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Urban Forestry & Urban Greening 66 (2021) 127404
Available online 23 November 2021
1618-8667/© 2021 The Author(s). Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Nature at work: The effects of day-to-day nature contact on workers’ stress
and psychological well-being
Sara P. Perrins
a
,
*, Usha Varanasi
b
, Edmund Seto
c
, Gregory N. Bratman
a
a
School of Environmental and Forest Sciences, University of Washington, Seattle, WA, United States
b
School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, United States
c
Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
ARTICLE INFO
Handling Editor: Wendy Chen
Keywords:
Mental health
Nature contact
Psychological well-being
Burnout
Stress
Anxiety
Workers
Employees
Workspaces
ABSTRACT
Objectives: Chronic stress and burnout are key health issues for ofce workers that may contribute to a myriad of
poor health outcomes. The presence of natural elements may improve psychological well-being in workers but
the number of existing studies is relatively low, and more longitudinal research is specically needed to assess
how characteristics of workers’ day-to-day environments may impact mental health outcomes like affect,
depression and stress. This report outlines a multi-study investigation of workers at Amazon, a multinational e-
commerce company based in Seattle, Washington, USA, and the mental health benets associated with exposure
to nature.
Methods: In Study 1, participants (n =153) responded to a cross-sectional survey that assessed the association of
self-reported visitation to an indoor company greenspace with psychological well-being including symptoms of
depression, anxiety, positive and negative affect, and stress. In Study 2, a subset of participants from Study 1 (n =
33) completed multiple surveys in a 2-week period that assessed the association of the naturalness of their
current environments with their state levels of psychological well-being.
Results: We found contact with more natural outdoor environments was signicantly associated with reduced
state anxiety, after adjusting for activity type, location, and participants’ trait levels of nature relatedness.
Conclusions: Findings demonstrate that nature contact in everyday life is signicantly associated with decreased
levels of state anxiety. More research is needed to investigate the role of nature contact as a potential inter-
vention in the workplace for improved mental health.
1. Introduction
The World Health Organization denes “mental health” as not only
the absence of mental illness, but also the presence of psychological
well-being (WHO, 2001). Growing evidence suggests contact with nat-
ural environments may be a source of benets for a wide range of mental
health and psychological well-being outcomes (Frumkin et al., 2017;
Hartig et al., 2014; Fong et al., 2018; Gascon et al., 2015). While there
are many possible denitions of “nature” and “natural environments”,
they often refer to features of non-human origin such as ora and fauna
(Frumkin et al., 2017; Bratman et al., 2012; Perrins and Bratman, 2020).
Why might nature contact improve psychological well-being?
Attention Restoration Theory (ART) (Kaplan and Kaplan, 1989) and
Stress Reduction Theory (SRT) (Ulrich, 1983) are prominent theories in
the eld of nature contact and human health that posit restorative
mechanisms. ART suggests that urban environments deplete our limited
capacity for voluntary, directed attention with which we must distin-
guish between relevant and irrelevant stimuli. Natural environments
may give this capacity a chance to replenish, with stimuli that engage
“soft fascination”, such as dappling sunlight through tree leaves or the
trickling of a stream. Studies have supported this theory wherein par-
ticipants performed better on attention-related tasks after exposure to
natural environments (compared to pre-exposure, or to an urban envi-
ronment exposure) (Berman et al., 2008; Ohly et al., 2016; Berto, 2005).
SRT suggests that the characteristics of attractive natural environments
elicit positive affective states and restorative psychophysiological re-
sponses in the human autonomic nervous system (Ulrich, 1983; Ulrich
et al., 1991) via parasympathetic nervous system activation and
reduction in arousal (e.g., increased heart rate) that accompanies stress
(Ulrich, 1983; Ulrich et al., 1991). Researchers have tested SRT by
* Corresponding author at: Anderson Hall, Box 352100 School of Environmental and Forest Sciences, University of Washington, Seattle, WA 98195, United States.
E-mail address: saraparkperrins@gmail.com (S.P. Perrins).
Contents lists available at ScienceDirect
Urban Forestry & Urban Greening
journal homepage: www.elsevier.com/locate/ufug
https://doi.org/10.1016/j.ufug.2021.127404
Received 18 April 2021; Received in revised form 20 August 2021; Accepted 5 November 2021
Urban Forestry & Urban Greening 66 (2021) 127404
2
measuring physiological indicators of stress (e.g., heart rate, skin
conductance, and biomarkers such as salivary cortisol) and self-report
measures in contrasting environmental exposure conditions, such as
natural vs. urban conditions. There is relatively strong empirical support
for SRT in the literature, with ndings associating exposure to natural
environments with decreased stress (de Vries et al., 2013; Nielsen and
Hansen, 2007; Roe et al., 2013; Stigsdotter et al., 2010; Grahn and
Stigsdotter, 2003), improved affect (Neill et al., 2019; Bratman et al.,
2015), and lower rates of depression and anxiety disorders (Maas et al.,
2009).
Although there are relatively few studies on the effects of nature
contact on workers’ stress specically, ndings generally align with ART
and SRT, with workplace nature contact being associated with improved
psychological well-being. One experimental study found that an ofce
greening intervention was associated with improved concentration
(Nieuwenhuis et al., 2014). Multiple studies reported greater psycho-
logical restoration and reduced stress in workers with exposure to nat-
ural environments; workers with window views of natural elements had
higher ratings of restoration compared to those with views of built en-
vironments (Kaplan, 1993), and ofce workers with a forest view had
decreased job-related stress, whereas those with views of built elements
(e.g., paved areas and adjacent buildings) had increased job-related
stress (Shin, 2007). Additionally, some emerging evidence indicates
that physical contact with nature may be even more effective than
viewing alone. A study found that while physical and visual access to
greenery improved workplace attitude and perceived levels of stress,
employees with physical access reported the lowest levels of stress
(Lottrup et al., 2013). Despite the benets of physical contact with na-
ture, studies identied barriers such as perceptions of being too busy to
go outside (Lottrup et al., 2012) and that going outside during the
workday may be ill-regarded by others (Hitchings, 2010). Therefore,
provision of nature contact that is both accessible and encouraged may
be important for employees’ well-being.
While this growing body of work on nature contact at the workplace
and psychological well-being is promising, more studies are needed to
address remaining gaps. Although studies (e.g., Largo-Wight et al.
(2011)) have typically assessed the amount of nature present in a
workplace environment, Hyvonen et al. (2018) found that the amount of
time spent in natural environments signicantly predicted psychological
well-being. Specically, more studies are needed to assess whether time
spent in company greenspaces (i.e., natural spaces that employers pro-
vide, and of which they encourage use) is associated with psychological
well-being; such studies could illuminate important implications on
workplace nature contact with reduced barriers to access. Furthermore,
gaps exist in assessing various domains of psychological well-being
associated with nature contact for workers. Existing studies indicate
workplace nature contact may benet stress-related outcomes (Shin,
2007; Lottrup et al., 2013; Largo-Wight et al., 2011a; Hyv¨
onen et al.,
2018) but other outcomes (such as positive and negative affect, and
symptoms of depression and anxiety) remain understudied. Addition-
ally, to our knowledge, no study in the United States has used a longi-
tudinal study design to investigate nature contact at/near the workplace
and state psychological well-being of workers. Studies that use repeated
measures offer important contributions to the existing body of largely
cross-sectional ndings–as the effects of nature contact on human health
may vary across instances and shifting circumstances (Frumkin et al.,
2017; Gascon et al., 2015), longitudinal designs can provide rich data on
real-world occurrences of changing environments and state well-being.
