Built Environment Interventions Research Articles

Pilot study to evaluate school safety zone built environment interventions

BackgroundSchool safety zones were created in 2017 under the City of Toronto’s Vision Zero Road Safety Plan. This pilot study examined the effect of built environment interventions on driver speeds,...

Leveraging built environment interventions to equitably promote health during and after COVID-19 in Toronto, Canada.

SummaryA key public health response to the COVID-19 pandemic is the mandate to stay home and practice physical distancing. In Canada, with essential activities such as grocery shopping, outdoor exercise and transportation, people need to be able to safely navigate dense, urban spaces while staying at least two metres or six feet apart. This pandemic has exacerbated the health inequities across neighbourhoods in cities like Toronto, Canada which are often segregated along racial and income lines. These inequities impact who has access to urban infrastructure that promotes health and quality of life. Safety in a time of COVID-19 goes beyond just exposure to the virus, it is complicated by notions of who belongs where, and who has access to what resources. The built environment has a role in maintaining and promoting physical and mental health during this pandemic and beyond it. This paper puts forwards three considerations for built environment interventions to promote health equitably: (i) addressing structural determinants of health and embedding anti-racist intersectional principles, (ii) revisiting tactical urbanism as a health promotion tool and (iii) rethinking community engagement processes through equity-based placemaking. This paper outlines four built environment interventions in Toronto, Canada that seek to address the challenges in navigating urban space safely in the short term, including street design that prioritizes pedestrians, protected cycling infrastructure, access to inclusive green space and safe, affordable housing. Longer-term strategies to create health-promoting urban environments that are equitable are discussed and may be valuable to other cities with similar urban equity concerns.

Legacies of Environmental Injustice on Neighborhood Violence, Poverty and Active Living in an African American Community.

Features of the built environment such as parks and open spaces contribute to increased physical activity in populations, while living in neighborhoods with high poverty, racial/ethnic segregation, presence of neighborhood problems, and violence has been associated with less active living. Our present study examined the factors that may facilitate or hinder the long-term success of built environment interventions aimed at promoting physical activity in communities with a legacy of environmental injustice. The data for this study came from a larger assessment of the impact of a new local park in Newark, NJ. Analysis included all adults from the original study population who self-identified as African American/Black (N=95). To provide an in-depth understanding of how neighborhood social and physical features influence physical activity among African Americans living in high poverty neighborhoods, we analyzed data from two focus groups with a total of 14 participants, and six in-depth interviews held in 2009-2010. Survey results indicated high exposure to violence, and associations between neighborhood features and walking. Self-reported neighborhood walkability was associated with increased walking (P=.01), while increased perception of neighborhood safety was associated with less walking (P=.01). Qualitative results indicated that residents perceived the new park as a positive change, but also expressed concern about the presence of violence and lack of social cohesion among neighbors, with younger generations expressing less optimism than the elderly. Positive changes associated with improvements to the built environment may be limited by social conditions such as neighborhood violence. These mixed findings suggest that policies and initiatives aimed at improving the built environment should address poverty, safety, and social cohesion to ensure more active living communities.

Varying influences of the built environment on daily and hourly pedestrian crossing volumes at signalized intersections estimated from traffic signal controller event data

Direct-demand models of pedestrian volumes (identifying relationships with built environment characteristics) require pedestrian data, typically from short-duration manual counts at a limited number of locations. We overcome these limitations using a novel source of pedestrian data: estimated pedestrian crossing volumes based on push-button event data recorded in traffic signal controller logs. These continuous data allow us to study more sites (1494 signalized intersections throughout Utah, US) over a much longer time period (one year) than in previous models, including the ability to detect variations across days-of-week and times-of-day. Specifically, we develop direct demand (log-linear regression) models that represent relationships between built environment variables (calculated at ¼- and ½-mile network buffers) and annual average daily and hourly pedestrian metrics. We control spatial autocorrelation through the use of spatial error models. All results confirm theorized relationships: There is more pedestrian activity at intersections with greater population and employment densities, a larger proportion of commercial and residential land uses, more connected street networks, more nearby services and amenities, and in lower-income neighborhoods with larger households. Notably, we also find relevant day-of-week and time-of-day differences. For example, schools attract pedestrian activity, but only on weekdays during daytime hours, and the coefficient for places of worship is higher in the weekend model. K-fold cross-validation results show the predictive power of our models. Results demonstrate the value of these novel pedestrian signal data for planning purposes and offer support for built environment interventions and land use policies to encourage walkable communities.

Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods.

