Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Combined with Additional Interventions
Summary of CPSTF Finding
The Community Preventive Services Task Force (CPSTF) recommends park, trail, and greenway infrastructure interventions when combined with additional interventions to increase physical activity. Evidence from the systematic review shows these interventions increase the number of people who engage in moderate-to-vigorous physical activity in the park, trail, or greenway. Studies also show increases in the number of people who use the park, trail, or greenway.
There were no economic studies that evaluated park, trail, and greenway infrastructure interventions when combined with additional interventions. However, CPSTF finds the economic benefits exceed the cost for park, trail, and greenway infrastructure interventions when implemented alone.
CPSTF finds insufficient evidence for park, trail, and greenway infrastructure interventions when implemented alone.
Intervention
- Parks designated public areas that often combine greenery with paths, facilities for physical activity and recreation, and places for relaxation and social interaction
- Trails and Greenways routes for walking, hiking, or cycling in urban, suburban, or rural areas (e.g., “rails to trails” conversion projects). These may involve street conversions that provide opportunities for walking and cycling (most often in urban areas).
Additional interventions include the following:
- Community engagement to ensure community participation in intervention planning
- Public awareness activities (e.g., banners, flyers, promotional campaigns, event days)
- Programs that offer structured opportunities for physical activity and social interaction (e.g., walking groups, exercise classes, organized sports)
- Access enhancements including transportation connections, street crossings, and expanded hours of operation
CPSTF Finding and Rationale Statement
Promotional Materials
- CPSTF Recommends Park, Trail, and Greenway Infrastructure Interventions to Increase Physical Activity
- Economic Review Highlights Costs and Benefits of Park, Trail, and Greenway Infrastructure Interventions
One Pager
Graphic for Social Media
Please visit our social media messages and graphics page for full sized images and suggested social media messages.
Audio Clip
We are affected by the world around us, and evidence shows that combined approaches to enhance the built environment can increase physical activity. Drs. Shiriki Kumanyika and David Hopkins and Mr. Chris Kochtitzky talk with CDC’s Dr. John Anderton about the systematic review evidence and how the CPSTF recommendation for combined built environment approaches can be implemented in communities.
Listen to the audio clip (6:53) [MP3 – 9 MB]
Read the audio transcript [PDF – 139 KB]
Recorded June, 2018
About The Systematic Review
- Studies included in a broader systematic review published in 2019 (Hunter et al., 14 studies, search period through August 2016)
- Studies identified in an update search (7 studies, search period August 2016 March 2019)
The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity and the built environment.
Summary of Results
The systematic review included 21 studies that evaluated infrastructure interventions combined with additional interventions.
- The number of people engaging in moderate-to-vigorous physical activity increased by 17% (7 studies).
- The number of people using the park, trail, or greenway increased by 18.3% (9 studies).
Across all 21 studies, changes in physical activity were generally favorable for the following outcomes:
- Moderate-to-vigorous physical activity in the park, trail, or greenway (11 studies)
- Total physical activity (4 studies)
- Physical activity meeting recommended levels (4 studies)
- Other measures of physical activity (8 studies)
Summary of Economic Evidence
Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.
A systematic review of economic evidence from the societal perspective shows the economic benefits exceed the cost for park, trail, and greenway infrastructure interventions. The systematic economic review did not find any economic studies of parks, trails, and greenways with additional interventions.
The review included 8 studies (search period through March 2022) that evaluated the infrastructure component of interventions. The review team did not find any studies that evaluated infrastructure plus additional interventions to increase community engagement, public awareness, programming, or access. Monetary values are reported in 2021 U.S. dollars.
- The median one-time capital cost was : $8,679,850 (7 studies).
- The median annual maintenance cost was: $34,570 (7 studies).
- The median annual benefit was: $994,000 (7 studies).
- The cost per disability-adjusted life year (DALY) averted was: $23,254 (1 study).
- The median benefit to cost ratio was: 3.1 (7 studies).
Applicability
Evidence Gaps
- How effective are infrastructure improvements, in combination with additional interventions, in improving the following outcomes?
- Fitness
- Mental health including measures of anxiety, depression, and well-being
- Perceptions of social cohesion and connectiveness
- Injuries
- Quality of life
- How effective are infrastructure improvements in combination with additional interventions when implemented in the following?
- Rural or indigenous settings
- Communities with lower incomes
- Which characteristics of infrastructure improvements are consistently effective in increasing physical activity and use (e.g., signage and other wayfinding aids, park-based trails, indoor or outdoor fitness centers, ball fields and courts, skateparks)?
- Which additional interventions or combinations (e.g., programming, access, promotion of use or community engagement) are most effective at increasing physical activity and use?
- How effective are park, trail, and greenway infrastructure improvements in combination with additional interventions in reducing perceptions of crime, and improving perceptions of safety among members of the community?
- Which interventions or combinations are most effective in addressing barriers to use of parks, trails, and greenways by older adults or in communities with lower incomes?
- What is the cost-effectiveness of park, trail, and greenway interventions?
- What are the economic effects of neighborhood displacement on residents from historically disadvantaged racial and ethnic populations and populations with lower incomes?
Study Characteristics
- Study designs included randomized controlled trials (1 study), other designs with a concurrent comparison group (10 studies), before-after designs with a comparison group (4 studies), time-series (2 studies), and before-after designs without a comparison group (4 studies).
- Studies were conducted in the United States (14 studies), Australia (3 studies), the United Kingdom (2 studies), Canada (1 study), and the Netherlands (1 study).
- Studies were conducted in urban communities (10 studies), urban and suburban settings (5 studies), suburban communities (2 studies), and a rural community (1 study).
- Park infrastructure improvements noted in the studies included new structures (8 studies), renovations to existing structures (8 studies); and the addition of signage (2 studies).
