ed
bluespace,
es o a i e
quali y, and
physical ac i i y
⁃ Bluespace also
associa ed wi h
highe noise
exposu e and
annoyance
Dzhambo
(2018)
C oss-
sec ional
& 2-
wa e
panel
S uden s (N
=109)
Median age:
21 ( ange
18–35 y s)
45% emale
Residen ial
(Bulga ia)
G eenness
(NDVI)
Dis ance o
bluespace
Ai pollu ion
(NO
2
) and a ic
noise (L
day
)
concep ualised as
media o s in he
analysis
Pe cei ed
neighbou hood
social cohesion
concep ualised as
media o in he
analysis
Res o a ion
Pe cei ed
es o a i e
quali y o he
neighbou hood
Ins o a ion
Social cohesion,
Physical ac i i y
S ess
En i onmen al
annoyance
(noise, ai
pollu ion,
ib a ion)
O he s
Ai pollu ion,
noise
Gene al
men al
heal h
(GHQ-12)
C oss-sec ional
single media ion
models;
longi udinal
media ion using
c oss-lagged
panel single
media ion
models
O he co a ia es
in SEM: sex, age,
e hnici y, SES,
du a ion o
esidence, ime
spen a home
⁃ C oss-sec ional
analysis: highe
esiden ial
g eenness
associa ed wi h
be e men al
heal h only
indi ec ly
h ough highe
physical ac i i y
and es o a i e
quali y. Blue
space: media ion
by physical
ac i i y and
es o a i e
quali y;
⁃ Longi udinal
analysis: highe
g eenness and
nea e blue space
associa ed wi h
be e men al
heal h, bu no
media ion.
Dzhambo
e al.
(2018a)
C oss-
sec ional
S uden s (N
=720)
Mean age:
21 y s ( ange
18–35 y s)
66% emale
Residen ial
(Bulga ia)
Ai pollu ion
NO
2
, T a ic
noise LAeq
Pe cei ed
neighbou hood
social cohesion
concep ualised as
media o in he
analysis
Res o a ion
Pe cei ed
es o a i e
quali y o he
neighbou hood
Ins o a ion
Social cohesion,
Physical ac i i y
S ess
En i onmen al
annoyance
(noise, ai
pollu ion,
ib a ion)
Sleep
dis u bance
Di icul y alling
Gene al
men al
heal h
( educed
GHQ-11)
S uc u al
equa ion
modelling
O he co a ia es
in SEM: sex, age,
e hnici y, mon h,
income,
popula ion
densi y, du a ion
o esidence,
ime spen a
home
⁃ Associa ion
be ween highe
L
Aeq
and GHQ
⁃ L
Aeq
associa ed
wi h highe
annoyance, and
h ough i wi h
lowe es o a i e
quali y, and hen
wi h lowe
physical ac i i y,
and hus wi h
highe GHQ.
⁃ Highe
annoyance
associa ed wi h
highe sleep
(con inued on nex page)
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
7
Table 2 (con inued)
S udy Design Popula ion Se ing Exposome Media o Ou come Analysis me hod Resul s
Physical Social
asleep +waking
up du ing he
nigh
dis u bance, and
hen wi h highe
GHQ.
⁃ NO
2
associa ed
wi h GHQ only
indi ec ly
h ough highe
annoyance,
lowe es o a i e
quali y, and
lowe physical
ac i i y
Dzhambo
e al.
(2017)
C oss-
sec ional
High school
and
uni e si y
s uden s (N
=399)
Mean age:
17.89 y s
( ange:
15–25 y s)
32.1%
emale
Residen ial
(Bulga ia)
Road a ic noise
(L
den
)
Pe cei ed
neighbou hood
social cohesion
concep ualised as
media o in he
analysis
Res o a ion
Pe cei ed
es o a i e
quali y o he
neighbou hood
Ins o a ion
Social cohesion,
Physical ac i i y
S ess
Road a ic
noise annoyance
Gene al
men al
heal h
(GHQ-12)
Linea eg ession
media ion
models (p oduc
o coe icien s
me hod),
s uc u al
equa ion
modelling
O he co a ia es
in SEM: sex, SES,
e hnici y, noise
sensi i i y
⁃ Highe noise
exposu e
associa ed wi h
wo se men al
heal h only
indi ec ly.
