Association Between Neighborhood Socionatural Environments and Health Satisfaction: A Longitudinal Mediation Analysis

Association Between Neighborhood Socionatural Environments and Health Satisfaction: A Longitudinal Mediation Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Association Between Neighborhood Socionatural Environments and Health Satisfaction: A Longitudinal Mediation Analysis Yuta Mori, Tomoki Tachi, Kazutaka Matsumoto This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9352721/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 22 You are reading this latest preprint version Abstract Background: Neighborhood environments influence health in older adults; however, the mechanisms linking environmental factors to health outcomes remain insufficiently understood. In particular, few longitudinal studies have simultaneously examined the roles of social and natural environments and their potential pathways through health behaviors. This study aimed to investigate the longitudinal associations of neighborhood social and natural environments with health satisfaction in older adults and to examine whether physical activity mediates these relationships. Methods: This study used secondary data from a nationwide survey of community-dwelling older adults in Japan. A total of 1,043 participants aged 65 years or older were included in the analysis. Social participation was used as an indicator of the neighborhood social environment, and perceived green space around the residence was used as an indicator of the natural environment. Physical activity was assessed as a potential mediator, and health satisfaction was used as the outcome variable. Health satisfaction was dichotomized at the median. Causal mediation analysis was conducted to estimate the total effect, natural direct effect, and natural indirect effect through physical activity. The proportion mediated was also calculated. Analyses adjusted for demographic, socioeconomic, and lifestyle factors, including age, sex, alcohol use, employment status, household income, educational attainment, household composition, marital status, prefecture, and baseline health satisfaction. Results: Among the participants, 432 (41.4%) were classified as having low health satisfaction and 611 (58.6%) as having high health satisfaction. Social participation was significantly associated with health satisfaction. The natural direct effect of social participation on health satisfaction was 0.099 (95% CI: 0.031–0.168), and the indirect effect mediated by physical activity was 0.017 (95% CI: 0.004–0.032). The total effect was 0.117 (95% CI: 0.046–0.189), and the proportion mediated by physical activity was 14.6%. In contrast, perceived green space showed a positive but non-significant association with health satisfaction. Conclusions: Social participation was longitudinally associated with higher health satisfaction among older adults, and part of this relationship was mediated by physical activity. These findings suggest that neighborhood social environments that promote social participation may support active lifestyles and contribute to better perceived health in later life. Earth and environmental sciences/Environmental social sciences Health sciences/Health care Environments Mediation Analysis well-being Background Older adults’ health is influenced not only by individual characteristics but also by the broader social and natural environments in which they live. The World Health Organization’s framework of age-friendly environments emphasizes that community social and physical features are fundamental determinants of physical and mental well-being in later life ¹ ) . Consistent with this perspective, the Decade of Healthy Ageing: Baseline Report identifies social participation and the maintenance of functional capacity within familiar neighborhoods as central policy priorities ² ) . Empirical evidence from East Asia underscores this conclusion, demonstrating that social environmental conditions are associated with self-rated health among older adults ³ ) . Together, these findings highlight the importance of social context as a structural contributor to healthy aging. Similarly, natural environmental characteristics contribute to health in older populations. In particular, access to neighborhood green spaces has been associated with better subjective perceptions of health ⁴ ) . Green environments may also serve as settings that facilitate informal social interactions, indirectly fostering well-being ⁵ ) . These mechanisms suggest that natural environments influence health through both direct restorative effects and social pathways. Collectively, the evidence indicates that understanding healthy aging requires an integrated framework that considers social and natural environmental influences. Older adults’ social participation has been consistently linked to a wide range of positive health outcomes across international populations. Evidence from the European SHARE cohort shows that engagement in social activities and reciprocal support exchanges are associated with higher subjective quality of life among older adults ⁶⁾. Social participation has also been found to reduce the risk of chronic conditions and lower depressive symptoms, indicating broader psychosocial and physical health benefits ⁷⁾. Exposure to the natural environment demonstrates similarly robust associations with health in later life. Reviews have reported that access to green and natural environments is consistently associated with better subjective health and improved physical and mental well-being among older adults ⁸⁾. Proposed mechanisms include increased opportunities for physical activity, stress reduction, and enhanced social interaction facilitated by neighborhood green spaces⁸⁾. Research further suggests that exposure to natural environments may directly promote subjective well-being ⁹⁾. Together, these findings indicate that social participation and exposure to the natural