CHN Annual Report 2022

ANNUAL REPORT

Center for Health & Nature

FROM THE DIRECTORS

Jay Maddock, PhD

Director, Center for Health and Nature

Professor, Department of Environmental and Occupational Health, Texas A&M University School of Public Health

We are excited to share our first report on the Center for Health and Nature (CHN) as we take a retrospective look at our work and accomplishments since the center’s launch in 2018 and provide an outlook into the next three years of activities. The CHN was established as a unique and powerful partnership between Houston Methodist, Texas A&M University, and Texan by Nature about four years ago with merely a vision towards improving health through exposure to nature’s healing elements. As part of this vision, we have now secured institutional core funding for the center for the next three years and have established a healthy research innovation fund to support research that will accelerate the adoption of nature into the practice of medicine, the health care delivery system, and environments we live and work in daily.

The last four years have been marked with advancement in knowledge and dissemination—mostly in the area of how to study the impact of nature (methodology), facilities, and urban design that incorporates green space and empirically proving that elements of nature can improve mental and physical health. As we head into the next three years with a solid and informed strategic plan, we expect to continue our track record of disseminating knowledge while focusing on two implementation projects (NatureRx and the Healing Garden at Houston Methodist), which are designed to serve as both a laboratory of more rigorous research and a vehicle towards new environmental sustainability behaviors among individuals, institutions and industry.

Bita Kash, PhD

Co-Director, Center for Health and Nature

Professor, Outcomes Research in Medicine, Houston Methodist

CENTER FOR HEALTH & NATURE

MISSION VALUES

To drive research on the impact of nature on health with evidence-based programs across the full continuum of health: prevention, treatment and recovery.

COLLABORATION INNOVATION

TRANSPARENCY ACTION

EQUITY

The Center for Health & Nature is a partnership between Houston Methodist Hospital, Texan by Nature and Texas A&M Health. It is the only collaboration in the world of a health system, a conservation foundation, and a university to advance our understanding of nature as a health system.

Houston Methodist President and CEO Marc Boom, MD, former First Lady Laura Bush, A&M Chancellor John Sharp

ORGANIZATIONAL CHART

Director Jay Maddock, PhD

Texas A&M School of Public Health Co-Director Bita Kash, PhD

Houston Methodist

HISTORY

& TIMELINE

In 2016, Houston Methodist and Texan by Nature co-hosted a symposium to discuss and identify gaps in the science around the mechanisms in nature that produce positive physiological and psychological health and healing benefits. This led to the creation of the Center for Health & Nature. In the years since, we have conducted research, implemented data-driven projects, and disseminated our learnings through publication and our symposium. Our next symposium will be February 3, 2023.

AUTHORIZED REPRESENTATIVES

Houston Methodist: Edward A. Jones

Texas A&M University: Jon Mogford, PhD

Texan by Nature: Joni B. Carswell

EXECUTIVE ADVISORY BOARD

Texas A&M University: Shawn Gibbs & Jorge Vanegas

Houston Methodist: Robert Jackson, MD, & Rebecca Hall, PhD

Texan by Nature: Amy Snelgrove, & Cynthia Pickett-Stevenson

2016 Houston Methodist and Texan by Nature Symposium

Natural Connection: Exploring Positive Outcomes in Health and Healing through Nature

STAFF

Houston Methodist Research Fellow: Omar Elsayed

Support: Jennifer Taylor & Megan Taubert

Organization Development Contractor: Katy Atkiss

2017 1st Strategic Plan

2018

MD and John Sharp

CHN Launched with former First Lady Laura Bush, Marc Boom,

FACULTY FELLOWS

Houston Methodist

Texas A&M, Public Health

Texas A&M, Architecture

Texas A&M, Agriculture and Life Sciences

University of Washington University of Maryland

University of Minnesota Virginia Polytechnic Institute West Virginia University

Younglin Healthcare Foundation

COMMITTEES

RESEARCH AND IMPLEMENTATION

• Texas A&M University: Jay Maddock, & Howie Frumkin

• Houston Methodist: Bita Kash (Chair), & Khurram Nasir

• Texan by Nature: Taylor Keys (conservation) & Jenny Burden (industry)