- Greenway and trail infrastructure improvements included new greenways or trails (6 studies), a trail extension (2 studies s), and the addition of signage (1 study).
- Additional interventions noted in the studies included access enhancements (13 studies), community engagement (7 studies), additional programming (4 studies), and promotional activities (4 studies).
Publications
Analytic Framework
Effectiveness Review
- Logic Model – Effectiveness Review [PDF – 153 KB]
- Text Description – Effectiveness Review [PDF – 73 KB]
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.
Economic Review
The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.
Summary Evidence Table
Effectiveness Review
Economic Review
Included Studies
Effectiveness Review
Auchincloss AH, Michael YL, Kuder JF, Shi J, Khan S, et al. Changes in physical activity after building a greenway in a disadvantaged urban community: a natural experiment. Preventive Medicine Reports 2019;15:100941.
Clark S, Bungum T, Shan G, Meacham M, Coker L. The effect of a trail use intervention on urban trail us in Southern Nevada. Preventive Medicine 2014;S17-20.
Cohen DA, Golinelli D, Williamson S, Sehgal A, Marsh T, et al. Effects of park improvements on park use and physical activity-policy and programming implications. American Journal of Preventive Medicine 2009;37(6):475-80.
Cohen DA, Han B, Derose KP, Williamson S, Marsh T, et al. Physical activity in parks, a randomized controlled trial using community engagement. American Journal of Preventive Medicine 2013;45(5):590-97.
Cohen DA, Han B, Isacoff J, Shulaker B, Williamson S. Renovations of neighborhood parks: long-term outcomes on physical activity. Journal of Epidemiology and Community Health 2019;73:214-18.
Cranney L, Phongsavan P, Kariuki M, Stride V, Scott A, et al. Impact of an outdoor gym on park users’ physical activity: a natural experiment. Health & Place 2016;37:26-34.
Cummins S, Clark C, Lewis D, Smith N, Thompson C, et al. The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment. Public Health Research 2018;6(12).
Droomers M, Jongeneel-Grimen B, Kramer D, de Vries Sjer, Kremers S, et al. The impact of intervening in green space in Dutch deprived neighbourhoods on physical activity and general health: results from the quasi-experimental URBAN40 study. Journal of Epidemiology and Community Health 2016;70:147-54.
Evenson KR, Herring AH, Huston SL. Evaluating change in physical activity with the building of a multi-use trail. American Journal of Preventive Medicine 2005;28(2S2):177-85.
Fitzhugh EC, Bassett Jr DR, Evans MF. Urban trails and physical activity: a natural experiment. American Journal of Preventive Medicine 2010;39(3):259-62.
Frank LD, Hong A, Ngo VD. Causal Evaluation of urban greenway retrofit: a longitudinal study on physical activity and sedentary behavior. Preventive Medicine 2019;123;109-16.
Goodman A, Sahlqvist S, Ogilvie D. New walking and cycling routes and increased physical activity: one and 2-year findings from the UK iConnect Study. American Journal of Public Health 2014;104(9):e38-46.
Grunseit A, Crane M, Klarenaar P, Noyes J, Merom D. Closing the loop: short term impacts on physical activity of the completion of a loop trail in Sydney, Australia. International Journal of Behavioral Nutrition and Physical Activity 2019;16(1):1-2.
Gustat J, Rice J, Parker KM, Becker AB, Farley TA. Effect of changes to the neighborhood built environment on physical activity in a low-income African American neighborhood. Preventing Chronic Disease 2012;9:e57.
Harding MC, Bott QD, Jonas CE. The M laekahana Path: an ecological model-based intervention for increasing walking and biking in rural Hawai’i. Journal of Physical Activity and Health 2017;14(12):965-67.
King DK, Litt J, Hale J, Burniece KM, Ross C. ‘The park a tree built’: evaluating how a park development project impacted where people play. Urban Forestry & Urban Greening 2015;14(2):293-9.
New South Wales Department of Health. Walk It: Active Local Parks. The effect of park modifications and promotion on physical activity participation: summary report. Sydney, Australia: New South Wales Department of Health; 2002
Schultz CL, Stanis SA, Sayers SP, Thombs LA, Thomas IM. A longitudinal examination of improved access on park use and physical activity in a low-income and majority African American neighborhood park. Preventive Medicine 2017;95:S95-100.
Slater S, Pugach O, Lin W, Bontu A. If you build it will they come? Does involving community groups in playground renovations affect park utilization and physical activity? Environment and Behavior 2016;48(1):246-65.
Tester J, Baker R. Making the playfields even: evaluating the impact of an environmental intervention on park use and physical activity. Preventive Medicine 2009;48(4):316-20.
Economic Review
Alfranca O, García J, Varela H. Economic valuation of a created wetland fed with treated wastewater located in a peri-urban park in Catalonia, Spain. Water Science and Technology 2011;63.5:891-8.
Atlanta Beltline Inc. Build Grant Program 2020 Repurposing Transportation Infrastructure for Atlanta’s Future. Atlanta (GA): 2020. Available at URL: https://beltline.org/wp-content/uploads/2021/07/BCA.pdf.
Dallat MAT, Soerjomataram I, Hunter RF, et al. Urban greenways have the potential to increase physical activity levels cost-effectively. European Journal of Public Health 2014;24(2):190-5.
Hunter RF, Dallat MAT, Tully MA, et al. Social return on investment analysis of an urban greenway. Cities & Health 2020:1-18.
Lockwood M, Tracy K. Nonmarket economic valuation of an urban recreation park. Journal of Leisure Research 1995;27(2):155-67.
Macháč J, Rybová K, Louda J, et al. How to support planning and implementation of climate adaptation measures in urban areas? Case study of Brno-Nový Lískovec. In: 2018 Smart City Symposium Prague (SCSP) 2018;IEEE:1-6.
