Nature within cities will have a central role in helping address key global public health challen... more Nature within cities will have a central role in helping address key global public health challenges associated with urbanization. However, there is almost no guidance on how much or how frequently people need to engage with nature, and what types or characteristics of nature need to be incorporated in cities for the best health outcomes. Here we use a nature dose framework to examine the associations between the duration, frequency and intensity of exposure to nature and health in an urban population. We show that people who made long visits to green spaces had lower rates of depression and high blood pressure, and those who visited more frequently had greater social cohesion. Higher levels of physical activity were linked to both duration and frequency of green space visits. A dose-response analysis for depression and high blood pressure suggest that visits to outdoor green spaces of 30 minutes or more during the course of a week could reduce the population prevalence of these illnesses by up to 7% and 9% respectively. Given that the societal costs of depression alone in Australia are estimated at AUD$12.6 billion per annum, savings to public health budgets across all health outcomes could be immense. Urbanization is emerging as one of the most important global health issues of the 21 st century 1,2 , with cities becoming epicenters for chronic, non-communicable physical and mental health conditions 3,4. There is growing recognition of the crucial role of urban green spaces in addressing this public health challenge 5,6 , with over 40 years of research showing that experiences of nature are linked to a remarkable breadth of positive health outcomes. This includes improved physical health (e.g. reduced blood pressure 7 and allergies 8 , lower mortality from cardio-vascular disease 9 , improved self-perceived general health 10,11), improved mental wellbeing (e.g. reduced stress 12 and improved restoration 13,14), greater social wellbeing 15 , and promotion of positive health behaviors (e.g. physical activity 16,17). Consequently, cities across the world are investing in the provision, management and enhancement of public green spaces, with the 100 largest cities in the US alone spending over US$6 billion in 2015 18. Advice about how to achieve health outcomes from green spaces currently remains very general 19,20. Evidence on how frequent or how long nature experiences need to be, or what types of nature are needed, is vital to ensure that investment in green space provision can cost-effectively help to meet the public health challenges of urbanization 21-23. Here, for the first time we use the nature-dose framework posed by Shanahan et al. 21 to quantify the link between health outcomes and experiences of nature, as measured by intensity (i.e. the quality or quantity of nature itself), and the frequency and duration of a city resident's experiences. We focus on examples of health issues across four domains for which there is some prior evidence that nature exposure can provide benefits. These health issues are also particularly relevant for cities, and include mental health (the prevalence of depression), physical health (high blood pressure), social wellbeing (social cohesion), and a positive health behaviour (physical activity). These health outcomes could be tied to experiences of nature through a range of mechanistic pathways (some of which are outlined in Fig. 1) 22. For example, a higher level of vegetation within a landscape (a measure of nature intensity) may be linked to enhanced physical, mental and social wellbeing through providing a visually complex environment that can lead to reduction in stress 24 , reduction of mental fatigue 25 , or by adding to the look and feel of a place and so providing a pleasant location for social or physical activities 22 (Fig. 1). Similarly, variation in duration and frequency of nature exposure could also influence the long-term health outcomes people experience, with even short-duration exposure to natural environments shown to deliver an immediate reduction
h i g h l i g h t s • We examine how nature experiences and attitudes vary with neighbourhood tre... more h i g h l i g h t s • We examine how nature experiences and attitudes vary with neighbourhood tree cover. • Public and private green space use was higher in greener neighbourhoods. • City resident's orientation towards nature was higher in greener neighbourhoods. • We found highly similar patterns for both sprawling and compact city designs. • Maintaining nature close to home is vital for providing daily experiences of nature.
People with psychotic illness included in the survey sample. 7,955 people were identified through... more People with psychotic illness included in the survey sample. 7,955 people were identified through the three cohort entry pathways. Of these, a sample of 1,825 was randomly selected for interview. People with psychotic illness not included in the survey sample.
