Green Environment for Community Health Improvement

(HEAL Trial)

Overseen By Jackie Research Coordinator, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Louisville

Disqualifiers: HIV/AIDS, Cancer, Active bleeding, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

835 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how adding green spaces, such as trees and shrubs, to neighborhoods might improve residents' heart health and overall well-being. Participants will live either in neighborhoods with new greenery or in areas without environmental changes. It targets individuals aged 30 to 70 who reside in the study location. The goal is to determine if increased greenery can reduce disease risks and enhance community ties. As an unphased study, this trial provides a unique opportunity to contribute to research that could improve community health and the environment.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this environmental health intervention is safe?

Research shows that being around greenery, such as trees and plants, is generally safe. Studies have found that adding green spaces to cities can improve health by reducing stress, lowering the risk of heart disease, and boosting mental health.

No known negative effects exist from being near green spaces. Instead, they often link to positive health changes, suggesting that people handle greenness well. Therefore, for those considering joining a trial focused on green spaces, past research indicates promising safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using greenness as a therapeutic intervention because it introduces a novel approach to improving community health by enhancing the local environment. Unlike traditional medical treatments that rely on medications or clinical procedures, this method involves planting shrubs, grasses, and trees to assess their impact on health and pollution levels. This environmental strategy is unique because it aims to provide long-term health benefits by naturally improving air quality and promoting well-being through increased exposure to green spaces. This trial could pave the way for innovative, sustainable health interventions that integrate nature into urban planning.

What evidence suggests that greenness as a therapeutic intervention is effective for improving community health?

Research has shown that green spaces, such as parks and gardens, in cities benefit health. Studies have found that these areas can address issues like obesity, heart health, and mental well-being. For instance, proximity to green spaces is linked to improved mental health. One study found that people living near more green areas might have a lower risk of heart disease. This trial will evaluate the impact of using greenness as a therapeutic intervention in targeted neighborhoods, where shrubs, grasses, and trees will be planted. These findings suggest that adding more greenery to neighborhoods could enhance the health of the entire community. ^{1 2 4 5 6}

Who Is on the Research Team?

Rachel Keith, PhD

Principal Investigator

University of Louisville

Aruni Bhatnagar, PhD

Principal Investigator

University of Louisville

Are You a Good Fit for This Trial?

This trial is for individuals aged 30-70 living in a specific study area, who are not prisoners or part of other vulnerable groups. Participants must be able to consent and should not have HIV/AIDS, active cancer treatment, active bleeding issues, weigh less than 100 pounds or have a BMI over 40.

Inclusion Criteria

I am between 30 and 70 years old.

Live within the targeted study location

Exclusion Criteria

I do not have HIV/AIDS, am not currently being treated for cancer, and do not have any active bleeding or wounds.

I weigh less than 100 pounds or my BMI is over 40.

Prisoners and other vulnerable populations

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Initial health assessments and environmental exposure measurements are conducted

4 weeks

1 visit (in-person)

Intervention

Greenness intervention with planting of shrubs, grasses, and trees in targeted neighborhoods

2 years

Follow-up

Participants are monitored for changes in health and environmental exposure

2 years

Periodic assessments (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Greenness as a therapeutic intervention

Trial Overview The study investigates the impact of neighborhood green spaces on heart health and well-being. It aims to understand how environmental changes like increased greenery can influence cardiovascular disease risk and metabolic health.

How Is the Trial Designed?

Group I: Targeted neighborhoods for Greenness Experimental Treatment 1 Intervention

Using greenness as a therapeutic intervention, we will plant shrubs, grasses, young and mature trees (40-50 ft in height), so that we can evaluate changes in health and pollution, 2 years after planting.

Group II: Control Group Active Control 1 Intervention

No intervention

Greenness as a therapeutic intervention is already approved in United States for the following indications:

Approved in United States as Green Heart Louisville Project for:

• Improvement in heart health
• Reduction in inflammation
• Enhancement of overall well-being
• Strengthening of community connections

Who Is Running the Clinical Trial?

University of Louisville

Lead Sponsor

Trials

353

Recruited

76,400+

The Nature Conservancy

Collaborator

Trials

1

Recruited

840+

National Institute of Environmental Health Sciences (NIEHS)

Collaborator

Trials

294

Recruited

1,233,000+

Published Research Related to This Trial

In a study analyzing nearly 500,000 BMI records in Phoenix, AZ, and 225,000 in Portland, OR, it was found that increased street tree cover significantly lowers the odds of being overweight or obese, with every 10% increase in tree cover linked to an 18% reduction in these odds.

The protective effect of street tree cover was consistent across both cities, highlighting the importance of urban greenery in promoting healthy weight, while the impact of herbaceous street cover varied by location, suggesting that different types of greenery may have different effects on weight status.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations between types of greenery along neighborhood roads and weight status in different climates. Tsai, WL., Davis, AJS., Jackson, LE.[2020]

An umbrella review of 40 systematic reviews found that exposure to greenspace is associated with several health benefits, including reduced mortality from all causes and strokes, improved cardiovascular health, better mental health, and enhanced physical activity.