Mekala, GD, Jones RN, McDonald DH. Valuing the benefits of creek rehabilitation: building a business case for public investments in urban green infrastructure. Environmental Management 2015;55(6): 1354-65.
Reynaud A, Lanzanova D, Liquete C, et al. Going green? Ex-post valuation of a multipurpose water infrastructure in Northern Italy. Ecosystem Services 2017;27:70-81.
Additional Materials
Implementation Resources
Active Parks! Implementation Guide: Increasing Physical Activity Through Parks, Trails and Greenways
Developed by the National Recreation and Park Association and CDC’s Division of Nutrition, Physical Activity, and Obesity
Actionable Public Health Strategies to Boost Community Well-Being with Safe Routes to Parks
Developed by the Safe Routes Partnership
Rural Health Information Hub, Transportation Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of transportation programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.
Publication
Serrano N, Realmuto L, Graff KA, et al. Healthy community design, anti-displacement, and equity strategies in the USA: a scoping review. J Urban Health (2022).
Search Strategies
Effectiveness Review
The CPSTF recommendation is based on a systematic review of 38 studies (published through July 2020). The review combined 26 studies of park, trail, or greenway interventions identified from a published systematic review (Hunter et al. 2019; search period through August 2016) with 12 studies identified in an updated search that used the same search terms (search period August 2016 to July 2020).
Hunter et al. (2019) included 38 studies in their review. The Community Guide review team assessed each study based on community guide methods and identified 26 eligible studies for this review. The Community Guide updated search for evidence used a search strategy adapted from Hunter et al. 2019.
Databases searched for this review included Medline, PsycINFO, CAB Abstracts, Scopus, Cochrane, Greenfiles, and Agricultural & Environmental Science Dissertations Environmental Science Collection.
Medline
1 Environment Design/
2 Urban Health/
3 Parks, Recreational/
4 Forestry/
5 (urban adj green adj space).ti,ab.
6 green*space.ti,ab.
7 (open adj space).ti,ab.
8 (public adj space).ti,ab.
9 (public adj open adj space).ti,ab.
10 (park not parkin*).ti,ab.
11 (city adj park).ti,ab.
12 (public adj park).ti,ab.
13 (urban adj park).ti,ab.
14 (municipal adj park).ti,ab.
15 (greenway or urban greenway).ti,ab.
16 (urban adj regen*).ti,ab.
17 (trail* or (urban adj trail*)).ti,ab.
18 (urban adj forestry).ti,ab.
19 water sensitive urban design.ti,ab.
20 WSUD.ti,ab.
21 sustainable urban drainage system*.ti,ab.
22 bio?retention basin*.ti,ab.
23 green roof*.ti,ab.
24 roof garden.ti,ab.
25 living roof*.ti,ab.
26 green wall*.ti,ab.
27 living wall*.ti,ab.
28 vertical garden*.ti,ab.
29 street tree*.ti,ab.
30 green corridor*.ti,ab.
31 green screen*.ti,ab.
32 urban green*.ti,ab.
33 urban conservation.ti,ab.
34 urban naturalization.ti,ab.
35 urban rehabilitation.ti,ab.
36 urban agriculture.ti,ab.
37 or/1-36
38 intervention stud*.mp.
39 randomised control* trial.mp.
40 randomized control* trial.mp.
41 comparative stud*.mp.
42 control group.mp.
43 (randomised or randomized or randomly or groups).mp.
44 quasi*experiment*.mp.
45 natural experiment*.mp.
46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.
47 (intervention or interventional or process or program*).mp.
48 (evaluat* or intervention or interventional or treatment).mp.
49 case stud*.mp.
50 retrofit*.mp.
51 or/38-50
52 37 and 51
53 52 not (animals not humans).sh.
54 limit 53 to dt=20200201-20200731
55 limit 54 to english language
56 limit 55 to abstracts
PsycINFO
1 (Environment* adj design).ti,ab.
2 (urban adj health).ti,ab.
3 Parks, Recreational/
4 (urban adj green adj space).ti,ab.
5 green*space.ti,ab. 49
6 (open adj space).ti,ab. 447
7 (public adj space).ti,ab. 784
8 (public adj open adj space).ti,ab.
9 (park not parkin*).ti,ab.
10 (park not parkin*).ti,ab.
11 (city adj park).ti,ab.
12 (public adj park).ti,ab.
13 (urban adj park).ti,ab.
14 (municipal adj park).ti,ab.
15 (greenway or urban greenway).ti,ab.
16 (urban adj regen*).ti,ab.
17 (trail* or (urban adj trail*)).ti,ab.
18 (urban adj5 forestry).ti,ab.
19 (green adj5 roof*).ti,ab.
20 (roof adj5 garden).ti,ab.
21 (living adj5 roof*).ti,ab.
22 green wall*.ti,ab.
23 (living adj5 wall*).ti,ab.
24 street tree*.ti,ab.
25 green corridor*.ti,ab.
26 green screen*.ti,ab.
27 urban green*.ti,ab.
28 urban conservation.ti,ab.
29 urban rehabilitation.ti,ab.
30 urban agriculture.ti,ab.
31 or/1-30
32 intervention stud*.mp.
33 randomised control* trial.mp.
34 randomized control* trial.mp.
35 comparative stud*.mp.
36 control group.mp.
37 (randomised or randomized or randomly or groups).mp.
38 quasi*experiment*.mp.
39 natural experiment*.mp.
40 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.
41 (intervention or interventional or process or program*).mp.
42 (evaluat* or intervention or interventional or treatment).mp.
43 case stud*.mp.
44 retrofit*.mp.
45 or/32-44
46 31 and 45
47 exp Animals/ not humans.sh.