Longitudinal, natural experiments provide an ideal evaluation approach to better understand the impact of built environment interventions on community health outcomes, particularly health disparities. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. This paper shares practical lessons learned from the Physical Activity and Redesigned Community Spaces (PARCS) study, which is an evaluation of the impact of a citywide park renovation initiative on physical activity, psychosocial health, and community well-being. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants’ needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color.

Re-open our city and campus post-Covid: A case study of Trinity college Dublin, the University of Dublin

Dublin, Ireland, like most other large cities has undergone lockdown due to the outbreak of the coronavirus. Ongoing physical distancing requirements, as cities reopens, has resulted in a collapse to transit’s capacity and ability to meet demand, forcing authorities to reimagine how people can travel in a pandemic/post-pandemic world. For Dublin, campaigns have focused on encouraging those who can walk or cycle to use active transport options if they are close enough to their place of employment, when the city fully reopens. The purpose of this is to ensure adequate physical distancing can occur while alleviating the pressure on public transport systems, thereby freeing up space for those who are unable to commute via active transport and for those beyond a range in which it is feasible. Trinity College Dublin, the University of Dublin (TCD) is located in the city centre of Ireland’s capital. Since less than 1% of staff drive to the campus and students arenot permitted to park on the campus, the University community has been working with Dublin City Council (DCC) to advance planning and built environment interventions to enable staff and students to safely return to work and education. This paper presents the results of the “Commuting to Trinity while Covid-19 Social Distancing is Required” Travel Survey for TCD students and staff, conducted in June and July 2020 (n = 2653). Conducted to determine how staff and students would like to travel to TCD, when the campus fully reopens, it identifies which factors influence their mode choice and choice of working locations. The Trinity University campus makes for an interesting case study as it allows us to understand how the reopening of a major employment, educational and cultural site within an urban area, which is primarily served by transit and active transport, can address physical distancing restrictions and decreased capacity of public transport.

Rural climate resilience through built-environment interventions: modified deliberation with analysis as a tool to address barriers to adaptive capacity

ABSTRACT The public health impacts of climate change, and how they can be addressed through implementable built-environment interventions in non-agricultural-based rural communities, is an understudied area in the academic literature and adaptation planning practice, particularly in the United States. This paper addresses this gap in understanding through a pilot project that developed a climate and health-adaptation plan with Marquette County, a geographically large, coastal, non-agricultural-based, rural community in Michigan’s Upper Peninsula. We show how the Deliberation with Analysis model of public participation, supported by visualizations and followed by post-participant surveys to measure its impact on barriers to adaptive capacity, can be used effectively to overcome barriers to adaptive capacity identified in the literature, specifically in understudied non-agricultural-based, rural, coastal communities in the United States. This study contributes to academic debates on adaptation and rurality by displaying the utility of a method that overcomes these key barriers to adaptive capacity noted in past research, specifically a lack of public awareness, a lack of or difficulty understanding climate information, a lack of leadership, and limited coordination and competing priorities.

Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?

BackgroundEfforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated...

Tactical Urbanism for COVID-19, Equity, and Health

Tactical Urbanism for COVID-19, equity, and healthBackground. The COVID-19 pandemic has impacted daily-life activities around the world. Several countries have implemented mitigation strategies(MS) to reduce COVID-19 transmission (e.g., physical distancing, stay-at-home orders, reduced large gatherings). Urban built environment interventions, through tactical urbanism(TU), can support COVID-19 MS and, at the same time, promote equity and healthy urban design.Aim. Develop a conceptual framework and guidance for tactical urbanism to support COVID-19 mitigation strategies and opportunities for equity and urban health.Methods. Conceptual framework and critical analysis. Results. COVID-19 MS has reduced motorize traffic, improving air quality, traffic noise, and traffic incidents. MS has also reduced access to public spaces translating into less physical activity opportunities. Vulnerable populations, such as the elderly, socially deprived communities, and people with underlying health conditions, have been reported to be more impacted by COVID-19. TU interventions like expanding sidewalks and bike lanes; implementing temporary open streets; lowering speed limits; promoting biking and bike-share; designating bike shops as essential services; shifting from actuated to fixed traffic signals; adjusting traffic signal timing; establishing on-sidewalk queuing and dedicated delivering/loading zones; restricting access to areas where physical distancing is not possible; prioritizing active and public transport(PT) for essential workers; implementing PT back-door boarding and waived fares; providing clear and accessible TU signaling; providing transport access to testing sites and other services beyond cars; providing homeless shelter; and prioritizing TU for vulnerable communities, among others, can help reduce COVID-19 transmission and promote a healthy and equitable urban design. Conclusions. Tactical urbanism offers an opportunity to support COVID-19 mitigation strategies and provide co-benefits reducing risk factors of non-communicable diseases, traffic incidents, and the need for health services. Tactical urbanism interventions should be prioritized for vulnerable communities and considered as a low-cost, short-term action with a vision for long-term interventions.