⁃ Single and
pa allel
media ion
models:
media ion by
annoyance,
social cohesion,
and physical
ac i i y.
⁃ SEM: highe
annoyance
associa ed wi h
less social
cohesion, and in
u n wi h wo se
men al heal h
⁃ Annoyance also
associa ed wi h
lowe es o a i e
quali y, hen
wi h less social
cohesion and
physical ac i i y,
and in u n wi h
wo se men al
heal h
Dzhambo
e al.,
2018c
C oss-
sec ional
S uden s
om high
schools and
uni e si ies
(N =399)
Mean age:
17.89 y s
( ange:
15–25 y s)
32.1%
emale
Residen ial
(Bulga ia)
G eenness
(NDVI, SAVI, ee
co e ), Dis ance
o g een space,
Pe cei ed
g eenness scale
Ai pollu ion
(NO
2
) and T a ic
noise (L
day
)
concep ualised as
media o s in he
analysis
Neighbou hood
social cohesion
concep ualised as
media o in he
analysis
Res o a ion
Pe cei ed
es o a i e
quali y o he
neighbou hood
Ins o a ion
Social cohesion,
Physical ac i i y
S ess
Road a ic
noise annoyance
O he
Pe cei ed ai
pollu ion
Gene al
men al
heal h
(GHQ-12)
Single media ion
models wi h
media o s es ed
one-a -a- ime
(p oduc o
coe icien s
me hod)
Pa allel
media ion model
wi h media o s
assumed o ac
independen ly
Theo e ically-
indica ed se ial
media ion
models
O he co a ia es
in SEM: sex, age,
e hnici y, SES,
popula ion
densi y, du a ion
o esidence,
ime spen a
home, school,
mon h
⁃ No di ec
associa ion
be ween
objec i ely-
measu ed g een-
space and men al
heal h
⁃ Res o a i e
quali y media ed
he ela ionship
be ween NDVI
and men al
heal h in some
single media ion
models.
⁃ No indi ec
e ec s in pa allel
media ion
models
⁃ In se ial
media ion
models, highe
g eenness
associa ed wi h
be e men al
heal h ia highe
es o a i e
quali y, and hen
highe physical
ac i i y and
(con inued on nex page)
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
8
highe annoyance and sleep dis u bance. The social exposome was
ep esen ed by pe cei ed neighbou hood social cohesion, which was
concep ualised as one o he media o s ha connec ed es o a i e
quali y o men al heal h.
Pa hways o which e idence o signi ican media ion was ound (i.
e., s a is ically signi ican indi ec e ec epo ed) a e shown in Fig. 2.
The s udies employed o mal media ion analyses, compa ing single,
pa allel, and se ial media ion models, o i ing complex s uc u al
equa ion models ha a emp ed o model he in e ela ionships be ween
objec i e and pe cei ed physical exposu es, es o a i e quali y, and he
ins o a ion a iables social cohesion and physical ac i i y. Physical ac-
i i y was consis en ly associa ed wi h be e men al heal h, wo king in
se ial wi h highe es o a i e quali y. O no e, he panel s udy ound
e idence o media ion by es o a i e quali y and physical ac i i y only
a baseline (c oss-sec ional analysis), bu no in he longi udinal analysis
(Dzhambo , 2018).
3.3. Suppo ing e idence
S udies ha we e excluded om he scoping e iew o ha we e
published a e he las upda e o he sea ches o ha came om pe -
sonal lib a ies ha epo ed ele an in o ma ion on speci ic pa hways
o in e es , we e e iewed a his s age (see Table 3). Se en addi ional
s udies supplemen ed he limi ed e idence p o ided by he scoping e-
iew. None o hese we e iden i ied in he sea ches o he scoping e-
iew because hey we e no add essing exposu es in he i le/abs ac s in
an explici exposome/cumula i e app oach acco ding o Equal-li e’s
s a egy (Pe sson Waye e al., 2023a manusc ip in p epa a ion/A). The
eason o excluding mos o hese s udies om he scoping e iew was
he lack o a second exposome indica o in mos o hem.
Mos s udies we e o c oss-sec ional design, bu hei samples we e
conside ably la ge and mo e di e se han he con enience samples
included in he scoping e iew. Di e en age g oups we e co e ed,
including child en, eenage s, and uni e si y s uden s. One coho s udy
in es iga ed men al and psychomo o de elopmen indica o s in in an s,
ollowed om bi h un il he age o wo yea s (Liao e al., 2019).