48 46 not 47
49 limit 48 to up=20200201-20200731
50 limit 49 to (english language and abstracts)
CAB Abstracts
1 (Environment adj design).ti,ab.
2 (Urban adj Health).ti,ab.
3 (recreational adj park*).ti,ab.
4 Forestry/
5 (urban adj green adj space).ti,ab.
6 green*space.ti,ab.
7 (open adj space).ti,ab.
8 (public adj space).ti,ab.
9 (public adj open adj space).ti,ab.
10 (park not parkin*).ti,ab.
11 (city adj park).ti,ab.
12 (public adj park).ti,ab.
13 (urban adj park).ti,ab.
14 (municipal adj park).ti,ab.
15 (greenway or urban greenway).ti,ab.
16 (urban adj regen*).ti,ab.
17 (trail* or (urban adj trail*)).ti,ab.
18 (urban adj forestry).ti,ab.
19 water sensitive urban design.ti,ab.
20 WSUD.ti,ab.
21 sustainable urban drainage system*.ti,ab.
22 bio?retention basin*.ti,ab.
23 green roof*.ti,ab.
24 roof garden.ti,ab.
25 living roof*.ti,ab.
26 green wall*.ti,ab.
27 living wall*.ti,ab.
28 vertical garden*.ti,ab.
29 street tree*.ti,ab.
30 green corridor*.ti,ab.
31 green screen*.ti,ab.
32 urban green*.ti,ab.
33 urban conservation.ti,ab.
34 (urban adj5 naturalization).ti,ab.
35 urban rehabilitation.ti,ab.
36 urban agriculture.ti,ab.
37 or/1-36
38 intervention stud*.mp.
39 randomised control* trial.mp.
40 randomized control* trial.mp.
41 comparative stud*.mp.
42 control group.mp.
43 (randomised or randomized or randomly or groups).mp.
44 quasi*experiment*.mp.
45 natural experiment*.mp.
46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.
47 (intervention or interventional or process or program*).mp.
48 (evaluat* or intervention or interventional or treatment).mp.
49 case stud*.mp.
50 retrofit*.mp.
51 or/38-50
52 37 and 51
53 52 not (animals not humans).sh.
54 (202002* or 202003* or 202004* or 202005* or 202006* or 202007*).ud.
55 53 and 54 762
56 limit 55 to (abstracts and english language)
57 from 56 keep 1-617 617
Scopus
( TITLE-ABS ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio W/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” ) ) AND ( TITLE-ABS-KEY ( “intervention stud*” OR “comparative stud*” OR “case stud*” OR ( clinic* W/1 trial* ) OR ( randomi* W/1 control* ) OR ( randomi* W/2 trial* ) OR ( random* W/1 assign* ) OR ( random* W/1 allocat* ) OR ( control* W/1 clinic* ) OR ( control* W/1 trial ) OR placebo* OR ( quantitat* W/1 stud* ) OR ( control* W/1 stud* ) OR ( randomi* W/1 stud* ) OR ( singl* W/1 blind* ) OR ( singl* W/1 mask* ) OR ( doubl* W/1 blind* ) OR ( doubl* W/1 mask* ) OR ( tripl* W/1 blind* ) OR ( tripl* W/1 mask* ) OR ( trebl* W/1 blind* ) OR ( trebl* W/1 mask* ) ) AND NOT ( SRCTYPE ( b ) OR SRCTYPE ( k ) OR DOCTYPE ( ab ) OR DOCTYPE ( bk ) OR DOCTYPE ( ch ) OR DOCTYPE ( bz ) OR DOCTYPE ( cr ) OR DOCTYPE ( ed ) OR DOCTYPE ( er ) OR DOCTYPE ( le ) OR DOCTYPE ( no ) OR DOCTYPE ( pr ) OR DOCTYPE ( rp ) OR DOCTYPE ( re ) OR DOCTYPE ( sh ) ) ) AND NOT INDEX ( medline ) AND ( LIMIT-TO ( PUBYEAR,2020) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )
Cochrane
#1 (“urban green space”):ti,ab,kw (Word variations have been searched)
#2 (“green*space”):ti,ab,kw (Word variations have been searched)
#3 (“open space”):ti,ab,kw (Word variations have been searched)
#4 (“public space”):ti,ab,kw (Word variations have been searched)
#5 (Park NOT parking):ti,ab,kw (Word variations have been searched)
#6 (“city park”):ti,ab,kw (Word variations have been searched)
#7 (“public park”):ti,ab,kw (Word variations have been searched)
#8 (“urban park”):ti,ab,kw (Word variations have been searched)
#9 (“municipal park”):ti,ab,kw (Word variations have been searched)
#10 (greenway or “urban greenway”):ti,ab,kw (Word variations have been searched)
#11 urban NEXT/5 regen*
#12 (trail):ti,ab,kw (Word variations have been searched)
#13 (“urban forestry”):ti,ab,kw
#14 (“green roof”):ti,ab,kw (Word variations have been searched)
#15 (“urban green*”):ti,ab,kw (Word variations have been searched)
#16 (“urban naturalization”):ti,ab,kw (Word variations have been searched)
#17 “urban rehabilitation” ):ti,ab,kw (Word variations have been searched)
#18 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 with Cochrane Library publication date Between Feb 2020 and Aug 2020
GreenFILES (Ebsco)
S1 TI ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) OR AB ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” “bio retention basin”)
S2 “intervention studies”
S3 “randomized control* trials” or rtc or “randomised control* trials”
S4 comparative stud*
S5 control group
S6 randomised or randomized or randomly or groups
S7 “quasi* experiment*”
S8 “natural experiment*”
S9 (“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)
S10 (intervention OR inteventional OR process OR programs*)
S11 (evaluat* OR intervention OR interventional OR treatment)
12 “case stud*”
S13 retrofit*
S14 S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13
S15 S1 AND S14
S16 S1 AND S14 Limiters – Scholarly (Peer Reviewed) Journals; Publication Date: 20200201-20200731
Agricultural & Environmental Science Dissertations
Environmental Science Collection