Examining non-linear built environment effects on elderly’s walking: A random forest approach

Previous studies often assume a pre-specified relationship between walking and the built environment. Using data from 702 older adults in Nanjing (China), this study employs a random forest method to scrutinise the refined associations between the built environment and walking time among older adults, while controlling for socio-demographics. Results show that all the analysed built environment attributes tend to impose salient non-linear and threshold effects on walking time. For example, population density and land use mix only increase older adults’ walking at certain levels. Ultra-densely populated areas and excessively mixed land uses may even lead to a decline in walking. Built environment interventions would consequently only be effective in certain ranges. By quantifying the relative importance of built environment attributes, we further indicate the hierarchy of intervention priorities. These results offer nuanced and appropriate guidance for building age-friendly neighbourhoods.

Successes and failures of built environment interventions: Using concept mapping to assess stakeholder perspectives in four Canadian cities.

Healthy communities can be supported through built environment interventions that redesign cities for improved health outcomes. Understanding the context of these interventions is critical for assessing how an intervention impacts population health; such context is often poorly documented. This study uses concept mapping to capture stakeholders' perspectives on the factors that influence the success and failure of built environment interventions across cities. The INTErventions, Research, and Action in Cities Team (INTERACT) research program undertook concept mapping exercises related to interventions in four Canadian cities: public bike share program (Vancouver); a cycling network (Victoria); a bus rapid transit program (Saskatoon); and interventions related to the Montreal Sustainability Plan (Montreal). Concept mapping synthesised stakeholder perceptions and Go zones were used to prioritise factors based on importance and feasibility. Resulting themes were integrated into implementation science frameworks. Across four cities, 95 stakeholders participated. An average of 38 factors were identified in each city, resulting in 5 emerging clusters in Victoria and Montreal and 6 clusters in Vancouver and Saskatoon. Clusters covered domains of economic and political context, intervention planning, equity considerations, user experience, and stakeholder engagement. Common across all cities was the importance of stakeholder engagement. Concerns for citizen safety were prominent in Victoria, Vancouver, and Saskatoon. Interventions in Saskatoon and Vancouver were related to programs, and reliability of service and ease of use emerged. Go zones highlighted 2-5 items in each city, which can inform priority actions. Our study provides stakeholders' collective thinking on the contextual factors that influence the success and failure of built environment interventions. Organising context within an implementation science framework can provide a common language to synthesise stakeholder perspectives across settings. Go zone items can inform city-specific priority actions to support a common vision around implementing built environment interventions in pursuit of designing equitable and healthy cities.

Cross-sectional associations between the neighborhood built environment and physical activity in a rural setting: the Bogalusa Heart Study

BackgroundInsufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies.MethodsParticipants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations.ResultsParticipants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics.ConclusionsSignificant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.

Adults\u2019 leisure-time physical activity and the neighborhood built environment: a contextual perspective

BackgroundContext-free outcome measures, such as overall leisure-time physical activity (LTPA), are habitually applied to study the neighborhood built environment correlates of physical activity. This cross sectional study identifies and empirically tests potential methodological limitations related to the use of context-free measures and discusses how these may help in the interpretation of inconsistent associations between participation in moderate-to-vigorous LTPA and objectively measured neighborhood-level built environment attributes.MethodsWe employ a public participation geographic information system (PPGIS), an advanced participatory mapping method, to study the spatial distribution of moderate-to-vigorous LTPA among adult urban Finnish residents (n 1322). Secondary sources of GIS land-use and sport facility data were used to disaggregate respondent-mapped LTPA by the behavioral context, such as indoor and outdoor sport facilities, green spaces, and other public open spaces. Associations between the use of the identified LTPA settings and a range of objectively measured neighborhood built environment attributes were studied with multilevel logistic regression models.ResultsDisaggregated by behavioral context, we observed varied and partly opposite built environment correlates for LTPA. The use of indoor and outdoor sport facilities showed no significant associations with their neighborhood availability, but were significantly associated with personal-level attributes. By contrast, participation in LTPA in green and built public open space shared significant associations with access to and availability of neighborhood green space that persisted after controlling for personal-level covariates. Moreover, neighborhood distances up to 1600 m poorly captured participation in moderate-to-vigorous LTPA, as, on average, 40% of visits were located further from home. However, we found the immediate home environment to be an important LTPA setting for the least active participants.ConclusionsThis study demonstrates that LTPA can be a highly heterogeneous measure regarding both the spatial distribution and the environmental correlates of behavioral contexts. The results show that context-free LTPA outcome measures yield inconsistent associations with built environment exposure variables, challenging the applicability of such measures in designing neighborhood-level built environment interventions.