environment are complementary domains that influence older adults’ health. Each may operate through distinct yet overlapping behavioral and psychosocial pathways, highlighting the need to consider both environmental dimensions within an integrated framework of healthy aging. The influence of neighborhood environments on older adults’ health may operate in part through pathways involving physical activity. Cross-sectional structural equation modeling studies have shown that neighborhood resources are associated with both physical activity and social participation, suggesting that environmental opportunities encourage active engagement in daily life ¹⁰⁾. Community-based social participation programs have likewise been linked to increased walking and routine physical activity among older adults, reinforcing the behavioral role of socially supportive environments ¹¹⁾. Evidence related to natural environments indicates a similar mechanism. Greater exposure to green space has been linked with a slower decline in physical activity among older adults, with everyday behaviors, such as dog walking, partially mediating this relationship ¹²⁾. Additional cross-sectional analyses suggest that physical activity is an important mediator of the relationship between green environments and favorable health outcomes ¹³⁾. Collectively, these findings show that neighborhood social and natural environments influence health not only directly but also through activity-related behavioral pathways. Physical activity, therefore, represents a plausible and shared mechanism through which environmental conditions contribute to healthy aging. Despite growing evidence linking neighborhood environments to older adults’ health, relatively few studies have evaluated social and natural environmental factors in an integrated framework using longitudinal designs. In particular, the extent to which neighborhood social participation and natural green environments influence health satisfaction through physical activity and the relative contributions of each remains insufficiently understood. This knowledge gap limits the development of evidence-based strategies that combine environmental improvements with behavioral health promotion. Addressing these mechanisms is essential for designing individual- and community-level interventions that support healthy aging. Therefore, this longitudinal study examines the direct effects of neighborhood social and natural environments on health satisfaction among older adults and the indirect effects mediated by physical activity. By clarifying these pathways, this study seeks to provide empirical evidence to inform coordinated approaches linking environmental enhancement with active health behaviors. Methods Study Design and Participants This longitudinal study used data from the 2023 and 2024 waves of the Survey on Satisfaction and Quality of Life conducted by the Cabinet Office of Japan. The 2023 survey (baseline) was administered between February 10 and March 5, 2023, through a web-based self-administered questionnaire (computer-assisted web interviewing, CAWI). The target population consisted of registered internet panel monitors aged 15–89 years living in Japan (minimum eligible age: 15 years) (n = 10,633). Participants were selected using quota sampling based on prefecture, sex, and age group to reflect the national population distribution. The baseline sample included respondents who had participated in previous survey waves. The 2024 survey (follow-up) took place between February 2 and February 28, 2024, using the same methodology and targeting the same sample size (n = 10,633). The web-based survey was designed with mandatory response settings to minimize missing data for key variables. Individual-level identifiers were used to link respondents across the two waves, yielding a longitudinal panel sample. For the present study, we restricted the analytic sample to older adults aged 65 years and above. After applying this criterion, the final analytic sample comprised 1,043 participants. Using this longitudinal panel dataset, we examined the associations between the neighborhood social environment, the neighborhood natural environment, physical activity, and health satisfaction over approximately one year of follow-up. Outcome Variable The primary outcome of this study was health satisfaction, a widely used indicator of subjective health status. Previous studies have consistently associated subjective health measures with mortality risk, functional status, and quality of life ¹⁴⁾. In this survey, participants were asked: “On a scale from 0 (‘not at all satisfied’) to 10 (‘very satisfied’), how satisfied are you with your overall health?” Responses were recorded on an 11-point scale ranging from 0 to 10. Single-item measures of health satisfaction have been widely used in gerontological and public health research because of their simplicity and established validity ¹⁵⁾. Although the health satisfaction score could be analyzed as a continuous variable, we dichotomized it at the sample median. Participants scoring at or above the median were categorized as having high health satisfaction, whereas those scoring below the median were classified as having low health satisfaction. Dichotomization based on the median of subjective health or life satisfaction measures has been adopted in previous studies to reduce distributional skewness and facilitate the interpretation of between-group differences ¹⁶ , ¹⁷⁾. This binary variable was used as the outcome in longitudinal analyses examining associations with neighborhood social environment, neighborhood natural environment, and physical activity. Exposure Variables The neighborhood environment was assessed through the complementary dimensions of the social and natural environments. The neighborhood social environment was operationalized as social participation, a key social determinant consistently associated with health and functional outcomes among older