Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Implemented Alone

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether park, trail, and greenway infrastructure improvements increase physical activity when they are implemented without additional interventions. Evidence was considered insufficient because changes in physical activity were inconsistent. Studies did find meaningful increases in the number of people using parks, trails, and greenways following infrastructure improvements. CPSTF finds, however, that the economic benefits exceed the cost for these interventions.

CPSTF recommends park, trail, and greenway infrastructure interventions when combined with additional interventions.

Intervention

Park, trail, and greenway infrastructure interventions improve the built and natural environments by creating or enhancing public locations for physical activity, relaxation, social interaction, and enjoyment. Locations include the following:
  • Parks designated public areas that often combine greenery with paths, facilities for physical activity and recreation, and places for relaxation and social interaction
  • Trails and Greenways routes for walking, hiking, or cycling in urban, suburban, or rural areas (e.g., “rails to trails” conversion projects). These may involve street conversions that provide opportunities for walking and cycling (most often in urban areas).

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Promotional Materials

Community Guide News

One Pager

Audio Clip
We are affected by the world around us, and evidence shows that combined approaches to enhance the built environment can increase physical activity. Drs. Shiriki Kumanyika and David Hopkins and Mr. Chris Kochtitzky talk with CDC’s Dr. John Anderton about the systematic review evidence and how the CPSTF recommendation for combined built environment approaches can be implemented in communities.

Listen to the audio clip (6:53) [MP3 – 9 MB]

Read the audio transcript [PDF – 139 KB]

Recorded June, 2018

About The Systematic Review

The CPSTF finding is based on a systematic review of 38 studies (published through July 2020). Seventeen of the studies evaluated intervention that evaluated infrastructure interventions when used alone. Studies were identified from two sources:
  • Studies included in a broader systematic review published in 2019 (Hunter et al., 12 studies, search period through August 2016)
  • Studies identified in an update search (5 studies, search period August 2016 July 2020)

The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity and the built environment.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 17 studies that evaluated infrastructure improvements when used alone. Physical activity outcomes reported in the included studies could not be combined to provide summary effect estimates.

  • Ten studies examined changes in moderate-to-vigorous physical activity in the park, trail, or greenway and observed inconsistent effects.
  • Five studies evaluated changes in total physical activity and observed inconsistent effects.
  • Six studies examined other measures of physical activity and observed inconsistent effects.
  • Nine studies examined changes in use of the park, trail, or greenway (regardless of the level of physical activity) and observed a median increase of 32.1%.

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

A systematic review of economic evidence from a societal perspective shows the economic benefits exceed the cost for park, trail, and greenway infrastructure interventions.

The review included 8 studies (search period through March 2022) that evaluated the infrastructure component of interventions. The review team did not find any studies that evaluated infrastructure plus additional interventions to increase community engagement, public awareness, programming, or access. Monetary values are reported in 2021 U.S. dollars.

  • The median one-time capital cost was: $8,679,850 (7 studies).
  • The median annual maintenance cost was: $34,570 (7 studies).
  • The median annual benefit was: $994,000 (7 studies).
  • The cost per disability-adjusted life year (DALY) averted was: $23,254 (1 study).
  • The median benefit to cost ratio was: 3.1 (7 studies).

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
  • Do these interventions increase physical activity?
  • Which characteristics of infrastructure improvements are effective in increasing physical activity and use?
  • Are these interventions effective for improving other health and health-related outcomes including the following?
    • Fitness
    • Mental health including measures of anxiety, depression, and well-being
    • Perceptions of social cohesion and connectiveness
    • Injuries
    • Quality of life
  • How effective are these interventions across different communities and populations?
  • How effective are park, trail, and greenway infrastructure improvements alone in reducing perceptions of crime and improving perceptions of safety among members of the community?
  • Which interventions, or combinations of interventions, are most effective in addressing barriers to use of parks, trails, and greenways among the following populations?
    • Communities with lower incomes
    • Older adults
    • People with disabilities
  • What is the cost-effectiveness of park, trail, and greenway interventions?
  • What are the economic effects of neighborhood displacement on residents from historically disadvantaged racial and ethnic populations and populations with lower incomes?

Study Characteristics

  • Study designs included randomized controlled trials (1 study), other designs with a concurrent comparison group (9 studies), and before-after without control (7 studies).
  • Park infrastructure improvements noted in the studies included a new park (1 study), added new structures (3 studies), renovations to existing structures (7 studies), and a combination of new construction and renovations (2 studies).
  • Trail and greenway infrastructure improvements included a new route (1 study) and extensions to existing routes (2 studies).

Analytic Framework

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies, or one study may be explained in several publications).

Effectiveness Review

Andersen HB, Christiansen LB, Klinker CD, Ersb ll AK, Troelsen J, et al. Increases in use and activity due to urban renewal: effect of a natural experiment. American Journal of Preventive Medicine 2017;53(3):e81-7.

Bohn-Goldbaum EE, Phongsavan P, Merom D, Rogers K, Kamalesh V, et al. Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment. Journal of Environmental and Public Health 2013:9p.

Buller DB, English DR, Buller MK, Simmons J, Chamberlain JA, et al. Shade sails and passive recreation in public parks of Melbourne and Denver: a randomized intervention. American Journal of Public Health 2017;107(12):1869-75.

Burbidge SK, Goulias KG. Evaluating the impact of neighborhood trail development on active travel behavior and overall physical activity of suburban residents. Transportation Research Record 2009;2135(1):78-86.

