Earth Day 2017: Talking with Children about Climate Change

“Climate change is not about a distant, unforeseeable future. It is about the world in which our children live today and the future in which they will raise their own children.”  –  AAP report on Global Climate Change and Children’s Health

Each year, in honor of Earth Day, I think about how I can help children – those in my practice and those in my home – consider ways they can directly make a difference to keep our Earth healthy.  One consistent message I’ve conveyed over the years is that how we care for the Earth has a direct impact on our own health.  The directness of that message is often missing in educational programs about climate change, the greatest ecological health challenge of our age.  Kids do seem to know that polar bears and penguins are in danger; they always seem moved by the threat to animals in distant parts of the world.  Yet most are unaware of the real threat to their own well-being right at home.  Why the gap?  There is no lack of information documenting the direct and indirect impacts of climate change on children’s health, as I’ve previously detailed.  If we want our kids to ultimately lead the charge to effectively address climate change, we have to do a more effective job educating them about how complex scientific phenomena directly affect them.  It has become evident that the “facts and fear” approach is not working.  Our natural tendency is to deny and avoid inconvenient, complex truths – and children are even more likely to push away risks that are perceived as far off in the future.  What strategies should we be using to motivate this generation to take effective eco-action?

The best current thinking on influencing climate change action comes from Norwegian psychologist and economist Per Espen Stoknes, author of “What We Think About When We Try Not To Think About Global Warming.”  Stoknes acknowledges the disconnect between knowledge and action.  Most important, he has devised a five-step paradigm to bridge the divide; I’ve adapted it here for our work with children.  Ideally, we would build this paradigm directly into an integrated school science and health curricula, from preK through 12th grade.  Then, truly, would we be raising a generation of eco-warriors.

1.    Be positive: A crucial point, for all of us but especially for kids.  Fear-based approaches have not worked.  There are notable social and economic co-benefits to effectively addressing climate change.  Indeed, engaging in activities that trigger positive emotions leads us to great action.  We should help kids focus on opportunities to “do good” in their neighborhoods.

2.    Make it feel personal, urgent, and local: Nothing drives action for a cause than understanding the personal stakes.  However, we must be mindful when working with kids of various ages to craft the message in sync with their developmental stage.  Young elementary school age kids will need more simple and concrete examples that don’t scare them.  Teenagers will be more able to handle more abstract and complex information with greater emotional reach, however we still need to focus on direct impacts to their world, their communities.  How did a recent hurricane and flooding, or lack of rain and drought, affect their families?

3.     Give kids a way to take visible, consistent action: Following on point #2, we need to provide children with simple and direct ways to make their world – their specific community – a better place to live.  Help them examine what’s going on in their lives – at their schools, their homes – to start to make a difference.  Maybe pollution from idling buses is a main concern, maybe food waste or recycling or reducing plastic bottle use are problems for them – or maybe something entirely different.  Every bit helps and the more they can connect with ongoing projects that have a visible, apparent impact, the more their “doing good” behaviors will be reinforced.

4.     Reduce polarization: Adults are more sensitive to this problem, that climate change is more a liberal/Democratic issue.  Really, it’s a human issue.  Kids more or less get that, however they certainly pick up on messaging from the adults in their lives. The more we can remove the political rhetoric from scientific arguments, the better off we all will be.  This goes for both sides.  No progress is made by demonizing those who believe something you don’t.  In order to model effective change strategies for our kids, we must see that those who deny climate change (or the human impact on climate change) are real people, with real fears and wishes, just like us.  We can in fact use these disagreements as opportunities to explore problem-solving strategies when facing complex issues.

5.     Use the power of social networking: Those of us that work with tweens and teens already know well the power of one well-placed viral photo or video.  We can use this power for good.  This generation natively gets social media in a way most of us educating them do not.  They, as peers, are the most important influencers on others kids’ behaviors.  Messaging, again, should focus on real-life positive examples of what people (ideally, other same-age kids) are doing in their communities to address climate change.