adults. Participants were asked: “During the past year, how often did you participate in volunteer activities or community activities, such as neighborhood associations, hobby groups, or sports clubs?” Responses were recorded on a seven-point scale, ranging from “almost daily” to “once a year.” Following previous research ¹⁸⁾, responses were dichotomized into social participation present (at least once per month) and no social participation (less than once per month). The neighborhood’s natural environment was measured using participants’ perception of neighborhood greenness, which reflects subjective evaluations of green spaces in their residential area. Green environments have been widely examined as environmental determinants of physical activity and psychological well-being ¹⁹⁾. Participants were asked: “To what extent do you perceive the presence of greenery in parks and green spaces in your neighborhood?” Responses were provided on an 11-point scale ranging from 0 (“not at all”) to 10 (“very much”). Using the median value of the score distribution, perceived neighborhood greenness was dichotomized into high greenness (at or above the median) and low greenness (below the median). Mediator Physical activity was specified as the mediating variable linking neighborhood environments to health satisfaction. The survey assessed physical activity using a single-item question: “Do you engage in moderate exercise (including sports) or other activities that involve moving your body?” Responses were recorded as “yes” or “no.” Participants who responded “yes” were classified as engaging in physical activity, whereas those who responded “no” were classified as not engaging in physical activity ²⁰⁾. This dichotomous physical activity variable was used as the mediator in longitudinal analyses to estimate the indirect effects of the neighborhood social and natural environments on health satisfaction. Covariates To minimize potential confounding, we adjusted for multiple baseline covariates measured in 2023, informed by previous research ²¹,²²⁾. The following ten variables were included in the models: age, sex, alcohol consumption, employment status, household income, educational attainment, household composition, marital status, prefecture of residence, and baseline health satisfaction. Age was categorized into five groups (65–69, 70–74, 75–79, 80–84, and ≥ 85 years). Sex was classified as male or female. Alcohol consumption and employment status were each dichotomized (yes/no). Household income was grouped into three categories (< 3 million JPY, < 5 million JPY, and ≥ 5 million JPY). Educational attainment was categorized as junior high school, high school, or vocational school/university/junior college. Household composition was classified as living with others or living alone, and marital status was classified as married or unmarried. We accounted for regional variation, using the prefecture of residence (47 categories) as a covariate. Additionally, baseline health satisfaction, measured in 2023, was included in the models to adjust for prior health status. Statistical Analysis Descriptive statistics were first calculated to summarize participants’ baseline characteristics. The distribution of each variable was examined overall and compared by the binary health satisfaction outcome (high vs. low). Similarly, the proportion of participants who did and did not engage in physical activity was assessed. The primary analysis employed causal mediation analysis to estimate the mediating role of physical activity in the relationship between neighborhood environments and health satisfaction. Unlike traditional mediation approaches, causal mediation analysis allows the inclusion of exposure–mediator interaction terms and provides effect estimates within a counterfactual framework ²³ , ²⁴⁾. We estimated the marginal total effect (TE), natural indirect effect (NIE), and natural direct effect (NDE). The TE represents the overall effect of neighborhood environment on health satisfaction. The NIE reflects the portion of the effect mediated through physical activity, whereas the NDE represents the effect not mediated by physical activity. For each effect, regression coefficients (B) and 95% confidence intervals (95% CI) were calculated. Additionally, we computed the proportion mediated (PM) to quantify the proportion of the total effect explained by the mediating pathway. All statistical analyses were conducted using R version 4.4.2. Results Participant Characteristics The analytic sample comprised 1,043 older adults. After dichotomizing health satisfaction at the median, 432 participants (41.4%) were classified as having low health satisfaction and 611 (58.6%) as having high health satisfaction (Table 1). Overall, 252 participants (24.2%) reported social participation. The proportion of social participation was significantly higher in the high health satisfaction group than in the low health satisfaction group (28.5% vs. 18.1%, p < 0.001). A total of 651 participants (62.4%) perceived high neighborhood greenness; this proportion was 65.0% in the high health satisfaction group and 58.8% in the low group (p = 0.049). Physical activity was reported by 554 participants (53.1%) and was significantly more prevalent among those with high health satisfaction than among those with low health satisfaction (60.6% vs. 42.6%, p < 0.001). Among the covariates, household income was significantly associated with health satisfaction (p = 0.004), whereas the other covariates showed no significant associations. Table 2 presents the distribution of physical activity. Social participation was more common among participants who engaged in physical activity than among those who did not (29.1% vs. 18.6%, p < 0.001). Similarly, high perceived neighborhood greenness was more prevalent among participants who engaged in physical activity than among those who did not (65.7% vs. 58.7%, p = 0.023). Age, alcohol consumption, and employment status were also