Nonlinear Relationships among the Natural Environment, Health, and Sociodemographic Characteristics across US Counties

Levi N. Bonnell and Benjamin Littenberg
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Levi N. Bonnell: Division of General Internal Medicine Research, Department of Medicine, University of Vermont College of Medicine, 89 Beaumont Ave S459, Burlington, VT 05405, USA
Benjamin Littenberg: Division of General Internal Medicine Research, Department of Medicine, University of Vermont College of Medicine, 89 Beaumont Ave S459, Burlington, VT 05405, USA

IJERPH, 2022, vol. 19, issue 11, 1-10

Abstract: Background: The aim of this study was to explore the nonlinear relationships between natural amenities and health at the intersection of sociodemographic characteristics among primary care patients with chronic conditions. Methods: We used survey data from 3409 adults across 119 US counties. PROMIS-29 mental and physical health summary scores were the primary outcomes. The natural environment (measured using the County USDA Natural Amenities Scale (NAS)) was the primary predictor. Piecewise spline regression models were used to explore the relationships between NAS and health at the intersection of sociodemographic factors. Results: We identified a nonlinear relationship between NAS and health. Low-income individuals had a negative association with health with each increase in NAS in high-amenity areas only. However, White individuals had a stronger association with health with each increase in NAS in low-amenity areas. Conclusions: In areas with low natural amenities, more amenities are associated with better physical and mental health, but only for advantaged populations. Meanwhile, for disadvantaged populations, an increase in amenities in high-amenity areas is associated with decreases in mental and physical health. Understanding how traditionally advantaged populations utilize the natural environment could provide insight into the mechanisms driving these disparities.

Keywords: environment and public health; environmental epidemiology; mental health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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