Cohen DA, Sehgal A, Williamson S, Marsh T, Golinelli D, et al. New recreational facilities for the young and the old in Los Angeles: policy and programming implications. Journal of Public Health Policy 2009;30:S248-63.

Cohen DA, Marsh T, Williamson S, Golinelli D, McKenzie TL. Impact and cost-effectiveness of family fitness zones: a natural experiment in urban public parks. Health & Place 2012;18(1):39-45.

Cohen DA, Marsh T, Williamson S, Han B, Derose KP, et al. The potential for pocket parks to increase physical activity. American Journal of Health Promotion 2014;28(3 suppl):S19-26.

Dobbinson SJ, Simmons J, Chamberlain JA, MacInnis RJ, Salmon J, et al. Examining health-related effects of refurbishment to parks in a lower socioeconomic area: the ShadePlus Natural Experiment. International Journal of Environmental Research and Public Health 2020;17(17):6102.

Peschardt KK, Stigsdotter UK. Evidence for designing health promoting pocket parks. ArchNet-IJAR: International Journal of Architectural Research 2014;8(3):149.

Quigg R, Reeder AI, Gray A, Holt A, Waters D. The effectiveness of a community playground intervention. Journal of Urban Health 2012;89(1):171-84.

Roemmich JN, Beeler JE, Johnson L. A microenvironment approach to reducing sedentary time and increasing physical activity of children and adults at a playground. Preventive Medicine 2014;62:108-12.

Sami M, Smith M, Ogunseitan OA. Peer reviewed: changes in physical activity after installation of a fitness zone in a community park. Preventing Chronic Disease 2018;15.

Veitch J, Salmon J, Crawford D, Abbott G, Giles-Corti B, et al. The REVAMP natural experiment study: the impact of a play-scape installation on park visitation and park-based physical activity. International Journal of Behavioral Nutrition and Physical Activity 2018;15(1):1-4.

Veitch J, Ball K, Crawford D, Abbott GR, Salmon J. Park improvements and park activity: a natural experiment. American Journal of Preventive Medicine 2012;42:616-19.

West ST, Shores KA. The impacts of building a greenway on proximate residents’ physical activity. Journal of Physical Activity and Health 2011;8(8):1092-7.

West ST and Shores KA. Does building a greenway promote physical activity among proximate residents? Journal of Physical Activity and Health 2015;12:52-7.

Economic Review

Alfranca O, García J, Varela H. Economic valuation of a created wetland fed with treated wastewater located in a peri-urban park in Catalonia, Spain. Water Science and Technology 2011;63.5:891-8.

Atlanta Beltline Inc. Build Grant Program 2020 Repurposing Transportation Infrastructure for Atlanta’s Future. Atlanta (GA): 2020. Available at URL: https://beltline.org/wp-content/uploads/2021/07/BCA.pdf.

Dallat MAT, Soerjomataram I, Hunter RF, et al. Urban greenways have the potential to increase physical activity levels cost-effectively. European Journal of Public Health 2014;24(2):190-5.

Hunter RF, Dallat MAT, Tully MA, et al. Social return on investment analysis of an urban greenway. Cities & Health 2020:1-18.

Lockwood M, Tracy K. Nonmarket economic valuation of an urban recreation park. Journal of Leisure Research 1995;27(2):155-67.

Macháč J, Rybová K, Louda J, et al. How to support planning and implementation of climate adaptation measures in urban areas? Case study of Brno-Nový Lískovec. In: 2018 Smart City Symposium Prague (SCSP) 2018;IEEE:1-6.

Mekala, GD, Jones RN, McDonald DH. Valuing the benefits of creek rehabilitation: building a business case for public investments in urban green infrastructure. Environmental Management 2015;55(6): 1354-65.

Reynaud A, Lanzanova D, Liquete C, et al. Going green? Ex-post valuation of a multipurpose water infrastructure in Northern Italy. Ecosystem Services 2017;27:70-81.

Additional Materials

Implementation Resources

Active Parks! Implementation Guide: Increasing Physical Activity Through Parks, Trails and Greenways
Developed by the National Recreation and Park Association and CDC’s Division of Nutrition, Physical Activity, and Obesity

Actionable Public Health Strategies to Boost Community Well-Being with Safe Routes to Parks
Developed by the Safe Routes Partnership

Rural Health Information Hub, Transportation Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of transportation programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

Publication

Serrano N, Realmuto L, Graff KA, et al. Healthy community design, anti-displacement, and equity strategies in the USA: a scoping review. J Urban Health (2022).

Search Strategies

Effectiveness Review

The CPSTF recommendation is based on a systematic review of 38 studies (published through July 2020). The review combined 26 studies of park, trail, or greenway interventions identified from a published systematic review (Hunter et al. 2019; search period through August 2016) with 12 studies identified in an updated search that used the same search terms (search period August 2016 to July 2020).

Hunter et al. (2019) included 38 studies in their review. The Community Guide review team assessed each study based on community guide methods and identified 26 eligible studies for this review. The Community Guide updated search for evidence used a search strategy adapted from Hunter et al. 2019.

Databases searched for this review included Medline, PsycINFO, CAB Abstracts, Scopus, Cochrane, Greenfiles, and Agricultural & Environmental Science Dissertations Environmental Science Collection.

Medline

1 Environment Design/

2 Urban Health/

3 Parks, Recreational/

4 Forestry/

5 (urban adj green adj space).ti,ab.