significantly associated with physical activity, whereas sex, household income, educational attainment, household composition, and marital status were not. The results of the causal mediation analysis are shown in Table 3. For social participation, the NDE on health satisfaction was 0.099 (95% CI: 0.031–0.168), indicating a statistically significant direct association. The NIE mediated through physical activity was also significant (0.017; 95% CI: 0.004–0.032). The TE was 0.117 (95% CI: 0.046–0.189), indicating a significant overall link between social participation and health satisfaction. The proportion mediated was 14.6%, suggesting that part of the association was explained through physical activity. In contrast, for perceived neighborhood greenness, the NDE (0.052; 95% CI: −0.011–0.112), NIE (0.009; 95% CI: −0.002–0.022), and TE (0.061; 95% CI: −0.003–0.123) all included zero in their confidence intervals, indicating no statistically significant association with health satisfaction. Although the proportion mediated was 13.9%, the mediating effect of physical activity was not statistically significant. Discussion This longitudinal study examined the mediating role of physical activity in the associations between older adults’ neighborhood social and natural environments and health satisfaction. The findings indicate that social participation was significantly associated with health satisfaction, and that part of this association was mediated through physical activity. In contrast, perceived neighborhood greenness showed a positive but nonsignificant association with health satisfaction, and the mediating effect of physical activity was not statistically supported. These results suggest that a neighborhood’s social environment may exert a relatively greater influence on subjective health in later life than a neighborhood’s natural environment. The observed association between social participation and health satisfaction is consistent with previous research showing links between social participation and self-rated health among older adults ²⁵⁾. Furthermore, longitudinal evidence has shown that engagement in leisure activities and physical activity improves subjective well-being ²⁶⁾. These findings, therefore, extend the literature by demonstrating, within a longitudinal framework, that physical activity partially mediates the relationship between social participation and health satisfaction. The consistency with previous research supports the validity of the current analysis and strengthens the plausibility of the identified pathway. This study finds that social participation influences health satisfaction, in part, through physical activity. Previous research has shown that social participation is associated with a lower risk of functional disability among older adults ²⁷⁾, suggesting that engagement in social activities may promote physical functioning, potentially through increased opportunities for movement and exercise embedded in social roles and community participation. Thus, the neighborhood social environment may contribute to health not only through psychological support but also through behavioral pathways involving physical activity. This interpretation is consistent with studies demonstrating that social engagement affects self-rated health through functional activities of daily living ²⁸⁾. Such findings indicate that social involvement enhances functional activity, in turn improving health perceptions. The pathway identified in the present study—social participation → physical activity → health satisfaction—aligns with this conceptual framework. Furthermore, previous research has reported that greater diversity of social participation among older adults is associated with maintaining physical activity levels and improved subjective health²⁷⁾, suggesting that social engagement links activity behaviors and health perceptions. Importantly, the present study extends this body of literature by formally testing this mechanism using causal mediation analysis within a longitudinal design. The identification of a statistically significant indirect effect of physical activity empirically supports the behavioral pathway underlying the association between the neighborhood social environment and health satisfaction, highlighting this study's novel contribution. Although perceived neighborhood greenness was positively associated with health satisfaction, the mediating effect of physical activity was not statistically significant. This suggests that the neighborhood’s natural environment may not necessarily influence health satisfaction through increased physical activity. Instead, greenness may operate through alternative, nonbehavioral pathways. Natural environments have been found to contribute to subjective health through psychological restoration and stress reduction mechanisms that are independent of activity levels. Previous studies have reported that residential greenness is associated with better subjective and mental health outcomes; however, these associations are not fully explained by physical activity ²⁹⁾. Furthermore, evidence from older adults indicates that access to green spaces is positively associated with psychological well-being, whereas associations with physical activity are less consistent ³⁰⁾. These findings are consistent with the literature, suggesting that the health benefits of a neighborhood’s natural environment may arise from multiple pathways beyond physical activity. These results highlight the complexity of environmental influences on health satisfaction and underscore the importance of considering diverse mechanisms when evaluating the role of natural environments in healthy aging. This study has several strengths. First, the use of a two-wave longitudinal design allowed for partial establishment of temporal ordering between neighborhood environment, physical activity, and health satisfaction. Second, multiple baseline covariates including age, socioeconomic