20.D. Skills building seminar: Design for mental health integration through built environment interventions

Abstract Mental illness is associated with social exclusion and stigma more than most other health issues. This affects psychiatric facility provision (Chrysikou et al 2017), prevention and early treatment interventions. The planning and design of services both conceptually (service procedures, experience designs, campaigns and physically (e.g. buildings, products, interiors) could help change that. New approaches could build resilience by increasing access to and acceptance of mental health services and enable recovery as a constant process (Slade et al 2008). This intense skill- building workshop will use a role-game approach with cross-disciplinary methods from experience design and design thinking to foster innovative spatial concepts in a co-creative manner. This helps to build capacity and knowledge on exploring and developing innovative and disruptive concepts for public urban mental health. Focus is on spatial configuration, architectural and design aspects for services and mental health systems. The highly interactive seminar-workshop starts with two 5' presentations to set the theoretical multi-disciplinary stage. A third 5' presentation addresses issues addressed to the participants and presents the locus of the role play, i.e. Crete, chosen for its unique socio-spatial and systemic characteristics. A 5' presentation explains the scenario and stakeholder roles. The group session comprises a 50' long structured series of ideation and analysis methods based on a role-play-like schedule in which delegates act as service provider for a municipal client (Crete) that request an innovative mental health care solution for a specific urban context. Then 10' will be the closing session on the process by mapping the reflections of the process on a collective SWOT diagram. Chrysikou, E., Kostopoulou, E., Savvopoulou, E., Fatah gen. Schieck, A., 2017. Medical Architecture on the Social Valorisation of Psychiatric Patients: Employing transdisciplinary approaches between architecture, physical and mental well-being disciplines. Proceedings of the AAE 2017 Conference, Architecture Connects, 6th -9th September 2017. Oxford Brookes University, UK Slade, Mike; Amering, Michaela; Oades, Lindsay (2008): Recovery: an international perspective. In: Epidemiologia e psichiatria sociale 17 (2), S. 128-137. Key messages Participants will explore participatory design methodologies to help them consider and use building infrastructure as resource for public health and healthcare actions in relation to mental health. Participants will cross disciplinary boundaries exposed to eco- and psychosocial frameworks, i.e, build and social infrastructure, to co-create healthy, vibrant, resilient and equitable communities.

Sustainable Development Goals, Sports and Physical Activity: The Localization of Health-Related Sustainable Development Goals Through Sports in China: A Narrative Review.

Sport has been recognized as an essential tool for the implementation of the SDGs by The Agenda 2030 for sustainable development. The Chinese government has launched a Healthy China 2030 plan in response to the health-related SDGs. The Chinese government has introduced different kinds of measures under Healthy China 2030 plan to achieve health-related SDGs through sport and physical activity. The Healthy China program is compatible with SDGs regarding health, sport, and physical activity. After introducing the program with sustainable built environment intervention for sport and physical activity, the elderly population of China is participating in sport and physical activity to improve the national fitness level and prevent NCDs. Sport is playing a vital role in preventing NCDs in the shape of increasing physical activity among the Chinese people. Sports and physical activity play a crucial role in the implementation of health-related SDGs and further help in the achievement of “Healthy China” 2030 goal. China’s localization policies for the realization of SDGs have a global impact through glocalization in the BRI participant’s countries and supporting them to make their public health system secure and promoting global health governance.

Built Environment Approaches to Increase Physical Activity: A Science Advisory From the American Heart Association.

Engaging in regular physical activity is one of the most important things people can do to improve their cardiovascular health; however, population levels of physical activity remain low in the United States. Effective population-based approaches implemented in communities can help increase physical activity among all Americans. Evidence suggests that built environment interventions offer one such approach. These interventions aim to create or modify community environmental characteristics to make physical activity easier or more accessible for all people in the places where they live. In 2016, the Community Preventive Services Task Force released a recommendation for built environment approaches to increase physical activity. This recommendation is based on a systematic review of 90 studies (search period, 1980-June 2014) conducted using methods outlined by the Guide to Community Preventive Services. The Community Preventive Services Task Force found sufficient evidence of effectiveness to recommend combined built environment strategies. Specifically, these strategies combine interventions to improve pedestrian or bicycle transportation systems with interventions to improve land use and environmental design. Components of transportation systems can include street pattern design and connectivity, pedestrian infrastructure, bicycle infrastructure, and public transit infrastructure and access. Components of land use and environmental design can include mixed land use, increased residential density, proximity to community or neighborhood destinations, and parks and recreational facility access. Implementing this Community Preventive Services Task Force recommendation in communities across the United States can help promote healthy and active living, increase physical activity, and ultimately improve cardiovascular health.