6 green*space.ti,ab.

7 (open adj space).ti,ab.

8 (public adj space).ti,ab.

9 (public adj open adj space).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj forestry).ti,ab.

19 water sensitive urban design.ti,ab.

20 WSUD.ti,ab.

21 sustainable urban drainage system*.ti,ab.

22 bio?retention basin*.ti,ab.

23 green roof*.ti,ab.

24 roof garden.ti,ab.

25 living roof*.ti,ab.

26 green wall*.ti,ab.

27 living wall*.ti,ab.

28 vertical garden*.ti,ab.

29 street tree*.ti,ab.

30 green corridor*.ti,ab.

31 green screen*.ti,ab.

32 urban green*.ti,ab.

33 urban conservation.ti,ab.

34 urban naturalization.ti,ab.

35 urban rehabilitation.ti,ab.

36 urban agriculture.ti,ab.

37 or/1-36

38 intervention stud*.mp.

39 randomised control* trial.mp.

40 randomized control* trial.mp.

41 comparative stud*.mp.

42 control group.mp.

43 (randomised or randomized or randomly or groups).mp.

44 quasi*experiment*.mp.

45 natural experiment*.mp.

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

47 (intervention or interventional or process or program*).mp.

48 (evaluat* or intervention or interventional or treatment).mp.

49 case stud*.mp.

50 retrofit*.mp.

51 or/38-50

52 37 and 51

53 52 not (animals not humans).sh.

54 limit 53 to dt=20200201-20200731

55 limit 54 to english language

56 limit 55 to abstracts

PsycINFO

1 (Environment* adj design).ti,ab.

2 (urban adj health).ti,ab.

3 Parks, Recreational/

4 (urban adj green adj space).ti,ab.

5 green*space.ti,ab. 49

6 (open adj space).ti,ab. 447

7 (public adj space).ti,ab. 784

8 (public adj open adj space).ti,ab.

9 (park not parkin*).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj5 forestry).ti,ab.

19 (green adj5 roof*).ti,ab.

20 (roof adj5 garden).ti,ab.

21 (living adj5 roof*).ti,ab.

22 green wall*.ti,ab.

23 (living adj5 wall*).ti,ab.

24 street tree*.ti,ab.

25 green corridor*.ti,ab.

26 green screen*.ti,ab.

27 urban green*.ti,ab.

28 urban conservation.ti,ab.

29 urban rehabilitation.ti,ab.

30 urban agriculture.ti,ab.

31 or/1-30

32 intervention stud*.mp.

33 randomised control* trial.mp.

34 randomized control* trial.mp.

35 comparative stud*.mp.

36 control group.mp.

37 (randomised or randomized or randomly or groups).mp.

38 quasi*experiment*.mp.

39 natural experiment*.mp.

40 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

41 (intervention or interventional or process or program*).mp.

42 (evaluat* or intervention or interventional or treatment).mp.

43 case stud*.mp.

44 retrofit*.mp.

45 or/32-44

46 31 and 45

47 exp Animals/ not humans.sh.

48 46 not 47

49 limit 48 to up=20200201-20200731

50 limit 49 to (english language and abstracts)

CAB Abstracts

1 (Environment adj design).ti,ab.

2 (Urban adj Health).ti,ab.

3 (recreational adj park*).ti,ab.

4 Forestry/

5 (urban adj green adj space).ti,ab.

6 green*space.ti,ab.

7 (open adj space).ti,ab.

8 (public adj space).ti,ab.

9 (public adj open adj space).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj forestry).ti,ab.

19 water sensitive urban design.ti,ab.

20 WSUD.ti,ab.

21 sustainable urban drainage system*.ti,ab.

22 bio?retention basin*.ti,ab.

23 green roof*.ti,ab.

24 roof garden.ti,ab.

25 living roof*.ti,ab.

26 green wall*.ti,ab.

27 living wall*.ti,ab.

28 vertical garden*.ti,ab.

29 street tree*.ti,ab.

30 green corridor*.ti,ab.

31 green screen*.ti,ab.

32 urban green*.ti,ab.

33 urban conservation.ti,ab.

34 (urban adj5 naturalization).ti,ab.

35 urban rehabilitation.ti,ab.

36 urban agriculture.ti,ab.

37 or/1-36

38 intervention stud*.mp.

39 randomised control* trial.mp.

40 randomized control* trial.mp.

41 comparative stud*.mp.

42 control group.mp.

43 (randomised or randomized or randomly or groups).mp.

44 quasi*experiment*.mp.

45 natural experiment*.mp.

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

47 (intervention or interventional or process or program*).mp.

48 (evaluat* or intervention or interventional or treatment).mp.

49 case stud*.mp.

50 retrofit*.mp.

51 or/38-50

52 37 and 51

53 52 not (animals not humans).sh.

54 (202002* or 202003* or 202004* or 202005* or 202006* or 202007*).ud.