of a comprehensive health assessment programme for Australian adults with intellectual disability... more of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial
In the context of stubbornly high childhood obesity rates, health promotion activities in schools... more In the context of stubbornly high childhood obesity rates, health promotion activities in schools provide a potential avenue to improve children's nutritional behaviours. Theatre production has a rich history as a health behaviour promotion strategy but lacks sound, outcome-based evaluation. This study evaluated the effect of an integrated, two-part, place-based theatre performance program with 212 students in five schools in a regional urban and semi-rural area. The program included a theatre performance and a healthy eating competition. A brief survey assessed student healthy eating knowledge and attitudes at three time points. Nutrition behaviour was measured by scoring the contents of children's lunch boxes before, during and up to six weeks after the intervention. Statistical analysis tested change over time on five variables (Knowledge, Attitude, Sometimes foods, Everyday foods, Overall lunch box score). Results showed that both components of the integrated program improved nutrition knowledge and that the theatre performance improved children's healthy eating attitudes. All three lunch box scores peaked after the integrated program and remained significantly higher than baseline at 4-6 weeks follow-up. Interaction effects were identified for school catchment area on four of the five dependent variables. Evaluation of this integrated theatre production program indicates the potential benefit of taking a "super-setting" approach. It demonstrates an effect from students taking home information they had learned and incorporating it into lunch box preparation. It also showed consistent effects for school geographical catchment. This study suggests that, with careful, theory-based design, theatre productions in schools can improve student nutritional activities.
Introduction: Childhood obesity is increasing in the Southeast Asian region, including in the nat... more Introduction: Childhood obesity is increasing in the Southeast Asian region, including in the nation of Brunei Darussalam. Within the public health focus on obesity prevention, specific settings, including primary schools, have been singled out as suitable sites for action. Recognizing that stakeholders are, in their various roles, producers of policy or implementers of practice, the purpose of this study in Brunei was to establish a baseline for interventions as well as to establish strengths and limitations in the current practice. Methods: Semi-structured interview with government and school community stakeholders was conducted, and transcriptions were thematically analyzed. Results: Three themes emerged from the data. The first theme was “children’s eating habits today = healthy adult population tomorrow;” many of the stakeholders believed that, if healthy eating is not practiced from an early stage, this can lead to the development of harmful diet-related diseases in the future...
There is growing recognition that interactions with nature provide many desirable human well-bein... more There is growing recognition that interactions with nature provide many desirable human well-being outcomes, yet increasing urbanization is degrading the quality and quantity of nature experiences. Thus, it has become increasingly important to understand how and why urban dwellers interact with nature. Studies of urban green space use have largely focused on the availability and ease of access to green space, suggesting that greater opportunities to experience such space will lead to increased use. However, a growing literature emphasizes the potential for an individual's nature orientation to affect their interaction with green space. Here we measure the importance of both opportunity and orientation factors in explaining urban park use. An urban lifestyle survey was deployed across Brisbane, Australia in November 2012 to assess patterns of green space use. Participants (n=1479) were asked to provide information on demographics, private yard use, park visitations in the past we...
International journal of environmental research and public health, Jun 29, 2018
Nature relatedness is a psychological characteristic with the potential to drive interaction with... more Nature relatedness is a psychological characteristic with the potential to drive interaction with nature and influence well-being. We surveyed 1538 people in Brisbane, Australia to investigate how nature relatedness varies among socio-demographic groups. We determined whether people with higher nature relatedness reported fewer symptoms of depression, anxiety, stress and better overall health, controlling for potentially confounding socio-demographic and health-related variables. Overall nature relatedness was higher in older people, females, those without children living at home, not working, and people speaking English at home. Aspects of nature relatedness reflecting enjoyment of nature were consistently associated with reduced ill health, consistent with widespread evidence of the health and well-being benefits of experiencing nature. In contrast, aspects of nature relatedness reflecting self-identification with nature, and a conservation worldview, were associated with increase...
Objective: The 2010 Survey of High Impact Psychosis (SHIP) is Australia’s second national psychos... more Objective: The 2010 Survey of High Impact Psychosis (SHIP) is Australia’s second national psychosis survey. This paper provides an overview of its findings, including comparisons with the first psychosis survey and general population data. Methods: The survey covered 1.5 million people aged 18–64 years, approximately 10% of Australians in this age group. A two-phase design was used. In phase 1, screening for psychosis took place in public mental health services and non-government organizations supporting people with mental illness. In phase 2, 1825 of those screen-positive for psychosis were randomly selected and interviewed. Data collected included symptomatology, substance use, functioning, service utilization, medication use, education, employment, housing, and physical health including fasting blood samples. Results: The estimated 1-month treated prevalence of psychotic disorders in public treatment services was 3.1 people per 1000 population; the 12-month treated prevalence was 4.5 people per 1000. The majority (63.0%) of participants met ICD-10 criteria for schizophrenia/schizoaffective disorder. One-half (49.5%) reported attempting suicide in their lifetime and two-thirds (63.2%) were rated as impaired in their ability to socialize. Over half (54.8%) had metabolic syndrome. The proportion currently smoking was 66.1%. Educational achievement was low. Only 21.5% were currently employed. Key changes in the 12 years since the first survey included: a marked drop in psychiatric inpatient admissions; a large increase in the proportion attending community mental health clinics; increased use of rehabilitation services and non-government organizations supporting people with mental illness; a major shift from typical to atypical antipsychotics; and large increases in the proportions with lifetime alcohol or drug abuse/dependence. Conclusion: People with psychotic illness face multiple challenges. An integrated approach to service provision is needed to ensure that their living requirements and needs for social participation are met, in addition to their very considerable mental and physical health needs.