Additional climate change resources for working with children

NASA ClimateKids:

National Wildlife Federation:

NOAA Talking to Children about Climate Change:

(originally posted for the Deirdre Imus Environmental Health Center at HackensackUMC)

Greening Healthcare: Next Steps

Recently, I led a webinar for Practice Greenhealth detailing our efforts at The Deirdre Imus Environmental Health Center® to reduce the use of endocrine-disrupting plastics in hospitals. Reducing DEHP use in particular is one of our main current initiatives, given its adverse impact on health, especially in newborns. I was inspired by the hospital community’s engaged participation during and after the webinar. Healthcare Without Harm, in addition to Practice Greenhealth, provides terrific resources and opportunities for those dedicated to hospital sustainability. Novel initiatives addressing antibiotic overuse and climate change (emerging issues in pediatric environmental health) complement ongoing programs supporting environmentally preferable purchasing.

As I reflect, though, on the growth in hospital system efforts, I remain dismayed by the relatively slow adoption of green health principles in primary care community practices and clinics. Most of us receive care in these settings, and primary care should be synonymous with preventive care, arguably best represented by the environmental health “precautionary principle.” It remains evident that the safest, most effective and most cost-effective strategies to create and maintain optimal health are preventive in nature. Environmental factors contribute mightily to all causes of disease and may cost the U.S. in excess of $75 billion annually just for children’s health issues alone. Care delivered in primary care settings should be a role model for ecologically sustainable health practices, limiting rather than contributing to environmental hazards in our communities.

When I founded the Whole Child Center with a dedication to ecological sustainability, I learned what I needed to know by witnessing the creation of the Gabrellian Women’s and Children’s Pavilion at HackensackUMC. I understood that what mattered was both selecting the greenest building materials and furniture available as well as optimizing practices like recycling, reduction of material use, and green cleaning. Obstacles to practices like mine at the time included cost increases to build, though these were easily offset by reductions in energy and paper use. Most importantly, we adopted a philosophy of practice that reflected our mission – we serve as role models for our patients and their families, demonstrating that how and not just what we practice actually creates health. Yet in the decade since, very few practices and clinics have “gone green,” despite growing concerns for and increased awareness of environmental health harms.  What are the barriers? Why have primary care practices not followed the lead of academic institutions? In part, there remains a misperception that greening our offices costs much more than conventional building/operational practices. Perhaps of greater concern, community-based physicians are unable to locate resources to assist them even if they have the right intentions.  Creating online resources and practical, educational workshops for clinicians and administrators interested in developing eco-sustainable practices remains a priority.

(originally posted for the Deirdre Imus Environmental Health Center)

The Growing Pediatric Health Gap: Environmental Injustice Threatens Our Future


The Deirdre Imus Environmental Center® at HackensackUMC publishes landmark paper on The Growing Pediatric Health Gap: Environmental Injustice Threatens Our Future

Deirdre Imus, president and founder of The Deirdre Imus Environmental Center® at HackensackUMC, andLawrence Rosen, M.D., the Center’s medical advisor, pediatrician and founder of the Whole Child Center, have co-authored a landmark paper entitled The Growing Pediatric Health Gap: Environmental Injustice Threatens Our Future, which was recently published in EXPLORE: The Journal of Science and Healing, a leading interdisciplinary publication in the field of integrative medicine.

Nine years after releasing their 2007 paper, Environmental Injustice: Children’s Health Disparities and the Role of the Environment, Deirdre and Dr. Rosen revisit the issue of children’s environmental health and its intricate relationship with childhood health disparities. The current paper highlights the latest trends and statistics in pediatric health issues, including the concerning high prevalence of childhood cancer, allergies, asthma, obesity, diabetes and developmental disabilities in recent years.

“Simply put, children are our future,” said Deirdre Imus. “An investment in the health of our kids is an investment in generations to come. This paper is a must-read call-to-action that emphasizes the steps we can all take to protect our children’s health.”

This new paper explores emerging environmental concerns that disproportionately affect the health and well-being of children, such as climate change, toxic stress, and electromagnetic radiation. It highlights eye-opening statistics about the impacts of these issues on our children’s health, such as toxic stress early in life leading to heart disease, depression, and substance abuse. Moreover, the paper focuses on the relationship between environmental issues and poverty, offering the sad truth that children living in poverty bear the greatest burden of environmental health issues, ultimately widening the health gap in America.

“What has transpired in the decade since our first paper is heartbreaking,” said Dr. Rosen. “It’s important to understand the full implications of these emerging threats and to discover what we believe are important strategies to reverse the worsening health trends affecting our children.”

