Improving the Sleep Health of Mashhad Women by Using Urban Green Spaces

Document Type : Scientific-Research

Authors

lia shaddel ¹

Mohammad Rahim Rahnama ²

Omid Ali Kharazmi ³

¹ Ph.D Candidate of Geography and Urban Planning, Ferdowsi University of Mashhad, Mashhad, Iran

² Professor of Geography and Urban Planning, Ferdowsi University of Mashhad, Mashhad, Iran

³ Assistant Professor of Geography and Urban Planning, Ferdowsi University of Mashhad, Mashhad, Iran

https://doi.org/10.22067/jgusd.2023.45148.0

Abstract

The present study emphasizes the impact of urban planning to improve the sleep health of women in Mashhad by using urban green spaces. By studying the literature, the relationship between green space and sleep health was determined. It was also found that sleep health has an effect on physical health and the research model was drawn based on this. Each of these dimensions are hidden variables, and in order to fit the hidden variables, the structural equation model was used in the Amos software. Since people with low socio-economic status are likely to suffer from sleep disorders, three different income areas of Mashhad were considered as the statistical population and based on the Cochran formula, 400 of their women were selected as samples. Data collection was done using a questionnaire tool and the green space was examined from the 4 dimensions of access, presence, facilities and protection. Also, the Cronbach's alpha of the questionnaire was equal to 0.9. The research results show that based on the RMSEA=0.9 index, the designed model is consistent with the data of the studied population. Also, the effect of green space on sleep health and sleep health on physical health was confirmed. In relation to the dimensions of the green space, the dimensions of protection and facilities have the most effect. The findings of this study have important applications for urban planners and managers because the quality of urban environments and especially green spaces and the nature of development are the main factors of health.
Keywords: sleep health; Structural Equation Modeling; urban green space; women, Mashhad
 
 
Extended Abstract

Introduction

Today, residing in modern societies is often associated with sleep deprivation and related health challenges. Numerous scholars have confirmed the substantial influence of sleep on physical well-being. Research indicates that insufficient quality sleep can contribute to the development of obesity, overweight conditions, cardiovascular diseases, and other health issues. Additionally, individuals living in greener neighborhoods tend to experience more restorative and healthier sleep.
Review of Literature
Urban green spaces are recognized as key indicators of societal development. These spaces hold significant importance, ranking among the top five urban land uses. They serve as essential indicators for assessing quality of life and overall societal progress. Parks, a prominent component of urban green spaces, have evolved from advancements in social development. Today, park therapy is acknowledged as a beneficial health intervention. Urban green spaces contribute to improved sleep quality at night and help reduce sleep disorders. Adequate sleep is crucial for overall health and well-being, comparable in importance to nutrition. Poor sleep health can threaten the sustainability of healthcare systems. Evidence confirms that effective sleep management supports weight control and other health outcomes. The characteristics of the neighborhood environment influence sleep quality, and gender differences are evident from early life stages. Women tend to report lower sleep quality than men and are at higher risk for insomnia, which can negatively impact their overall quality of life. Non-pharmaceutical interventions are recommended for addressing these sleep-related issues.
 

Method

This study employed a cross-sectional survey design. A review of existing research literature indicated that urban green spaces influence women's sleep health, which in turn impacts overall physical health. A research model was developed, and underlying variables were identified. To evaluate the model's goodness of fit, structural equation modeling was conducted using AMOS software. Data were collected through a structured questionnaire that assessed three dimensions: physical health, sleep health, and green space. Questions related to physical health were adapted from an established lifestyle questionnaire. The Pittsburgh Sleep Quality Index was utilized to develop items measuring sleep health. The green space dimension included variables such as protection, facilities, accessibility, and presence. The questionnaire demonstrated high internal consistency, with a Cronbach’s alpha coefficient of 0.9, and its validity was confirmed through expert review. Given that individuals with lower socioeconomic status are more prone to sleep disorders, the study population comprised women residing in three income areas of Mashhad (areas 3, 5, and 11). Using Cochran’s formula, a sample size of 380 participants was determined, and a total of 400 questionnaires were collected.
 
 

Results

The average body mass index (BMI) among participants was 27. The mean age of participants was 35.5 years, and a BMI of 24 is considered typical for individuals in this age group, indicating a tendency toward overweight status. The Root Mean Square Error of Approximation (RMSEA) is a key measure used to assess the goodness of fit for a model. In this study, the RMSEA was calculated as 0.9, suggesting that the model fits the data well.  Results also indicated that, in Mashhad, green space has a positive effect on women’s sleep health, with a path coefficient of 0.25. Additionally, sleep health was found to influence physical health, with a coefficient of 0.26. Among the green space variables, facility availability and protective features were the most influential dimensions.  Reviewing existing empirical studies in this area supports the findings of this research. For example, Astell-Burt et al. (2013) and Grisby-Toussaint et al. (2015) found that residents of greener areas tend to experience a lower risk of short sleep duration at night. Studies by Kim et al. (2012) and Stranges et al. (2010) demonstrated that, in women, sleep duration is associated with high blood pressure and heart disease. Overall, the relationship between insufficient healthy sleep and perceived health has been established by Steptoe et al. (2006). Furthermore, Lee et al. (2013) and Sister et al. (2010) emphasized that protecting existing green spaces and enhancing their quality can increase their utilization.
 

