Associations between greenness change and mental distress prevalence change by housing tenure: An analysis of 109 U.S. metropolitan areas

Access to greenspace is associated with improved long-term health, particularly mental health. However, existing evidence suggests that interventions to promote “greening,” or increased greenspace, in urban areas often reproduce social, environmental, and health injustice, primarily through green gentrification. Our objectives were to quantify the association between changes in greenspace and changes in mental distress prevalence in United States metropolitan statistical areas and to evaluate whether this association varies by housing tenure. We assessed change in area-level mental distress prevalence among homeowners and renters using 2011 and 2019 Selected Metropolitan/Micropolitan Area Risk Trends from the Behavioral Risk Factor Surveillance System (SMART BRFSS), and we estimated area-level greenness change using population-weighted average annual normalized difference vegetation index (NDVI) from NASA satellite imagery. We then constructed multivariable linear regression models stratified by housing tenure. We found no significant association between annual average NDVI change and change in mental distress prevalence overall, among homeowners, or among renters, in our main analysis and sensitivity analyses. In a secondary tract-level analysis, 2014–2019 annual average NDVI change was also not significantly associated with mental distress prevalence change, and we found no significant effect heterogeneity by renter prevalence. Further research should investigate causal effects of greening on gentrification and health, as well as pathways through which social housing, tenant protections, and other structural interventions may advance environmental and health equity.