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Background: It is unknown whether the quantity or quality of green space is more important for mental wellbeing. We aimed to explore associations between availability of, satisfaction with, and use of green space and mental wellbeing among children aged 4 years in a multi-ethnic sample. Methods: We did a 4-year follow-up assessment of participants in the Born in Bradford longitudinal cohort study, which recruited children and mothers at the city's main maternity unit from 2007 to 2011. The primary outcome was parent-reported mental wellbeing for children aged 4 years, assessed with the standardised Strengths and Difficulties Questionnaire. Total, internalising, and externalising behavioural difficulties and prosocial behaviour scales were computed (with higher scores indicating greater difficulties or more prosocial behaviour). Residential green space around participants' home addresses and distance to major green spaces were computed with the normalised difference vegetation index (NDVI). A subsample of participants completed additional questionnaires on measures of satisfaction with, and use of, local green spaces. Multiple regressions examined associations between green space and children's mental wellbeing and explored moderation by ethnicity (white British vs south Asian) and socioeconomic status. Findings: Between Oct 1, 2012, and June 30, 2015, 2594 mothers attended a follow-up appointment during which they completed a detailed questionnaire assessing the health of their child. 1519 (58%) participants were of south Asian origin, 740 (29%) of white British origin, and 333 (13%) of another ethnicity. Data on ethnicity were missing for two participants. 832 (32%) of 2594 participants completed additional questionnaires. Ethnicity moderated associations between residential green space and mental wellbeing (p<0·05 for total and internalising difficulties). After adjusting for all relevant variables, more green space was associated with fewer internalising behavioural difficulties (mean NDVI 100 m: β −2·35 [95% CI −4·20 to −0·50]; 300 m: −3·15 [−5·18 to −1·13]; 500 m: −2·85 [−4·91 to −0·80]) and with fewer total behavioural difficulties (100 m: −4·27 [−7·65 to −0·90]; 300 m: −5·22 [−8·91 to −1·54]; 500 m: −4·82 [−8·57 to −1·07]) only for south Asian children across all three buffer zones. In the subsample of participants, the effect of NDVI on wellbeing was rendered non-significant after controlling for satisfaction with, and use of, green space. Among south Asian children, satisfaction with green space was significantly associated with fewer total behavioural difficulties across all three buffer zones (β −0·59 [95% CI −1·11 to −0·07]), fewer internalising behavioural difficulties within 100 m (–0·28 [95% CI −0·56 to −0·003]) and 300 m buffer zones (–0·28 [−0·56 to −0·002]), and greater prosocial behaviour across all three buffer zones (0·20 [0·02 to 0·38]); no such associations were observed among white British children. Interpretation: Positive effects of green space on wellbeing differ by ethnicity. Satisfaction with the quality of green space appears to be a more important predictor of wellbeing than does quantity of green space. Public health professionals and urban planners need to focus on both quality and quantity of urban green spaces to promote health, particularly among ethnic minority groups. Funding: European Community's Seventh Framework Programme. ; This work was supported by the European Community's Seventh Framework Programme (FP7/2007–2013; grant number 282996) Positive Effects of Natural Outdoor Environments and the LIFE-CYCLE project. The LIFE-CYCLE project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 733206. This publication reflects only the author's views and the European Commission is not liable for any use that might be made of the information contained therein. RRCM, KEP, and JW are supported by the National Institute for Health Research Collaboration for Leadership in Applied Health and Research Care (CLARHC Yorkshire and Humber). TCY was supported by the, MRC Health eResearch Centre grant MR/K006665/1, and DA-P was supported by a University of York Health Sciences Master Studentship. HR was supported by a White Rose University Consortium Network studentship.

Exposure to natural outdoor environments (NOE) has been shown in population-level studies to reduce anxiety and psychological distress. This study investigated how exposure to one's everyday natural outdoor environments over one week influenced mood among residents of four European cities including Barcelona (Spain), Stoke-on-Trent (United Kingdom), Doetinchem (The Netherlands) and Kaunas (Lithuania). Participants (n = 368) wore a smartphone equipped with software applications to track location and mood (using mobile ecological momentary assessment (EMA) software), for seven consecutive days. We estimated random-effects ordered logistic regression models to examine the association between mood (positive and negative affect), and exposure to green space, represented by two binary variables indicating exposure versus no exposure to NOE using GPS tracking and satellite and aerial imagery, 10 and 30 min prior to participants' completing the EMA. Models were adjusted for home city, day of the week, hour of the day, EMA survey type, residential NOE exposure, and sex, age, education level, mental health status and neighbourhood socioeconomic status. In addition, we tested for heterogeneity of effect by city, sex, age, residential NOE exposure and mental health status. Within 10 min of NOE exposure, compared to non-exposure, we found that overall there was a positive relationship with positive affect (OR: 1.39, 95% CI: 1.06, 1.81) of EMA surveys, and non-significant negative association with negative affect (OR: 0.80, 95% CI: 0.58, 1.10). When stratifying, associations were consistently found for Stoke-on-Trent inhabitants and men, while findings by age group were inconsistent. Weaker and less consistent associations were found for exposure 30 min prior to EMA. Our findings support increasing evidence of psychological and mental health benefits of exposure to natural outdoor environments, especially among urban populations such as those included in our study. ; This study was funded from the European Community's Seventh Framework Programme (FP/2007–2013) under grant agreement No: 282996 (ENV.2011.1.2.3-2). Margarita Triguero-Mas was funded by the Spanish government's Juan de la Cierva training fellowship (FJCI-2017-33842). We owe thanks to Graham Smith for his help in the geocoding process and in the production of exposure measures; Magdalena van den Berg, Tania Martínez-Íñiguez and Tomas Grazulevicius for their help collecting data; Marta Cirach, and Audrius Dedele for their contributions in the geocoding process and in the production of exposure measures; Hanneke Kruize for her initial contributions in the conception of the study and Judith Cirac-Claveras for her contributions in data management.

This study investigated whether residential availability of natural outdoor environments (NOE) was associated with contact with NOE, overall physical activity and physical activity in NOE, in four different European cities using objective measures. A nested cross-sectional study was conducted in Barcelona (Spain); Stoke-on-Trent (United Kingdom); Doetinchem (The Netherlands); and Kaunas (Lithuania). Smartphones were used to collect information on the location and physical activity (overall and NOE) of around 100 residents of each city over seven days. We used Geographic Information Systems (GIS) to determine residential NOE availability (presence/absence of NOE within 300 m buffer from residence), contact with NOE (time spent in NOE), overall PA (total physical activity), NOE PA (total physical activity in NOE). Potential effect modifiers were investigated. Participants spent around 40 min in NOE and 80 min doing overall PA daily, of which 11% was in NOE. Having residential NOE availability was consistently linked with higher NOE contact during weekdays, but not to overall PA. Having residential NOE availability was related to NOE PA, especially for our Barcelona participants, people that lived in a city with low NOE availability. ; This study was funded from the European Community's Seventh Framework Programme (FP/2007–2013) under grant agreement No: 282996 (ENV.2011.1.2.3-2). Margarita Triguero-Mas is funded by a pre-doctoral grant from the Catalan Government (AGAUR FI-DGR-2013)