Mos s udies ocused on he psychological e ec s o exposu e o
esiden ial g eenspace, measu ed objec i ely wi h a sa elli e image-
based ege a ion index o wi h pe cep ual measu es o g eenness, such
as pe cei ed gene al neighbou hood g eenness o g een window iews
om home. One s udy measu ed pe cei ed g eenspace quali y a he
han a ailabili y (Pu a e al., 2021). O he s udies did ha e a second
exposome indica o bu did no di ec ly measu e es o a ion as a p ocess
o he es o a i e quali y o a se ing, while wo s udies looked a
pe cei ed es o a i e quali y (Hipp e al., 2016; Gulwadi e al., 2019)
bu no om an exposome pe spec i e. Besides g eenspace, No dbø e al.
(2020a) measu ed popula ion densi y, numbe o acili ies/ameni ies,
playg ounds, and schools in he neighbou hood, and Liao e al. (2019)
concep ualised ine pa icula e ma e ai pollu ion as a media o o
g eenness. Th ee s udies (Wang e al., 2019; No dbø e al., 2020a; Pu a
e al., 2021) concep ualised social cohesion/social in e ac ion as a
media o be ween g eenspace and heal h. Physical ac i i y was also
equen ly es ed as a media o , wi h he coho s udy by Liao e al.
(2019) looking a ma e nal physical ac i i y du ing p egnancy. Some
s udies also conside ed ai pollu ion and noise (Liao e al., 2019),
pe cei ed ai pollu ion and noise le els (Wang e al., 2019), and psy-
chological symp oms as media o s (Pu a e al., 2021).
O e all, be e psychological wellbeing and less beha iou p oblems
we e obse ed in child en/adolescen s li ing o going o school in a
g eene neighbou hood. Al hough hese s udies employed less ad anced
media ion analysis ( es ed single media o s) han hose included in he
scoping e iew, hey could s ill de ec ha pa o he e ec on psy-
chological wellbeing and beha iou p oblems was media ed by highe
pe cei ed es o a i e quali y (Hipp e al., 2016; Gulwadi e al., 2019),
highe o mo e equen engagemen in ou doo physical ac i i y (Wang
e al., 2019; No dbø e al., 2020a; Pu a e al., 2021), and mo e social
in e ac ion (Wang e al., 2019; No dbø e al., 2020a; Pu a e al., 2021).
Lowe ai pollu ion (Liao e al., 2019) and pe cei ed a ic emissions
(Wang e al., 2019) also eme ged as media o s. Findings we e no
en i ely consis en . Fo example, Pu a e al. (2021) ound s onge
media ion e idence o child men al heal h ia heal h- ela ed quali y o
li e han ia physical ac i i y and social in e ac ion; his e idence was
also mo e p onounced in la e childhood and when he ou come (p o-
social beha iou ) was ca egi e - epo ed. Ano he s udy did no de ec
media ion by physical ac i i y and only epo ed an associa ion be ween
dis ance o g eenspace and hype ac i i y/ina en ion in boys, and no
Table 2 (con inued)
S udy Design Popula ion Se ing Exposome Media o Ou come Analysis me hod Resul s
Physical Social
highe social
cohesion
No e. Abb e ia ions: GHQ – Gene al Heal h Ques ionnai e; L
Aeq
– equi alen A-weigh ed sound p essu e le el; L
day
– day ime sound p essu e le el; L
den
– day-e ening-
nigh sound p essu e le els; NDVI – no malized di e ence ege a ion index; NO
2
– ni ogen dioxide; SAVI – soil-adjus ed ege a ion index; SES – socio-economic
s a us; SEM – s uc u al equa ion modelling.
Fig. 2. Pa hways o which e idence o media ion (i.e., s a is ically signi ican indi ec e ec ) was ound in he scoping e iew. No e. Se e al s udies based on he
da ase supplied e idence o cons uc ion o he diag am. G een a ows indica e posi i e associa ions, and ed a ows, nega i e associa ions. Abb e ia ions: GS –
g eenspace, BS – bluespace.
A.M. Dzhambo e al.