• University of Washington: Gregory Bratman

EDUCATION AND DISSEMINATION

• Texas A&M University: Jay Maddock (Chair)

• Houston Methodist: Bita Kash, & Robert Jackson

• Texan by Nature: Joni Carswell, & Amy Snelgrove (logistics)

FUNDRAISING

• Texas A&M University: Jay Maddock, & Karen Slater

• Houston Methodist: Bita Kash, Jackie Callies, & Michael Homan

• Texan by Nature: Cynthia Pickett-Stevenson (Chair)

CENTER FOR HEALTH & NATURE

STRATEGIC PLAN, 2023 - 2025

STRATEGIC GOALS

1. Research: Drive applicable understanding of the elements and impact of nature on health.

2. Translation and Implementation: Increase equitable access to nature in Texas institutions, industry and public settings.

3. Education and Dissemination: Inform data-driven policy and practices nationally and globally.

4. Infrastructure and Sustainability: Continue to build CHN to restore and protect nature for health.

RESEARCH & PROGRAMS

RESEARCH FOCUS AREAS

• Understanding the impacts of nature on health. Looking at nature as a construct.

• Nature as medicine.

• Integrating nature in our institutions, including health care practices, workplace interventions, and campus design such as green school yards.

• Equitable access to and use of nature.

• Conservation and sustainability.

AUDIENCES

OUTCOMES & IMPACT

MEDIUM TERM

The CHN will be participating as a lead organization in the newly established Nature and Health Alliance, funded by Recreational Equipment, Inc. (REI), which brings together leading researchers in the field of health and nature from four universities to develop and support an inclusive and equitable international nature and health research movement. There is a strong research foundation on the health benefits of nature in the human health, social science, and environmental literature, and strong public interest. This Alliance seeks to accelerate the momentum of this field to meet the potential of nature improving human health and to ensure that access to nature is available to all people.

OUR RESEARCH STUDIES - FELLOWS

Frumkin Newest Addition to Center

He

Frumkin’s research investigates the positive health impacts of natural environments by comparing data from groups of people with regular nature contact with groups who don’t. His interests include public health aspects of the built environment, climate change, energy policy and nature contact. He has studied the impact of nature on veterans with post-traumatic stress disorder through hiking, the effects of urban nature on physical activity, authored studies that propose frameworks for determining how changes in urban nature can increase physical activity as well as city-planning policies that might lead to healthier and more sustainable cities.

Frumkin’s research into climate change has indicated that health professionals should cultivate hope in themselves and their patients as evidence suggests that hopeful people weather stress more successfully and live longer, even when diagnosed with serious diseases.

Frumpkin noted that in his medical training, he learned more treating disease than promoting health. During his training in environmental health, he learned more about environmental hazards than how the environment can promote health. He built his career around the health-promoting aspects of the natural environment, which offers low-cost treatment options with few side effects.

Howard Frumkin, DrPH, MD, has joined the Center for Health & Nature as a Hagler Fellow. The Hagler Institute for Advanced Study at Texas A&M University selects its fellows from among top scholars with outstanding professional accomplishments.

is a senior vice president with the Trust for Public Land and Professor Emeritus of Environmental and Occupational Health Sciences at the University of Washington School of Public Health.

FELLOWS

Christiaan Abildso, PhD, MPH; Associate Professor, School of Public Health, West Virginia University

Aruni Bhatnagar, PhD, FAHA; Professor, Division of Environmental Medicine, University of Louisville

Gregory Bratman, PhD; Assistant Professor, School of Environmental and Forest Sciences, University of Washington

Ohbet Cheon, PhD, MPA; Assistant Professor, David D. Reh School of Business, Clarkson University

John Cooke, MD, PhD; Joseph C. “Rusty” Walter and Carole Walter Looke Presidential Distinguished Chair in Cardiovascular Disease Research, Houston Methodist

Yingling Fan, PhD; Professor, Urban and Regional Planning Program, Humphrey School of Public Affairs, University of Minnesota