55 53 and 54 762

56 limit 55 to (abstracts and english language)

57 from 56 keep 1-617 617

Scopus

( TITLE-ABS ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio W/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” ) ) AND ( TITLE-ABS-KEY ( “intervention stud*” OR “comparative stud*” OR “case stud*” OR ( clinic* W/1 trial* ) OR ( randomi* W/1 control* ) OR ( randomi* W/2 trial* ) OR ( random* W/1 assign* ) OR ( random* W/1 allocat* ) OR ( control* W/1 clinic* ) OR ( control* W/1 trial ) OR placebo* OR ( quantitat* W/1 stud* ) OR ( control* W/1 stud* ) OR ( randomi* W/1 stud* ) OR ( singl* W/1 blind* ) OR ( singl* W/1 mask* ) OR ( doubl* W/1 blind* ) OR ( doubl* W/1 mask* ) OR ( tripl* W/1 blind* ) OR ( tripl* W/1 mask* ) OR ( trebl* W/1 blind* ) OR ( trebl* W/1 mask* ) ) AND NOT ( SRCTYPE ( b ) OR SRCTYPE ( k ) OR DOCTYPE ( ab ) OR DOCTYPE ( bk ) OR DOCTYPE ( ch ) OR DOCTYPE ( bz ) OR DOCTYPE ( cr ) OR DOCTYPE ( ed ) OR DOCTYPE ( er ) OR DOCTYPE ( le ) OR DOCTYPE ( no ) OR DOCTYPE ( pr ) OR DOCTYPE ( rp ) OR DOCTYPE ( re ) OR DOCTYPE ( sh ) ) ) AND NOT INDEX ( medline ) AND ( LIMIT-TO ( PUBYEAR,2020) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )

Cochrane

#1 (“urban green space”):ti,ab,kw (Word variations have been searched)

#2 (“green*space”):ti,ab,kw (Word variations have been searched)

#3 (“open space”):ti,ab,kw (Word variations have been searched)

#4 (“public space”):ti,ab,kw (Word variations have been searched)

#5 (Park NOT parking):ti,ab,kw (Word variations have been searched)

#6 (“city park”):ti,ab,kw (Word variations have been searched)

#7 (“public park”):ti,ab,kw (Word variations have been searched)

#8 (“urban park”):ti,ab,kw (Word variations have been searched)

#9 (“municipal park”):ti,ab,kw (Word variations have been searched)

#10 (greenway or “urban greenway”):ti,ab,kw (Word variations have been searched)

#11 urban NEXT/5 regen*

#12 (trail):ti,ab,kw (Word variations have been searched)

#13 (“urban forestry”):ti,ab,kw

#14 (“green roof”):ti,ab,kw (Word variations have been searched)

#15 (“urban green*”):ti,ab,kw (Word variations have been searched)

#16 (“urban naturalization”):ti,ab,kw (Word variations have been searched)

#17 “urban rehabilitation” ):ti,ab,kw (Word variations have been searched)

#18 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 with Cochrane Library publication date Between Feb 2020 and Aug 2020

GreenFILES (Ebsco)

S1 TI ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) OR AB ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” “bio retention basin”)

S2 “intervention studies”

S3 “randomized control* trials” or rtc or “randomised control* trials”

S4 comparative stud*

S5 control group

S6 randomised or randomized or randomly or groups

S7 “quasi* experiment*”

S8 “natural experiment*”

S9 (“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)

S10 (intervention OR inteventional OR process OR programs*)

S11 (evaluat* OR intervention OR interventional OR treatment)

12 “case stud*”

S13 retrofit*

S14 S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13

S15 S1 AND S14

S16 S1 AND S14 Limiters – Scholarly (Peer Reviewed) Journals; Publication Date: 20200201-20200731

Agricultural & Environmental Science Dissertations
Environmental Science Collection

(((((ti((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”)) OR ab((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”))) AND peer(yes)) AND PEER(yes)) AND ((ti(“intervention studies”) OR ab(“intervention studies”)) OR (ti(“randomized control* trials” OR rtc OR “randomised control* trials”) OR ab(“randomized control* trials” OR rtc OR “randomised control* trials”)) OR (ti(“comparative stud*”) OR ab(“comparative stud*”)) OR (ti(“control group”) OR ab(“control group”)) OR (ti(randomised OR randomized OR randomly OR groups) OR ab(randomised OR randomized OR randomly OR groups)) OR (ti(“quasi* experiment*”) OR ab(“quasi* experiment*”)) OR (ab(“natural experiment*”) OR ti(“natural experiment*”)) OR (ti((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)) OR ab((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest))) OR (ti((intervention OR interventional OR process OR programs*)) OR ab((intervention OR interventional OR process OR programs*))) OR (ti((evaluat* OR intervention OR interventional OR treatment)) OR ab((evaluat* OR intervention OR interventional OR treatment))) OR (ti(“case stud*”) OR ab(“case stud*”)) OR (ti(retrofit*) OR ab(retrofit*)))) NOT (stype.exact(“Books”) AND la.exact(“ENG”) AND pd(20160801-20200731) AND PEER(yes)))

Economic Review

In March 2022, a research librarian used terms adapted from Hunter et al. (2019) to search the following databases: Medline, CAB Abstracts (OVID), PsycINFO (OVID), Scopus, Cochrane Library, GreenFILE (EBSCO), EconLit (EBSCO), Agricultural & Environmental Science collection (ProQuest), CRD York/NHS EED, CRD York/DARE, NTIS. The search covered the period from database inception through March 2022.

The search was limited to high income countries as defined by the World Bank. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software. The review team also screened reference lists of included studies and consulted subject matter experts about additional studies.