En i onmen al Resea ch 233 (2023) 116452
9
Table 3
Summa y o s udies p o iding suppo ing e idence abou pa hways om he physical exposome o child men al heal h/cogni ion in ol ing es o a ion/ins o a ion.
S udy Design Popula ion Se ing Exposome Media o Ou come Analysis
me hod
Resul s
Physical Social
Hipp e al.,
(2016)
C oss-
sec ional
S uden s
om h ee
uni e si ies
(N =441)
Mean age:
23.6 y s.
78.2%
emale
School
campus
(USA and
Sco land)
Pe cei ed
g eenness scale
No Res o a ion
Pe cei ed
es o a i e
quali y (PRS),
subscales:
Being away,
Fascina ion,
Cohe ence,
Compa ibili y
Quali y o li e
(WHOQOL-
BREF)
Single
media ion
analysis
(p oduc o
coe icien s
me hod)
⁃ Highe pe cei ed
campus g eenness
associa ed wi h
g ea e quali y o
li e ia highe
pe cei ed campus
es o a i eness
Liao e al.,
(2019)
Coho New-bo ns
ollowed o
2 y s (N =
1312)
Age 2
Residen ial
(China)
G eenness
(NDVI)
Ai pollu ion
(PM
2.5
)
concep ualised
as media o in
he analysis
No Ins o a ion
Physical
ac i i y o
mo he du ing
p egnancy
O he
Ai pollu ion
Men al
de elopmen ,
Psychomo o
de elopmen
(Bayley Scales
o In an
De elopmen )
(expe
adminis e ed)
Single
media ion
analysis (causal
s eps app oach)
⁃ Reduced le els o
a ic- ela ed ai
pollu ion
explained 13.6%–
28.0% o he asso-
cia ion be ween
exposu e o g een
space and ea ly
childhood psycho-
mo o
de elopmen
Wang e al.,
(2019)
C oss-
sec ional
Teenage s
(N =4538)
Mean age:
14.57 y s.
51% emale
Residen ial
(USA)
G eenness
(NDVI)
Social cohesion
concep ualised
as media o in
he analysis
Ins o a ion
Social
cohesion,
Physical
ac i i y
S ess
Sel - epo ed
s ess
O he
Pe cei ed ai
quali y and
noise in he
neighbou hood
Psychological
dis ess (K6)
Single
media ion
analysis
(di e ence o
coe icien s
me hod)
⁃ S ee scape
g eene y and
NDVI we e
posi i ely
associa ed wi h
men al wellbeing.
⁃ Signi ican pa ial
media o s o he
s ee scape
g eene y we e
physical ac i i y,
s ess, pe cei ed
ai quali y and
noise, and social
cohesion
⁃ Fo NDVI, only
physical ac i i y
and social
cohesion we e
signi ican pa ial
media o s
Ma ke ych
e al.,
(2014)
C oss-
sec ional
Child en (N
=1625)
Mean age:
10.1 y s.
49% emale
Residen ial
(Ge many)
Dis ance o
g een space,
G eenness
(NDVI)
No Ins o a ion
Physical
ac i i y p oxies
– Time spen
ou doo s, Time
spen in on o
a sc een
Beha iou al
p oblems (SDQ
- di e en
subscales and
o al sco e)
Pa allel
media ion
analysis
(Di e ence o
coe icien s
me hod –
adjus ing o
media o )
⁃ G ea e dis ance
be ween he
esidence and he
nea es g een
space associa ed
wi h highe odds
o hype ac i i y/
ina en ion
⁃ This associa ion
was only
s a is ically
signi ican among
males.
⁃ Beha iou al
p oblems we e no
associa ed wi h
he dis ance o
o es s o
esiden ial
su ounding
g eenness
Gulwadi
e al.,
(2019)
C oss-
sec ional
S uden s (N
=1079)
Mean age:
21.5 y s.
61% emale
School
campus
(Tu key
and USA)
G eenness
(NDVI)
No Res o a ion
Pe cei ed
es o a i e
quali y
O he
Pe cei ed
g eenness
Quali y o li e
(WHOQOL-
BREF)
Se ial media ion
analysis
(P oduc o
coe icien s
me hod)
⁃ Highe g eenness
di ec ly associa ed
wi h be e o e all
quali y o li e
⁃ Indi ec
associa ions
media ed by
pe cei ed
g eenness and
(con inued on nex page)
A.M. Dzhambo e al.
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