Finally, studies to date have not accounted for potential confounding
of effects introduced by certain activities. For example, natural envi-
ronments can promote physical activity (Astell-Burt et al., 2014; Ban-
croft et al., 2015) and social cohesion (de Vries et al., 2013; Dadvand
et al., 2016), which are in turn associated with psychological well-being
(Bekele et al., 2013; McDowell et al., 2019; Chan et al., 2019; U.S.
Department of Health and Human Services, 2021). In order to reduce
potential omitted variable bias, more studies are needed that account for
these activities as covariates.
2. Purpose
We conducted two studies to investigate the association of increased
nature contact at/near the workplace with improved mental health –
dened here as the absence of mental illness (e.g., depressive symptoms)
and the presence of psychological well-being (e.g., increased positive
affect and decreased negative affect and stress) (WHO, 2001; Bratman
et al., 2019). Amazon, an e-commerce company in Seattle, Washington,
USA, had recently completed construction on multistory nature con-
servatories called “the Spheres” (The Spheres, 2021) which provided
employees with 2 acres of plant-lled spaces for work and relaxation
(Fig. 1). These climate-controlled buildings maintained over 40,000
plants and were easily accessible amidst Amazon’s downtown campus.
In Study 1, we conducted a cross-sectional survey in which we tested
the hypothesis that more frequent visitation to the Spheres would be
associated with lower anxiety and depressive symptoms, negative affect,
and stress, and with higher positive affect. The study aimed to address
gaps in the literature by assessing the frequency of visitation to a
corporate greenspace and multiple outcomes on psychological well-
being, while controlling for potential confounding by activity type.
In Study 2, we conducted longitudinal assessments over a two-week
period of state levels of psychological well-being and nature contact.
This study aimed to address gaps in the literature through the use of
repeated assessments to test the hypothesis that workers experience
lower state anxiety and more state positive affect with increasing de-
grees of naturalness in environments encountered throughout the day,
after controlling for activity (e.g., chores, socializing, working, etc.) and
location (e.g., work, home, restaurant, etc.).
3. Materials and methods
3.1. Participants (N =153)
All employees 18 years of age or older were eligible to participate.
Potential participants were recruited through posters within the com-
pany’s buildings in downtown Seattle, Washington, USA, and through
notices in Amazon’s internal e-newsletters. Those who were interested
could use the included URL or QR code to visit the online consent form.
Participation was voluntary and anonymous. Amazon did not know who
participated or declined to participate. Due to company privacy policies,
we did not collect information about any individual’s demographic
traits, such as age, sex, or race or ethnicity. Incentives were not provided
for participation.
Fig. 1. Interior shot of the Spheres.
Image source: AshlynG/Flickr, CC BY-ND 2.0 (G A, 2018).
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
3
3.2. Procedures
Those who provided informed consent were emailed a link to a
survey hosted on Qualtrics (2020). Survey responses were recorded from
April to June 2019.
3.3. Instruments
Nature contact was assessed by asking participants, “In an average
week, how often do you visit the Spheres?” with ve ordinal response
choices (“0 times”, “1 time”, “2−3 times”, “4 times”, “5 or more times”).
Psychological well-being outcome variables included positive and
negative affect using the 20-item Positive and Negative Affective
Schedule (PANAS) (Watson et al., 1988) which asked participants to rate
the extent to which they felt feelings such as “interested” and “ashamed”
in general using 5-point Likert responses ranging from “Very slightly or
not at all” to “Extremely”. Positive and negative affect items were
summed separately, with a possible score range of 10–50 (Cronbach’s
alpha =0.89 for positive affect, 0.88 for negative affect).
Depression, anxiety and stress outcome variables were assessed using
the subscales from the 21-item Depression, Anxiety and Stress Scale
measure (Lovibond and Lovibond, 1995). Participants were asked the
extent to which the measure’s statements (e.g., “I felt down-hearted and
blue” (depression), “I was aware of dryness of my mouth” (anxiety), and
“I felt that I was rather touchy” (stress)) applied to them in general, using
4-point Likert responses from “Did not apply to me at all” to “Applied to
me very much or most of the time”. The sums from each subscale were
multiplied by 2, for a possible score range of 0−42 (Cronbach’s alpha =
0.91 for depression, 0.79 for anxiety, 0.81 for stress).
Trait relatedness to nature was included as a control variable using
the 6-item Nature Relatedness Scale (Nisbet and Zelenski, 2013), which
assessed the degree to which participants in general agree to such
statements as “My relationship to nature is an important part of who I
am” with ve Likert responses from “disagree strongly” to “agree
strongly”. Responses were averaged, creating a possible score range of
1–5 (Cronbach’s alpha =0.85).
Activity type within the Spheres was also included as a control var-
iable. Participants were asked how often they partook in each of the six
activities listed (“Attending work meetings”, “Socializing”, “Eating/
Drinking”, “Working alone (e.g., on a computer)”, “Taking a break from
work”, “Admiring nature”), with possible responses on a 5-point Likert
scale from “Never” to “Very often/always”.
3.4. Data analysis
Each outcome variable (positive affect, negative affect, depression,
anxiety and stress) was regressed on average visitation frequency to the
Spheres in separate linear models using RStudio version 1.2.5033
(RStudio Team, 2019). Depression and anxiety variables’ density plots
showed a positive skew, so log transformation was used to achieve
normality. The exposure and outcome variables were treated as
continuous. Base models included nature relatedness as a control vari-
able and adjusted models also included activity types as covariates. A
priori statistical signicance cutoff was set at a p-value of 0.05. As-
sumptions of normality were met, as assessed by residual versus tted
and Q-Q plots.
In preliminary analyses, we also assessed whether trait neuroticism
(Gosling et al., 2003), rumination (Trapnell and Campbell, 2021),
cognitive reappraisal (Gross and John, 2003) or somatic symptoms
(Schat et al., 2005) moderated the association between time spent in the
Spheres and psychological well-being. These exploratory analyses were
conducted based on hypotheses of potential effect modication by these
traits, as omission of signicant interactions from regressions could lead
to erroneous conclusions (Friedrich, 1982). Given the statistically
insignicant (all ps>0.08) interaction effects in the base models
(wherein the outcome variable was regressed on Spheres visitation
frequency, with the addition of neuroticism, rumination, cognitive
reappraisal or somatic symptoms as the interaction term), no further
analyses were conducted with these variables.
4. Results
Table 1 outlines the summary statistics for the nature contact
exposure and outcome variables.
We found that more self-reported frequency of visitation to the
Spheres was signicantly associated with more positive affect and less
negative affect in the base models (Table 2), but these associations were
no longer statistically signicant when controlling for various activities.