D. Kirk Hamilton, PhD; Professor, Department of Architecture, Texas A&M University

Steven Hankey, PhD, MS; Affiliate Faculty, Department of Civil and Environmental Engineering, Virginia Polytechnic and State University

Perry Hystad, PhD; Assistant Professor, College of Public Health and Human Sciences, Oregon State University

Robert Jackson, MD, MACP; Professor of Clinical Medicine, C. Richard Stasney, M.D. Distinguished Chair in Performing Arts Medicine, Houston Methodist

Peter James, ScD, MHS; Instructor, Department of Medicine, Harvard Medical School

Natalie Johnson, PhD; Associate Professor, Dept. of Environmental & Occupational Health, School of Public Health, Texas A&M University

Bita Kash, PhD, MBA, FACHE; Co-Director, Center for Healthy & Nature, Houston Methodist

Debra Kellstedt, DrPH; Assistant Professor, AgriLife Extension, School of Public Health, Texas A&M University

Karla M. Kurrelmeyer, MD, FACC, FASE; Medical Director, DeBakey Cardiology Associates, Houston Methodist

Chanam Lee, PhD, MLA; Professor, Department of Landscape Architecture and Urban Planning; Coordinator, PhD Program in Urban and Regional Sciences; Director, Design Research for Active Living, Texas A&M University

Zhipeng Lu, PhD, LEED AP BD+C; Associate Director, Center for Health System & Design; Assistant Professor, Dept. of Architecture, Texas A&M University

Jay Maddock, PhD, FAAHB; Director, Center for Healthy & Nature; Professor, Dept. of Environmental and Occupational Health, Texas A&M University

Anne Martin, PhD; Research Fellow, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow

Paul McCrorie; Research Fellow, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow Ann McNamara, PhD; Associate Professor, Department of Visualization, Texas A&M University

Khurram Nasir, MD, MPH; Chief, Division of Cardiovascular Prevention and Wellness, Department of Cardiology; Advisory Board Chair, Center for Health Data Science & Analytics, Jerold B. Katz Investigator, Houston Methodist

Galen Newman, PhD, ASLA, APA; Associate Professor, Dept. of Landscape Architecture and Urban Planning, Texas A&M University

Jennifer Roberts, DrPH, MPH; Associate Professor, Department of Kinesiology; Director, Public Health Outcomes and Effects of the Built Environment Laboratory; co-Director, NatureRx, University of Maryland College Park

Taehyun Roh, PhD; Assistant Professor, Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University

Garett Sansom, DrPH; Research Assistant Professor, School of Public Health, Texas A&M University

Selina M. Stasi, DrPH; Instructional Assistant Professor, Dept. of Health Promotion and Community Health Sciences, Texas A&M University

Renee Stubbins, PhD; Assistant Professor of Nutritional Sciences in Oncology, Houston Methodist

Courtney Suess, PhD; Assistant Professor, Department of Recreation, Park, and Tourism Sciences, Texas A&M University

Ashley Verzwyvelt, RN, OCN; Registered Nurse, Houston Methodist

Susan Xu, PhD; Senior Biostatistician, Houston Methodist

Huey-Wen Yien, MD, PhD, EMBA; Chief Executive Officer, Yonglin Healthcare Foundation, Taipei, Taiwan

CHN uses best research practices to quantify the impacts of nature exposure on health and wellness. To develop interventions that increase time spent in nature, the CHN has devised and validated metrics for systematically investigating the impact of nature on health.

Newly Validated Nature Stimuli Creates New Options for Laboratory-Based Studies

Managing the experimental conditions of outdoor settings can be difficult. Using visual representations of nature in laboratory settings to generate data that helps experts develop interventions for increasing time spent in nature would be quite valuable. Until now, no validated images of nature have been developed for such studies because there is a wide range of ideas on what is considered natural.

A CHN research team led by Bita Kash, PhD, has solved this issue by identifying which characteristics of visual stimuli are perceived as most representative of nature and validating images of nature for use in future experiments.

In the study, young adult participants rated how well images represented nature on a 5-point Likert scale. The images were divided into categories of bodies of water, canopies of vegetation taller than 8 feet, mountains, unnatural man-made elements and image framing properties. Canopies scored the highest, followed by mountains, bodies of water and finally unnatural elements.

