Open research questions in Urban Green Space and Health

What the literature leaves open

• children’s potential cognition, comprehension and expression, a “motherese” style of questioning was used for items on PANAS, such as “upset” and “alert.”

  A multidimensional exploration of the immediate physiological and psychological restorativeness of nature education for children in Giant Panda National Park · 2026 · DOI

• Thereby filling a gap in literature focused on cities in the Global South with unique demograph- ic and environmental pressures, the methodological approach applied here is readily transferable to oth- er cities, especially in the Global South, facing simi- lar challenges of rapid urbanization and green space provision.

  Geospatial analysis of urban green space enjoyment in Mashhad metropolis based on Multi-Criterion Spatial Decision Support System (MC-SDSS) · 2026 · DOI

• While this study provides novel neurophysiological insights into urban scaling, several limitations must be acknowledged to contextualize the findings: Journal of Architectural and Planning Research 39:4 (17-38, 2026) 33 (1) Exposure Duration. The use of a 10-second "Rapid Spatial Assessment" protocol focused exclusively on immediate, instinctive perception. While this effectively captured the "first impression" mechanism critical for pedestrian navigation, it does not account for long-term physiological adaptation or "dwelling" experiences (e.g., sitting on a bench for 30 minutes). This limitation is consistent with Stamps’ findings that initial environmental judgments stabilize within seconds (Stamps, 2010). Future studies should employ longitudinal designs to examine how these stress responses evolve over time. (2) Ecological Validity and Generalizability of the Simplified VR Environment. To isolate the geometric variable of L/H ratio and maximise internal validity, the virtual plazas were rendered as abstract enclosures with uniform, untextured boundary walls and standardised lighting. While this approach is well-established in controlled neuro-architectural research (Banaei et al., 2017; Higuera-Trujillo et al., 2021), it introduces several important constraints on the generalisability of the recommended ratios to real-world plazas. First, the "building height" in our simulation represents a uniform, unbroken wall surface. Real facades are typically articulated with windows, recesses, balconies, podium setbacks, and varying materials, all of which alter the perceived visual weight and enclosure of a boundary (Stamps, 2005). Facade permeability in particular — the degree to which a boundary feels visually porous rather than solid — has been shown to modulate enclosure perception independently of geometric height (Stamps, 2005). Buildings with highly transparent ground-floor facades or articulated upper-floor setbacks may effectively reduce the perceived height, implying that the recommended L/H thresholds could be somewhat relaxed in such contexts. Second, the simulated environments contained no vegetation, street furniture, human activity, or ground-level programming. In real plazas, trees and planting are known to provide intermediate-scale visual anchors that partially substitute for architectural enclosure, potentially reducing spatial stress even at L/H ratios that our model identifies as suboptimal (S. Kaplan, 1995; Ulrich, 1984). Similarly, active ground-floor uses (cafés, retail, pedestrian movement) provide social stimuli that may buffer the agoraphobic response to oversized open spaces (Gehl, 2011; Whyte, 1980). This suggests that the recommended ratio of L/H ≈ 1.9 for high-rise contexts could be partially offset by soft-landscape and programming interventions — a direction already proposed in Section 4.3.2 as the "Visual Layering" strategy.

  Building Height Modulates Optimal Plaza Scale: A Virtual Reality and Psychophysiological Study on Spatial Perception in High-Density Contexts · 2026 · DOI

• for • Design Exploration: Based on the above theories, we designed and implemented a prototype of an interactive ecological intervention system combining software and hardware. Through features like "remote network 11 EAI Endorsed Transactions on Pervasive Health and Technology | Volume 11 | 2025 | C. Zhai et al. interaction," we to seamlessly integrate nature conservation into digital home life. successfully explored how 2.People's Government of Jiangdong Town, No. 1 Fuqian Street, Jiangdong Town, Chaoan District, Chaozhou City, Guangdong Province, China • Preliminary validation: User research and model analysis have preliminarily confirmed that the system demonstrates excellent perceptual usability and sustained engagement mechanisms, validating the potential effectiveness of the intervention pathway: "technology-driven-psychological satisfaction-natural connection". 7.2 Contributions and Prospects The core value of this study lies in its methodological and design paradigm innovation. We demonstrate that digital technology should not merely serve as a barrier isolating children from nature, but can instead become a bridge through well-designed approaches (such as IoT integration and gamification). This work provides a low-cost, scalable proactive prevention design model for the field of Digital Health. While long-term health benefits still require rigorous validation at the medical level, this study confirms the logical and experiential validity of this "digital-physical hybrid intervention" model, paving the way for future exploration in smart education and family health.