factors, and health-related behaviors—were adjusted in the statistical models, enhancing internal validity and reducing potential confounding. Third, both the neighborhood social and natural environments were examined simultaneously in the same individuals, enabling comparison of their relative contributions to health satisfaction. Additionally, the use of a nationwide sample of community-dwelling older adults improves the stability of estimates and supports some external validity. Several limitations should also be considered. Ideally, mediation analysis would involve three temporally separated measurements of exposure, mediator, and outcome; however, this study was based on two waves, which limits the temporal separation of the mediating pathway. Second, perceived neighborhood greenness was assessed using a subjective measure and may, therefore, reflect individual perception or psychological disposition rather than objective environmental conditions. Third, physical activity was measured using a self-reported single-item question, which may be subject to measurement error and social desirability bias. Given these limitations, future studies should incorporate objective environmental indicators and multiwave longitudinal designs to strengthen the mechanisms linking neighborhood environments, physical activity, and health satisfaction. Conclusion This longitudinal study examined the mediating role of physical activity in the associations between older adults' neighborhood social and natural environments and their health satisfaction. The findings demonstrated that social participation was positively associated with health satisfaction, and this association was partially mediated by physical activity. In contrast, perceived neighborhood greenness was positively associated with health satisfaction, but its mediating effect through physical activity was not significant. These results suggest that neighborhood social environments that promote social engagement may help maintain and improve health satisfaction by supporting active lifestyles among older adults. At the same time, the influence of neighborhood natural environments may operate through mechanisms beyond physical activity. Overall, fostering socially engaging neighborhood environments may represent an important strategy for promoting healthy aging. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethical Review Committee of Hana-no-Oka Hospital (approval number: 02045). Informed consent to participate was obtained electronically from all participants prior to completing the web-based survey. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial number Not applicable. Funding No funds have been granted. All authors reported no conflicts of interest. Author Contribution MY analysed and visualised the data and drafted the manuscript; TT,MKinterpreted the results and drafted the manuscript. All authors reviewed the article andapproved the submitted version. Acknowledgement The secondary analysis in this study was conducted using individual-level data from the Survey on Satisfaction and Quality of Life, 2023 and 2024, conducted by the Cabinet Office of Japan. The data were provided by the SSJ Data Archive at the Center for Social Research and Data Archives, Institute of Social Science, The University of Tokyo. The datasets are available at https://doi.org/10.34500/SSJDA.1613 and https://doi.org/10.34500/SSJDA.1746 Data Availability The dataset used to support the findings of this study is available from the corresponding author on reasonable request. References WHO Age–friendly Environments. https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/age-friendly-environments WHO Healthy Ageing Report /. Healthy Ageing Decade 2020–2030. https://www.who.int/publications/i/item/9789241515073 Liu, J., Luo, Y., Haller, W., Vander Mey, B. & Granberg, E. Neighborhood environments and self-rated health in Mainland China, Japan and South Korea. PLoS One . 13 , e0204910 (2018). Huang, B. et al. Residential exposure to natural outdoor environments and general health among older adults in Shanghai, China. Int. J. Equity Health . 18 , 178 (2019). Hong, A. et al. Linking green space to neighborhood social capital in older adults: the role of perceived safety. Soc. Sci. Med. 207 , 38–45 (2018). Lestari, S. K., de Luna, X., Eriksson, M., Malmberg, G. & Ng, N. A longitudinal study on social support, social participation, and older Europeans' Quality of life. SSM Popul. Health . 13 , 100747 (2021). Santini, Z. I. et al. Formal social participation protects physical health through enhanced mental health: a longitudinal mediation analysis using three consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Soc. Sci. Med. 251 , 112906 (2020). Wang, Q., Song, J., Liu, Z. & Shi, C. Green space and older adults' health: a scoping review. Innov. Aging . 9 , igaf119 (2025). Xu, T., Nordin, N. A. & Aini, A. M. Urban green space and subjective well-being of older people: a systematic literature review. Int. J. Environ. Res. Public. Health . 19 , 14227 (2022). Herbolsheimer, F. et al. Neighborhood environment, social participation, and physical activity in older adults with lower limb osteoarthritis: a mediation analysis. Health Place . 68 , 102513 (2021). Chaudhury, H., Campo, M., Michael, Y. & Mahmood, A. Neighbourhood environment and physical activity in older adults. Soc. Sci. Med. 149 , 104–113 (2016). Dalton, A. M., Wareham, N., Griffin, S. & Jones, A. P. Neighbourhood greenspace is associated with a slower decline in physical activity in older adults: a prospective cohort study. SSM Popul. Health . 2 , 683–691 (2016). Zuo, W., Cheng, B., Feng, X. & Zhuang, X. Relationship between urban green space and mental health in older adults: mediating role of relative deprivation, physical activity, and social trust. Front. Public. Health . 12 , 1442560 (2024). Idler, E. L. & Benyamini, Y. Self-rated health and mortality: a review of twenty-seven community studies. J. Health Soc. Behav. 