Page - 126 - in Biodiversity and Health in the Face of Climate Change

126 autumn and spring (Alcaraz-Segura et  al. 2009), living closer to green spaces was associated with a reduced risk of bronchitis. Similarly, a study including seven birth cohorts from across Europe, Australia and Canada has reported heterogeneous asso- ciations for different regions (Fuertes et  al. 2016). While the association between green spaces and allergic rhinitis was positive in Sweden and Southern Germany, it was negative in Northern Germany and the Netherlands. For the Australian and two Canadian cohorts, no associations were observed. A similar pattern was observed for aeroallergen sensitisation (Fuertes et  al. 2016). Further research with more refined green space assessment is warranted in this field. 6.6 Cardiometabolic Risk Factors Living in a green neighbourhood or close to green spaces has been postulated to increase physical activity or, in other terms, reduce sedentary behaviour (see Cook et  al. Chap. 11, this volume). However, the available evidence is not conclusive and there are inconsistencies in the reported direction and strength of associations (Lachowycz and Jones 2011; Markevych et  al. 2017; McGrath et  al. 2015). The main reason for this inconsistency could be the fact that the majority of these studies have only focused on the mere presence of green spaces without taking into account their quality aspects. Aesthetics, walkability, biodiversity, availability of sport/play facilities, organised social events and perceived safety have all been suggested to affect the use of green spaces for physical activity (McCormack et  al. 2010). For children and their parents, the perceived safety and crime rate in the neighborhood are main determinants of their outdoor physical activity (Sullivan et  al. 2017). Moreover, most studies have relied on the mere presence of green spaces without taking into account whether they are actually accessible. Some green spaces are not open to the public at all or have restricted access. The methods with which physical activity was measured can be another source of the observed heterogeneity. While some studies have applied objective measures of physical activity (e.g. personal monitors), others have relied on questionnaires to obtain data on physical activity. Each of these methods has strengths and limitations. In addition to the association between residential green spaces and physical activity, studies have also evaluated how active children were while in green spaces (McCrorie et  al. 2014). These studies mainly relied on Global Positioning Systems and accelerometers to objectively characterise time-activity patterns and the loca- tions. They revealed that children are more likely to engage in moderate-to-vigorous physical activity while they are in green spaces, and such an activity accounts for a notable part of the total moderate-to-vigorous physical activity that a child might perform (McCrorie et  al. 2014). Similar to physical activity, the available evidence on the association between green spaces and obesity is not conclusive yet (Gascon et  al. 2016). For other cardiometabolic risk factors, the available evidence for a potential influence of P. Dadvand et al.