(source: The Deirdre Imus Environmental Center®)

Antibiotic Overuse: A Worldwide Emergency


For most of human history, infectious diseases have been the leading causes of illness and death.  Most ancient peoples used botanicals as the earliest antibiotics to combat various plagues, even without specific knowledge regarding the microbes responsible.  With the advent of modern pharmaceutical techniques, industrialized nations no longer rely on plants for cures, and millions of lives have been saved. However, we have now entered an age where the indiscriminate use of antibiotics in health and the food industries is causing significant harm to all living forms on Earth – and to the planet itself.  According to a Princeton Environmental Institute study published in The Lancet, worldwide antibiotic use increased an incredible 36 percent from 2000 to 2010.   The United States, sadly but not surprisingly, led the world in antibiotic use per person during this time period.  The report also noted the grave consequences of the escalation: rising resistance to many of our most commonly used life-preserving medications.

How profound is the resulting cost?  Staggering, both in terms of human health and healthcare costs.  One report, “A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future,” notes, “The mortality rates due to multidrug-resistant bacterial infections are high. Each year, about 25,000 patients in the EU die from an infection with the selected multidrug-resistant bacteria (ECDC/EMEA Joint Working Group, 2009), and more than 63,000 patients in the United States die every year from hospital-acquired bacterial infections. Estimated economic costs due to infections by multidrug-resistant bacteria in the EU result in extra healthcare costs and productivity losses of at least EUR 1.5 billion each year (ECDC/EMEA Joint Working Group, 2009). The annual additional cost of treating hospital-acquired infections from just six species of antibiotic-resistant bacteria was estimated to be at least $1.3 billion in 1992 dollars ($1.87 billion in 2006 dollars) – more than the annual spending on influenza.”  A newly publishedstudy directly links antibiotic abuse in animals with significant pediatric health concerns.  The authors warn, “Antimicrobial resistance is considered one of the major threats to the world’s health. The use of antimicrobial agents in agriculture can harm public health, including child health, through the promotion of resistance. Because of the link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans, antibiotic agents should be used in food-producing animals only to treat and control infectious diseases and not to promote growth or to prevent disease routinely.”

In addition to the surge of antibiotic resistant infections, other related health ills are of increasing concern.  Children regularly exposed to antibiotics gain weight faster than those never prescribed such medications and are atsignificantly higher risk of obesity later in life.  The mechanism is likely through altered metabolism caused by dysbiosis, or the imbalance of microbes in the gastrointestinal tract.  Antibiotics destroy not only harmful bugs but also the health-promoting bacteria that help regulate metabolic energy efficiency.  This disruption in the microbiome increases our likelihood of developing other metabolic diseases like diabetes and impairs our ability to defend against environmental toxins, thereby increasing risk for a whole host of other diseases like cancer and neurological disorders.  And we are not the only victims.  As I’ve previously written, the spread of resistant infections has also been tied to massive die-offs in various animal and insect species, in turn threatening the health of our planet and all who reside here.

The good news?  Finally, doctors are taking notice.  A 2014 Consumer Reports National Research Center poll found that greater than 95 percent of those surveyed are very concerned about antibiotic overuse.  Most are actively following CDC-recommended steps to prescribe only when medically necessary, not use broad-spectrum drugs when simpler options will work, and talk to patients about why these medications are not needed for all infections.  The CDC is also targeting consumers, in particular, parents who historically ask for and expect antibiotics for self-limited conditions like upper respiratory infections and non-streptococcal sore throats.

While we may be making progress in reducing antibiotic demand and prescribing, we are failing miserably in another industry, one that is responsible for about 80% of antibiotic sales in the U.S.  According to a 2014 report by the FDA, “the amount of medically important antibiotics sold to farmers and ranchers for use in animals raised for meat grew by 16 percent from 2009 to 2012.”  The meat and poultry industries are now increasingly feeding broad-spectrum antibiotics to healthy animals to not only prevent disease but primarily to promote growth.  Ironically, this rampant overuse has been linked to increased transmission of resistant organisms (causing life-threatening infections) to humans eating meat from antibiotic-fed animals.  The CDC now actively supports the FDA’s call for “the judicious use of antibiotics that are important in treating humans (and) recommends that such antibiotics should be used in food-producing animals only under veterinary oversight and only to address animal health needs, not to promote growth.”  Healthcare professionals are urged to petition food industry organizations responsible for antibiotic misuse to change their practices, citing evidence of human harm.  Other strategies to limit antibiotic resistance include reducing or eliminating meat consumption and only purchasing meat and animal products (milk and eggs) that come from animals not exposed to antibiotics.