Discussion and Conclusion

The results indicated that access to green spaces positively impacts the sleep health of women in Mashhad, which in turn influences their overall physical health. A significant portion of the participants were overweight; thus, promoting healthy sleep habits may contribute to obesity management. These findings can be valuable for urban planners and policymakers, as environmental quality and sustainable development are key determinants of public health, with a well-established connection between urban planning and health outcomes.
It is recommended to enhance both the quality and quantity of urban green spaces in low-income areas, particularly because obesity and sleep deprivation tend to be more prevalent among women in economically disadvantaged communities and minority groups. Regarding green space characteristics, the most influential factors were facilities and conservation efforts. Therefore, prioritizing improvements in these areas within Mashhad’s urban green spaces is advisable.
 

Keywords

Sleep health

Structural Equation Modeling

Urban Green Space

Women of Mashhad

Subjects

• urban planinnin

---

References

1. 1- جنادله، ع. (1395). فضاهای سبز شهری و کیفیت زندگی (مدلی برای ارزیابی تاثیرات اجتماعی بوستان ها و فضاهای سبز شهری و کاربرد تجربی آن در سه بوستان شهر تهران). فصلنامه برنامه ریزی رفاه و توسعه اجتماعی، (27)7، 284-225.

   2. حمید، ن.، و بابامیری، م. (1391). بررسی رابطه فضای سبز با سلامت روان. مجله دانشگاه علوم پزشکی یاسوج، (4)17، 316-309.
   3. سی و دومین همایش سالانه ی انجمن علمی روانپزشکان ایران با تاکید بر اختلالات خواب، تهران، بیمارستان میلاد، 24-21 مهرماه 1394
   4. صالحی فرد، م.، و علیزاده، س. د. (1387). تحلیلی بر ابعاد اجتماعی و روان شناختی فضاهای سبز در شهرها با رویکرد مدیریت شهری. فصلنامه مدیریت شهری، شماره 21، 33-19.
   5. صفری شالی، ر.، و حبیب پورگتابی، ک. (1391). راهنمای جامع کاربرد spss در تحقیقات پیمایشی(تحلیل داده های کمی). تهران: نشر لویه.
   6. گلی، ع.، قاسم زاده، ب.، فتح بقالی، ع.، و رمضان مقدم واجاری، ی. (1394). عوامل موثر در احساس امنیت اجتماعی زنان در فضاهای عمومی شهری مطالعه موردی پارک ائل گلی تبریز. فصلنامه شورای فرهنگی اجتماعی زنان و خانواده، شماره 69، 136-97.
   7. لعلی، م.، عابدی، ا.، و کجباف، م. ب. (1391). ساخت و اعتباریابی پرسشنامه سبک زندگی. پژوهش های روانشناختی، (11)15، 80-64.
   8. ملکی، س.، رحیمی، و.، نوری، ا.، و حاتمی، د. (1394). ارزیابی شاخص های اجتماعی فضای سبز شهری از دیدگاه شهروندان نمونه موردی ایرانشهر. جغرافیا و توسعه، شماره 40، 42-19.
   9. ودادهیر، ا. ا.، ساداتی، س. م. ه.، و احمدی، ب. (1387). سلامت زنان از منظر مجلات بهداشت و سلامت در ایران. پژوهش زنان، (2)6، 155-133.
   10. یاری پور، م.، و هادی زاده زرگر، ص. (1393). بررسی شاخص های کمی و کیفی موثر در برنامه ریزی فضای سبز شهری مطالعه موردی شهر میانه. فصلنامه اقتصاد و مدیریت شهری، (10)3، 57-37.
   11. Amagai, Y. Ishikawa, S. Gotoh, T. Kayaba, K. Nakamura, Y and Kajii, E. (2010). Sleep duration and incidence of cardiovascular events in a Japanese population: the Jichi Medical School cohort study. Journal Epidemiology, N. 20,106-10.
   12. Astell-Burt, T. Feng, X and Kolt, G.S. (2013). Does access to neighbourhood green space promote a healthy duration of sleep? Novel findings from a crosssectional study of 259 319 Australians. BMJ Open.
   13. Barton, H and Tsourou, C. (2000). Healthy urban planning, Published on behalf of the world health organization. Regional office for Europe, Spon press: page: 10, 11.
   14. Beunza, J. J. Martinez-Gonzalez, M. A, Ebrahim, S. Bes-Rastrollo, M. Nunez, J. Martinez, J.A. Alonso, A. (2007). Sedentary behaviors and the risk of incident hypertension: the SUN Cohort. Am J Hypertens, 20, 1156–1162.
   15. Browne, M and cudeck, R. (1993). Alternative Ways of assessing model fit. K. Bollen. In Testing structural equation models, Newburry Park, CA, sage publication, pp136-162.
   16. Buysse, D. J. Reynolds, C. F. Monk, T. H, et al. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 28, 192-213.
   17. Centers for Disease Control and Prevention. (2009). Overweight and Obesity. Available at: http://www. cdc.gov/nccdphp/dnpa/obesity/index.htm. Accessed May 11, 2009.
   18. Chaput, J. P. Klingenberg, L. Sjodin, A. (2010). Do all sedentary activities lead to weight gain: sleep does not? .NCBI, 13, 601–607.