Australian and New Zealand Journal of Public Health, 2002
Objective: To deter mine the prevalence and socio-demographic associations of physical, emotional... more Objective: To deter mine the prevalence and socio-demographic associations of physical, emotional and sexual abuse by a partner or ex-partner for women attending Australian general practices. Method: In 1996, women attending 20 randomly chosen Brisbane inner south region general practices were screened f or a history of partner abuse using a selfreport questionnaire. Multivariate analyses were conducted on the data, using presence of abuse or not adjusting for cluster effect to obtain prevalence rate ratios for socio-demographic background data and history of violence in the family of origin. Results: Thirty-seven per cent (CI 31.0-42.4) of the survey participants (n=1,836, response rate 78.5%) admitted to having ever experienced abuse in an adult intimate relationship. One in four women (23.3%) had ever exper ienced physical abuse, one in three (33.9%) emotional abuse and one in 10 (10.6%) sexual abuse. Abused women were 64.1 (CI 44.4-94.1) times more likely to have ever been afraid of any partner than non-abused women. Of women in current relationships (n=1,344), 8.0% self-reported physical or emotional or sexual abuse in the past 12 months and 1.5% all three types of abuse. Associations of abuse included being younger (<60 years), separated or divorced, having a history of child abuse or domestic violence between their parents. Conclusion: Partner abuse is ver y common in women attending general practices and clinicians need to be alert to possible indications of par tner abuse (age, marital status , past history of abuse).
Nature within cities will have a central role in helping address key global public health challen... more Nature within cities will have a central role in helping address key global public health challenges associated with urbanization. However, there is almost no guidance on how much or how frequently people need to engage with nature, and what types or characteristics of nature need to be incorporated in cities for the best health outcomes. Here we use a nature dose framework to examine the associations between the duration, frequency and intensity of exposure to nature and health in an urban population. We show that people who made long visits to green spaces had lower rates of depression and high blood pressure, and those who visited more frequently had greater social cohesion. Higher levels of physical activity were linked to both duration and frequency of green space visits. A dose-response analysis for depression and high blood pressure suggest that visits to outdoor green spaces of 30 minutes or more during the course of a week could reduce the population prevalence of these illnesses by up to 7% and 9% respectively. Given that the societal costs of depression alone in Australia are estimated at AUD$12.6 billion per annum, savings to public health budgets across all health outcomes could be immense. Urbanization is emerging as one of the most important global health issues of the 21 st century 1,2 , with cities becoming epicenters for chronic, non-communicable physical and mental health conditions 3,4. There is growing recognition of the crucial role of urban green spaces in addressing this public health challenge 5,6 , with over 40 years of research showing that experiences of nature are linked to a remarkable breadth of positive health outcomes. This includes improved physical health (e.g. reduced blood pressure 7 and allergies 8 , lower mortality from cardio-vascular disease 9 , improved self-perceived general health 10,11), improved mental wellbeing (e.g. reduced stress 12 and improved restoration 13,14), greater social wellbeing 15 , and promotion of positive health behaviors (e.g. physical activity 16,17). Consequently, cities across the world are investing in the provision, management and enhancement of public green spaces, with the 100 largest cities in the US alone spending over US$6 billion in 2015 18. Advice about how to achieve health outcomes from green spaces currently remains very general 19,20. Evidence on how frequent or how long nature experiences need to be, or what types of nature are needed, is vital to ensure that investment in green space provision can cost-effectively help to meet the public health challenges of urbanization 21-23. Here, for the first time we use the nature-dose framework posed by Shanahan et al. 21 to quantify the link between health outcomes and experiences of nature, as measured by intensity (i.e. the quality or quantity of nature itself), and the frequency and duration of a city resident's experiences. We focus on examples of health issues across four domains for which there is some prior evidence that nature exposure can provide benefits. These health issues are also particularly relevant for cities, and include mental health (the prevalence of depression), physical health (high blood pressure), social wellbeing (social cohesion), and a positive health behaviour (physical activity). These health outcomes could be tied to experiences of nature through a range of mechanistic pathways (some of which are outlined in Fig. 1) 22. For example, a higher level of vegetation within a landscape (a measure of nature intensity) may be linked to enhanced physical, mental and social wellbeing through providing a visually complex environment that can lead to reduction in stress 24 , reduction of mental fatigue 25 , or by adding to the look and feel of a place and so providing a pleasant location for social or physical activities 22 (Fig. 1). Similarly, variation in duration and frequency of nature exposure could also influence the long-term health outcomes people experience, with even short-duration exposure to natural environments shown to deliver an immediate reduction