5. Discussion
Results from the Study 1 cross-sectional survey suggest that one’s
activity within the Spheres may explain some of the associations with
positive and negative affect. This potential confounding is consistent
with studies that have found different activities (such as exercising and
socializing) can inuence psychological well-being outcomes like stress
and anxiety (Bekele et al., 2013; McDowell et al., 2019; Dour et al.,
2014; Stonerock et al., 2015), and motivates further investigation of the
role of specic behaviors within nature with regard to well-being.
Study 2 followed a subset of participants from Study 1 over a two-
week period to track how exposure to a gradient of nature in day-to-
day environments, and activities within these environments, were
associated with affective outcomes for this population of workers. The
longitudinal design allowed us to account for how the effects of nature
contact on human health may vary across situations and circumstances
(Frumkin et al., 2017; Hartig et al., 2014; Gascon et al., 2015).
6. Study 2 introduction
Study 2 used a longitudinal design to track the ways in which daily
contact with a range of naturalness in environments impacts within-
person, state changes in affect and stress. We hypothesized that the
presence of more vs. fewer natural features indoors would be associated
with state psychological well-being. We also hypothesized that this as-
sociation would be true in outdoor environments as well. The current
study differed from an existing study on indoor versus outdoor nature
contact at work (Largo-Wight et al., 2011a) in important ways; rst, the
nature contact measure (Largo-Wight et al., 2011b) used by Largo-Wight
et al. assessed frequency of activities such as taking a break, eating
lunch, or exercising outside (without specically assessing the presence
of nature outdoors), and the amount of various natural features (plants,
photographs of natural scenes, etc.) in the primary workspace. In
contrast, the current study assessed the degree of naturalness of par-
ticipants’ current environments, and throughout the day regardless of
location (i.e., not just in the primary workspace but in the various lo-
cations workers visited throughout their day). Second, the current study
Table 1
Descriptive statistics for cross-sectional exposure and outcome variables.
mean (sd) range
Positive affect 34.07 (7.26) 11−50
Negative affect 19.9 (6.68) 10−42
Depression 8.89 (8.98) 0−42
Anxiety 6.93 (6.89) 0−32
Stress 13.27 (7.72) 0−32
categorical N (%)
Spheres visitation frequency 0 times/week 67 (43.8)
1 time/week 73 (47.7)
2−3 times/week 11 (7.3)
4 times/week 0 (0)
5+times/week 2 (1.3)
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
4
was the rst to use brief, repeated surveys to assess in situ changes in
affect, using ecological momentary assessment (EMA). EMA encom-
passes a range of methodological traditions and methods with the
overall objective to gather real-time data in real-world settings that can
reduce recall bias and allow for better understanding of the contexts in
which data were gathered as well as their short-term impacts (Shiffman
et al., 2008). Recent reviews cite EMA as well-suited for studying mental
health outcomes, including psychological well-being (de Vries et al.,
2020; Wenze and Miller, 2010). This study used repeated assessments to
contribute to knowledge gaps on the effects of day-to-day environmental
naturalness on workers’ state psychological well-being while in and
outside of the workplace, after controlling for potential confounding by
activity type.
7. Materials and methods
7.1. Participants
A subset of participants from Study 1 was asked to participate;
sampling was stratied based on their response to the survey item from
assessing their self-reported average visitation frequency to the Spheres.
Since those who visit the Spheres more or less often may also be likely to
visit other natural spaces more or less frequently, respectively, we
employed the stratied sampling in order to increase the likelihood of
capturing variability in daily nature contact within the sample popula-
tion for Study 2. Three strata were used to capture this variability: low
frequency Spheres users (those who self-reported visiting the conser-
vatories 0–1 time/week), medium frequency users (2–4 times/week),
and high frequency users (5+times/week). A total of 60 participants
were recruited.
7.2. Procedures
The short (~2-minute), repeated web-based survey assessed the
characteristics of the participant’s current environment along with their
self-reported well-being. This same survey was distributed 5 times per
day (every 3 h between 8am and 8 pm, Monday through Sunday, with
calendar reminders sent for each survey) for a two-week period in July
2019. This study design sought to assess each individual’s outcome re-
sponses across various locations (e.g., gym, work) and activities (e.g.,
eating, doing chores), so that each participant could act as their own
control.
7.3. Instruments
The degree of naturalness in participants’ environments was assessed
using the question, “Which of the following most closely resembles your
current environmental attributes?” with 5 categorical choices (“indoors
with no/very little natural elements”, “indoors with some natural ele-
ments”, “outdoors with no/very little natural elements”, “outdoors with
some natural elements”, and “outdoors, completely natural elements (e.
g., park)”). Each choice was accompanied by an image to help guide
categorization (Fig. 2). The degree of naturalness was reected in the
images’ density of green vegetation. The scenes were likely to reect
typical settings for the study population (i.e., ofce interiors, downtown
settings and parks) and the vegetation (where applicable) matched the
season of data collection.
Outcome variables included state positive affect, assessed with the 5
positive affect items from the PANAS (Kercher, 1992; Mackinnon, 1999)
(Cronbach’s alpha =0.88). Score calculation methods were the same as
those described in Study 1. State anxiety was assessed using the 6-item
State Trait Anxiety Inventory-Short Form (Marteau and Bekker, 1992)
which asked participants to rate the degree to which they felt each of the
listed emotions (e.g., “tense”) on a 4-point Likert scale. Items 1, 4 and 5
were reverse-coded, and scores were calculated by multiplying the sum
by 20/6. Possible scores ranged from 20 to 80 (Cronbach’s alpha =
Table 2
Estimates (95 % CI) for associations between company greenspace visitation frequency and outcomes, controlling for trait nature relatedness (base) and activity types (adjusted). N =153.
Positive Affect Negative Affect Depression Anxiety Stress
Base Adjusted Base Adjusted Base Adjusted Base Adjusted Base Adjusted
B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p B (95% CI) p
Spheres visitation 1.63 0.043 1.19 0.38 −1.84 0.014 −1 0.437 −0.22 0.064 −0.07 0.736 −0.11 0.316 −0.08 0.685 −1.26 0.15 −0.99 0.514
(0.06,3.2) (-1.48,3.87) (-3.3,-0.37) (-3.54,1.54) (-0.45,0.01) (-0.47,0.33) (-0.34,0.11) (-0.47,0.31) (-2.97,0.46) (-3.97,1.99)
Nature relatedness 1.38 0.027 1.17 0.068 0.36 0.53 0.56 0.354 −0.02 0.861 0 0.99 0.02 0.848 0.04 0.692 0.17 0.807 0.18 0.798
(0.16,2.6) (-0.09,2.44) (-0.77,1.5) (-0.63,1.76) (-0.19,0.16) (-0.19,0.19) (-0.16,0.19) (-0.15,0.22) (-1.17,1.5) (-1.22,1.59)
Working with others −0.51 0.62 −0.11 0.908 −0.01 0.969 0 0.973 −0.64 0.576
(-2.54,1.52) (-2.04,1.81) (-0.31,0.3) (-0.3,0.29) (-2.91,1.62)
Socializing 1.03 0.136 −0.73 0.263 −0.13 0.201 −0.08 0.407 −0.59 0.443
(-0.33,2.38) (-2.01,0.55) (-0.33,0.07) (-0.28,0.11) (-2.09,0.92)
Eating/Drinking 0.97 0.189 −0.36 0.61 −0.11 0.331 −0.01 0.963 −0.47 0.57
(-0.48,2.43) (-1.74,1.02) (-0.32,0.11) (-0.22,0.21) (-2.09,1.15)
Working alone −1 0.097 0.43 0.451 0.02 0.857 0.02 0.805 0.65 0.329
(-2.18,0.18) (-0.69,1.55) (-0.16,0.19) (-0.15,0.19) (-0.66,1.97)
Taking a break −0.34 0.673 0 0.627 0.11 0.363 0.09 0.426 −0.59 0.515
(-1.95,1.26) (-1.15,1.9) (-0.13,0.35) (-0.14,0.33) (-2.38,1.2)
Admiring nature 0.07 0.929 −0.24 0.758 0.01 0.939 −0.05 0.68 0.81 0.38
(-1.56,1.7) (-1.79,1.3) (-0.23,0.25) (-0.29,0.19) (-1.01,2.62)
The bold values are the signicance values.