38 , 21–37 (1997). Jylhä, M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc. Sci. Med. 69 , 307–316 (2009). Galenkamp, H., Braam, A. W., Huisman, M. & Deeg, D. J. Seventeen-year time trend in poor self-rated health in older adults: changing contributions of chronic diseases and disability. Eur. J. Public. Health . 23 , 511–517 (2013). Bijani, A., Shah-Hosseini, Z., Hosseini, S. R., Ghadimi, R. & Mouodi, S. Self-rated health and its impact on survival of older adults. Adv. Biomed. Res. 13 , 45 (2024). Ueno, T. et al. Social participation and functional disability trajectories in the last three years of life: the Japan Gerontological Evaluation Study. Arch. Gerontol. Geriatr. 121 , 105361 (2024). Banwell, N., Michel, S. & Senn, N. Greenspaces and health: scoping review of studies in Europe. Public. Health Rev. 45 , 1606863 (2024). Falck, R. S., McDonald, S. M., Beets, M. W., Brazendale, K. & Liu-Ambrose, T. Measurement of physical activity in older adult interventions: a systematic review. Br. J. Sports Med. 50 , 464–470 (2016). Ide, K. et al. Frequency of social participation by types and functional decline: a six-year longitudinal study. Arch. Gerontol. Geriatr. 112 , 105018 (2023). Mori, Y. et al. Built environments and frailty in older adults: the JAGES longitudinal study using mediation analysis. J. Am. Med. Dir. Assoc. 24 , 1677–1682 (2023). VanderWeele, T. J. Explanation in causal inference: methods for mediation and interaction (Oxford University Press, 2015). Baron, R. M. & Kenny, D. A. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J. Pers. Soc. Psychol. 51 , 1173–1182 (1986). Ichida, Y. et al. Does social participation improve self-rated health in the older population? A quasi-experimental intervention study. Soc. Sci. Med. 94 , 83–90 (2013). Feng, C., Shi, Z., Tian, Y., Ma, C. & Sun, Q. Longitudinal associations between leisure activities and subjective happiness among middle-aged and older adults people in China: national cohort study. Front. Public. Health . 12 , 1441703 (2024). Kanamori, S. et al. Social participation and the prevention of functional disability in older Japanese: the JAGES cohort study. PLoS One . 9 , e99638 (2014). Zhou, J. et al. Patterns of social participation among older adults and their association with self-rated health: the mediating role of activities of daily living. Aging Clin. Exp. Res. 37 , 221 (2025). Zhou, J. et al. Patterns of social participation among older adults and their association with self-rated health: the mediating role of activities of daily living. Aging Clin. Exp. Res. 37 , 221 (2025). Sugiyama, T., Leslie, E., Giles-Corti, B. & Owen, N. Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships? J. Epidemiol. Community Health . 62 , e9 (2008). Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.png Table2.png Table3.png Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 27 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 25 Apr, 2026 Reviews received at journal 23 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 17 Apr, 2026 Editor invited by journal 14 Apr, 2026 Editor assigned by journal 08 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 08 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9352721","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":628114299,"identity":"0a5730aa-caea-4192-983e-1b61c17db2f0","order_by":0,"name":"Yuta Mori","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDADNgbmgw8+gBjsBNUyw7SwJRvOADGYidXCwMBjJs2DIoADGNzIP/iBMccmn4+BLU3a5tc2eT5mBsYPH3PwaUlmlmDclmbZxsB82Dq377ZhGzMDs+TMbXi1MAC1HDYA+iXxdm7PbUagFjZmXvxamH9AtPAYSFv23LYnRgsb1BYeI2mGH7cTCWqRPPPYzCJxW5oBGzMwkHsbbie3MTM24/UL3/HExzc+brMxkG9vPvjgx5/btvOBjA8f8WhROAAkEkAsUHQwtoFYjA241QOBPKr0H7yKR8EoGAWjYIQCAFBpSVqxqz5mAAAAAElFTkSuQmCC","orcid":"","institution":"Nagoya Gakuin University","correspondingAuthor":true,"prefix":"","firstName":"Yuta","middleName":"","lastName":"Mori","suffix":""},{"id":628114300,"identity":"c54d4824-8f90-4c4b-9659-aed713e65a62","order_by":1,"name":"Tomoki Tachi","email":"","orcid":"","institution":"Syutaikai hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomoki","middleName":"","lastName":"Tachi","suffix":""},{"id":628114303,"identity":"775c4ba1-4921-419a-8e95-2973a4e8c1b8","order_by":2,"name":"Kazutaka Matsumoto","email":"","orcid":"","institution":"Matsumoto Clinic","correspondingAuthor":false,"prefix":"","firstName":"Kazutaka","middleName":"","lastName":"Matsumoto","suffix":""}],"badges":[],"createdAt":"2026-04-08 06:53:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9352721/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9352721/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107696543,"identity":"6f967ca7-557e-45e1-99c0-1ad088c92908","added_by":"auto","created_at":"2026-04-24 07:12:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":200399,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9352721/v1/ef829961-f762-40d7-a5f3-4ad7f47244d1.pdf"},{"id":107696496,"identity":"46500f85-e0b2-4436-82da-b34525f09305","added_by":"auto","created_at":"2026-04-24 07:11:41","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24464,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.png","url":"https://assets-eu.researchsquare.com/files/rs-9352721/v1/21abe13139c58c3e4ed941a0.png"},{"id":107696527,"identity":"a6627ace-9be4-4b84-85e5-1a9395dff344","added_by":"auto","created_at":"2026-04-24 07:11:51","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16950,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.png","url":"https://assets-eu.researchsquare.com/files/rs-9352721/v1/7f6d4d9ad40be042433568f5.png"},{"id":107696526,"identity":"b9e5b3d0-0cae-404a-8cfd-2fbcb4894fa1","added_by":"auto","created_at":"2026-04-24 07:11:51","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":10207,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.png","url":"https://assets-eu.researchsquare.com/files/rs-9352721/v1/008a2c926adbeb235f4db3d7.