h i g h l i g h t s • We examine how nature experiences and attitudes vary with neighbourhood tre... more h i g h l i g h t s • We examine how nature experiences and attitudes vary with neighbourhood tree cover. • Public and private green space use was higher in greener neighbourhoods. • City resident's orientation towards nature was higher in greener neighbourhoods. • We found highly similar patterns for both sprawling and compact city designs. • Maintaining nature close to home is vital for providing daily experiences of nature.
People with psychotic illness included in the survey sample. 7,955 people were identified through... more People with psychotic illness included in the survey sample. 7,955 people were identified through the three cohort entry pathways. Of these, a sample of 1,825 was randomly selected for interview. People with psychotic illness not included in the survey sample.
of a comprehensive health assessment programme for Australian adults with intellectual disability... more of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial
In the context of stubbornly high childhood obesity rates, health promotion activities in schools... more In the context of stubbornly high childhood obesity rates, health promotion activities in schools provide a potential avenue to improve children's nutritional behaviours. Theatre production has a rich history as a health behaviour promotion strategy but lacks sound, outcome-based evaluation. This study evaluated the effect of an integrated, two-part, place-based theatre performance program with 212 students in five schools in a regional urban and semi-rural area. The program included a theatre performance and a healthy eating competition. A brief survey assessed student healthy eating knowledge and attitudes at three time points. Nutrition behaviour was measured by scoring the contents of children's lunch boxes before, during and up to six weeks after the intervention. Statistical analysis tested change over time on five variables (Knowledge, Attitude, Sometimes foods, Everyday foods, Overall lunch box score). Results showed that both components of the integrated program improved nutrition knowledge and that the theatre performance improved children's healthy eating attitudes. All three lunch box scores peaked after the integrated program and remained significantly higher than baseline at 4-6 weeks follow-up. Interaction effects were identified for school catchment area on four of the five dependent variables. Evaluation of this integrated theatre production program indicates the potential benefit of taking a "super-setting" approach. It demonstrates an effect from students taking home information they had learned and incorporating it into lunch box preparation. It also showed consistent effects for school geographical catchment. This study suggests that, with careful, theory-based design, theatre productions in schools can improve student nutritional activities.
Introduction: Childhood obesity is increasing in the Southeast Asian region, including in the nat... more Introduction: Childhood obesity is increasing in the Southeast Asian region, including in the nation of Brunei Darussalam. Within the public health focus on obesity prevention, specific settings, including primary schools, have been singled out as suitable sites for action. Recognizing that stakeholders are, in their various roles, producers of policy or implementers of practice, the purpose of this study in Brunei was to establish a baseline for interventions as well as to establish strengths and limitations in the current practice. Methods: Semi-structured interview with government and school community stakeholders was conducted, and transcriptions were thematically analyzed. Results: Three themes emerged from the data. The first theme was “children’s eating habits today = healthy adult population tomorrow;” many of the stakeholders believed that, if healthy eating is not practiced from an early stage, this can lead to the development of harmful diet-related diseases in the future...
There is growing recognition that interactions with nature provide many desirable human well-bein... more There is growing recognition that interactions with nature provide many desirable human well-being outcomes, yet increasing urbanization is degrading the quality and quantity of nature experiences. Thus, it has become increasingly important to understand how and why urban dwellers interact with nature. Studies of urban green space use have largely focused on the availability and ease of access to green space, suggesting that greater opportunities to experience such space will lead to increased use. However, a growing literature emphasizes the potential for an individual's nature orientation to affect their interaction with green space. Here we measure the importance of both opportunity and orientation factors in explaining urban park use. An urban lifestyle survey was deployed across Brisbane, Australia in November 2012 to assess patterns of green space use. Participants (n=1479) were asked to provide information on demographics, private yard use, park visitations in the past we...
