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      Is spatial exposure to heritage associated with visits to heritage and to mental health? A cross-sectional study using data from the UK Household Longitudinal Study (UKHLS)

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          Abstract

          Objectives

          Existing research highlights the beneficial nature of heritage engagement for mental health, but engagement varies geographically and socially, and few studies explore spatial exposure (ie, geographic availability) to heritage and heritage visits. Our research questions were ‘does spatial exposure to heritage vary by area income deprivation?’, ‘is spatial exposure to heritage linked to visiting heritage?’ and ‘is spatial exposure to heritage linked to mental health?’. Additionally, we explored whether local heritage is associated with mental health regardless of the presence of green space.

          Design

          Data were collected from January 2014 to June 2015 via the UK Household Longitudinal Study (UKHLS) wave 5. Our study is cross-sectional.

          Setting

          UKHLS data were either collected via face-to-face interview or online questionnaire.

          Participants

          30 431 adults (16+ years) (13 676 males, 16 755 females). Participants geocoded to Lower Super Output Area (LSOA) ‘neighbourhood’ and ‘English Index of Multiple Deprivation’ 2015 income score.

          Main exposures/outcome measures

          LSOA-level heritage exposure and green space exposure (ie, population and area densities); heritage site visit in the past year (outcome, binary: no, yes); mental distress (outcome, General Health Questionnaire-12, binary: less distressed 0–3, more distressed 4+).

          Results

          Heritage varied by deprivation, the most deprived areas (income quintile (Q)1: 1.8) had fewer sites per 1000 population than the least deprived (Q5: 11.1) (p<0.01). Compared with those with no LSOA-level heritage, those with heritage exposure were more likely to have visited a heritage site in the past year (OR: 1.12 (95% CI 1.03 to 1.22)) (p<0.01). Among those with heritage exposure, visitors to heritage had a lower predicted probability of distress (0.171 (95% CI 0.162 to 0.179)) than non-visitors (0.238 (95% CI 0.225 to 0.252)) (p<0.001).

          Conclusions

          Our research contributes to evidence for the well-being benefits of heritage and is highly relevant to the government’s levelling-up heritage strategy. Our findings can feed into schemes to tackle inequality in heritage exposure to improve both heritage engagement and mental health.

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          Most cited references43

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover 3 main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors, to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all 3 study designs and 4 are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available at http://www.annals.org and on the Web sites of PLoS Medicine and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            Exploring pathways linking greenspace to health: Theoretical and methodological guidance.

            In a rapidly urbanizing world, many people have little contact with natural environments, which may affect health and well-being. Existing reviews generally conclude that residential greenspace is beneficial to health. However, the processes generating these benefits and how they can be best promoted remain unclear.
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              The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes

              Background The health benefits of greenspaces have demanded the attention of policymakers since the 1800s. Although much evidence suggests greenspace exposure is beneficial for health, there exists no systematic review and meta-analysis to synthesise and quantify the impact of greenspace on a wide range of health outcomes. Objective To quantify evidence of the impact of greenspace on a wide range of health outcomes. Methods We searched five online databases and reference lists up to January 2017. Studies satisfying a priori eligibility criteria were evaluated independently by two authors. Results We included 103 observational and 40 interventional studies investigating ~100 health outcomes. Meta-analysis results showed increased greenspace exposure was associated with decreased salivary cortisol −0.05 (95% CI −0.07, −0.04), heart rate −2.57 (95% CI −4.30, −0.83), diastolic blood pressure −1.97 (95% CI −3.45, −0.19), HDL cholesterol −0.03 (95% CI −0.05, <-0.01), low frequency heart rate variability (HRV) −0.06 (95% CI −0.08, −0.03) and increased high frequency HRV 91.87 (95% CI 50.92, 132.82), as well as decreased risk of preterm birth 0.87 (95% CI 0.80, 0.94), type II diabetes 0.72 (95% CI 0.61, 0.85), all-cause mortality 0.69 (95% CI 0.55, 0.87), small size for gestational age 0.81 (95% CI 0.76, 0.86), cardiovascular mortality 0.84 (95% CI 0.76, 0.93), and an increased incidence of good self-reported health 1.12 (95% CI 1.05, 1.19). Incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease were reduced. For several non-pooled health outcomes, between 66.7% and 100% of studies showed health-denoting associations with increased greenspace exposure including neurological and cancer-related outcomes, and respiratory mortality. Conclusions Greenspace exposure is associated with numerous health benefits in intervention and observational studies. These results are indicative of a beneficial influence of greenspace on a wide range of health outcomes. However several meta-analyses results are limited by poor study quality and high levels of heterogeneity. Green prescriptions involving greenspace use may have substantial benefits. Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas. Furthermore the development of strategies and interventions for the utilisation of such greenspaces by those who stand to benefit the most.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                28 March 2023
                : 13
                : 3
                : e066986
                Affiliations
                [1 ]Ringgold_47970MRC/CSO Social and Public Health Sciences Unit, University of Glasgow , Glasgow, UK
                [2 ]departmentPolicy and Evidence , Ringgold_443824Historic England , London, UK
                Author notes
                [Correspondence to ] Mrs Laura Macdonald; Laura.Macdonald@ 123456glasgow.ac.uk
                Author information
                http://orcid.org/0000-0002-0593-8079
                http://orcid.org/0000-0003-0745-7065
                http://orcid.org/0000-0003-3353-516X
                http://orcid.org/0000-0003-3827-7155
                Article
                bmjopen-2022-066986
                10.1136/bmjopen-2022-066986
                10069496
                36990477
                bfd00526-8ee4-4e0f-a2c9-9abea11f5b16
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 27 July 2022
                : 12 March 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MC_UU_00022/4
                Funded by: FundRef http://dx.doi.org/10.13039/501100000589, Chief Scientist Office;
                Award ID: SPHSU2019
                Categories
                Public Health
                1506
                1724
                Original research
                Custom metadata
                unlocked

                Medicine
                mental health,statistics & research methods,public health
                Medicine
                mental health, statistics & research methods, public health

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