The newly validated nature stimuli open new possibilities for quantifying nature’s restorative effects. The authors encourage the use of functional magnetic resonance imaging to examine the brain’s responses to nature stimuli in a controlled setting with replicable results. This information could aid in designing interventions that can be tailored to patients’ specific needs.

The researchers published the findings in Frontiers of Psychology and made the most highly representative nature images available online for use by researchers worldwide at: symposium.centerforhealthandnature.org/fmri-images-research-study

Development and Validation of Scales to Understand Views on Spending Time in Nature

Despite strong evidence confirming the health benefits of spending time in nature, recent efforts to incorporate natural elements into urban planning and increasing support for “green prescriptions” from health care providers, most Americans spend little time in nature. The development of these new scales is an important step in implementing theory-based interventions that increase exposure to nature.

Scales To Measure Attitudes Toward Spending Time in Nature

Interventions designed to increase time spent in nature at the population level must address a range of factors, including social, fiscal and physical barriers to access, experiences of discrimination and lack of safety and motivation.

Theory-based interventions help integrate complex concepts into a framework capable of interpreting and adapting to new information. Programs based on behavioral theories have worked well across a broad range of health behaviors. To develop evidence-based programs on the positive health impact of spending time in nature, valid and reliable measurement tools must first be developed.

To meet this need, in a paper published in Ecopsychology, Jay Maddock, PhD, and his colleagues developed a valid and reliable scale to quantify attitude toward time spent in nature. They confirmed the consistency and accuracy of the scales using a recruited sample of 2,019 adults from throughout the U.S. The scales were strongly related to intentions and time spent in nature with large effect sizes.

Scales to Measure

Self-Efficacy

and Intention Toward Spending Time in Nature

A person’s intentions as well as their self-efficacy, which is their belief they can attain a goal, are strong predictors of positive health behaviors including physical activity. However, the scales needed to quantify the impact of these factors on spending time in nature had not been established.

A recent CHN study published in BMC Psychology, led by Jay Maddock, PhD, detailed the development and confirmation of the reliability and validity of these factors on time spent in nature.

The team used a sequential nine-step procedure to construct the scales. The scales were then tested in a survey administered to a nationwide sample of more than 2,000 adults. Overall, the study resulted in reliable and valid measures of self-efficacy and intentions to spend time in nature.

“We’re working on developing a whole suite of measures,” Maddock said. “Once those are completed, we’re going to be looking to develop theory-based interventions to increase time spent in nature.”

Addressing the Mental Health of Health Practitioners

A proposed CHN study at Houston Methodist might be just what the doctor ordered for health care workers who are feeling the pressures of the job.

Omar Elsayed, MD, a Houston Methodist postdoctoral fellow in the CHN, has created the Nature Pill, a clinical trial that would test the cortisol levels of ICU nurses and physicians to learn whether a dose of nature is beneficial to mental and physical health.

The randomized, controlled clinical trial would put 28 health care providers, 14 men and 14 women, into an intervention or control group. Those is the control group would spend their weekend in typical fashion, doing the things they normally do. The intervention group would spend the weekend at a house on Galveston Bay, walking on the beach, maybe visiting a rookery and enjoying their free time in whatever manner they choose.

At various points, the cortisol levels of the participants would be tested, before the weekend begins, immediately after, and then four weeks post. The team hypothesizes that spending time in nature will decrease the susceptibility to burn out or decrease the burnout.

Previous studies into this area were observational, so this would be a first-ofits-kind pilot study, pending IRB approval.

How do we take what we learn and integrate nature into health care centers, workplaces, and school yards to increase equitable nature exposure?

Chemotherapy Gets an Infusion of Nature

From increased empathy to decreased pain, psychological and biomedical research data are building a robust case for tapping into the healing power of nature.

Oncology patients are impacted by many worries during chemotherapy infusions, including anxiety, travel to appointments, treatment side effects, distress and pain. In fact, 50%–70% of oncology patients experience uncontrolled pain and fear pain over death. Previous studies have shown that physical and mental distress levels can be reduced with consistent exposure to nature. In a recent pilot study, the CHN investigated whether a biophilic green therapy (GT) or virtual reality (VR) environment decreased the pain and distress of oncology patients during chemotherapy infusion.