International journal of environmental research and public health, Jun 29, 2018
Nature relatedness is a psychological characteristic with the potential to drive interaction with... more Nature relatedness is a psychological characteristic with the potential to drive interaction with nature and influence well-being. We surveyed 1538 people in Brisbane, Australia to investigate how nature relatedness varies among socio-demographic groups. We determined whether people with higher nature relatedness reported fewer symptoms of depression, anxiety, stress and better overall health, controlling for potentially confounding socio-demographic and health-related variables. Overall nature relatedness was higher in older people, females, those without children living at home, not working, and people speaking English at home. Aspects of nature relatedness reflecting enjoyment of nature were consistently associated with reduced ill health, consistent with widespread evidence of the health and well-being benefits of experiencing nature. In contrast, aspects of nature relatedness reflecting self-identification with nature, and a conservation worldview, were associated with increase...
Objective: The 2010 Survey of High Impact Psychosis (SHIP) is Australia’s second national psychos... more Objective: The 2010 Survey of High Impact Psychosis (SHIP) is Australia’s second national psychosis survey. This paper provides an overview of its findings, including comparisons with the first psychosis survey and general population data. Methods: The survey covered 1.5 million people aged 18–64 years, approximately 10% of Australians in this age group. A two-phase design was used. In phase 1, screening for psychosis took place in public mental health services and non-government organizations supporting people with mental illness. In phase 2, 1825 of those screen-positive for psychosis were randomly selected and interviewed. Data collected included symptomatology, substance use, functioning, service utilization, medication use, education, employment, housing, and physical health including fasting blood samples. Results: The estimated 1-month treated prevalence of psychotic disorders in public treatment services was 3.1 people per 1000 population; the 12-month treated prevalence was 4.5 people per 1000. The majority (63.0%) of participants met ICD-10 criteria for schizophrenia/schizoaffective disorder. One-half (49.5%) reported attempting suicide in their lifetime and two-thirds (63.2%) were rated as impaired in their ability to socialize. Over half (54.8%) had metabolic syndrome. The proportion currently smoking was 66.1%. Educational achievement was low. Only 21.5% were currently employed. Key changes in the 12 years since the first survey included: a marked drop in psychiatric inpatient admissions; a large increase in the proportion attending community mental health clinics; increased use of rehabilitation services and non-government organizations supporting people with mental illness; a major shift from typical to atypical antipsychotics; and large increases in the proportions with lifetime alcohol or drug abuse/dependence. Conclusion: People with psychotic illness face multiple challenges. An integrated approach to service provision is needed to ensure that their living requirements and needs for social participation are met, in addition to their very considerable mental and physical health needs.
Australian and New Zealand Journal of Public Health, 2002
Objective: To deter mine the prevalence and socio-demographic associations of physical, emotional... more Objective: To deter mine the prevalence and socio-demographic associations of physical, emotional and sexual abuse by a partner or ex-partner for women attending Australian general practices. Method: In 1996, women attending 20 randomly chosen Brisbane inner south region general practices were screened f or a history of partner abuse using a selfreport questionnaire. Multivariate analyses were conducted on the data, using presence of abuse or not adjusting for cluster effect to obtain prevalence rate ratios for socio-demographic background data and history of violence in the family of origin. Results: Thirty-seven per cent (CI 31.0-42.4) of the survey participants (n=1,836, response rate 78.5%) admitted to having ever experienced abuse in an adult intimate relationship. One in four women (23.3%) had ever exper ienced physical abuse, one in three (33.9%) emotional abuse and one in 10 (10.6%) sexual abuse. Abused women were 64.1 (CI 44.4-94.1) times more likely to have ever been afraid of any partner than non-abused women. Of women in current relationships (n=1,344), 8.0% self-reported physical or emotional or sexual abuse in the past 12 months and 1.5% all three types of abuse. Associations of abuse included being younger (<60 years), separated or divorced, having a history of child abuse or domestic violence between their parents. Conclusion: Partner abuse is ver y common in women attending general practices and clinicians need to be alert to possible indications of par tner abuse (age, marital status , past history of abuse).
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Papers by Robert Bush