  Active Prevention of Nature-Deficit Disorder in Urban Children: An IoT-Based Interactive Ecological Intervention System Design · 2026 · DOI

• Plant-based therapy is recommended as a practical, low-cost, and sustainable intervention for reducing stress among healthcare workers, with evidence showing its strongest effect on stress management and moderate influence on psychological well-being. Future research should expand the scope by including additional variables such as job satisfaction, coping strategies, burnout levels, and workplace environmental conditions to better explain psychological outcomes. It is also recommended to increase the sample size and include participants from different professions to strengthen generalizability. Extending the intervention period to 8–12 weeks and enhancing plant interaction through increased frequency of care, variety of plant types, and participant selection may further improve therapeutic effects. To enhance overall psychological well-being, plant-based therapy may be combined with other interventions such as mindfulness practices, physical activity programs, and peer support systems. Future studies should also include follow-up assessments to determine long-term effects and incorporate physiological measures of stress such as cortisol levels for more objective evaluation. The use of more specific and validated instruments like the Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), or Psychological Well-Being Scale (PWBS) is likewise recommended for more precise measurement. Finally, healthcare institutions are encouraged to adopt structured plant-based wellness programs with continuous monitoring, feedback mechanisms, and consideration of workplace environmental factors such as lighting and space design to maximize effectiveness and sustainability.

  The Effect of Plant-Based Therapy on Psychological Well-Being and Stress among Health Care Workers in Pasay City · 2026 · DOI

• Future research should consider using finer spatial units, such as city-level or metropolitan statistical area (MSA) data, to further validate these findings (Glaeser & Kahn, 2004).

  Does vertical urban development improve or worsen public health? Evidence from skyscraper concentration across U.S. States · 2026 · DOI

• One of the key strengths of this study is its innovative use of skyscraper count as a proxy for urban intensity, which is supported by both urban economic theory and empirical studies (Ahlfeldt and Barr, 2022). The analysis is robust, incorporating multiple control variables, such as smoking prevalence, population density, and air quality indicators (NO2 and PM2.5), to ensure that the findings are not confounded by other factors (Pope et al., 2011; Ritchie and Roser, 2021). By linking urban economics with public health, the study provides a comprehensive framework for understanding how spatial and behavioral factors influence health outcomes in cities. However, the observational design and reliance on state-level data present limitations. The use of state-level data introduces potential risks of ecological fallacy and geographic exposure misclassification, as state-level relationships may not hold at the individual level. Additionally, the skyscraper variable is time- invariant, which reduces its explanatory power in dynamic models (Ahlfeldt & Barr, 2021; Ahlfeldt and Barr, 2022). While robustness checks provide consistency, future research should consider finer spatial units to improve the generalizability of these findings.

  Does vertical urban development improve or worsen public health? Evidence from skyscraper concentration across U.S. States · 2026 · DOI

• Translating complex spatial analysis into tangible urban policy is a significant challenge in addressing the health and environmental issues in the Global South. The research findings carry direct implications for integrated UGI, climate adaptation, and public health policy for decision makers. First, urban forests and UGI should be systematically incorporated into maternal and child health resilience strategies, particularly in areas identified as heat- and health-vulnerable through spatial clustering. Greening initiatives such as the expansion of urban forests, park systems, and vegetated public spaces should be prioritized as part of comprehensive climate-health preventive planning, especially in environmentally deprived and heat-stressed districts. Second, geographic hotspots of poor birth outcomes, such as those observed in Dharwad, Belgaum, and Koppal, warrant targeted, intersectoral interventions that combine ecological upgrading with strengthened maternal healthcare services, to simultaneously address climatic, structural, and clinical determinants of health. Third, spatially informed, climate-integrated planning frameworks must become central to urban governance in the Global South. By adopting the spatial analysis model developed here, environmental and health agencies can more effectively identify climate-health vulnerability zones, prioritize adaptive resource allocation, and tailor interventions to local bioclimatic and social conditions. Additionally, the integration of satellite-derived environmental indicators into health surveillance systems could significantly enhance monitoring and early warning capacities. This would enable more dynamic, climate-sensitive responses to emerging environmental health risks such as heat exposure, air pollution, and pollution-related birth outcomes. Finally, equity in the spatial distribution of green infrastructure must be embedded in urban development policies. Reducing disparities in green cover across sub-districts is critical to ensuring that the co-benefits of climate adaptation and public health promotion are equitably shared across all population groups, particularly those currently underserved or socio-environmentally marginalized. Subramanian et al.