Database: Medline

Date Searched: 03/0

/2022
Results: 1,503

9 Environment Design/ 6962

10 Urban Health/ 18229

11 Parks, Recreational/ 1854

12 Forestry/ 3572

13 (urban adj green adj space*).ti,ab. 482

14 (green adj3 space*).ti,ab. 1905

15 (open adj space*).ti,ab. 1437

16 (public adj space*).ti,ab. 1239

17 (public adj open adj space*).ti,ab. 117

18 (park not parkin*).ti,ab. 18028

19 (city adj park*).ti,ab. 221

20 (public adj park*).ti,ab. 420

21 (urban adj park*).ti,ab. 544

22 (municipal adj park*).ti,ab. 48

23 (greenway* or urban greenway*).ti,ab. 120

24 (urban adj regen*).ti,ab. 82

25 (trail* or (urban adj trail*)).ti,ab. 26075

26 (urban adj forestry).ti,ab. 40

27 “water sensitive urban design*”.ti,ab. 41

28 WSUD.ti,ab. 25

29 sustainable urban drainage system*.ti,ab. 50

30 bio?retention basin*.ti,ab. 13

31 green roof*.ti,ab. 282

32 roof garden*.ti,ab. 10

33 living roof*.ti,ab. 4

34 green wall*.ti,ab. 69

35 living wall*.ti,ab. 21

36 vertical garden*.ti,ab. 9

37 street tree*.ti,ab. 131

38 green corridor*.ti,ab. 35

39 green screen*.ti,ab. 26

40 urban green*.ti,ab. 1028

41 urban conservation.ti,ab. 21

42 urban naturalization.ti,ab. 0

43 urban rehabilitation.ti,ab. 44

44 urban agriculture.ti,ab. 261

45 or/9-44 77610

46 intervention stud*.mp. 23456

47 randomised control* trial.mp. 29090

48 randomized control* trial.mp. 599042

49 comparative stud*.mp. 1969522

50 control group.mp. 460271

51 (randomised or randomized or randomly or groups).mp. 3219361

52 quasi*experiment*.mp. 800

53 natural experiment*.mp. 2910

54 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp. 53527

55 (intervention or interventional or process or program*).mp. 3108226

56 (evaluat* or intervention or interventional or treatment).mp. 8906485

57 case stud*.mp. 122979

58 retrofit*.mp. 1382

59 meta-analysis/ 154469

60 meta-analysis as topic/ 21031

61 (meta analy* or metanaly* or metaanaly*).ti,ab. 228046

62 ((systematic* or evidence*) adj3 (review* or overview*)).ti,ab. 302147

63 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 49723

64 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 69704

65 (search* adj4 literature).ab. 83266

66 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 302967

67 cochrane.jw. 15860

68 ((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab. 3399

69 or/46-68 13153670

70 8 and 45 and 69 5196

71 Economics/ 27433

72 “costs and cost analysis”/ 50443

73 Cost-benefit analysis/ 88661

74 Cost control/ 21641

75 Cost savings/ 12533

76 Cost of illness/ 30453

77 Cost sharing/ 2666

78 “deductibles and coinsurance”/ 1824

79 Medical savings accounts/ 544

80 Health care costs/ 42972

81 Direct service costs/ 1217

82 Drug costs/ 17092

83 Employer health costs/ 1097

84 Hospital costs/ 11784

85 Health expenditures/ 22649

86 Capital expenditures/ 2000

87 Value of life/ 5782

88 exp economics, hospital/ 25516

89 exp economics, medical/ 14329

90 Economics, nursing/ 4013

91 Economics, pharmaceutical/ 3056

92 exp “fees and charges”/ 31074

93 exp budgets/ 13978

94 (low adj cost).mp. 72930

95 (high adj cost).mp. 17308

96 (health?care adj cost*).mp. 14257

97 (fiscal or funding or financial or finance).tw. 173357

98 (cost adj estimate$).mp. 2548

99 (cost adj variable).mp. 48

100 (unit adj cost$).mp. 2857

101 (economic adj2 model*).mp. 14378

102 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).ti,ab,kf,kw. 37655

103 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs).ti,kf,kw. 80989

104 (life year or life years or qaly* or cost-benefit analys?s or cost-effectiveness analys?s).ab,kf,kw. 35213

105 (cost or economic*).ti,kf,kw. and (costs or cost-effectiveness or markov).ab. 65599

