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Longitudinal access and exposure to green-blue spaces and individual-level mental health and well-being: protocol for a longitudinal, population-wide record-linked natural experiment
  1. Amy Mizen1,
  2. Jiao Song1,
  3. Richard Fry1,
  4. Ashley Akbari1,
  5. Damon Berridge1,
  6. Sarah C Parker1,
  7. Rhodri Johnson1,
  8. Rebecca Lovell2,
  9. Ronan A Lyons1,
  10. Mark Nieuwenhuijsen3,
  11. Gareth Stratton4,
  12. Benedict W Wheeler2,
  13. James White5,
  14. Mathew White2,
  15. Sarah E Rodgers1,6
  1. 1Swansea University Medical School, Swansea University, Swansea, UK
  2. 2European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
  3. 3Instituto de Salud Global de Barcelona.c/ Rosselló, 132, 5º 2ª, Barcelona, Spain
  4. 4Research Centre in Applied Sports, Technology Exercise and Medicine, College of Engineering, Swansea University, Swansea, UK
  5. 5DECIPHer, Centre for Trials Research, Cardiff University, Cardiff, UK
  6. 6Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor Sarah E Rodgers; Sarah.Rodgers{at}


Introduction Studies suggest that access and exposure to green-blue spaces (GBS) have beneficial impacts on mental health. However, the evidence base is limited with respect to longitudinal studies. The main aim of this longitudinal, population-wide, record-linked natural experiment, is to model the daily lived experience by linking GBS accessibility indices, residential GBS exposure and health data; to enable quantification of the impact of GBS on well-being and common mental health disorders, for a national population.

Methods and analysis This research will estimate the impact of neighbourhood GBS access, GBS exposure and visits to GBS on the risk of common mental health conditions and the opportunity for promoting subjective well-being (SWB); both key priorities for public health. We will use a Geographic Information System (GIS) to create quarterly household GBS accessibility indices and GBS exposure using digital map and satellite data for 1.4 million homes in Wales, UK (2008–2018). We will link the GBS accessibility indices and GBS exposures to individual-level mental health outcomes for 1.7 million people with general practitioner (GP) data and data from the National Survey for Wales (n=~12 000) on well-being in the Secure Anonymised Information Linkage (SAIL) Databank. We will examine if these associations are modified by multiple sociophysical variables, migration and socioeconomic disadvantage. Subgroup analyses will examine associations by different types of GBS. This longitudinal study will be augmented by cross-sectional research using survey data on self-reported visits to GBS and SWB.

Ethics and dissemination All data will be anonymised and linked within the privacy protecting SAIL Databank. We will be using anonymised data and therefore we are exempt from National Research Ethics Committee (NREC). An Information Governance Review Panel (IGRP) application (Project ID: 0562) to link these data has been approved.

The research programme will be undertaken in close collaboration with public/patient involvement groups. A multistrategy programme of dissemination is planned with the academic community, policy-makers, practitioners and the public.

  • wellbeing
  • environmental exposure
  • geographic information systems
  • routine linked data
  • longitudinal
  • mental health

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  • AM and JS contributed equally.

  • Contributors AM and JS contributed equally to writing this paper. This paper was based on a grant proposal developed by SER, RF, AA, DB, RJ, BWW, RL, RAL, MN, GS, JW and MW. This paper was written based on a draft manuscript written by RF based on the grant proposal. Specifically, the Introduction and discussion were written by AM. JS wrote the analysis plan and developed the conceptual model. The methods section was written by AM and JS. All the coauthors made substantial contributions to the writing of the methods section and editing of the whole paper. All authors then read the final version and approved it for submission and publication.

  • Funding This project was funded by the NIHR PHR (project number 16/07/07). This work was supported by Health Data Research UK (NIWA1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, National Institute for Health Research (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome. RF is supported by the National Centre for Population Health and Wellbeing Research (NCPHWR).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

  • Patient consent for publication Not required.