(((((ti((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”)) OR ab((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”))) AND peer(yes)) AND PEER(yes)) AND ((ti(“intervention studies”) OR ab(“intervention studies”)) OR (ti(“randomized control* trials” OR rtc OR “randomised control* trials”) OR ab(“randomized control* trials” OR rtc OR “randomised control* trials”)) OR (ti(“comparative stud*”) OR ab(“comparative stud*”)) OR (ti(“control group”) OR ab(“control group”)) OR (ti(randomised OR randomized OR randomly OR groups) OR ab(randomised OR randomized OR randomly OR groups)) OR (ti(“quasi* experiment*”) OR ab(“quasi* experiment*”)) OR (ab(“natural experiment*”) OR ti(“natural experiment*”)) OR (ti((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)) OR ab((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest))) OR (ti((intervention OR interventional OR process OR programs*)) OR ab((intervention OR interventional OR process OR programs*))) OR (ti((evaluat* OR intervention OR interventional OR treatment)) OR ab((evaluat* OR intervention OR interventional OR treatment))) OR (ti(“case stud*”) OR ab(“case stud*”)) OR (ti(retrofit*) OR ab(retrofit*)))) NOT (stype.exact(“Books”) AND la.exact(“ENG”) AND pd(20160801-20200731) AND PEER(yes)))
Economic Review
In March 2022, a research librarian used terms adapted from Hunter et al. (2019) to search the following databases: Medline, CAB Abstracts (OVID), PsycINFO (OVID), Scopus, Cochrane Library, GreenFILE (EBSCO), EconLit (EBSCO), Agricultural & Environmental Science collection (ProQuest), CRD York/NHS EED, CRD York/DARE, NTIS. The search covered the period from database inception through March 2022.
The search was limited to high income countries as defined by the World Bank. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software. The review team also screened reference lists of included studies and consulted subject matter experts about additional studies.
Database: Medline
Date Searched: 03/0
/2022
Results: 1,503
9 Environment Design/ 6962
10 Urban Health/ 18229
11 Parks, Recreational/ 1854
12 Forestry/ 3572
13 (urban adj green adj space*).ti,ab. 482
14 (green adj3 space*).ti,ab. 1905
15 (open adj space*).ti,ab. 1437
16 (public adj space*).ti,ab. 1239
17 (public adj open adj space*).ti,ab. 117
18 (park not parkin*).ti,ab. 18028
19 (city adj park*).ti,ab. 221
20 (public adj park*).ti,ab. 420
21 (urban adj park*).ti,ab. 544
22 (municipal adj park*).ti,ab. 48
23 (greenway* or urban greenway*).ti,ab. 120
24 (urban adj regen*).ti,ab. 82
25 (trail* or (urban adj trail*)).ti,ab. 26075
26 (urban adj forestry).ti,ab. 40
27 “water sensitive urban design*”.ti,ab. 41
28 WSUD.ti,ab. 25
29 sustainable urban drainage system*.ti,ab. 50
30 bio?retention basin*.ti,ab. 13
31 green roof*.ti,ab. 282
32 roof garden*.ti,ab. 10
33 living roof*.ti,ab. 4
34 green wall*.ti,ab. 69
35 living wall*.ti,ab. 21
36 vertical garden*.ti,ab. 9
37 street tree*.ti,ab. 131
38 green corridor*.ti,ab. 35
39 green screen*.ti,ab. 26
40 urban green*.ti,ab. 1028
41 urban conservation.ti,ab. 21
42 urban naturalization.ti,ab. 0
43 urban rehabilitation.ti,ab. 44
44 urban agriculture.ti,ab. 261
45 or/9-44 77610
46 intervention stud*.mp. 23456
47 randomised control* trial.mp. 29090
48 randomized control* trial.mp. 599042
49 comparative stud*.mp. 1969522
50 control group.mp. 460271
51 (randomised or randomized or randomly or groups).mp. 3219361
52 quasi*experiment*.mp. 800
53 natural experiment*.mp. 2910
54 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp. 53527
55 (intervention or interventional or process or program*).mp. 3108226
56 (evaluat* or intervention or interventional or treatment).mp. 8906485
57 case stud*.mp. 122979
58 retrofit*.mp. 1382
59 meta-analysis/ 154469
60 meta-analysis as topic/ 21031
61 (meta analy* or metanaly* or metaanaly*).ti,ab. 228046
62 ((systematic* or evidence*) adj3 (review* or overview*)).ti,ab. 302147
63 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 49723
64 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 69704
65 (search* adj4 literature).ab. 83266
66 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 302967
67 cochrane.jw. 15860
68 ((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab. 3399
69 or/46-68 13153670
70 8 and 45 and 69 5196
71 Economics/ 27433
72 “costs and cost analysis”/ 50443
73 Cost-benefit analysis/ 88661
74 Cost control/ 21641
75 Cost savings/ 12533
76 Cost of illness/ 30453
77 Cost sharing/ 2666
78 “deductibles and coinsurance”/ 1824
79 Medical savings accounts/ 544
80 Health care costs/ 42972
81 Direct service costs/ 1217
82 Drug costs/ 17092
83 Employer health costs/ 1097
84 Hospital costs/ 11784
85 Health expenditures/ 22649
86 Capital expenditures/ 2000
87 Value of life/ 5782
88 exp economics, hospital/ 25516
89 exp economics, medical/ 14329
90 Economics, nursing/ 4013
91 Economics, pharmaceutical/ 3056
92 exp “fees and charges”/ 31074
93 exp budgets/ 13978
94 (low adj cost).mp. 72930
95 (high adj cost).mp. 17308
96 (health?care adj cost*).mp. 14257
97 (fiscal or funding or financial or finance).tw. 173357
98 (cost adj estimate$).mp. 2548
99 (cost adj variable).mp. 48
100 (unit adj cost$).mp. 2857
101 (economic adj2 model*).mp. 14378
102 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).ti,ab,kf,kw. 37655
103 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs).ti,kf,kw. 80989
104 (life year or life years or qaly* or cost-benefit analys?s or cost-effectiveness analys?s).ab,kf,kw. 35213
105 (cost or economic*).ti,kf,kw. and (costs or cost-effectiveness or markov).ab. 65599
106 or/71-105 615001
107 70 and 106 272
108 107 not (animals not humans).sh. 267
109 limit 108 to english language 264
110 45 and 69 and 106 1614
111 110 not (animals not humans).sh. 1562
112 limit 111 to english language 1503
Database: CAB Abstracts
Date Searched: 03/08/2022
Results: 1817
1 (Environment adj design).ti,ab. 121