106 or/71-105 615001

107 70 and 106 272

108 107 not (animals not humans).sh. 267

109 limit 108 to english language 264

110 45 and 69 and 106 1614

111 110 not (animals not humans).sh. 1562

112 limit 111 to english language 1503

Database: CAB Abstracts

Date Searched: 03/08/2022
Results: 1817

1 (Environment adj design).ti,ab. 121

2 (Urban adj Health).ti,ab. 782

3 (recreational adj park*).ti,ab. 164

4 Forestry/ 27201

5 (urban adj green adj space).ti,ab. 810

6 green*space.ti,ab. 483

7 (open adj space).ti,ab. 1865

8 (public adj space).ti,ab. 494

9 (public adj open adj space).ti,ab. 139

10 (park not parkin*).ti,ab. 49022

11 (city adj park).ti,ab. 273

12 (public adj park).ti,ab. 296

13 (urban adj park).ti,ab. 872

14 (municipal adj park).ti,ab. 142

15 (greenway or urban greenway).ti,ab. 173

16 (urban adj regen*).ti,ab. 313

17 (trail* or (urban adj trail*)).ti,ab. 15572

18 (urban adj forestry).ti,ab. 865

19 water sensitive urban design.ti,ab. 131

20 WSUD.ti,ab. 74

21 sustainable urban drainage system*.ti,ab. 139

22 bio?retention basin*.ti,ab. 37

23 green roof*.ti,ab. 1405

24 roof garden.ti,ab. 53

25 living roof*.ti,ab. 17

26 green wall*.ti,ab. 212

27 living wall*.ti,ab. 72

28 vertical garden*.ti,ab. 74

29 street tree*.ti,ab. 1219

30 green corridor*.ti,ab. 155

31 green screen*.ti,ab. 12

32 urban green*.ti,ab. 3662

33 urban conservation.ti,ab. 98

34 (urban adj5 naturalization).ti,ab. 9

35 urban rehabilitation.ti,ab. 17

36 urban agriculture.ti,ab. 2230

37 or/1-36 102877

38 intervention stud*.mp. 6620

39 randomised control* trial.mp. 2973

40 randomized control* trial.mp. 11039

41 comparative stud*.mp. 43439

42 control group.mp. 139626

43 (randomised or randomized or randomly or groups).mp. 1039290

44 quasi*experiment*.mp. 122

45 natural experiment*.mp. 1211

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp. 9095

47 (intervention or interventional or process or program*).mp. 1125627

48 (evaluat* or intervention or interventional or treatment).mp. 2720608

49 case stud*.mp. 162180

50 retrofit*.mp. 1575

51 meta-analysis/ 22899

52 (meta analy* or metanaly* or metaanaly*).ti,ab. 27908

53 ((systematic* or evidence*) adj3 (review* or overview*)).ti,ab. 37033

54 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 17931

55 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 6457

56 (search* adj4 literature).ab. 9113

57 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 27306

58 cochrane.jw. 420

59 ((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab. 425

60 or/38-59 4140056

61 37 and 60 38248

62 Economics/ 56871

63 Cost-benefit analysis/ 26216

64 Cost control/ 500

65 Health care costs/ 6911

66 budgets/ 1295

67 (low adj cost).mp. 40691

68 (high adj cost).mp. 9540

69 (health?care adj cost*).mp. 953

70 (fiscal or funding or financial or finance).tw. 103723

71 (cost adj estimate$).mp. 1226

72 (cost adj variable).mp. 62

73 (unit adj cost$).mp. 2264

74 (economic adj2 model*).mp. 6414

75 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).ti,ab. 25246

76 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs).ti. 20564

77 (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s).ab. 8657

78 (cost or economic*).ti. and (costs or cost-effectiveness or markov).ab. 28425

79 or/62-78 280835

80 61 and 79 2567

81 80 not (animals not humans).sh. 2193

82 limit 81 to english language 1817

83 limit 82 to abstracts 1813

Database: PsycINFO

Date Searched: 03/08/2022
Results: 431

1 (Environment adj design).ti,ab. 288

2 (Urban adj Health).ti,ab. 360

3 Parks, Recreational/ 1229

4 (urban adj green adj space).ti,ab. 36

5 green*space.ti,ab. 75

6 (open adj space).ti,ab. 474

7 (public adj space).ti,ab. 885

8 (public adj open adj space).ti,ab. 28

9 (park not parkin*).ti,ab. 4956

10 (city adj park).ti,ab. 29

11 (public adj park).ti,ab. 56

12 (urban adj park).ti,ab. 70

13 (municipal adj park).ti,ab. 5

14 (greenway or urban greenway).ti,ab. 39

15 (urban adj regen*).ti,ab. 88

16 (trail* or (urban adj trail*)).ti,ab. 7699

17 (urban adj forestry).ti,ab. 10

18 green roof*.ti,ab. 5

19 green wall*.ti,ab. 10

20 living wall*.ti,ab. 1

21 vertical garden*.ti,ab. 1

22 street tree*.ti,ab. 14

23 green corridor*.ti,ab. 6

24 green screen*.ti,ab. 11

25 urban green*.ti,ab. 130

26 urban conservation.ti,ab. 5

27 urban rehabilitation.ti,ab. 20

28 urban agriculture.ti,ab. 32

29 or/1-28 15480

30 intervention stud*.mp. 8371

31 randomised control* trial.mp. 4439

32 randomized control* trial.mp. 23146

33 comparative stud*.mp. 16056

34 control group.mp. 76341

35 (randomised or randomized or randomly or groups).mp. 715007

36 quasi*experiment*.mp. 463

37 natural experiment*.mp. 1548

38 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp. 41598

39 (intervention or interventional or process or program*).mp. 1061850

40 (evaluat* or intervention or interventional or treatment).mp. 1394396

41 case stud*.mp. 110546

42 retrofit*.mp. 164

43 meta-analysis/ 5179

44 (meta analy* or metanaly* or metaanaly*).ti,ab. 44177

45 ((systematic* or evidence*) adj3 (review* or overview*)).ti,ab. 59987

46 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 21575

47 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 8802

48 (search* adj4 literature).ab. 12858

49 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 4892322

50 ((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab. 366

51 or/30-50 4931154

52 Economics/ 25250

53 Health care costs/ 10977

54 budgets/ 1322

55 (low adj cost).mp. 5210

56 (high adj cost).mp. 1736

57 (health?care adj cost*).mp. 1763

58 (fiscal or funding or financial or finance).tw. 78868

59 (cost adj estimate$).mp. 408

60 (cost adj variable).mp. 11

61 (unit adj cost$).mp. 362

62 (economic adj2 model*).mp. 2325

63 (cost minimi* or cost-utilit* or health utilit* or economic evaluation* or economic review* or cost outcome or cost analys?s or economic analys?s or budget* impact analys?s).ti,ab. 4947