Despite these positive associations, the overall evidence is limited by methodological flaws in the studies, indicating a need for higher-quality research to confirm the health benefits of greenspace exposure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Greenspace and human health: An umbrella review. Yang, BY., Zhao, T., Hu, LX., et al.[2023]

Green space is linked to various health benefits, including improvements in physical, mental, and social wellbeing, highlighting its importance as a positive environmental factor.

The paper emphasizes the need for clarity in the terminology and indicators used to measure green space, which is crucial for health practitioners and researchers to effectively utilize this information in public health initiatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Green space in health research: an overview of common indicators of greenness. Vilcins, D., Sly, PD., Scarth, P., et al.[2022]

In a study of 80 Dutch urban neighborhoods with 1,641 resident participants, both the quantity and quality of green spaces were found to positively impact self-reported health indicators.

Streetscape greenery was shown to be as strongly related to health as larger green areas, suggesting that smaller natural elements in urban environments also play a significant role in promoting well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Greenspace in urban neighbourhoods and residents' health: adding quality to quantity. van Dillen, SM., de Vries, S., Groenewegen, PP., et al.[2015]

A systematic review of 19 studies highlights a positive relationship between green and blue spaces and various health metrics, suggesting that aesthetically pleasing environments can benefit human health.

However, there is a significant gap in research regarding how changes in environmental quality and aesthetics directly impact community health, indicating a need for further studies in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Beneficial Use Impairments, Degradation of Aesthetics, and Human Health: A Review. Slawsky, ED., Hoffman, JC., Cowan, KN., et al.[2022]

There is strong evidence that neighborhood greenness is positively associated with increased physical activity, which can lead to better health outcomes.

Greenness exposure during pregnancy is linked to higher birth weights, suggesting it may have protective effects for maternal and infant health, although more research is needed to clarify its impact on other birth outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Review of the Health Benefits of Greenness. James, P., Banay, RF., Hart, JE., et al.[2022]

Urban green and blue spaces (UGBS) can significantly enhance public health and wellbeing, but their full potential is not yet realized due to various challenges in implementation and research.

To improve UGBS effectiveness, it is crucial to engage communities and policymakers in a collaborative approach, strengthen the evidence base, and address health inequities in access and quality of these spaces.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advancing urban green and blue space contributions to public health. Hunter, RF., Nieuwenhuijsen, M., Fabian, C., et al.[2023]

Nature-based and green space strategies are crucial for improving public health and safety in urban areas, particularly in cities that lack natural environments.

Further research is needed to refine how we measure the impact of green spaces on health and safety, and to explore interdisciplinary approaches and economic evaluations of urban greening initiatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature-Based Strategies for Improving Urban Health and Safety. Kondo, MC., South, EC., Branas, CC.[2021]

Urban green spaces are essential for improving human health and adapting to climate change, highlighting the need for effective management and design strategies.

The paper proposes eight specific interventions to enhance green spaces, which aim to maximize health benefits and climate resilience, emphasizing the importance of integrating these factors in urban planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Greening Blocks: A Conceptual Typology of Practical Design Interventions to Integrate Health and Climate Resilience Co-Benefits. Barron, S., Nitoslawski, S., Wolf, KL., et al.[2023]

Increased accessibility to neighborhood greenspaces and greater tree canopy cover are linked to lower rates of intentional deaths, such as homicides and suicides, across three cities in North Carolina.

Neighborhood greenspace accessibility was found to be the most protective factor against intentional deaths, particularly for non-firearm related incidents, highlighting the importance of considering weapon type in community health interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between urban greenspace, tree canopy cover and intentional deaths: An exploratory geospatial analysis. Ryan, SC., Sugg, MM., Runkle, JD.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5876990/

Urban Green Space and Its Impact on Human Health - PMC Greening Interventions. Twelve studies measured changes in health outcomes measured within proximity to environmental interventions. These ...

2. cbd.int cbd.int/health/who-euro-green-spaces-urbanhealth.pdf

Urban Green Space Interventions and Health Interventions on green space in urban settings can help address public health issues related to obesity, cardiovascular effects, mental health and ...

3. apps.who.int apps.who.int/iris/bitstream/handle/10665/366036/WHO-EURO-2017-6358-46124-66715-eng.pdf?sequence=1

Urban green space interventions and health Interventions on green space in urban settings can help address public health issues related to obesity, cardiovascular effects, mental health and ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S0160412023001538

A health impact assessment of the Barcelona “Eixos Verds ... There is a positive association between green space exposure and better mental health, and therefore urban greening can be an effective public health tool.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8582763/

Green Space Quality and Health: A Systematic Review - PMC We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits.

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0013935125024107

The Effect of Place-Based Nature Interventions on Human ... The beneficial associations between living in greener environments and human health outcomes, including mortality 1, cardiovascular disease 2, ...