2 (Urban adj Health).ti,ab. 782
3 (recreational adj park*).ti,ab. 164
4 Forestry/ 27201
5 (urban adj green adj space).ti,ab. 810
6 green*space.ti,ab. 483
7 (open adj space).ti,ab. 1865
8 (public adj space).ti,ab. 494
9 (public adj open adj space).ti,ab. 139
10 (park not parkin*).ti,ab. 49022
11 (city adj park).ti,ab. 273
12 (public adj park).ti,ab. 296
13 (urban adj park).ti,ab. 872
14 (municipal adj park).ti,ab. 142
15 (greenway or urban greenway).ti,ab. 173
16 (urban adj regen*).ti,ab. 313
17 (trail* or (urban adj trail*)).ti,ab. 15572
18 (urban adj forestry).ti,ab. 865
19 water sensitive urban design.ti,ab. 131
20 WSUD.ti,ab. 74
21 sustainable urban drainage system*.ti,ab. 139
22 bio?retention basin*.ti,ab. 37
23 green roof*.ti,ab. 1405
24 roof garden.ti,ab. 53
25 living roof*.ti,ab. 17
26 green wall*.ti,ab. 212
27 living wall*.ti,ab. 72
28 vertical garden*.ti,ab. 74
29 street tree*.ti,ab. 1219
30 green corridor*.ti,ab. 155
31 green screen*.ti,ab. 12
32 urban green*.ti,ab. 3662
33 urban conservation.ti,ab. 98
34 (urban adj5 naturalization).ti,ab. 9
35 urban rehabilitation.ti,ab. 17
36 urban agriculture.ti,ab. 2230
37 or/1-36 102877
38 intervention stud*.mp. 6620
39 randomised control* trial.mp. 2973
40 randomized control* trial.mp. 11039
41 comparative stud*.mp. 43439
42 control group.mp. 139626
43 (randomised or randomized or randomly or groups).mp. 1039290
44 quasi*experiment*.mp. 122
45 natural experiment*.mp. 1211
46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp. 9095
47 (intervention or interventional or process or program*).mp. 1125627
48 (evaluat* or intervention or interventional or treatment).mp. 2720608
49 case stud*.mp. 162180
50 retrofit*.mp. 1575
51 meta-analysis/ 22899
52 (meta analy* or metanaly* or metaanaly*).ti,ab. 27908
53 ((systematic* or evidence*) adj3 (review* or overview*)).ti,ab. 37033
54 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 17931
55 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 6457
56 (search* adj4 literature).ab. 9113
57 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 27306
58 cochrane.jw. 420
59 ((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab. 425
60 or/38-59 4140056
61 37 and 60 38248
62 Economics/ 56871
63 Cost-benefit analysis/ 26216
64 Cost control/ 500
65 Health care costs/ 6911
66 budgets/ 1295
67 (low adj cost).mp. 40691
68 (high adj cost).mp. 9540
69 (health?care adj cost*).mp. 953
70 (fiscal or funding or financial or finance).tw. 103723
71 (cost adj estimate$).mp. 1226
72 (cost adj variable).mp. 62
73 (unit adj cost$).mp. 2264
74 (economic adj2 model*).mp. 6414
75 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).ti,ab. 25246
76 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs).ti. 20564
77 (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s).ab. 8657
78 (cost or economic*).ti. and (costs or cost-effectiveness or markov).ab. 28425
79 or/62-78 280835
80 61 and 79 2567
81 80 not (animals not humans).sh. 2193
82 limit 81 to english language 1817
83 limit 82 to abstracts 1813
Database: PsycINFO
Date Searched: 03/08/2022
Results: 431
1 (Environment adj design).ti,ab. 288
2 (Urban adj Health).ti,ab. 360
3 Parks, Recreational/ 1229
4 (urban adj green adj space).ti,ab. 36
5 green*space.ti,ab. 75
6 (open adj space).ti,ab. 474
7 (public adj space).ti,ab. 885
8 (public adj open adj space).ti,ab. 28
9 (park not parkin*).ti,ab. 4956
10 (city adj park).ti,ab. 29
11 (public adj park).ti,ab. 56
12 (urban adj park).ti,ab. 70
13 (municipal adj park).ti,ab. 5
14 (greenway or urban greenway).ti,ab. 39
15 (urban adj regen*).ti,ab. 88
16 (trail* or (urban adj trail*)).ti,ab. 7699
17 (urban adj forestry).ti,ab. 10
18 green roof*.ti,ab. 5
19 green wall*.ti,ab. 10
20 living wall*.ti,ab. 1
21 vertical garden*.ti,ab. 1
22 street tree*.ti,ab. 14
23 green corridor*.ti,ab. 6
24 green screen*.ti,ab. 11
25 urban green*.ti,ab. 130
26 urban conservation.ti,ab. 5
27 urban rehabilitation.ti,ab. 20
28 urban agriculture.ti,ab. 32
29 or/1-28 15480
30 intervention stud*.mp. 8371
31 randomised control* trial.mp. 4439
32 randomized control* trial.mp. 23146
33 comparative stud*.mp. 16056
34 control group.mp. 76341
35 (randomised or randomized or randomly or groups).mp. 715007
36 quasi*experiment*.mp. 463
37 natural experiment*.mp. 1548
38 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp. 41598
39 (intervention or interventional or process or program*).mp. 1061850
40 (evaluat* or intervention or interventional or treatment).mp. 1394396
41 case stud*.mp. 110546
42 retrofit*.mp. 164
43 meta-analysis/ 5179
44 (meta analy* or metanaly* or metaanaly*).ti,ab. 44177
45 ((systematic* or evidence*) adj3 (review* or overview*)).ti,ab. 59987
46 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 21575
47 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 8802
48 (search* adj4 literature).ab. 12858
49 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 4892322
50 ((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab. 366
51 or/30-50 4931154
52 Economics/ 25250
53 Health care costs/ 10977
54 budgets/ 1322
55 (low adj cost).mp. 5210
56 (high adj cost).mp. 1736
57 (health?care adj cost*).mp. 1763
58 (fiscal or funding or financial or finance).tw. 78868
59 (cost adj estimate$).mp. 408
60 (cost adj variable).mp. 11
61 (unit adj cost$).mp. 362
62 (economic adj2 model*).mp. 2325
63 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).ti,ab. 4947
64 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs).ti. 9030