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
5
0.82). To decrease participant burden, the survey omitted assessements
of negative affect or depressive symptoms (which had been included in
Study 1).
Participants’ current location was assessed with, “Where are you right
now?” with possible responses: “home”, “work (e.g., at the ofce)”, “the
Spheres”, “restaurant/eatery”, “in a form of transportation”, “park/
beach”, “gym”, “none of the above”. This item was included to address
potential confounding by location, e.g., whether being at home is asso-
ciated with relatively improved well-being compared to being at work.
Activity was an additional control variable, assessed with a survey
item, “What are you doing right now?”, with the following response
choices: “working with others”, “working alone”, “socializing”, “eating/
drinking”, “taking a break from work”, “admiring nature”, “exercising”,
“doing chores/running errands”, “none of the above”.
7.4. Data analysis
All analyses used current environment naturalness as the exposure
variable. This variable had 5 possible responses: indoors with no/very
little natural elements, indoors with some natural elements, outdoors
with no/very little natural elements, outdoors with some natural ele-
ments, or outdoors completely natural elements. We separated the data
into two datasets based on responses taken indoors versus responses
taken outdoors to test hypotheses that more natural elements present
indoors would confer greater health benets than indoor settings with
fewer natural elements, and that more natural elements present out-
doors would confer greater benets than outdoor settings with fewer
natural elements.
Additionally, we conducted preliminary analyses to test exploratory
hypotheses that state mindfulness (Brown and Ryan, 2003) and state
rumination (Marchetti et al., 2018) mediated the association between
environment naturalness and psychological well-being. Base linear
models (wherein state positive affect or state anxiety were regressed on
environment naturalness) showed no signicant effect of mindfulness or
rumination (all ps >0.09). According to mediation analysis steps set
forth by Baron and Kenny (1986) (Baron RM, Kenny DA, 1986), the
absence of a signicant effect of the causal variable on the outcome
variable precluded further mediation analyses.
Due to the correlated nature of within-person repeated assessments,
all analyses used multilevel random intercept and slope linear modelling
(Finch et al., 2014) which clustered surveys (level 1) within individuals
(level 2). Base models regressed anxiety or positive affect on environ-
ment naturalness, and controlled for trait nature relatedness. Adjusted
models also included current activity and survey location as covariates.
Assumptions of normality were met, as assessed by residual versus tted
and Q-Q plots.
Fig. 2. Images shown alongside survey ques-
tion assessing naturalness of participants’ cur-
rent environment. (A) “Indoors with no/very
little natural elements”. (B) “Indoors with some
natural elements”. (C) “Outdoors with no/very
little natural elements”. (D) “Outdoors with
some natural elements”. (E) “Outdoors with all
natural elements”.
Image sources in order A-E: Katy Warner/
Flickr, CC-BY-SA 2.0 (Warner, 2007); Reprinted
with permission/(Ready for Move, n.d.); public
domain image (Washington Street in downtown
Indianapolis, 2021); Reprinted with permis-
sion/(Visit Franklin (2021)); Copyright Tom-
assolizzul/Depositphotos (tommasolizzul,
2021).
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
6
8. Results
Of the 60 participants recruited, 33 subjects participated and 426
state surveys were completed (mean =13 surveys per participant).
For indoor environments (Table 3), the association between indoor
environment naturalness and positive affect was not statistically sig-
nicant (b =-0.25, p =0.56). The base model showed a signicant as-
sociation between environment naturalness and state anxiety (b =-4.10,
p =0.0017). This relationship was no longer statistically signicant in
the adjusted models, although the trend still suggests a negative asso-
ciation. Socializing (b =-5.31, p =0.03) and being at home (b =-8.65, p
<0.001) were associated with less anxiety.
For outdoor environments (Table 4), positive affect was signicantly
associated with outdoor natural environment (b =1.96, p =0.04) in the
base model, but the relationship was no longer statistically signicant in
the adjusted model. There was a signicant inverse association between
outdoor environment naturalness and anxiety (b =-7.86, p =0.0005) in
the base model, and this statistically signicant trend remained after
controlling for activity type, survey location and trait nature relatedness.
9. Study 2 discussion
Study 2 used repeated-measure assessments to demonstrate that time
spent in more natural environments is associated with less state anxiety
in outdoor settings, even after taking activity and location into account.
This adds support for Stress Reduction Theory, which posits that nature
contact reduces stress (Ulrich, 1983). These ndings also build upon
Table 4
Associations between environment naturalness and postive affect and state
anxiety in outdoor environments (Activity reference =no participation; Loca-
tion reference =Work).
Positive Affect Anxiety
base adjusted base adjusted
Independent Variables B (95%
CI)
B (95%
CI)
B (95%CI) B (95%CI)
Environment
naturalness
1.96*
(0.13,
3.79)
−0.02
(-2.36,
2.31)
−7.86**
(-11.97,
-3.74)
−6.71* (-11.9,
-1.51)
Nature relatedness −0.22
(-2.28,
1.85)
−0.10
(-1.8,
1.61)
4.96
(-2.23,12.15)
5.36
(-0.92,11.64)
Activity_Work with
others
5.3
(0.11,
10.49)
0.08
(-10.97,11.13)
Activity_Working alone 5.75
(-1.68,
13.19)
6.37
(-9.96,22.69)
Activity_Socializing 1.35
(-3.39,
6.08)
−1.4
(-11.73,8.93)
Activity_Eating/
Drinking
0.78
(-3.76,
5.33)
0.54
(-9.89,10.96)
Activity_Taking a break 0.91
(-2.67,
4.49)
4.09
(-4.04,12.22)
Activity_Admiring
nature
2.1
(-1.07,
5.26)
−7.63*
(-14.78,-0.48)
Activity_Exercising 3.03
(-0.6,
6.66)
7.2
(-1.24,15.64)
Activity_Doing chores 1.95
(-1.93,
5.83)
12.16*
(2.36,21.95)
Activity_None of the
above
3.72
(-0.4,
7.84)
0.75
(-8.49,9.99)
Location_Home 4.78
(-2.67,
12.22)
−0.27 (-16.7,
16.1)
Location_the Spheres 3.57
(-5.71,
12.86)
9.47 (-12.1,
31)
Location_Transportation 2.48
(-4.71,
9.66)
−0.92 (-16.1,
14.25)
Location_Park/beach 6.94
(-1.66,
15.54)
−3.67 (-22.3,
15)
Location_None of the
above
6.15
(-1.22,
13.52)
−7.5 (-23.3,
8.32)
**
p <0.01.
