The effect of urban green space on uncertainty stress and life stress: A nationwide study of university students in China
Introduction
Many studies have found that urban environments increase stress (Lederbogen et al., 2011), which is linked to adverse health behaviours and poorer general and mental health (Chen et al., 2017; Dong and Qin, 2017; Liu et al., 2017; Tan and Jin, 2009; Wang et al., 2016; Zhao et al., 2018). These issues are critical in low- and middle-income countries (LMICs) where most urban growth is occurring.
As part of this broader research effort there has been a focus on the impact of green space in ameliorating the negative health effects of stress and a large literature on the health benefits of green space and its planning implications has begun to emerge (Gascon et al., 2015; Grunewald et al., 2018; Kondo et al., 2018; Lee and Maheswaran, 2010; World Health Organisation, 2016). Numerous studies have reported the positive effects of green environments in relieving stress (Beil and Hanes, 2013; Hazer et al., 2018; Herrera et al., 2018; Jennings and Gaither, 2015; Van den Berg et al., 2010) and improving physical (Ying et al., 2015; Zhou et al., 2017) and mental health (Fang et al., 2008; Houlden et al., 2018; Van den Berg et al., 2015; Tsai et al., 2018; Wood et al., 2017), although links to population mortality rates are less clear (Gascon et al., 2016). There also appears to be general agreement that the presence of green spaces can enhance psychological well-being in a wide range of socio-demographic communities (Grunewald et al., 2018; Sarker et al., 2018), including more deprived places (Maas et al., 2006; Thompson et al., 2016).
The literature on green space initially focused on identifying links to physical and mental health, but in more recent years researchers have increasingly directed their attention to group differences in the effects of green space on social well-being along with social justice issues (Wolch et al., 2014). Given the emergence of government policy concerns regarding the importance of green spaces to the ecological health of cities (Chen and Hu, 2015), there has also been an increased focus on mapping changes in the provision of green space using GIS methodologies (Fan et al., 2017). Because green space comes in many different forms, the pattern of provision of green areas within cities has also received emphasis (Tsai et al., 2018), along with how people perceive and interact with such spaces (Dong and Qin, 2017). However, despite increased knowledge of the provision of green space and the positive aspects of green space exposure on relieving stress and health, writers such as Houlden et al. (2018) would argue that the evidence is still lacking in many respects and is not currently sufficient or specific enough to guide planning decisions.
With respect to links between green space, stress and health current research can be criticised on a number of counts. First, in attempting to unravel the effects of the urban environment on health, much current research does not distinguish between different types of stress, such as life and uncertainty stress. The stress-diathesis theory recommends further classifications of generic stress because some stressors are desirable and controllable, while others may exert a negative or chronic influence and are harder to manage (Monroe and Simons, 1991). Life stress refers to the persistent daily worries in one's life, such as poor living arrangements, health conditions, personal relationships and so on (Yang et al., 2017). Life stressors, so defined, are important challenges to an individual's ability to cope.
However, in recent years a host of evidence now supports the assertion that uncertainty also constitutes a powerful stressor (Greco and Roger, 2003) and contributes to ill health by arousing stress (Monat et al., 1972). Scholz (1983, p.237) has defined uncertainty as “incomplete information or knowledge about a situation, or the possible alternatives or the probability of their occurrence”. First shown to be a powerful stressor in the context of illness and hospitalization (Mishel, 1981), studies of uncertainty have since broadened their emphasis and recent work by Yang and colleagues in China (Table 1) has considered the effects of rapid socio-economic transition, increased job competition, and feelings of social anomie as sources of uncertainty stress. Drawing on theories of stress diathesis and theories of control and defense mechanisms (Mirowski and Ross, 1990), they have shown that uncertainty and life stress, although related, are distinct components of stress (see Wu et al., 2016). Further work has revealed that uncertainty stress, in particular, is associated with a range of negative health outcomes, including problem alcohol use, deliberate self-harm, suicide ideation and poorer self-rated health (see Table 1). Uncertainty stress damages mental wellbeing by challenging one's capacity to predict and plan in such a way as to be able to act efficaciously and, compared to more generic patterns of life stress, its coping requires more psychological resources. Festinger (1957) hypothesized that uncertainty causes cognitive confusion and when confronted with uncertainty stress people tend to engage in avoidance behavior which makes the problem worse.