(originally written for the Deirdre Imus Environmental Health Center)

7 Science-Backed Reasons To Get Your Kids Outside


(Originally posted for MindBodyGreen)

Most of us intuitively know that we feel better when we spend time outside.

But sadly, as our lives become more dependent on technology, we are increasingly disconnected from the Earth — and this disconnect could be harming our children more than we think.

Acknowledging the adverse effects on children’s well being, author Richard Louv coined the term “Nature Deficit Disorder.” His research has led pediatricians like myself to prescribe time in nature as a way to combat the health ills associated with lack of free outdoor play.

Looking for encouragement to get your kids off the couch this summer? Here are seven research-based reasons to venture into the Great Outdoors:

1. It encourages exercise.

The closer kids are to green spaces, the more likely they are to run around outside: a recent Canadian study found that the physical activity of 11 to 13 year olds rose relative to the amount of tree-filled space in their neighborhoods. Of course, this doesn’t mean you’re out of luck if you’re a city dweller — simply make time for play in a shaded public park.

2. It reduces anxiety.

Children in Maryland and Colorado who played in green schoolyardsreported less stress compared to their peers. They also showed an increased sense of competence, as well as ability to form supportive social groups.

3. It improves focus.

One study of kids in Illinois found that even just a twenty-minute walk in the park led to a substantial attention boost. As the researchers note: ” ‘Doses of nature’ might serve as a safe, inexpensive, widely accessible new tool in the tool kit for managing ADHD symptoms.”

4. It makes kids smarter.

Researchers found that Barcelona school children with more exposure to outdoor greenery performed better on cognitive testing. The effect was greatest when both home and school environments provided “green” time.

5. It builds a sense of community.

Canadian adolescents living in greener environments reported a stronger sense of “place,” or belonging to a healthy community. This finding has important ramifications, as these emotions might also increase kids’ engagement and involvement in keeping their neighborhoods safe and healthy.

6. It helps them develop deeper connections with family.

In a survey of 60 American families, participation in camping experiences was found to improve family relationships.

7. It raises their interest in the environment.

Childhood exposure to natural settings is associated with a greater interest in environmental stewardship — and ultimately with pursuing professional careers and adult hobbies connected to nature and the environment.

HCWH: A Conversation with Pediatrician Lawrence Rosen


Health Care Without Harm’s Safer Chemicals Program seeks to eliminate dangerous chemicals in the health care setting that can adversely affect patient health and employee safety without sacrificing quality of care. To achieve this goal, we focus on promoting a “green” approach to health care that prevents or reduces exposure to toxic chemicals among patients and staff, while also taking into consideration health care’s impact on the environment.

To learn more about the leadership role that physicians play when it comes to greening health care, we spoke with Dr. Lawrence Rosen, a pediatrician and founder of The Whole Child Center in Oradell, New Jersey. Taking a more holistic approach to health care delivery, Dr. Rosen set out to practice an integrated style of medicine that takes environmental exposures into consideration when treating his patients. The Whole Child Center is also a leading example of ecological sustainability in health care, designed in a way that minimizes impact to the environment while promoting health for staff and patients.

(Continue reading on HCWH’s site)

Bats, Birds, Bees and Butterflies In Crisis: What It Means For Us


One of my strongest memories of summers past, despite my lack of affection for insects in general, is the steady buzzing of bees and fluttering of butterflies in my mom’s garden.  These sounds and visions, along with the heat and abundance of time to play outside, were simply what made up “summer” as I knew it.  Adults, as we age, have a tendency to romanticize the “good old days,” yet the truth is – in some ways – things have indeed changed for the worse.  In a major environmental shift now recognized officially by the White House, we are witnessing catastrophic and accelerating declines in the honeybee and butterfly populations.  Furthermore, strange illnesses are increasingly reducing specific bat and bird populations.  What are the causes of these changes?  And why should we care?