64 (cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs).ti. 9030

65 (life year or life years or qaly* or daly* or cost-benefit analys?s or cost-effectiveness analys?s).ab. 4849

66 (cost or economic*).ti. and (costs or cost-effectiveness or markov).ab. 6921

67 or/52-66 129664

68 29 and 51 and 67 469

69 exp Animals/ not humans.sh. 365406

70 68 not 69 441

71 limit 70 to (english language and abstracts) 431

Database: Scopus

Date Searched: 03/08/2022
Results: 2,930

TITLE-ABS(“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio W/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture”) AND TITLE-ABS-KEY ( “intervention stud*” OR “comparative stud*” OR “case stud*” OR ( clinic* W/1 trial* ) OR ( randomi* W/1 control* ) OR ( randomi* W/2 trial* ) OR ( random* W/1 assign* ) OR ( random* W/1 allocat* ) OR ( control* W/1 clinic* ) OR ( control* W/1 trial ) OR placebo* OR ( quantitat* W/1 stud* ) OR ( control* W/1 stud* ) OR ( randomi* W/1 stud* ) OR ( singl* W/1 blind* ) OR ( singl* W/1 mask* ) OR ( doubl* W/1 blind* ) OR ( doubl* W/1 mask* ) OR ( tripl* W/1 blind* ) OR ( tripl* W/1 mask* ) OR ( trebl* W/1 blind* ) OR ( trebl* W/1 mask* ) )) AND (TITLE-ABS(Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR “fees AND charges” OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov)) AND PUBYEAR < 2013 AND ( EXCLUDE ( DOCTYPE,”ch” ) OR EXCLUDE ( DOCTYPE,”cr” ) OR EXCLUDE ( DOCTYPE,”bk” ) OR EXCLUDE ( DOCTYPE,”ed” ) OR EXCLUDE ( DOCTYPE,”no” ) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )

Database: Cochrane

Date Searched: 03/08/2022
Results: 154

1 (“urban green space”):ti,ab,kw 4

#2 (“green*space”):ti,ab,kw 25

#3 (“open space”):ti,ab,kw 13

#4 (“public space”):ti,ab,kw 5

#5 (Park NOT parking):ti,ab,kw 1128

#6 (“city park”):ti,ab,kw 7

#7 (“public park*”):ti,ab,kw 1

#8 (“urban park”):ti,ab,kw 3

#9 (“municipal park”):ti,ab,kw 0

#10 (greenway or “urban greenway”):ti,ab, kw 0

#11 (urban NEXT/5 regen*):ti,ab,kw 3

#12 (trail):ti,ab,kw 4320

#13 (“urban forestry”):ti,ab,kw 0

#14 (“green roof”):ti,ab,kw 0

#15 (“urban green*”):ti,ab,kw 10

#16 (“urban naturalization”):ti,ab,kw 0

#17 (“urban naturalization”):ti,ab,kw 0

#18 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 5481

#19 (“intervention studies” OR “intervention studies”):ti,ab,kw 2013

#20 (“randomised control trial” OR “randomized control trial”):ti,ab,kw 12022

#21 (“comparative study” OR “comparative studies”):ti,ab,kw 45999

#22 “control group”:ti,ab,kw 210803

#23 (randomised OR randomized OR randomly OR groups):ti,ab,kw 1199248

#24 (“quasi experiment”):ti,ab,kw 132

#25 (“natural experiment”):ti,ab,kw 137

#26 (“pre test” or pretest or “pre intervention” or “post intervention” or “post test” or posttest):ti,ab,kw 33627

#27 (intervention OR interventional OR process OR program*):ti,ab,kw 515070

#28 (evaluat* or treatment):ti,ab,kw 1081945

#29 (“case study” OR “case studies”):ti,ab,kw 3729

#30 retrofit*:ti,ab,kw 31

#31 {OR #19 -#30} 1062233

#32 #18 AND #31 3510

#33 costs:ti,ab 31207

#34 cost effective:ti,ab 25659

#35 (qaly* or daly* or “cost per qaly” or “cost per daly” or “cost-benefit analys” or cost-effectiveness):ti,ab 20868

#36 (cost or economic*):ti and (costs or cost-effectiveness or markov):ab 10229

#37 {OR #33-#36} 56080

#38 #32 AND #37 154

Database: GreenFILES (EBSCO)

Date Searched: 03/12/2022
Results: 503

S1 AB ( (“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) ) OR TI ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) )

S2 AB (( intervention stud*OR comparative stud* OR “case stud*” OR (clinic* trial*) OR ( randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR ( control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR ( singl* blind*) OR (singl* mask*) OR ( doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR ( tripl* mask*) OR ( trebl* blind*) OR ( trebl* mask*) ) OR TI ( ( intervention stud* OR comparative stud* OR “case stud*” OR (clinic* trial*) OR ( randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR ( control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR ( singl* blind*) OR (singl* mask*) OR ( doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR ( tripl* mask*) OR ( trebl* blind*) OR ( trebl* mask*) ) Expanders – Apply equivalent subjects

S3 TI ( (Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR (cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov) ) OR AB ( (Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR (cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov) )

S4 S1 AND S2 AND S3 509

S5 S1 AND S2 AND S3 Limiters – Peer Reviewed 503

Database: EconLit (EBSCO)