   19. Cizza, G. Skarulis, M. and Mignot, E. (2005). A link between short sleep and obesity: building the evidence for causation. Sleep, 10, 1217–20.
   20. Cohen-Cline, H. Turkheimer, E and Duncan, G.E. (2015). Access to green space, physical activity and mental health: a twin study. Journal Epidemiology Community Health, 69, 523-529.
   21. Corburn, J. (2009). Toward the health city, people, places and the politics of urban planning. MIT press, Cambridge, Massachusetts London, England.
   22. Cournot, M. Ruidavets, J. B. Marquie, J. C et al. (2004). Environmental factors associated with body mass index in a population of Southern France. Eur J Cardiovascular Prev Rehabil, 11, 291–297.
   23. Dallimer, M. Irvine, K. N. Skinner, A. M. J. Davies, Z. G. Rouquette, J. R. Maltby, L. L. Warren, P. H. Armsworth, P. R. Gaston, K. J. (2012). Biodiversity and the feel-good factor: Understanding associations between self-reported human well-being and species richness. Bio Science 62, 47–55.
   24. Flores, A. Pickett, S. T. Zipperer, W. C. Pouyat, R. V. and Pirani, R. (1998). Adopting a modern ecological view of the metropolitan landscape: the case of a greenspace system for the New York City region. Landscape and Urban Planning. 39 (4), 295-308.
   25. Ikehara, S. Iso, H. Date, C. et al. (2009). Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep, 32, 295-301.
   26. Kim, S. J. Lee, S. K. Kim, S. H. Yun, C. H. Kim, J. H. Thomas, R. J. Shin, C. (2012). Genetic association of short sleep duration with hypertension incidence—a 6-year follow-up in the Korean genome and epidemiology study. Circ J, 76, 907–913.
   27. Kondo, M.C., Fluehr, J. M., Mc Koen, T., Branas, C. C. (2018). Urban green space and its impact on human health, International Journal of Environmental Research and Public Health, 15 (445), 1-28.
   28. Knutson, K. L. and Van Cauter, E. (2008). Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Science, 1129, 287–304.
   29. Lee, C. Ory, M. G. Yoon, J. Forjuoh, S. N. (2013). Neighborhood walking among overweight and obese adults: Age variations in barriers and motivators. Journal of Community Health, 38, 12–22.
   30. Miller, M. A. (2015). The Role of Sleep and Sleep Disorders in the Development, Diagnosis, and Management of Neurocognitive Disorders. Frontiers in Neurology, 6, 224.
   31. Moore, P.J. Adler, N.E. Williams, D.R and Jackson, J.S. (2002). Socioeconomic Status and Health: the Role of Sleep. Psychosomatic Medicine, 64, 337-344.
   32. Pereira, G. Foster, S. Martin, K. Christian, H. Brouff, B.J. Knuiman, M and Giles-Corti, B. (2012). The association between neighborhoods Greenness and cardiovascular disease: an observational study. BMC Public Health, 12(466), 2-9.
   33. Pikora, T. Giles-Corti, B. Bull, F. Jamrozik, K. and Donovan, R. (2003). Developing a framework for assessment of the environmental determinants of walking and cycling. Soc. Sci. Med. 56, 1693–1703.
   34. Richardson, E. Pearce, J. Mitchell, R. Day, P. and Kingham, S. (2010). The association between green space and cause-specific mortality in urban New Zealand: an ecological analysis of green space utility. BMC Public Health, 10(1), 240.
   35. Sister, C. Wolch, J. and Wilson, J. (2010). Got green? Addressing environmental justice in park provision. Geo Journal, 75, 229–248.
   36. Spiegel, K. Leproult, R. and Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. Lancet, 354, 1435–1439.
   37. Steptoe, A. Peacey, V and Wardle, J. (2006). Sleep duration and health in young adults. Arch Intern Med, 166, 1689–1692.
   38. Stranges, S. Dorn, J. M. Cappuccio, F. P. Donahue, R. P. Rafalson, L. B. Hovey, K. M. Freudenheim, J. L. Kandala, N. B. Miller, M. A and Trevisan, M. (2010). A population- based study of reduced sleep duration and hypertension: the strongest association may be in premenopausal women. Journal hypertension, 28, 896–902.
   39. Van den berg, A.E. Hartig, T and Staats, H. (2007). Preference for nature in urbanized societies: stress, restoration, and the pursuit of sustainability. Journal of Social Issue. (63), 79–96.
   40. Villeneuve, P.J. Jerrett, M. Su, J.G. Burnett, R.T and Chen, H. (2012). A cohort study relating urban green space with mortality in Ontario, Canada. Environmental Research, 115, 51-58.