In the private GT infusion room, patients faced a large wall of windows overlooking a rooftop garden and scenic mural. The control room was a private standard treatment room with no windows, equipped with standard infusion equipment and a television.

Data collection of vital signs, saliva cortisol, pain and distress assessments, were done before and after the chemotherapy infusion.

In a private VR infusion space, patients utilized the Oculus Quest Head Mounted Display (HMD) and its Nature Treks software. The VR HMD is a stand-alone device with head tracking and a separate hand controller to allow interaction with the virtual environment. Patients wore the headset for 5- to 15-minute intervals, choosing any of nine different interactive nature environments.

The study, published in Science Reports and led by Renee Stubbins, PhD, was a crossover design, which means each case served as his/her own control and included 33 first-cycle oncology patients (breast, gynecologic, gastrointestinal, pancreatic and prostate cancers) receiving intravenous chemotherapy. While patient heart rate, blood pressure and self-reported distress levels were reduced after each biophilic intervention, these preliminary data did not significantly differ between the three groups. However, more patients reported the experience as “enjoyable” when in the GT or VR room compared to in the control room. In addition, 71.4% of participants reported spending at least 60 minutes outside since starting the study and over 90% of patients reported interest in the effects of nature on their health. These results suggest that biophilic interventions are safe and feasible and merit further study.

Over

90%

of patients reported interest in the effects of nature on their

health

OUR RESEARCH STUDIES - AMPLIFY

We bring thought leaders in conservation and health together to learn more about interventions that improve health through time spent in nature and exchange ideas to broaden our impact. These efforts also help make the case to our local, state and federal governments for cost-effective data-driven conservation and sustainability programs that benefit our world.

INVITED PRESENTATIONS

1. Kellstedt D, Maddock JE. Improving Health by Getting Out in Nature (2022) Webinar presented to Texas A&M AgriLife Extension.

2. Maddock JE. Nature Exposure as Part of Your Wellness Portfolio (2022). Webinar for the International Foundation of Employee Benefit Plans.

3. Maddock JE. Does Exposure to Nature Improve Human Health? (2022). Presented at Baylor University, Waco, TX.

4. Maddock JE. Nature Exposure as Part of Your Wellness Portfolio (2022). The Art and Science of Health Promotion Annual Meeting, San Diego, CA.

5. Maddock JE. ParkRX: Integrating Nature Prescriptions (2022) Invited presentation and panel at Baylor, Scott & White, Temple, TX.

6. Maddock JE. The Key to Building a Healthier Houston: Nature (2021) Webinar for Scenic Houston, Virtual.

7. Maddock JE. Does Exposure to Nature Improve Human Health? (2021) Presented at Shantou University, Guangdong, China (Virtual).

8. Maddock JE. Global Knowledge Collaborations to Solve Health and Climate Change by Design (2021) Panel presentation for the International Union of Architectures, Public Health Workgroup. Virtual.

9. Maddock JE. Health & Nature (2021). Invited virtual discussion leader at the Brown Bottle Series, Prevention Research Center, University of South Carolina.

10. Maddock JE. The Joy of the Journey: Transportation, Nature and Health: Our Resilient City (2020). Invited Panel Presentation to the Museum ParK Super Neighborhood, Houston, TX.

11. Maddock JE. The Relationship Between Nature and Human Health and Why Businesses Should Care (2019). Presented at the Texan by Nature Wrangler Summit, Dallas, TX.

PODCASTS

1. Time in Nature’s Impact on Wellbeing. Interview with Dr. Jay Maddock. Health, Wellness and Performance Catalyst, September 10, 2022.

2. Brainy Health Benefits of Nature, with Dr. Jay Maddock. The Brainy Business Podcast, May 2, 2022.

3. The Many Facets of Wellbeing. Interview with Dr. Jay Maddock. The Redesigning Wellness Podcast, December 9, 2020.

MEDIA

1. Nature as Nourishment. Interview with Dr. Jay Maddock. Benefits Magazine, July/August 2022.

2. Architecture for Health. KAMU – PBS, October 26, 2021.

3. The Key to Building a Healthier Houston Through Nature. Citizens’ Environmental Coalition and Scenic Houston, October 7, 2021.