  Linking urban green infrastructure and maternal and child health using spatial autocorrelation analysis of perinatal outcomes in India · 2026 · DOI

• The research findings offer robust empirical evidence in support of the hypothesis that urban forests and broader UGI systems significantly influence MCH outcomes in the context of a rapidly urbanizing and climate-vulnerable Global South region. While these results are promising, the study has several limitations that must be acknowledged upfront. As a cross-sectional analysis, it cannot support causal inference. The reliance on NDVI as a proxy for greenness does not account for access or quality of green spaces, which may vary across regions. Additionally, potential measurement bias and reporting inconsistencies in sub-district-level health data may influence the accuracy of stillbirth rates. The analysis is also constrained by omitted variables such as household income, healthcare quality, and air pollution exposure, all of which may act as confounding fac- tors. Finally, the use of a linear model may oversimplify complex environmental-health interactions, potentially missing threshold effects or non-linear relationships. These lim- itations point to the need for future research incorporating longitudinal datasets, non- linear modelling techniques, and additional indicators such as income, air pollution, and healthcare quality to better capture the multifaceted UGI–MCH relationships.

  Linking urban green infrastructure and maternal and child health using spatial autocorrelation analysis of perinatal outcomes in India · 2026 · DOI

• The current methodology involves only a small number of researchers and educators in Northeast Portugal; expansion to larger samples with systematic controls for researcher bias, educator experience levels, and pedagogical approach variations is necessary to establish reliable comparison models between researcher and educator perceptions.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• No empirical relationship exists between ECEC physical environment quality scores and measurable child outcomes; future studies must correlate environment quality ratings with children's play, cognitive development, motor skills, social-emotional competence, well-being, and engagement using standardized observational and developmental assessment scales.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• The study is geographically limited to Northeast Portugal; generalizability across rural vs. urban Portuguese contexts and minority/majority world countries with different socio-economic and cultural backgrounds remains unvalidated, requiring multi-regional comparative studies.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• Inter-rater reliability of researcher assessments has not been established; future studies must distribute multiple peer researchers across different ECEC institutions to measure consistency and reduce subjectivity in objective environmental quality evaluation.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• Educators' quantitative ECEC physical environment quality scores lack complementary qualitative data on actual activity types, educator-child interactions indoors and outdoors, and narrative perspectives on spatial design utilization; mixed-method triangulation combining quantitative ratings with qualitative activity observation is needed.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• The relationship between educators' years of experience, pedagogical approaches (adult-led vs. child-led), personal beliefs, work experience, and cultural background with their quantitative assessments on ECEC physical environment quality criteria remains unexplored; interviews investigating these moderating variables are needed.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• Educators' assessments of ECEC physical environment quality show bias from familiarity with their own work environments; future studies must have educators assess institutions different from their own to determine whether perception differences with researchers persist or diminish under conditions of institutional unfamiliarity.

  The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · 2026 · DOI

• Yet, despite limited access to traditional mental health services in many US communities, there remains limited research that jointly considers the role of nonclinical interventions such as park availability and neighborhood walkability.

  More Parks Are Linked to Lower Tract-Level Mental Distress in Less-Walkable Neighborhoods: A South Carolina Analysis · 2025 · DOI

• Based on the analysis of the studied selected aspects, recommendations were formulated for strengthening the interconnectivity of the green infrastructure system at an urban scale and implementation of new green infrastructure elements and in the intensively built-up districts where the number and size of green areas are insufficient.

  Analysis of green infrastructure and nature-based solutions in Warsaw – selected aspects for planning urban space · 2022 · DOI

• case studies; (2) early work employed qualitative methods but quantitative analyses have become more common; (3) little attention has been paid to the influence of greening characteristics/functions and non-greening factors on gentrification; (4) the mechanisms through which greening leads to gentrification are not well understood, particularly on the demand side; and (5) despite being the main concern of green gentrification, displacement has not been well-documented.

  How well do we know green gentrification? A systematic review of the methods · 2022 · DOI

• However, no conceptual frameworks to date have detailed the effect of urban environments on young people's mental health, and few studies have considered the growing role of digital and social media in this relationship, leading to calls for the development of holistic approaches to describe this relationship.

  How Do Urban Environments Affect Young People’s Mental Health? A Novel Conceptual Framework to Bridge Public Health, Planning, and Neurourbanism · 2021 · DOI

• Although a substantial literature has amassed documenting the overall positive outcomes associated with therapeutic gardening and horticulture for persons with dementia, little is known about the specific aspects of the gardening process that engender these benefits, and how and why they are important.