However, as Greco and Roger (2003) have shown, important individual differences occur on the part of individuals in their management of uncertainty. In the case of university students, uncertainty stress has been found to be related to be one's social standing, access to material resources and levels of social support (Yang et al., 2017). As predicted by social exchange theory (Blau, 1964), persons of lower social status will have less economic power and will be more likely to be challenged to cope with stressful situations. Given intense competition within universities and eventual job prospects, students face high levels of uncertainty with respect to their goals, social values and future life. Such stresses are also likely to be more pronounced among students originating from rural and poorer regions.
Second, while much research has investigated the beneficial effects of green space on different socio-demographic groups, including teenagers and young adults (Herrera et al., 2018; Ward et al., 2016) and how youth perceptions of green space may differ from those of adults (Gearin and Kahle, 2006; Mäkinen and Tyrväinen, 2008), there have been few studies which have specifically examined university student populations (Hipp, 2016). This is an important omission since anxiety and stress levels are often high amongst younger people (Yang et al., 2012b) and especially students (Holmberg, 2017). There is limited research which has explored the restorative effects of green space in relieving stress for this at-risk group (Holt et al., 2019; Li and Sullivan, 2016; Liu et al., 2018; Wang et al., 2016).
Third, most of the research examining links between green spaces and health has focused on western countries and, until recently, there has been a dearth of studies in LMICs. Hence the global importance of green spaces in terms of their public health benefits remains unclear. Much of the work in LMICs, using GIS methodologies, has focused on changes in the provision of green space (Fan et al., 2017; Huang et al., 2017; Zhou et al., 2018), but has paid less attention to its beneficial effects in reducing stress and improving residents’ well-being (Ma et al., 2018). The provision of green space may not necessarily lead to positive health outcomes and the global importance of green space in terms of public health benefits remains unclear. Indeed one study of 34 cities across the globe found that while green spaces were associated with better health outcomes in richer cities, this was not true of poorer cities thus suggesting that the positive effect of green spaces could be context dependent (Amano et al., 2018).
The objective of this study is to explore the impact of green space on urban stress levels among university students in China. Since 1978 China has been transitioning from a centralized to a market-based economy. While this transition has improved living standards, it has heightened personal competition for higher education and good career jobs and also presented other social challenges such as rising income inequality, social anomie and increased anxiety about the future (Yang et al., 2012b). This situation leads Chinese people to endure much stress which is a major social and public health problem. Despite an increased focus on stress in Chinese health research no researchers have specifically examined links between green space and stress.
With this in mind the rest of the paper is structured as follows. First we outline the methodology of the study before reporting the results. Here we begin by examining variations in the provision of green space across our sample cities before considering the extent to which the provision of green space reduced student stress. Finally we discuss the theoretical and policy implications of our findings in the light of green space research internationally and in China along with the strengths and limitations of the present research.
Section snippets
Data source
This study reports data from the Global Health Professions Student Survey (GHPSS) on Tobacco Control in China GHPSS (Extended version). The extended version added additional health, mental stress, and behavioral items to the original version. The sample consisted of 11,954 students from 50 different universities in China. The 50 universities were located in 42 cities, differentiated by regional location (Table 2). A more detailed description of the survey and the data and study methods can be
City variations in provision of green space
The per capita provision of urban green space varied widely across the 42 cities, ranging from a high of 193.5 ha per 1000 persons in the southern city of Guangzhou in Guangdong Province to only 18.5 ha per 1000 in the western city of Nanchong in Sichuan. When viewed on a regional basis, and adopting the regional classification of Chen and Hu (2015), the average green space provision was greatest in cities in the Eastern Coastal Region (56.2 ha/1000; SD = 39.9), compared to cities in the
Discussion
The key finding of this paper is that the provision of urban green space helps to relieve urban stress. Our results are consistent with other studies linking urban green space to stress (Wang et al., 2016; Tan and Jin, 2009), but build on this literature in a number of ways. First, this is the first study, that we are aware of, which has considered the impact of green space on the well-being of a nationwide student population. While one other study has examined the impact of green space on
Conclusion
The present study provides evidence that urban green space contributes to reducing students' uncertainty stress. Given that college students’ mental stress, especially uncertainty stress, is a severe social and public health problem in China, increased attention to preventing mental stress is necessary especially since high levels of student stress reflect wider societal patterns of stress among younger population groups. While our findings are necessarily preliminary, this study adds insights
Acknowledgements
This study was partly funded by the National Natural Science Foundation of China (71490733/71473221) and Global Bridges/IGLC, 2014SC1 (13498319).
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