*
p <0.05.
Table 3
Estimates (95 % CI) between environment naturalness and positive affect and
state anxiety in indoor environments (Activity reference =no participation;
Location reference =Work).
Positive Affect Anxiety
base adjusted base adjusted
Independent Variables B(95%
CI)
B (95%CI) B (95%
CI)
B (95%CI)
Environment
naturalness
−0.25
(-1.08,
0.59)
−1.28
(-0.36,
0.56)
−4.1**
(-6.65,-
1.56)
−0.86
(-3.59,1.87)
Nature relatedness 1.25
(-0.4,
2.9)
1.24
(-0.43,
2.91)
1.54
(-3.01,
6.09)
1.39
(-3.32,6.09)
Activity_Work with
others
0.23
(-1.06,
1.51)
0.24
(-3.58,4.07)
Activity_Working alone −0.51
(-1.69,
0.67)
1.52
(-1.98,5.02)
Activity_Socializing 2.18**
(.57, 3.8)
−5.31*
(-10.12,-0.51)
Activity_Eating/
Drinking
0.002
(-1.06,
1.06)
−3.21 (-6.37,-
0.06)
Activity_Taking a break 0.09
(-1.22,
1.39)
2.91
(-0.97,6.79)
Activity_Admiring
nature
−1.02
(-3.08,
1.04)
0.44
(-5.7,6.59)
Activity_Exercising 1.39
(-1.91,
4.68)
−1.15
(-10.98,8.68)
Activity_Doing chores 0.22
(-1.72,
2.16)
3.31
(-2.45,9.07)
Activity_None of the
above
−1.84*
(-3.54,
-0.15)
0.46
(-4.59,5.51)
Location_Home 0.12
(-1.21,
1.44)
−8.65**
(-12.6, -4.7)
Location_the Spheres 2.09*
(0.34,
3.83)
−4.65
(-9.84,0.54)
Location_Restaurant 1.44
(-0.91,
3.8)
1.61 (-5.43,
8.64)
Location_Transportation −0.6
(-3.16,
1.94)
0.15 (-7.46,
7.76)
Location_Gym 1.64
(-5.19,
8.46)
−11.03
(-31.39, 9.33)
Location_None of the
above
−1.66
(-4.44,
1.13)
3.26 (-5.04,
11.56)
**
p <0.01.
*
p <0.05.
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
7
existing literature that has found stress and affect-related benets to
occur from nature contact (de Vries et al., 2013; Roe et al., 2013; Pun
et al., 2018; Ward Thompson et al., 2012), including in worker pop-
ulations specically (Kaplan, 1993; Shin, 2007; Largo-Wight et al.,
2011a; Hyv¨
onen et al., 2018).
Within indoor environments, the signicant relationship between
environment naturalness and state anxiety was reduced and no longer
signicant when location and activity covariates were included
(Table 2). In particular, results suggest the activity of socializing and
being at home (compared to work) may confound this relationship.
Study 2 was able to differentiate indoor and outdoor environments
within the same study population, which few studies have done. Out-
door natural environments were particularly associated with reductions
in state anxiety, which aligns with the ndings of a study by Largo-Wight
et al. (2011) that found the strongest relationships between nature
contact and less stress for employees who had more frequent direct,
outdoor exposure to nature. This study was novel, however, in specifying
environments (both indoors and outdoors) by their degree of natural-
ness, thereby assessing how nature contact and state psychological well-
being may change as workers go about their daily lives. In Study 2,
outdoor environments had the option to be characterized with “all
natural elements” (as may be the case when a participant is at a park, for
example), while indoor environments could at most be characterized as
having “some natural elements”. The capacity for the outdoors to pro-
vide more immersive natural environments may play a role in explaining
some of the study’s ndings.
10. General discussion
Taken together, the ndings from this pair of studies adds to
emerging research on the association between psychological well-being
and nature contact for workers. However, in some cases these associa-
tions were attenuated by location or activity type. In order to increase
understanding of the ways in which indoor and outdoor natural envi-
ronments at or near work affect mental health, more research is needed
on the contexts in which this nature contact occurs.
In Study 1, The Spheres was an accessible indoor natural environ-
ment for Amazon employees; it was located next to the company’s
headquarter buildings in a downtown area, with amenties such as wi
internet, power outlets and tables. This space was large in scale (nearly 2
acres), density (over 40,000 plants), and biodiversity (several hundred
species from dozens of countries), relative to its setting in downtown
Seattle, Washington. Furthermore, most of the plants were native to
tropical cloud forests, and thus not typically seen in this geographical
area. Thus, while this environmental exposure was highly accessible for
day-to-day contact, it may not be generalizable as a proxy for typical,
“everyday” nature contact. Future studies can assess the role of such
factors as awe—an emotion of wonder and amazement that arises in
response to out-of-the-ordinary stimuli (Keltner and Haidt, 1999; Piff
et al., 2015) and demonstrated in the context of nature contact (Ballew
and Omoto, 2018) —in such distinct environments. In Study 2, partici-
pants’ contact with natural environments was not limited to the Spheres.
Rather, participants self-reported on the naturalness of their current
environments—places they were visiting as part of their day-to-day
lives. Outdoor natural environments had stronger associations with af-
fective benets compared to indoor natural environments. This nding
can help employers to prioritize the provision of natural outdoor envi-
ronments at or near work in order to promote psychological well-being
in workers.
11. Limitations
There are several limitations to this study. The study population was
drawn from a single (albeit large) technological company in one region
of the United States. In addition, rather than recruit randomly-selected
employees of Amazon to participate, the study’s participants had
voluntarily responded to recruitment ads. Thus, self-selection bias limits
the generalizability of the ndings. In addition, demographic variables
were not available, prohibiting inclusion of analysis of differences in the
characteristics of the nal study sample versus other employees who did
not choose to participate. Despite the limitations of missing de-
mographic data, the design of Study 2 allowed for each participant to act
as their own control, thereby improving the estimation of effects. An
additional limitation is the potential for social desirability bias in which
participants may have provided responses to be viewed more favorably
the researchers. The anonymity of their participation (as outlined in the
informed consent form) may have attenuated this bias (Covert and
Colton, 2007), but future study iterations can further account for this
potential bias, for example by controlling for individual scores on the
Marlow-Crowne Social Desirabilty Scale (Crowne and Marlowe, 1960)
to adjust for individual concern with social approval.