  Digging into the experiences of therapeutic gardening for people with dementia: An interpretative phenomenological analysis · 2019 · DOI

• Recent research applies SOP in working landscapes—however, these studies encounter “troubles” that include measurement challenges and mixed results in predicting statistical relationships with conservation outcome variables.

  Trouble with Sense of Place in Working Landscapes · 2019 · DOI

• While local-area greenspace is associated with reduced symptoms of mental distress and greater life satisfaction, most previous research has measured the amount of local-area greenspace within administrative boundaries, and found mixed results for associations between greenspace and multidimensional mental wellbeing.

  A spatial analysis of proximate greenspace and mental wellbeing in London · 2019 · DOI

• To date, little is known about the extent to which the creation of new municipal green spaces over an entire city addresses social or racial inequalities in the distribution of environmental amenities - or whether such an agenda creates new socio-spatial inequities through processes of green gentrification.

  Assessing green gentrification in historically disenfranchised neighborhoods: a longitudinal and spatial analysis of Barcelona · 2017 · DOI

• Our findings demonstrate that not only will the distances to green spaces vary according to the methodologies adopted but that any study that aims to investigate relationships with attributes of the nearest green space should acknowledge that matches may vary widely according to the techniques used.

  Investigating the Implications of Using Alternative GIS-Based Techniques to Measure Accessibility to Green Space · 2012 · DOI

Most-cited papers in Urban Green Space and Health

• Nature and Health · Annual Review of Public Health · 2014 · 3,056 citations
• Green Roofs as Urban Ecosystems: Ecological Structures, Functions, and Services · BioScience · 2007 · 1,007 citations
• Nature contact, nature connectedness and associations with health, wellbeing and pro-environmental behaviours · Journal of Environmental Psychology · 2020 · 748 citations
• Urban planning and quality of life: A review of pathways linking the built environment to subjective well-being · Cities · 2021 · 730 citations
• Biodiversity and the Feel-Good Factor: Understanding Associations between Self-Reported Human Well-being and Species Richness · BioScience · 2012 · 666 citations
• Association of Park Size, Distance, and Features With Physical Activity in Neighborhood Parks · American Journal of Public Health · 2008 · 594 citations
• A Difference-in-Differences Analysis of Health, Safety, and Greening Vacant Urban Space · American Journal of Epidemiology · 2011 · 494 citations
• Street Trees and Equity: Evaluating the Spatial Distribution of an Urban Amenity · Environment and Planning A Economy and Space · 2009 · 432 citations
• Assessing green gentrification in historically disenfranchised neighborhoods: a longitudinal and spatial analysis of Barcelona · Urban Geography · 2017 · 419 citations
• The Health Benefits of Urban Nature: How Much Do We Need? · BioScience · 2015 · 395 citations

Most recent work

• A Systematic Literature Review on Factors and Outcomes of Park Perceived Accessibility · Journal of Planning Literature · 2026
• The Affective Economy of Toxic Atmospheres: Sensory Governance, Ecological Intelligence, and the Performative Politics of Urban Mosquito Management · Annals of the American Association of Geographers · 2026
• Making Participation Tangible: A Methodological Reflection on the Potentials and Limitations of Immersive Virtual Reality, Electrodermal Activity Measurement, and Qualitative Inquiry in the Analysis of Urban Fear Spaces · ISPRS International Journal of Geo-Information · 2026
• Achieving Equitable Distribution of Urban Park Green Spaces: A Case Study of Zibo City, China · Sustainability · 2026
• Reconnecting Seniors with Blue Spaces: A Technology-Mediated Immersive Approach · 2026
• Harnessing our knowledge of the relationship between experience in greenspace, nature connectedness and pro-environmental behaviour: a conceptual framework for healthy cities · Cities & Health · 2026
• Uncovering the structural influence of urban park landscapes on psychological restoration via graph learning · Scientific Reports · 2026
• Linking urban green infrastructure and maternal and child health using spatial autocorrelation analysis of perinatal outcomes in India · Discover Sustainability · 2026
• The quality of the physical environment of Early Childhood Care and Education Centers in the Northeast region of Portugal: a comparison between researchers’ and educators’ assessments · Learning Environments Research · 2026
• Comparing physiological emotional responses to traditional hutongs and modern streets in Beijing through EEG and an interpretable machine learning approach · Humanities and Social Sciences Communications · 2026

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