4. Texas Medical Centers Exploring Potential Benefits of Nature Therapy. Yahoo News, KRHD News, September 21, 2021.

5. Researchers Investigate Impact of Actual, Virtual Nature on Cancer Patients. Medical Construction & Design, Health News Digest, April 27, 2020.

6. Enjoy Nature: Fight off the Coronavirus Blues. Op-Ed by Jay Maddock and Bita Kash in the Bryan-College Station Eagle, April 26, 2020.

7. Exposure to Natural Environments and Health. Jay Maddock and Chanam Lee, PBS, March 31, 2020.

8. A Garden in The Sky Lifts Patients’ Spirits at Houston Methodist. Texas Medical Center News, November 6, 2019.

9. Laura Bush Developed Her Love for Conservation by Growing Up in Oil Country. The Dallas Morning News, May 26, 2019.

10. Science’s Newest Miracle Drug is Free. Outside Magazine, May 1, 2019.

11. Why Some Doctors Are Prescribing a Day in The Park or A Walk on The Beach for Good Health. The Conversation, the Associated Press, WTOP News, Medical Xpress, San Antonio Express-News, Philly Voice, Connecticut Post, Lincoln Journal Star, Stamford Advocate, The Times of Northwest Indiana, Econo Times, The Hour, Westport News, Edge Media Network, New Milford Spectrum, Laredo Morning Times, The Middle East North Africa Financial Network and Houston Chronicle, May 1, 2019.

12. Laura Bush Visits Houston for Opening of Center That Will Research Health and Nature. Good Morning America, Houston Public Media, KTRK-ABC Houston, KPRC-NBC Houston, KRIV-Fox Houston, KHOU-CBS Houston, Houston Business Journal, Dallas Innovates, May 2018.

PEER-REVIEWED PAPERS

1. Jilani MH, Simon-Friedt B, Yahya T, Khan AY, Hassan SZ, Kash B, Blankstein R, Blaha MJ, Virani SS, Rajagopalan S, Cainzos-Achirica M, Nasir K. (2020) Associations between particulate matter air pollution, presence and progression of subclinical coronary and carotid atherosclerosis: A systematic review. Atherosclerosis. doi.org/10.1016/j.atherosclerosis.2020.06.018

2. Menser T, Baek J, Siahaan J, Kolman J, Delgado D, Kash BA. (2021) Validating visual stimuli of nature images and identifying the representative characteristics. Frontiers in Psychology. doi.org/10.3389/fpsyg.2021.685815

3. Verzwyvelt LA, McNamara A, Xu X, Stubbins R. (2021) Effects of virtual reality vs. biophilic environments on pain and distress in oncology patients: a case-crossover pilot study. Scientific Reports. doi.org/10.1038/s41598-021-99763-2

4. Maddock JE, Suess C, Bratman GN, Smock C, Kellstedt D, Gustat J, Perry CK, Kaczynski AT. (2022) Development and Validation of Self-Efficacy and Intention Measures for Spending Time in Nature. BMC Psychology. doi.org/10.1186/s40359-022-00764-1

5. Maddock JE, Suess C, Bratman GN, Smock C, Kellstedt D, Layton R, Christiana RW, Horton T, Gustat J, Perry CK, Kaczynski. (2022) Development and Validation of an Attitude Toward Spending Time in Nature Scale. EcoPsychology. doi.org/10.1089/eco.2022.0017

6. Simon-Friedt B, Pan AP, Nisar T, Al-Kindi S, Nunley A, Graiff L, Kash BA, Maddock JE, Nasir K. Effects of trail and greenspace exposure on hospitalisations in a highly populated urban area: retrospective cohort study of the Houston Bayou Greenways 2020 program. Local Environment. Accepted for publication October 11, 2022.

OUR RESEARCH STUDIES - AMPLIFY

Annual Symposia

The Center for Health & Nature has held three symposia since its launch in 2018, with the purpose to:

• Grow interest and investment in the field.