The authors know of one validated measure on nature contact at
work (Largo-Wight et al., 2011b). However, the instrument was not
appropriate for current studies’ primary research questions on green-
space visitation frequency, and changing environment naturalness with
regard to psychological well-being. Furthermore, existing nature contact
measures do not include current activity and location, which were added
as covariate items in our studies. Thus, the nature contact exposure and
covariate variables in Study 1 and Study 2 were assessed with unvali-
dated survey questions, and the lack of content validity testing is a
limitation. Additionally, reliability assessments (e.g., test re-test) were
not reported; Study 1 used a one-time survey (thus not allowing for such
assessments), and Study 2 used EMA methodology that did not assume a
priori entirely consistent responses from survey to survey—on the con-
trary, we expected outcome responses to change as a function of mul-
tiple predictors, including the naturalness of the environment, location,
and activity at the time of each particular survey. Nonetheless, the lack
of test-retest reliability limits the inferencibility of study ndings.
Although Study 2 used a longitudinal design, the ndings from these
studies do not allow causal inferences; without randomization, it is not
possible to eliminate alternate plausible explanations for observed as-
sociations between our exposure and outcome variables. More research
on workplace nature contact and mental health should seek to use robust
study designs, such as randomized controlled experiments, to elucidate
causal pathways.
12. Conclusions
The ndings from these studies support the notion that nature con-
tact is associated with less anxiety in employees. This is especially
important given the need for greater psychological well-being at the
workplace. The United States’ National Institute for Occupational Safety
and Health found 40 % of workers described their job as being very/
extremely stressful, and 25 % cited their jobs as the number one stressor
in their lives (U.S. Department of Health and Human Services, 1999).
Additionally, the World Health Organization recently recognized
“burnout” as a work-specic chronic stress phenomenon which is now
included in the most recent revision of the International Classication of
Diseases (World Health Organization, 2021). Although one study found
stress reduction effects from exposure to natural environments in a study
sample with burnout syndrome (Kjellgren, 2010), more research is
needed on the mental health benets of nature contact at or near the
workplace.
Given previous ndings on the barriers to nature contact at the
workplace—primarily perceived lack of time and perception that going
outside during work hours may be frowned upon by others—companies
may foster better mental health in their employees by providing op-
portunities for nature contact in easily accessible indoor and outdoor
spaces, and by encouraging employees to utilize these opportunities.
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
8
Authors statement
Sara Perrins: Conceptualization, Methodology, Software, Validation,
Formal analysis, Investigation, Data curation, Writing- Original Draft,
Writing- Review & Editing, Visualization
Usha Varanasi: Conceptualization, Methodology, Resources,
Writing- Original Draft, Writing- Review & Editing, Supervision, Project
administration
Edmund Seto: Conceptualization, Methodology, Writing -Original
Draft, Writing- Review & Editing
Gregory Bratman: Conceptualization, Methodology, Resources,
Writing- Original Draft, Writing- Review & Editing, Supervision, Project
administration, Funding acquisition
Author contributions
All authors contributed to study concept, design, data acquisition or
analysis, manuscript draft or critical revision.
Data availability
No data was used for the research described in the article.
Funding
The authors do not have funding sources to disclose.
Declaration of Competing Interest
The authors report no declarations of interest.
Acknowledgements
We would like to acknowledge the Amazon Spheres staff members
Ron Gagliardo, Claire Woodward, Justin Schroeder, and Ben Eiben for
working with the science team to discuss and provide support for lo-
gistics and conduct of the experiments. Greg Bratman and Sara Perrins
are grateful for support from the Doug Walker Endowed Professorship,
Craig McKibben and Sarah Merner, John Miller, and the JPB Environ-
mental Health Fellowship.
References
Astell-Burt, T., Feng, X., Kolt, G.S., 2014. Green space is associated with walking and
moderate-to-vigorous physical activity (MVPA) in middle-to-older-aged adults:
ndings from 203 883 Australians in the 45 and up study. Br. J. Sports Med. 48 (5),
404–406. https://doi.org/10.1136/bjsports-2012-092006.
Ballew, M.T., Omoto, A.M., 2018. Absorption: how nature experiences promote awe and
other positive emotions. Ecopsychology 10 (1), 26–35. https://doi.org/10.1089/
eco.2017.0044.
Bancroft, C., Joshi, S., Rundle, A., et al., 2015. Association of proximity and density of
parks and objectively measured physical activity in the United States: a systematic
review. Soc. Sci. Med. 138, 22–30. https://doi.org/10.1016/j.
socscimed.2015.05.034.
Baron RM, Kenny DA, 1986. The moderator-mediator variable distinction in social
psychological research: conceptual, strategic and statistical considerations. J. Pers.
Soc. Psychol. 51, 1173–1182.
Bekele, T., Rourke, S.B., Tucker, R., et al., 2013. Direct and indirect effects of perceived
social support on health-related quality of life in persons living with HIV/AIDS. AIDS
Care 25 (3), 337–346. https://doi.org/10.1080/09540121.2012.701716.
Berman, M.G., Jonides, J., Kaplan, S., 2008. The cognitive benets of interacting with
nature. Psychol. Sci. 19 (12), 1207–1212. https://doi.org/10.1111/j.1467-
9280.2008.02225.x.
Berto, R., 2005. Exposure to restorative environments helps restore attentional capacity.
J. Environ. Psychol. 25 (3), 249–259. https://doi.org/10.1016/j.jenvp.2005.07.001.
Bratman, G.N., Hamilton, J.P., Daily, G.C., 2012. The impacts of nature experience on
human cognitive function and mental health: nature experience, cognitive function,
and mental health. Ann. N. Y. Acad. Sci. 1249 (1), 118–136. https://doi.org/
10.1111/j.1749-6632.2011.06400.x.
Bratman, G.N., Daily, G.C., Levy, B.J., Gross, J.J., 2015. The benets of nature
experience: improved affect and cognition. Landsc. Urban Plan. 138, 41–50. https://
doi.org/10.1016/j.landurbplan.2015.02.005.
Bratman, G.N., Anderson, C.B., Berman, M.G., et al., 2019. Nature and mental health: an
ecosystem service perspective. Sci. Adv. 5 (7), eaax0903. https://doi.org/10.1126/
sciadv.aax0903.
Brown, K.W., Ryan, R.M., 2003. The benets of being present: mindfulness and its role in
psychological well-being. J. Pers. Soc. Psychol. 84 (4), 822–848. https://doi.org/
10.1037/0022-3514.84.4.822.
Chan, J.S.Y., Liu, G., Liang, D., Deng, K., Wu, J., Yan, J.H., 2019. Special issue –
therapeutic benets of physical activity for mood: a systematic review on the effects
of exercise intensity, duration, and modality. J. Psychol. 153 (1), 102–125. https://
doi.org/10.1080/00223980.2018.1470487.
Covert, R.W., Colton, D., 2007. Designing and Constructing Instruments for Social
Research and Evaluation, 1st ed. Jossey-Bass, San Francisco, CA.
Crowne, D.P., Marlowe, D.A., 1960. A new scale of social desirability independent of
pathology. J. Consult. Psychol. 24, 351.