The Washington Post notes, “…over the past five years, winter losses of commercial honeybee colonies have averaged roughly 30 percent. A consortium of universities and research laboratories announced last week that beekeepers lost 42.1 percent of their colonies between April 2014 and 2015, an 8 percent spike from the previous year, and that the number of summer deaths exceeded winter deaths for the first time since the survey began in 2010.”  Additionally, the monarch butterfly population now covers only a small fraction of the forest area in Mexico compared with their activity twenty years ago.  Little brown bats, at one time the most common bat species in the U.S., are dying off by the thousands, affected by the fungal “White Nose Syndrome.”  Mortality rates are greater than 90% in many states.  Finally, we are hearing more and more about large-scale bird flock deaths – in some cases, up to thousands at one time.  Most recently, sea birds along the California coast up to the Pacific Northwest have been dying in increasing numbers.

Why are we seeing these dramatic population shifts in such a short period of time?  Scientific evidence points to several potential causes.  Initial concern centered on increased exposure to pesticides, though more recently, a complex multifactorial answer is emerging – one that has direct relevance for human health.  Possibly related to climate change, a variety of infectious agents (parasites, viruses, bacteria and fungi) are killing the animals and insects noted above.  Circularly, some of the treatments used to limit these infestations are making things worse.  Loss of botanical food sources and habitats are some of the indirect sources of deaths, and each loss of population is compounding the others.  What we have is a complicated cyclical impact of change in climate conditions (air and water temperatures, pollution, effect on food sources) leading to new infectious agents affecting immune health, and the treatments themselves potentially causing further harm to natural immune system repair mechanisms.  Does this sound vaguely familiar?

Concern related to the massive deaths of these species has historically centered on the impact on our economic well-being.  It is estimated that, through direct affects on pollination and crop development, the loss of bees, birds, bats and butterflies could cost the US roughly $15 billion a year.  While the direct costs involved are substantial and deserve our attention, what is especially eerie is that notion that the increase in health morbidities we are witnessing, particularly in children (e.g., immune and inflammatory disorders), may be caused by the exact same sequence of events described above.  Activists have pointed out that climate change will potentially affect human health via an increase in vector-borne infectious diseases, like Lyme disease or malaria.  However, little attention has been paid to how subtle shifts in direct viral, bacterial, fungal and parasitic pathogens will alter the human gut microbiome and its ability to modulate immune function and detoxification.  Disruption in the human microbiome, connected to environmental toxins, then worsened by the overuse of antibiotics, could be seen as the human model of what we’re witnessing in bats, bees, butterflies and birds.

What can we do?  We must devote resources to better understanding the complex infectious etiologies of catastrophic species death.  Reversing true root causes, if climate change is the major culprit, is essential but will take time.  Today, we must develop safe and effective ways to protect these species, perhaps through microbiome modulation (using probiotics, for example, to change microbiota balance). Probiotics for bats, anyone?  In fact, researchers have not only used metagenomic methods to sequence the bat microbiome, they have found some bats are resistant to White Nose syndrome, perhaps due to variations in microbiota on their skin.  Similar work is being done in bees, demonstrating a relationship between levels and types of probiotic organisms and hive health.  Perhaps we can learn something from these experiences that would be adaptable to human health concerns.  Ultimately, addressing the needs of the birds and the bees (and the bats and butterflies) is a win-win situation for all of us.

(originally written for the Deirdre Imus Environmental Health Center)

