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?

The purpose of this study is to examine how the environment and neighborhood characteristics affects the health of the area residents. The study will help determine how changing neighborhood characteristics, such as green space, affect heart health, risk factors for other diseases, sense of well- being or neighborhood cohesion.

Will I have to stop taking my current medications?

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

Is exposure to greenspace generally safe for humans?

Research suggests that exposure to greenspace is generally safe and may even offer health benefits, such as improved mental health and reduced crime rates, although more high-quality studies are needed to confirm these findings. ^{1 2 3 4 5}

How does the treatment 'Greenness' differ from other treatments for health improvement?

The 'Greenness' treatment is unique because it involves enhancing urban green spaces to improve health, rather than using traditional medical interventions. This approach focuses on increasing exposure to natural environments, which can boost physical, mental, and social well-being by promoting physical activity, reducing stress, and improving air quality. ^{3 4 6 7 8}

What data supports the effectiveness of the treatment Greenness as a therapeutic intervention?

Research shows that exposure to green spaces can improve physical activity, reduce stress, and lower the risk of obesity and mental health issues. Urban greenery, like street trees, is linked to healthier weight status and better overall health, suggesting that greenness can be a beneficial treatment for community health improvement. ^{4 6 8 9 10}

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

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. Switzerland pubmed.ncbi.nlm.nih.gov

Greening Blocks: A Conceptual Typology of Practical Design Interventions to Integrate Health and Climate Resilience Co-Benefits. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Advancing urban green and blue space contributions to public health. [2023]

3. Switzerland pubmed.ncbi.nlm.nih.gov

A Review of the Health Benefits of Greenness. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

Associations between types of greenery along neighborhood roads and weight status in different climates. [2020]

5. England pubmed.ncbi.nlm.nih.gov

Greenspace in urban neighbourhoods and residents' health: adding quality to quantity. [2015]

6. United States pubmed.ncbi.nlm.nih.gov

Greenspace and human health: An umbrella review. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Nature-Based Strategies for Improving Urban Health and Safety. [2021]

8. Germany pubmed.ncbi.nlm.nih.gov

Green space in health research: an overview of common indicators of greenness. [2022]

9. Germany pubmed.ncbi.nlm.nih.gov

Association between urban greenspace, tree canopy cover and intentional deaths: An exploratory geospatial analysis. [2023]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Beneficial Use Impairments, Degradation of Aesthetics, and Human Health: A Review. [2022]