Dadvand, P., Bartoll, X., Basaga˜
na, X., et al., 2016. Green spaces and General Health:
roles of mental health status, social support, and physical activity. Environ. Int. 91,
161–167. https://doi.org/10.1016/j.envint.2016.02.029.
de Vries, S., van Dillen, S.M.E., Groenewegen, P.P., Spreeuwenberg, P., 2013. Streetscape
greenery and health: stress, social cohesion and physical activity as mediators. Soc.
Sci. Med. 94, 26–33. https://doi.org/10.1016/j.socscimed.2013.06.030.
de Vries, L.P., Baselmans, B.M.L., Bartels, M., 2020. Smartphone-based ecological
momentary assessment of well-being: a systematic review and recommendations for
future studies. J. Happiness Stud. https://doi.org/10.1007/s10902-020-00324-7.
Published online October 23, 2020.
Dour, H.J., Wiley, J.F., Roy-Byrne, P., et al., 2014. Perceived socials upport mediates
anxiety and depressive symptom changes following primary care intervention:
Research Article: Social Support Mediates Symptom Change. Depress. Anxiety 31
(5), 436–442. https://doi.org/10.1002/da.22216.
Finch, W.H., Bolin, J.E., Kelley, K., 2014. Multilevel Modeling Using R. CRC Press.
Fong, K.C., Hart, J.E., James, P., 2018. A review of epidemiologic studies on greenness
and health: updated literature through 2017. Curr. Environ. Health Rep. 5 (1),
77–87. https://doi.org/10.1007/s40572-018-0179-y.
Friedrich, R.J., 1982. In defense of multiplicative terms in multiple regression equations.
Am. J. Polit. Sci. 26 (4), 797. https://doi.org/10.2307/2110973.
Frumkin, H., Bratman, G.N., Breslow, S.J., et al., 2017. Nature contact and human health:
a research agenda. Environ. Health Perspect. 125 (7), 075001 https://doi.org/
10.1289/EHP1663.
G A, 2018. Inside the Amazon Spheres (Accessed 20 August 2021). https://www.ickr.co
m/photos/shlyn401/39785646655/in/photostream/.
Gascon, M., Triguero-Mas, M., Martínez, D., et al., 2015. Mental health benets of long-
term exposure to residential green and blue spaces: a systematic review. Int. J.
Environ. Res. Public Health 12 (4), 4354–4379. https://doi.org/10.3390/
ijerph120404354.
Gosling, S.D., Rentfrow, P.J., Swann, W.B., 2003. A very brief measure of the Big-Five
personality domains. J. Res. Personal 37 (6), 504–528. https://doi.org/10.1016/
S0092-6566(03)00046-1.
Grahn, P., Stigsdotter, U.A., 2003. Landscape planning and stress. Urban For. Urban
Green. 2 (1), 1–18. https://doi.org/10.1078/1618-8667-00019.
Gross, J.J., John, O.P., 2003. Individual differences in two emotion regulation processes:
implications for affect, relationships, and well-being. J. Pers. Soc. Psychol. 85 (2),
348–362. https://doi.org/10.1037/0022-3514.85.2.348.
Hartig, T., Mitchell, R., de Vries, S., Frumkin, H., 2014. Nature and health. Annu. Rev.
Public Health 35 (1), 207–228. https://doi.org/10.1146/annurev-publhealth-
032013-182443.
Hitchings, R., 2010. Urban greenspace from the inside out: an argument for the approach
and a study with city workers. Geoforum 41 (6), 855–864. https://doi.org/10.1016/
j.geoforum.2010.07.004.
Hyv¨
onen, K., T¨
ornroos, K., Salonen, K., Korpela, K., Feldt, T., Kinnunen, U., 2018.
Proles of nature exposure and outdoor activities associated with occupational well-
being among employees. Front. Psychol. 9, 754. https://doi.org/10.3389/
fpsyg.2018.00754.
Kaplan, R., 1993. The role of nature in the context of the workplace. Landsc. Urban Plan.
26 (1–4), 193–201. https://doi.org/10.1016/0169-2046(93)90016-7.
Kaplan, R., Kaplan, S., 1989. The Experience of Nature: A Psychological Perspective.
Cambridge University Press.
Keltner, D., Haidt, J., 1999. Social functions of emotions at four levels of analysis. Cogn.
Emot. 13 (5), 505–521. https://doi.org/10.1080/026999399379168.
Kercher, K., 1992. Assessing subjective well-being in the old-old. Res. Aging 14,
131–167.
Kjellgren, A., 2010. A comparison of the restorative effect of a natural environment with
that of a simulated natural environment. J. Environ. Psychol. 9. Published online
2010.
Largo-Wight, E., Chen, W.W., Dodd, V., Weiler, R., 2011a. Healthy workplaces: the
effects of nature contact at work on employee stress and health. Public Health Rep.
126 (1_suppl), 124–130. https://doi.org/10.1177/00333549111260S116.
Largo-Wight, E., Chen, W.W., Dodd, V., Weiler, R., 2011b. The nature contact
questionnaire: a measure of healthy workplace exposure. Work 40 (4), 411–423.
https://doi.org/10.3233/WOR-2011-1253.
Lottrup, L., Stigsdotter, U.K., Meilby, H., Corazon, S.S., 2012. Associations between use,
activities and characteristics of the outdoor environment at workplaces. Urban For.
Urban Green. 11 (2), 159–168. https://doi.org/10.1016/j.ufug.2011.12.006.
Lottrup, L., Grahn, P., Stigsdotter, U.K., 2013. Workplace greenery and perceived level of
stress: benets of access to a green outdoor environment at the workplace. Landsc.
Urban Plan. 110, 5–11. https://doi.org/10.1016/j.landurbplan.2012.09.002.
Lovibond, P.F., Lovibond, S.H., 1995. The structure of negative emotional states:
comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression
S.P. Perrins et al.
Urban Forestry & Urban Greening 66 (2021) 127404
9
and Anxiety Inventories. Behav. Res. Ther. 33 (3), 335–343. https://doi.org/
10.1016/0005-7967(94)00075-U.
Maas, J., Verheij, R.A., de Vries, S., Spreeuwenberg, P., Schellevis, F.G., Groenewegen, P.
P., 2009. Morbidity is related to a green living environment. J. Epidemiol.
Community Health 63 (12), 967–973. https://doi.org/10.1136/jech.2008.079038.
Mackinnon, A., 1999. A short form of the Positive and Negative Affect Schedule:
evaluation of factorial validity and invariance across demographic variables in a
community sample. Personal Individ Differ 12. Published online 1999.
Marchetti, I., Mor, N., Chiorri, C., Koster, E.H.W., 2018. The brief state rumination
inventory (BSRI): validation and psychometric evaluation. Cognit. Ther. Res. 42 (4),
447–460. https://doi.org/10.1007/s10608-018-9901-1.
Marteau, T., Bekker, H., 1992. The development of a 6-item Short-Form of the state scale
of the Spielberger State Trait Anxiety Inventory (STAI). Br. J. Clin. Psychol. 31,
301–306.
McDowell, C.P., Dishman, R.K., Gordon, B.R., Herring, M.P., 2019. Physical activity and
anxiety: a systematic review and meta-analysis of prospective cohort studies. Am. J.
Prev. Med. 57 (4), 545–556. https://doi.org/10.1016/j.amepre.2019.05.012.