• Inform people about current research being conducted by CHN and the health and nature research community at large.

• Drive collaboration and partnership across disciplines and organizations.

• Set a vision/direction for the future.

Each symposia features a theme and cross-discipline speakers examining the relationship between health and nature from multiple perspectives or highlighting examples of our learnings put into practice.

SYMPOSIUM 2021 RECAP: THE NATURE OF CHANGE

Key themes that emerged from the 2021 symposium and informed the future strategic plan:

1. Cross-sector partnerships are essential a. Build on existing research – data, frameworks, and analysis b. Network to build the case for investments in and care of nature c. Make data and images accessible for sharing

2. Additional tools and programs are needed to drive education, implementation, and adoption. This may include:

a. Equity and economic benefit calculator

b. Access mapping and walking maps

c. Biophilia opportunities are all over build environments – in the workplace, institutions, and public spaces. From parking lots to building and campus design.

3. Equitable access to nature must be prioritized

a. Previous policies and practices have created an access gap that has not been closed b. Understand our history and how we got here c. Differentiate between proximity and access d. Access to health care providers as well as access to nature.

Keynote: An Ecopsychological Riddle for Meaningful Change

Dennis Kiley President, EcoPsychology Initiative

Presentations

Center for Health & Nature Symposium 2023

The Center for Health & Nature Symposium convenes academic leaders, conservation leaders, and physician-scientists from around the country and world who are engaged in research related to the intersection of nature and health. The 2023 Symposium’s theme is “Health for All through Nature”.

Feb. 3, 2023 | 9 a.m. – 3:30 p.m.

Annenberg Center, Bush Presidential Library, Texas A&M University 1002 George Bush Drive W., College Station, TX 77843 attend.houstonmethodist.org/event/CHN-Symposium

Health for All Through Nature

Frumkin

The Center for Health & Nature is a partnership among Houston Methodist Hospital, Texan by Nature, and Texas A&M Health. It is the only collaboration of a health system, a conservation foundation, and a university to advance understanding of nature as a health system. Our symposium convenes researchers, clinicians, conservationists, advocates, and the public to share health and nature strategies across disciplines — including health care, conservation, public health, architecture, and many others. Our goal is to drive understanding, collaboration, and partnership. Join us in our work to bring health to all through nature.

KEYNOTE SPEAKER

Howard

Senior Vice President, Trust for Public Land Hagler Fellow, Texas A&M University Professor Emeritus, University of Washington

Our partners enrich our community with awe-inspiring places where we can encounter nature experiences from around the world close to our homes and families. By partnering with us, we can help them gather data on the impact these experiences are having on the health of our community. CHN catalyzes this research by finding faculty interested in the studies and providing them seed funding to run the studies with our Collaborative Research Innovation Fund.

NatureRX: A Prescription for Fresh Air

Imagine going to the cardiologist and, maybe along with a prescription for pills, you’re given a prescription for a walk in the park or a bike ride along the beach.

NatureRX is a nonprofit information hub for health practitioners interested in writing prescriptions for patients who would benefit from spending time in nature as part of their care and wellness plans.

Scientists at CHN are working with NatureQuant, an Oregon-based company that has developed an app called Nature Dose, to develop NatureRx.

Nature Dose can monitor a patient’s time inside and outside to nature to leverage the benefits of nature exposure for better mental and physical health. Researchers are working with the app developers to address potential behavioral problems. For example, if a patient hasn’t been out in green or blue space for a few days, the app would send a reminder telling them how great it would be to get outdoors for a while.

The NatureRX initiative builds on a CHN-led collaboration with the ParkRx project, in which primary care physicians and cardiology specialists will offer prescriptions to visit parks with the goal of improving their health and well-being in 2023. A study will evaluate the effect of the ParksRX program on health management and on sustainability behaviors that not only maintain our health but also preserve and enhance our environment.

Houston Parks Board and the Bayou Greenways Project

This $220 million public-private partnership project has created 150 miles of trails and 3,000 acres of greenspace in Houston to expand equitable access to nature for all Houstonians.