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Neighborhood Socionatural Environments and Health Satisfaction: A Longitudinal Mediation Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eOlder adults\u0026rsquo; health is influenced not only by individual characteristics but also by the broader social and natural environments in which they live. The World Health Organization\u0026rsquo;s framework of age-friendly environments emphasizes that community social and physical features are fundamental determinants of physical and mental well-being in later life \u0026sup1;\u003csup\u003e)\u003c/sup\u003e. Consistent with this perspective, the Decade of Healthy Ageing: Baseline Report identifies social participation and the maintenance of functional capacity within familiar neighborhoods as central policy priorities \u0026sup2;\u003csup\u003e)\u003c/sup\u003e. Empirical evidence from East Asia underscores this conclusion, demonstrating that social environmental conditions are associated with self-rated health among older adults \u0026sup3;\u003csup\u003e)\u003c/sup\u003e. Together, these findings highlight the importance of social context as a structural contributor to healthy aging.\u003c/p\u003e \u003cp\u003eSimilarly, natural environmental characteristics contribute to health in older populations. In particular, access to neighborhood green spaces has been associated with better subjective perceptions of health ⁴\u003csup\u003e)\u003c/sup\u003e. Green environments may also serve as settings that facilitate informal social interactions, indirectly fostering well-being ⁵\u003csup\u003e)\u003c/sup\u003e. These mechanisms suggest that natural environments influence health through both direct restorative effects and social pathways. Collectively, the evidence indicates that understanding healthy aging requires an integrated framework that considers social and natural environmental influences.\u003c/p\u003e \u003cp\u003eOlder adults\u0026rsquo; social participation has been consistently linked to a wide range of positive health outcomes across international populations. Evidence from the European SHARE cohort shows that engagement in social activities and reciprocal support exchanges are associated with higher subjective quality of life among older adults ⁶⁾. Social participation has also been found to reduce the risk of chronic conditions and lower depressive symptoms, indicating broader psychosocial and physical health benefits ⁷⁾. Exposure to the natural environment demonstrates similarly robust associations with health in later life. Reviews have reported that access to green and natural environments is consistently associated with better subjective health and improved physical and mental well-being among older adults ⁸⁾. Proposed mechanisms include increased opportunities for physical activity, stress reduction, and enhanced social interaction facilitated by neighborhood green spaces⁸⁾. Research further suggests that exposure to natural environments may directly promote subjective well-being ⁹⁾. Together, these findings indicate that social participation and exposure to the natural environment are complementary domains that influence older adults\u0026rsquo; health. Each may operate through distinct yet overlapping behavioral and psychosocial pathways, highlighting the need to consider both environmental dimensions within an integrated framework of healthy aging.\u003c/p\u003e \u003cp\u003eThe influence of neighborhood environments on older adults\u0026rsquo; health may operate in part through pathways involving physical activity. Cross-sectional structural equation modeling studies have shown that neighborhood resources are associated with both physical activity and social participation, suggesting that environmental opportunities encourage active engagement in daily life \u0026sup1;⁰⁾. Community-based social participation programs have likewise been linked to increased walking and routine physical activity among older adults, reinforcing the behavioral role of socially supportive environments \u0026sup1;\u0026sup1;⁾. Evidence related to natural environments indicates a similar mechanism. Greater exposure to green space has been linked with a slower decline in physical activity among older adults, with everyday behaviors, such as dog walking, partially mediating this relationship \u0026sup1;\u0026sup2;⁾. Additional cross-sectional analyses suggest that physical activity is an important mediator of the relationship between green environments and favorable health outcomes \u0026sup1;\u0026sup3;⁾. Collectively, these findings show that neighborhood social and natural environments influence health not only directly but also through activity-related behavioral pathways. Physical activity, therefore, represents a plausible and shared mechanism through which environmental conditions contribute to healthy aging.\u003c/p\u003e \u003cp\u003eDespite growing evidence linking neighborhood environments to older adults\u0026rsquo; health, relatively few studies have evaluated social and natural environmental factors in an integrated framework using longitudinal designs. In particular, the extent to which neighborhood social participation and natural green environments influence health satisfaction through physical activity and the relative contributions of each remains insufficiently understood. This knowledge gap limits the development of evidence-based strategies that combine environmental improvements with behavioral health promotion. Addressing these mechanisms is essential for designing individual- and community-level interventions that support healthy aging. Therefore, this longitudinal study examines the direct effects of neighborhood social and natural environments on health satisfaction among older adults and the indirect effects mediated by physical activity. By clarifying these pathways, this study seeks to provide empirical evidence to inform coordinated approaches linking environmental enhancement with active health