Possible Actions in the Built Environment to Enhance Physical Activity: Systematic ‎Review

As a crucial factor of health, physical activity is widely explored in many empirical studies. The problem of how the built environment may affect physical activity attributes was discussed in previous studies, and the classification of interventions was presented in a limited scope. Therefore, the present study aims to review built environment interventions while classifying them into motivators and barriers of physical activity in residential neighbourhoods worldwide. Firstly, the main dimensions explaining how the built environment affects physical activity are presented. Fifteen papers published between 2009 and 2019 were identified by an extensive search in ScienceDirect, Web of Science, Scopus and PubMed. These works were systematically reviewed based on their main characteristics and then classified based on their relevant operationalisation of variables. Improving motivators and conquering barriers of physical activity on neighbourhoods lead to a healthy and sustainable society. The results of the current work can help policymakers and urban planners use exclusive methods for each part of neighbourhood planning and create an environment that overcomes barriers and promotes public physical activity levels.

Slum upgrading and climate change adaptation and mitigation: Lessons from Latin America

Residents of informal settlements are some of the most vulnerable urban groups to the effects of climate change. Different responses have emerged to intervene in these communities and slum upgrading is currently considered the best framework. How slum upgrading interventions engage with climate change adaptation and mitigation is not fully explored in the literature. This article scrutinizes three recent slum upgrading programs in Latin America to uncover the ways these tend to engage or not with climate change adaptation and mitigation. The analysis revealed that slum upgrading is both a policy mechanism to address socio-economic issues and an instrument by which built-environment interventions can enhance adaptation and mitigation in informal settlements. Six key areas emerged from the analysis of the case studies that link slum upgrading to climate change adaptation and mitigation through infrastructure and policies: (1) security of tenure, (2) relocation and barriers, (3) public space, (4) energy-efficient and improved architecture, (5) connectivity, and (6) land management. Slum upgrading can be an effective mechanism that combines mitigation and adaptation efforts whilst addressing sustainable development priorities in disadvantaged territories.

Urban upgrading and levels of interpersonal violence in Cape Town, South Africa: The violence prevention through urban upgrading programme.

Violence Prevention through Urban Upgrading applies second generation crime prevention through environmental design, which includes built environment interventions alongside social programmes and community participation initiatives in Khayelitsha, one of South Africa's poorest and most violent suburbs. We conducted a retrospective population-based study using survey data from 3625 geo-located households collected between 2013 and 2015 and mapped alcohol outlets to assess the association between the intervention and reported experience of violence. The analysis used generalised linear models to estimate and compare selfreported experience of violence adjusting for known confounders, which included area and household deprivation as well as alcohol outlet density. Living in close proximity to the upgraded urban infrastructure was associated with a 34% reduced exposure to interpersonal violence after adjusting for confounders. This association was consistent across age and gender. Access to additional social programmes alongside the urban upgrading intervention was not associated with further reduction in risk. The association between urban-upgrading and reduced exposure to interpersonal violence supports its inclusion among interventions in national and local crime prevention policies to address social and structural environments.

Overview of "Systematic Reviews" of the Built Environment's Effects on Mental Health.

Good mental health is related to mental and psychological well-being, and there is growing interest in the potential role of the built environment on mental health, yet the evidence base underpinning the direct or indirect effects of the built environment is not fully clear. The aim of this overview is to assess the effect of the built environment on mental health-related outcomes. Methods. This study provides an overview of published systematic reviews (SRs) that assess the effect of the built environment on mental health. We reported the overview according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched until November 2019 included the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE (OVID 1946 to present), LILACS, and PsycINFO. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using the Assessing Methodological Quality of Systematic Reviews-2 (AMSTAR-2). Results. In total, 357 records were identified from a structured search of five databases combined with the references of the included studies, and eleven SRs were included in the narrative synthesis. Outcomes included mental health and well-being, depression and stress, and psychological distress. According to AMSTAR-2 scores, the quality assessment of the included SRs was categorized as “high” in two SRs and as “critically low” in nine SRs. According to the conclusions of the SRs reported by the authors, only one SR reported a “beneficial” effect on mental health and well-being outcomes. Conclusion. There was insufficient evidence to make firm conclusions on the effects of built environment interventions on mental health outcomes (well-being, depression and stress, and psychological distress). The evidence collected reported high heterogeneity (outcomes and measures) and a moderate- to low-quality assessment among the included SRs.