Neill, C., Gerard, J., Arbuthnott, K.D., 2019. Nature contact and mood benets: contact
duration and mood type. J. Posit. Psychol. 14 (6), 756–767. https://doi.org/
10.1080/17439760.2018.1557242.
Nielsen, T.S., Hansen, K.B., 2007. Do green areas affect health? Results from a Danish
survey on the use of green areas and health indicators. Health Place 13 (4), 839–850.
https://doi.org/10.1016/j.healthplace.2007.02.001.
Nieuwenhuis, M., Knight, C., Postmes, T., Haslam, S.A., 2014. The relative benets of
green versus lean ofce space: three eld experiments. J. Exp. Psychol. Appl. 20 (3),
199–214. https://doi.org/10.1037/xap0000024.
Nisbet, E.K., Zelenski, J.M., 2013. The NR-6: a new brief measure of nature relatedness.
Front. Psychol. 4 https://doi.org/10.3389/fpsyg.2013.00813.
Ohly, H., White, M.P., Wheeler, B.W., et al., 2016. Attention Restoration Theory: a
systematic review of the attention restoration potential of exposure to natural
environments. J. Toxicol. Environ. Health B Crit. Rev. 19 (7), 305–343. https://doi.
org/10.1080/10937404.2016.1196155.
Perrins, S.P., Bratman, G., 2020. Health Benets of Nature (Accessed 1 February 2021).
Washington State Recreation and Conservation Ofce. https://rco.wa.gov/wp-cont
ent/uploads/2020/01/HealthBenetsofNature.pdf.
Piff, P.K., Dietze, P., Feinberg, M., Stancato, D.M., Keltner, D., 2015. Awe, the small self,
and prosocial behavior. J. Pers. Soc. Psychol. 108 (6), 883–899. https://doi.org/
10.1037/pspi0000018.
Pun, V.C., Manjourides, J., Suh, H.H., 2018. Association of neighborhood greenness with
self-perceived stress, depression and anxiety symptoms in older U.S adults. Environ.
Health 17 (1), 39. https://doi.org/10.1186/s12940-018-0381-2.
Qualtrics, 2020. Qualtrics. Published 2020. (Accessed 11 November 2020). www.
qualtrics.com.
Ready for Move. No Title; n.d., (Accessed 20 August 2021). https://www.readyformove.
in/assets/uploads/1600511958911925e51a43761080c00cb93a77347d.jpg.
Roe, J., Thompson, C., Aspinall, P., et al., 2013. Green space and stress: evidence from
cortisol measures in deprived urban communities. Int. J. Environ. Res. Public Health
10 (9), 4086–4103. https://doi.org/10.3390/ijerph10094086.
RStudio Team, 2019. RStudio: Integrated Development Environment for R. RStudio, Inc..
http://www.rstudio.com/
Schat, A.C.H., Kelloway, E.K., Desmarais, S., 2005. The physical health questionnaire
(PHQ): construct validation of a self-report scale of somatic symptoms. J. Occup.
Health Psychol. 10 (4), 363–381. https://doi.org/10.1037/1076-8998.10.4.363.
Shiffman, S., Stone, A.A., Hufford, M.R., 2008. Ecological momentary assessment. Annu.
Rev. Clin. Psychol. 4 (1), 1–32. https://doi.org/10.1146/annurev.
clinpsy.3.022806.091415.
Shin, W.S., 2007. The inuence of forest view through a window on job satisfaction and
job stress. Scand. J. For. Res. 22 (3), 248–253. https://doi.org/10.1080/
02827580701262733.
Stigsdotter, U.K., Ekholm, O., Schipperijn, J., Toftager, M., Kamper-Jørgensen, F.,
Randrup, T.B., 2010. Health promoting outdoor environments - associations between
green space, and health, health-related quality of life and stress based on a Danish
national representative survey. Scand. J. Public Health 38 (4), 411–417. https://doi.
org/10.1177/1403494810367468.
Stonerock, G.L., Hoffman, B.M., Smith, P.J., Blumenthal, J.A., 2015. Exercise as
treatment for anxiety: systematic review and analysis. Ann. Behav. Med. 49 (4),
542–556. https://doi.org/10.1007/s12160-014-9685-9.
The Spheres. The Spheres (Accessed 10 November 2020). www.seattlespheres.com.
tommasolizzul. 2021 Path in Beautiful Green Forest; n.d. www.depositphotos.com.
Trapnell, P.D., Campbell, J.D., 2021. Private Self-Consciousness and the Five-Factor
Model of Personality: Distinguishing Rumination From Reection, p. 21.
U.S. Department of Health and Human Services, 1999. Stress…At Work. https://www.cd
c.gov/niosh/docs/99-101/pdfs/99-101.pdf?id=10.26616/NIOSHPUB99101.
U.S. Department of Health and Human Services. Healthy People 2020: Social Cohesion.
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinant
s-health/interventions-resources/social-cohesion.
Ulrich, R.S., 1983. Aesthetic and affective response to natural environment. In: Human
Behavior and Environment, Vol. 6. I. Altman & J. Wohwill, pp. 85–125.
Ulrich, R.S., Simons, R.F., Losito, B.D., Fiorito, E., Miles, M.A., Zelson, M., 1991. Stress
recovery during exposure to natural and urban environments. J. Environ. Psychol.
11 (3), 201–230. https://doi.org/10.1016/S0272-4944(05)80184-7.
Visit Franklin, 2021. Franklin and Main Street (Accessed 20 August 2021). www.
VisitFranklin.com.
Ward Thompson, C., Roe, J., Aspinall, P., Mitchell, R., Clow, A., Miller, D., 2012. More
green space is linked to less stress in deprived communities: evidence from salivary
cortisol patterns. Landsc. Urban Plan. 105 (3), 221–229. https://doi.org/10.1016/j.
landurbplan.2011.12.015.
Warner, K., 2007. Cubicle Row 2 (Accessed 20 August 2021). https://www.ickr.com
/photos/sundazed/1450388845/in/photolist-3daC5e-5krcxV-4tEdtp-4mPwsK-4
U8mbg-5twu1h-5x38tJ-4K45wq-4NbS6Y-5BeTzS-5LfuY3-5krcBR-5tNh18-4byzzQ-4
vxHMJ-4CHmYb.
Washington Street in downtown Indianapolis. https://en.wikipedia.org/wiki/File:Wash
ington_Street_in_downtown_Indianapolis.jpg#lelinks.
Watson, D., Anna, L., Tellegen, A., 1988. Development and validation of brief measures
of positive and negative affect: the PANAS scales. Published online 8.
Wenze, S.J., Miller, I.W., 2010. Use of ecological momentary assessment in mood
disorders research. Clin. Psychol. Rev. 30 (6), 794–804. https://doi.org/10.1016/j.
cpr.2010.06.007.
WHO, 2001. The World Health Report 2001: Mental Health: New Understanding, New
Hope. World Health Organization.
World Health Organization. Burn-out an “occupational phenomenon”: International
Classication of Diseases (Accessed 10 October 2020). https://www.who.int/mental
_health/evidence/burn-out/en/.
S.P. Perrins et al.