65 (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s).ab. 4849
66 (cost or economic*).ti. and (costs or cost-effectiveness or markov).ab. 6921
67 or/52-66 129664
68 29 and 51 and 67 469
69 exp Animals/ not humans.sh. 365406
70 68 not 69 441
71 limit 70 to (english language and abstracts) 431
Database: Scopus
Date Searched: 03/08/2022
Results: 2,930
TITLE-ABS(“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio W/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture”) AND TITLE-ABS-KEY ( “intervention stud*” OR “comparative stud*” OR “case stud*” OR ( clinic* W/1 trial* ) OR ( randomi* W/1 control* ) OR ( randomi* W/2 trial* ) OR ( random* W/1 assign* ) OR ( random* W/1 allocat* ) OR ( control* W/1 clinic* ) OR ( control* W/1 trial ) OR placebo* OR ( quantitat* W/1 stud* ) OR ( control* W/1 stud* ) OR ( randomi* W/1 stud* ) OR ( singl* W/1 blind* ) OR ( singl* W/1 mask* ) OR ( doubl* W/1 blind* ) OR ( doubl* W/1 mask* ) OR ( tripl* W/1 blind* ) OR ( tripl* W/1 mask* ) OR ( trebl* W/1 blind* ) OR ( trebl* W/1 mask* ) )) AND (TITLE-ABS(Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR “fees AND charges” OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov)) AND PUBYEAR < 2013 AND ( EXCLUDE ( DOCTYPE,”ch” ) OR EXCLUDE ( DOCTYPE,”cr” ) OR EXCLUDE ( DOCTYPE,”bk” ) OR EXCLUDE ( DOCTYPE,”ed” ) OR EXCLUDE ( DOCTYPE,”no” ) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )
Database: Cochrane
Date Searched: 03/08/2022
Results: 154
1 (“urban green space”):ti,ab,kw 4
#2 (“green*space”):ti,ab,kw 25
#3 (“open space”):ti,ab,kw 13
#4 (“public space”):ti,ab,kw 5
#5 (Park NOT parking):ti,ab,kw 1128
#6 (“city park”):ti,ab,kw 7
#7 (“public park*”):ti,ab,kw 1
#8 (“urban park”):ti,ab,kw 3
#9 (“municipal park”):ti,ab,kw 0
#10 (greenway or “urban greenway”):ti,ab, kw 0
#11 (urban NEXT/5 regen*):ti,ab,kw 3
#12 (trail):ti,ab,kw 4320
#13 (“urban forestry”):ti,ab,kw 0
#14 (“green roof”):ti,ab,kw 0
#15 (“urban green*”):ti,ab,kw 10
#16 (“urban naturalization”):ti,ab,kw 0
#17 (“urban naturalization”):ti,ab,kw 0
#18 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 5481
#19 (“intervention studies” OR “intervention studies”):ti,ab,kw 2013
#20 (“randomised control trial” OR “randomized control trial”):ti,ab,kw 12022
#21 (“comparative study” OR “comparative studies”):ti,ab,kw 45999
#22 “control group”:ti,ab,kw 210803
#23 (randomised OR randomized OR randomly OR groups):ti,ab,kw 1199248
#24 (“quasi experiment”):ti,ab,kw 132
#25 (“natural experiment”):ti,ab,kw 137
#26 (“pre test” or pretest or “pre intervention” or “post intervention” or “post test” or posttest):ti,ab,kw 33627
#27 (intervention OR interventional OR process OR program*):ti,ab,kw 515070
#28 (evaluat* or treatment):ti,ab,kw 1081945
#29 (“case study” OR “case studies”):ti,ab,kw 3729
#30 retrofit*:ti,ab,kw 31
#31 {OR #19 -#30} 1062233
#32 #18 AND #31 3510
#33 costs:ti,ab 31207
#34 cost effective:ti,ab 25659
#35 (qaly* or daly* or “cost per qaly” or “cost per daly” or “cost-benefit analys” or cost-effectiveness):ti,ab 20868
#36 (cost or economic*):ti and (costs or cost-effectiveness or markov):ab 10229
#37 {OR #33-#36} 56080
#38 #32 AND #37 154
Database: GreenFILES (EBSCO)
Date Searched: 03/12/2022
Results: 503
S1 AB ( (“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) ) OR TI ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) )
S2 AB (( intervention stud*OR comparative stud* OR “case stud*” OR (clinic* trial*) OR ( randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR ( control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR ( singl* blind*) OR (singl* mask*) OR ( doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR ( tripl* mask*) OR ( trebl* blind*) OR ( trebl* mask*) ) OR TI ( ( intervention stud* OR comparative stud* OR “case stud*” OR (clinic* trial*) OR ( randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR ( control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR ( singl* blind*) OR (singl* mask*) OR ( doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR ( tripl* mask*) OR ( trebl* blind*) OR ( trebl* mask*) ) Expanders – Apply equivalent subjects
S3 TI ( (Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR (cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov) ) OR AB ( (Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR (cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov) )
S4 S1 AND S2 AND S3 509
S5 S1 AND S2 AND S3 Limiters – Peer Reviewed 503
Database: EconLit (EBSCO)
Date Searched: 03/16/2022
Results: 36
S1 AB ( (“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” …
S2 AB ( ( intervention stud*”OR comparative stud* OR “case stud*” OR (clinic* trial*) OR ( randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR ( control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR ( singl* blind*) OR (singl* mask*) OR ( doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR ( tripl* mask*) OR ( trebl* blind*) OR ( trebl* mask*) ) OR TI ( ( intervention stud*”OR comparative stud* OR “cas …
S1 AND S2 View Results (36)
Database: Agricultural & Environmental Science Collection (ProQuest)
Date Searched: 03/16/2022
Results: 2,991
ti((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio N/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture”)) OR ab((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio N/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture”))
AND