Where people live play a role in accessibility to green spaces. Jay Maddock, PhD, from Texas A&M and Khurram Nasir, MD, from Houston Methodist have collaborated with the Houston Parks Board to show that with a population of one million Houstonians, residents of zip codes containing an accessible greenway trail had a lower likelihood of being admitted to the hospital for certain health conditions compared to those living in zip codes without a trail.

However, social disparity continues to play a role in access to green spaces. Findings indicate people of higher socioeconomic status more often choose to live in areas with access to these spaces, while people of lower socioeconomic statuses with access to green spaces are less likely to utilize them. The underlying factors are still being investigated. Access to bicycles, which has economic implications, in green spaces is one measure already in place.

Additional studies are needed to further clarify the relationship between the health benefit of walking trails and health. The next step is to directly survey users of the trails to determine how individuals use the trails and the perceived health benefits of the users as well as whether increased access to green spaces would be beneficial.

In a related study conducted at the center and lead by Omar Elsayed, researchers studied whether a more walkable environment is associated with a cardiovascular risk factor burden irrespective of a cardiovascular disease among a large, diverse population within an integrated health system.

These findings show that civic investments in greenspace and walkable parks and neighborhoods as a viable tool for improving our community cardiovascular health.

Main Findings

Residents living in zip codes with a greenway trail had a lower likelihood of being admitted to the hospital for certain health conditions compared to those living in zip codes without a trail.

What does this mean for you?

• Living within a 10 min walk of a Bayou Greenways trail can lead to opportunities for better health.

• Living in a zip code with long-term access to a Bayou Greenways trail can lead to better health outcomes.

• These findings can guide officials to develop healthier neighborhoods and communities for all.

The Houston Botanic Garden Partnership

This 132-acre garden is a curated collection of 1,000 taxa of tropical, sub-tropical, and arid plants from around the world that enriches lives through discovery, education, and the conservation of plants and the natural environment. Together with CHN, Houston Methodist is developingg several programs to gather the impact on the health of Houstonians that visit this rich nature experience.

The two organizations are also creating a Science of Health and Nature walking tour through various ecosystems within the garden. The tour is to be developed by academic medicine faculty from Houston Methodist and CHN researchers to teach the science behind the impact of nature on health in a hands-on setting.

Visitors will be able to access the CHN and Houston Botanic Garden walking tour through an app that guides them through an audio exploration of the science behind the impact of the garden’s ecosystems and plants on their health. The tour will be comprised of videos featuring subject matter experts who will speak on topics ranging from creating personal landscapes that are conducive to good physical and mental health, selecting herbs and other flowers for gardening that have health benefits and the benefits of plant-based eating and how nature can heal and restore.

People interested in participating will also be able to track their stress markers throughout the tour as part of our study. We are also collaborating on the design of an outdoor kitchen for studying the impact of programming that teaches balanced nutrition and cooking with plant-based foods.

In May 2022, Houston Botanic Garden hosted a Nurture by Nature festival featuring speakers from the CHN to educate the public on how nature can be used in healing. The festival was free to neighbors of the garden to encourage equitable access. Dr. Maddock served as the keynote speaker for the Houston Botanical Gardens Annual Luncheon in October 2022.

The Houston Botanic Gardens annual luncheon was held in October 2022.

Rooftop Healing Garden at Houston Methodist Hospital’s Centennial Tower

Houston Methodist is currently in the process of developing the Centennial Tower, a 26-story patient care tower. The 14th floor will feature an outdoor rooftop Healing Garden complete with trees and landscaping to provide patients, family and health care workers with an outdoor respite to relax and recharge.

The CHN, Houston Methodist and a Landscape Architecture Design class at Texas A&M University collaborated to develop evidence-based conceptual designs for the healing garden. Elements of the winning design will be featured in the new garden, slated to open 2028.

As we move into the next three-year cycle at the CHN, the impact of our work is expected to go beyond sharing practice and policy implications with the public; we are expecting to make an impact on health and environmental sustainability behaviors, behaviors that will not only improve our health but also preserve and enhance our environment, our green space, and our most valuable medicine, nature.

centerforhealthandnature.org centerforhealthandnature@houstonmethodist.org