The Center for Health and Nature is primarily a research institution, drawing on the distinguished expertise of Houston Methodist Hospital and Texas A&M. Faculty Fellows hail from Houston Methodist Hospital, various departments at Texas A&M, and national and international institutions. CHN’s research is broad in scope but we continue to refine our priorities, guided by our Research and Implementation Committee.
Featured Research Projects
Influences of Outdoor Experiences During Childhood on Time Spent in Nature as an Adult.
Purpose and design: Time spent in nature provides myriad physical and mental health benefits for both adults and children. Despite these benefits, most people spend too little time in nature to realize the maximal effect. Different types of childhood experiences may have differential influence on adult time in nature. This study assessed the influences of different kinds of childhood outdoor experiences on time spent in nature as an adult.
Key findings: Wild childhood nature experiences (e.g., camping, hiking, and fishing) that include skill building, that are immersive and engaging, and that involve opportunity for social interaction may translate better into adult nature activities.
Impact: This study developed a valid and reliable instrument measuring both wild and domesticated childhood experiences in nature. There is a need to further advocate for supplementing domesticated experiences with programs to introduce wild childhood experiences. Promoting time in nature as an adult could be more successful if wild childhood experiences in nature are also coupled with a family-based structure.
Publication: Kellstedt DK, Suess CS, Maddock JE. (2024). Influences of Outdoor Experiences During Childhood on Time Spent in Nature as an Adult. American Journal of Preventive Medicine Focus.
Physical Activity in Natural Settings: An Opportunity for Lifestyle Medicine.
Purpose and design: Physical activity is a well-known behavior for promoting health and preventing a variety of chronic diseases. Despite widespread knowledge of the benefits of physical activity, most Americans do not engage in sufficient physical activity. This review assesses the current evidence around physical activity in natural settings (PANS), strategies for promoting PANS including health professional engagement, and current gaps in the research literature.
Key findings: The review found PANS is a potentially powerful way to promote two important health behaviors simultaneously.
Impact: Health professionals can integrate PANS promotion into clinical practice, such as through the therapeutic approach to “prescribe” nature contact to patients, known as “NatureRx” or “ParkRx.” Health professionals can also promote PANS by engaging in this behavior themselves, which in turn engages in community efforts to promote outdoor spaces. This also presents the opportunity for health professionals to direct health funds toward the creation and maintenance of parks and greenspaces.
Publication: Maddock JE, Frumkin H. (2024). Physical Activity in Natural Settings: An Opportunity for Lifestyle Medicine. American Journal of Lifestyle Medicine.
Development and Validation of Self-Efficacy and Intention Measures for Spending Time in Nature.
Purpose and design: Attitudes are a strong predictor of health behaviors, but valid and reliable measurement tools regarding attitudes toward spending time in nature have been lacking until now. This study took a sequential procedure to develop and validate a reliable survey that can measure these attitudes.
Key findings: The study resulted in a reliable and valid scale to measure attitudes towards spending time in nature.
Impact: Health and nature researchers can now apply this attitude scale as a reliable and consistent measurement tool. It will inform more effective and personalized interventions to increase time spent in nature, helping to improve the efficacy of nature-based interventions from the design phase.
Publication: Maddock, JE, Suess, C, Bratman, GN, Smock, C., Kellstedt, D, Gustat, J, … & Kaczynski, AT (2022). Development and validation of self-efficacy and intention measures for spending time in nature. BMC Psychology, 10(1), 1-11.
Effects of virtual reality v. biophilic environments on pain and distress in oncology patients: a case- crossover pilot study.
Purpose and design: To understand if various nature exposures during treatment impacted chemotherapy patients. A case‐crossover study was conducted in a comprehensive cancer infusion center. Thirty-three participants with breast, gynecologic, gastrointestinal, pancreatic, and prostate cancers were studied in three treatment rooms in a random order at different cycles: control, Green Therapy (garden view), and Virtual Reality. Participants’ pain, distress, heart rate, blood pressure, and saliva cortisol were measured before and after infusion in each room.
Key findings: Patients’ heart rate, blood pressure, and self‐reported distress levels were reduced after each nature intervention – garden view or virtual reality. Patients reported the experience as “fun” and “enjoyable” compared to those in the control room. Since participating in this study, about 50% of patients reported spending at least thirty minutes in nature regularly between chemotherapy sessions. Results are not statistically significant due to the study size.
Impact: Exposure to nature via green therapy or virtual reality can reduce cancer patients’ perceived distress and pain, and encourage behavior change between sessions. Hospital administrators and philanthropists can use this information to invest in hospital design and technology to improve the experience of cancer patients.
Publication: Verzwyvelt, LA, McNamara, A, Xu, X, & Stubbins, R. (2021). Effects of virtual reality v. biophilic environments on pain and distress in oncology patients: a case-crossover pilot study. Scientific Reports, 11(1), 1-7.
Effects of trail and greenspace exposure on hospitalizations in a highly populated urban area: retrospective cohort study of the Houston Bayou Greenways 2020 program.
Purpose and design: To examine the health benefits of Houston’s Bayou Greenway trail system. Researchers examined the number of years residents in each zip code had trail access, the number of access points, and percentage of the population in a zip code living within a 10-minute walk of a trail. This data was compared to hospital admissions for health conditions from those zip codes.
Key findings: Residents of Houston zip codes with Bayou Greenway trail access had a significantly lower likelihood of being admitted to the hospital for heart disease, heart attack, and obesity related conditions (71% to 93%) than neighborhoods without access.
Impact: These findings demonstrate that trail access improves health outcomes and reduces overall healthcare costs. It provides the data for policy makers, philanthropists, developers, and community leaders to make informed investments in trail access for healthy communities.
Publication: Simon-Friedt, BR, Pan, AP, Nisar, T, Al-Kindi, S, Nunley, A, Graiff, L, Kash, BA, Maddock, JE, Nasir, K. (2022). Effects of trail and greenspace exposure on hospitalizations in a highly populated urban area: retrospective cohort study of the Houston Bayou Greenways 2020 program. Local Environment, 28 (3), 365-378.
Living in Walkable Neighborhoods Improves Your Cardiovascular Health
Purpose and design: Urban design, including greenspace, parks and other amenities that support walking, are becoming an important and proven determinant of health, especially cardiovascular health. This study assessed whether a more walkable environment is associated with cardiovascular risk factor burden by studying close to one million patients in an urban setting.
Key findings: Those living in very walkable neighborhoods, compared to those living in the least walkable areas, were two times more likely to be in optimal cardiovascular health. Living in urban neighborhoods with walkable access to parks, schools, and shops can improve cardiovascular health.
Impact: Those living in very walkable neighborhoods, compared to those living in the least walkable areas, were two times more likely to be in optimal cardiovascular health. Living in urban neighborhoods with walkable access to parks, schools, and shops can improve cardiovascular health. There is a robust favorable association between neighborhood walkability and cardiovascular health. These findings support investments in walkable neighborhoods as a viable tool for mitigating the growing burden of cardiovascular risk factors
Publication: Makram OM, Nwana N, Nicolas C, Pan AP, Gullapelli R, Bose B, et al. Favorable Neighborhood Walkability is Associated With Lower Burden of CV Risk Factors Among Patients Within An Integrated Health System. Current Problems in Cardiology, 48(6).
Support Our Work
There are many ways to get involved and support our mission. Collaborate on garden projects, sponsor or attend our symposium, or make a contribution to the Center for Health & Nature Collaborative Research Innovation Fund to support research projects that help us understand the connection between nature and health. Contact us for more information.