Date Searched: 03/16/2022
Results: 36

S1 AB ( (“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” …

S2 AB ( ( intervention stud*”OR comparative stud* OR “case stud*” OR (clinic* trial*) OR ( randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR ( control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR ( singl* blind*) OR (singl* mask*) OR ( doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR ( tripl* mask*) OR ( trebl* blind*) OR ( trebl* mask*) ) OR TI ( ( intervention stud*”OR comparative stud* OR “cas …

S1 AND S2 View Results (36)

Database: Agricultural & Environmental Science Collection (ProQuest)

Date Searched: 03/16/2022
Results: 2,991

ti((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio N/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture”)) OR ab((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio N/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture”))

AND

ti(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR ab(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*))

AND

ti((Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov)) OR ab((Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov))

Database: NHS EED

Date Searched: 03/16/2022
Results: 73

(environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):TI OR (environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):SO IN NHSEED

Database: NHS Dare

Date Searched: 03/16/2022
Results: 105

s(environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):TI OR (environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture):

Database: NTIS

Date Searched: 03/17/2022
Results: 28

TI ( (environment* OR park OR parks OR forestry OR green space OR green roof OR roof garden OR living roof OR green wall OR living wall OR vertical garden OR street tree OR green corridor OR green screen OR urban green OR urban conservation OR urban naturalization OR urban rehabilitation OR urban agriculture )

((Economics OR “costs and cost analysis” OR “Cost-benefit analysis” OR “Cost control” OR “cost saving” OR “Cost of illness” OR “cost sharing” OR “deductibles and coinsurance” OR “Medical savings accounts” OR “Health care costs” OR “Direct service costs” OR “Drug costs” OR “Employer health costs” OR “Hospital costs” OR “Health expenditures” OR “Capital expenditures” OR “Value of life” OR “hospital economics” OR “medical economics” OR “nursing economics” OR “pharmaceutical economics” OR (“fees AND charges”) OR budgets OR “low cost” OR “high cost” OR “health care cost” OR fiscal or funding or financial or finance OR “cost estimate” OR “cost variable” OR “unit cost” OR “economic model” OR “cost minimum” or “cost-utility” or “health utility” or “economic evaluation” or “economic review” or “cost outcome” or “cost analysis” or “economic analysis” or “budget impact analysis” OR cost-effective* or pharmacoeconomic* or pharmaco-economic* or cost-benefit or costs OR “life year” or “life years” or qaly* or daly* or “cost-benefit analysis” or “cost-effectiveness analysis” OR costs or cost-effectiveness or markov))

(TI (intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR ab(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR AB (intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)) OR ab(intervention stud* OR comparative stud* OR case stud* OR (clinic* trial*) OR (randomi* control*) OR (randomi* trial*) OR (random* assign*) OR (random* allocat*) OR (control* clinic*) OR (control* trial) OR placebo* OR (quantitat* stud*) OR (control* stud*) OR (randomi* stud*) OR (singl* blind*) OR (singl* mask*) OR (doubl* blind*) OR (doubl* mask*) OR (tripl* blind*) OR (tripl* mask*) OR (trebl* blind*) OR (trebl* mask*)))

Review References

Cole H, Triguero-Mas M, Connolly T, Anguelovski I. Determining the health benefits of green space: Does gentrification matter? Health & Place 2019; 57:1-11.

National Recreation and Park Association. Creating equity-based system master plans. Ashburn (VA): 2020. Accessed 12/3/21. Available from URL: www.nrpa.org/publications-research/best-practice-resources/creating-equity-based-system-master-plans/

Hunter RF, Cleland C., Cleary, A., Droomers, M., Wheeler, B.W., et al. Environmental, health, wellbeing, social and equity effects of urban green space interventions: a meta-narrative evidence synthesis. Environment International 2019;130:104923.

Considerations for Implementation

Despite the finding of insufficient evidence, the following are considerations for implementation drawn from the broader literature and expert opinion.

Equitable park access can be defined as the just and fair quantity, proximity, and connections to quality parks, as well as programs that are safe, inclusive, culturally relevant and welcoming to everyone (National Recreation and Park Association 2021). To achieve this, health equity principles can be used to guide park priorities and investments in ways that involve and sustainably benefit communities (Cole et al. 2019).

Implementation guidance incorporating equity considerations is available from several organizations:

The National Recreation and Park Association advocates for parks and recreation throughout communities with emphasis on health and wellness, equity, and conservation.

The Trust for Public Land works to create recreational spaces and provides a tool kit for collaborating with communities in the development of parks.

The Safe Routes Partnership provides fact sheets, toolkits, and infographics to help communities implement active travel to parks.

The Rails to Trails Conservancy provides implementation and equity guidance relevant to trails and greenways.

The City Parks Alliance is a network of leaders in urban parks and recreation that shares research and tools, including those promoting health equity and environmental practices.

Healthy Places by Design works to advance community-led action across the country. They provide reports and action guides for local government leaders and organizations as well as information about their Community Action model.

The Prevention Institute has developed a toolkit for community-based organizations, including a park equity toolkit tip sheet and a webinar series.

Park, trail, and greenway interventions may be linked or coordinated with other elements of the built environment including two CPSTF-recommended approaches to increase physical activity:

Greening-without-Gentrification [PDF – 2.6 MB] proposes strategies to prevent or reduce the possible harms of gentrification or displacement of current residents following the establishment of large parks, trails, or greenways.