Plastic Babies: The DEHP Dilemma

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(Originally posted for the Deirdre Imus Environmental Health Center)
DEHP (di-(2-ethylhexyl)phthalate) is a compound commonly found in plastic medical devices made from polyvinyl chloride (PVC).  This chemical has come under increased scrutiny with respect to the care of our most vulnerable children: critically ill newborns hospitalized in neonatal intensive care units (NICU’s). The incredibly sophisticated level of care found in the NICU saves the lives of thousands of premature babies every year, but it seems that the very equipment used to aid these infants may in fact be causing serious harm. The FDA lists the following products commonly used in NICUs as containing DEHP:
– IV bags and tubing
– Umbilical artery catheters
– Blood bags and tubing
– Nasogastric feeding tubes
– Respiratory tubing
– Enteral nutrition feeding bags
Concerned by the widespread exposure of sick newborns to these devices, researchers at Johns Hopkins Bloomberg School of Public Health – asreported by NPR – “determined that a critically ill preemie hooked up to multiple tubes and devices containing DEHP could be exposed to 16 milligrams per kilogram of body weight a day of the chemical, which is 160,000 times higher than desired to avoid liver damage.”  Why would this be a concern?  For one, DEHP has been linked, per report by the U.S. Environmental Protection Agency (EPA), to endocrine disruption, birth defects, asthma and cancer in animal studies. Additionally, Dr. Eric Mallow, the lead researcher on the Hopkins report, notes, “DEHP and other phthalates are proinflammatory, and most of the injuries that preemies get are inflammatory in nature.”  A recent review of the adverse effects of DEHP and related phthalates on children’s health found that “fetal and childhood exposure to some phthalates may perturb normal development, with several studies consistently reporting increased risk of allergic diseases” and offered that “providers can counsel concerned patients to reduce phthalate exposures in order to protect the developing fetus and child from potential adverse health outcomes.”
In this spirit, some hospitals have tried to eliminate or reduce the use of phthalate-containing products.  However despite  best intentions, hospitals have been unable to replace DEHP in all areas including the NICU. Why? Because there is a shortage of  vendors able to supply alternative, theoretically safer products.  “Consistent supply is essential to getting hospitals to switch to DEHP-free products. Additionally, as more healthcare facilities create demand, the more manufacturers will respond,” comments Kyle Tafuri, Sustainability Advisor at Hackensack University Medical Center in New Jersey.  Erin S. Ihde, MA, CCRP, researcher at the The Deirdre Imus Environmental Health Center at HackensackUMC, advises, “One of the keys to the success of DEHP-free medical products is having clinicians and administrators advocating for the change within their departments. It only takes one person to educate others and move the process forward.”
Does the benefit of current medical therapy in NICU’s outweigh the harm? While one would not advise abandoning the use of feeding tubes, IV’s, blood products and breathing tubes given their life-saving contributions, we should be concerned about the ongoing exposure of premature, critically ill babies to potentially toxic plasticizers.The theoretical, animal and preliminary human evidence linking DEHP and its metabolites to the disruption of hormonal and immunological pathways is deeply troubling.
Sadly, studies to evaluate the immediate and long-term impact of DEHP on babies’ endocrine, immune and neurological systems are lacking.  Under the precautionary principle guidelines, many environmental health scientists advocate for avoiding the use of any potential toxic chemicals until we can adequately insure human harm will not result from exposure. Yet, this is not the current regulatory environment in the United States. Too often, chemicals are introduced into mainstream use, even in the healthcare industry, without adequate proof of safety.  As we’ve previously noted, children in particular are quite vulnerable and are frequent victims of environmental injustice.  For the preservation of our children’s health, and our future, we must work together to adopt new integrative strategies to address the complex environmental challenges we now face.

Is Happiness the Key to Eco-Action?


As a pediatrician, I am incredibly lucky to work with children, day in and day out. It’s impossible not to be captured by their amazement with the mundane and their joy in the smallest moments.  I’m often reminded of Winslow Homer’s 1872 painting, “Snap the Whip,” depicting boys playing with abandon in a field outside their rural schoolhouse. So eloquently portrayed is the simplicity of another time, kids out in the natural world for no other purpose than to play, freely and without a care in the world.

Contrast this with contemporary schoolyards with their meticulously designed jungle gyms and artificial surfacing, often empty throughout the day as more and more schools abolish recess or replace free play with highly structured, adult-supervised activities. I’ve realized, as I see increasingly anxious and depressed children come to my office looking for guidance, that the answers often lie not in my prescription pad but outside my window.

(continue reading at Children and Nature Network)

Earth Day 2014: Connecting With Nature


Is it possible that something as simple as happiness could be the motivating factor to stimulate sustained ecological behavioral change? The developing field of ecopsychology has spurred an interest in research looking at how our connection to nature is tied to our well being.  Along these lines, John Zelenski and Elizabeth Nisbet from Carleton University in Ottawa, Canada recently published a fascinating study“Happiness and Feeling Connected: The Distinct Role of Nature Relatedness.”  The authors found that we have unique relationship with nature that is a “significant distinct predictor of many happiness indicators, even after controlling for other connections” and conclude that “nature relatedness could be a path to human happiness and environmental sustainability.”  

(continue reading at the Deirdre Imus Environmental Health Center site)