ti(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR ab(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*))
AND
ti((Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov)) OR ab((Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov))
Database: NHS EED
Date Searched: 03/16/2022
Results: 73
(environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):TI OR (environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):SO IN NHSEED
Database: NHS Dare
Date Searched: 03/16/2022
Results: 105
s(environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):TI OR (environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):
Database: NTIS
Date Searched: 03/17/2022
Results: 28
TI ( (environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture )
((Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov))
(TI (intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR ab(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR AB (intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR ab(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)))
Review References
National Recreation and Park Association. Creating equity-based system master plans. Ashburn (VA): 2020. Accessed 12/3/21. Available from URL: www.nrpa.org/publications-research/best-practice-resources/creating-equity-based-system-master-plans/
Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Social determinants of health. Rockville (MD): 2020. Accessed 11/18/21. Available from URL: https://health.gov/healthypeople/objectives-and-data/social-determinants-health
Hunter RF, Cleland C., Cleary, A., Droomers, M., Wheeler, B.W., et al. Environmental, health, wellbeing, social and equity effects of urban green space interventions: a meta-narrative evidence synthesis. Environment International 2019;130:104923.
Trust for Public Land. Toolkit for health, arts, parks, and equity. 2020. Accessed 12/3/21. Available from URL: www.tpl.org/the-toolkit-for-health-arts-parks-and-equity
Considerations for Implementation
The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.
Parks, trails, and greenways are modifiable social determinants of health (Healthy People 2030). Studies and implementation guidance (generally focused on parks) identified in the broader literature described public health and community opportunities to engage in the planning, allocation, and evaluation of these community improvements and advance health equity.
- Equitable park access can be defined as the just and fair quantity, proximity, and connections to quality parks, as well as programs that are safe, inclusive, culturally relevant and welcoming to everyone (Creating Equity-Based System Master Plans 2021). To achieve this, health equity principles can be used to guide park priorities and investments in ways that involve and sustainably benefit communities (Cole et al. 2019).
- Equity-based park guidelines emphasize cross-sector partnerships, community engagement, and strategic data collection and analysis (Creating Equity-based System Master Plans 2020; Toolkit for Equity 2020.
Implementation guidance incorporating equity considerations is available from several organizations:
The National Recreation and Park Association advocates for parks and recreation throughout communities with emphasis on health and wellness, equity, and conservation.
The Trust for Public Land works to create recreational spaces and provides a tool kit for collaborating with communities in the development of parks.
The Safe Routes Partnership provides fact sheets, toolkits, and infographics to help communities implement active travel to parks.
The Rails to Trails Conservancy provides implementation and equity guidance relevant to trails and greenways.
The City Parks Alliance is a network of leaders in urban parks and recreation that shares research and tools, including those promoting health equity and environmental practices.
Healthy Places by Design works to advance community-led action across the country. They provide reports and action guides for local government leaders and organizations as well as information about their Community Action model.
The Prevention Institute has developed a toolkit for community-based organizations, including a park equity toolkit tip sheet and a webinar series.
Park, trail, and greenway interventions may be linked or coordinated with other elements of the built environment including two CPSTF-recommended approaches to increase physical activity:
- Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design (2016)
- Interventions to Increase Active Travel to School (2018)
Greening-without-Gentrification [PDF – 2.6 MB] proposes strategies to prevent or reduce the possible harms of gentrification or displacement of current residents following the establishment of large parks, trails, or greenways.
Crosswalks
Healthy People 2030
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.
- Reduce the proportion of adults who do no physical activity in their free time — PA-01
- Increase the proportion of adults who do enough aerobic physical activity for substantial health benefits — PA-02
- Increase the proportion of adolescents who do enough aerobic physical activity — PA-06
- Increase the proportion of adults who walk or bike to get places — PA-10
- Increase the proportion of adolescents who walk or bike to get places — PA-11
- Increase the proportion of older adults with physical or cognitive health problems who get physical activity — OA-01