behaviors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThis longitudinal study used data from the 2023 and 2024 waves of the Survey on Satisfaction and Quality of Life conducted by the Cabinet Office of Japan. The 2023 survey (baseline) was administered between February 10 and March 5, 2023, through a web-based self-administered questionnaire (computer-assisted web interviewing, CAWI). The target population consisted of registered internet panel monitors aged 15\u0026ndash;89 years living in Japan (minimum eligible age: 15 years) (n\u0026thinsp;=\u0026thinsp;10,633). Participants were selected using quota sampling based on prefecture, sex, and age group to reflect the national population distribution. The baseline sample included respondents who had participated in previous survey waves. The 2024 survey (follow-up) took place between February 2 and February 28, 2024, using the same methodology and targeting the same sample size (n\u0026thinsp;=\u0026thinsp;10,633). The web-based survey was designed with mandatory response settings to minimize missing data for key variables. Individual-level identifiers were used to link respondents across the two waves, yielding a longitudinal panel sample. For the present study, we restricted the analytic sample to older adults aged 65 years and above. After applying this criterion, the final analytic sample comprised 1,043 participants. Using this longitudinal panel dataset, we examined the associations between the neighborhood social environment, the neighborhood natural environment, physical activity, and health satisfaction over approximately one year of follow-up.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome Variable\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of this study was health satisfaction, a widely used indicator of subjective health status. Previous studies have consistently associated subjective health measures with mortality risk, functional status, and quality of life \u0026sup1;⁴⁾. In this survey, participants were asked: \u0026ldquo;On a scale from 0 (\u0026lsquo;not at all satisfied\u0026rsquo;) to 10 (\u0026lsquo;very satisfied\u0026rsquo;), how satisfied are you with your overall health?\u0026rdquo; Responses were recorded on an 11-point scale ranging from 0 to 10.\u003c/p\u003e \u003cp\u003eSingle-item measures of health satisfaction have been widely used in gerontological and public health research because of their simplicity and established validity \u0026sup1;⁵⁾. Although the health satisfaction score could be analyzed as a continuous variable, we dichotomized it at the sample median. Participants scoring at or above the median were categorized as having high health satisfaction, whereas those scoring below the median were classified as having low health satisfaction. Dichotomization based on the median of subjective health or life satisfaction measures has been adopted in previous studies to reduce distributional skewness and facilitate the interpretation of between-group differences \u0026sup1;⁶\u003csup\u003e,\u003c/sup\u003e\u0026sup1;⁷⁾. This binary variable was used as the outcome in longitudinal analyses examining associations with neighborhood social environment, neighborhood natural environment, and physical activity.\u003c/p\u003e\n\u003ch3\u003eExposure Variables\u003c/h3\u003e\n\u003cp\u003eThe neighborhood environment was assessed through the complementary dimensions of the social and natural environments. The neighborhood social environment was operationalized as social participation, a key social determinant consistently associated with health and functional outcomes among older adults. Participants were asked: \u0026ldquo;During the past year, how often did you participate in volunteer activities or community activities, such as neighborhood associations, hobby groups, or sports clubs?\u0026rdquo; Responses were recorded on a seven-point scale, ranging from \u0026ldquo;almost daily\u0026rdquo; to \u0026ldquo;once a year.\u0026rdquo; Following previous research \u0026sup1;⁸⁾, responses were dichotomized into social participation present (at least once per month) and no social participation (less than once per month). The neighborhood\u0026rsquo;s natural environment was measured using participants\u0026rsquo; perception of neighborhood greenness, which reflects subjective evaluations of green spaces in their residential area. Green environments have been widely examined as environmental determinants of physical activity and psychological well-being \u0026sup1;⁹⁾. Participants were asked: \u0026ldquo;To what extent do you perceive the presence of greenery in parks and green spaces in your neighborhood?\u0026rdquo; Responses were provided on an 11-point scale ranging from 0 (\u0026ldquo;not at all\u0026rdquo;) to 10 (\u0026ldquo;very much\u0026rdquo;). Using the median value of the score distribution, perceived neighborhood greenness was dichotomized into high greenness (at or above the median) and low greenness (below the median).\u003c/p\u003e\n\u003ch3\u003eMediator\u003c/h3\u003e\n\u003cp\u003ePhysical activity was specified as the mediating variable linking neighborhood environments to health satisfaction. The survey assessed physical activity using a single-item question: \u0026ldquo;Do you engage in moderate exercise (including sports) or other activities that involve moving your body?\u0026rdquo; Responses were recorded as \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no.\u0026rdquo; Participants who responded \u0026ldquo;yes\u0026rdquo; were classified as engaging in physical activity, whereas those who responded \u0026ldquo;no\u0026rdquo; were classified as not engaging in physical activity \u0026sup2;⁰⁾. This dichotomous physical activity variable was used as the mediator in longitudinal analyses to estimate the indirect effects of the neighborhood social and natural environments on health satisfaction.\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eTo minimize potential confounding, we adjusted for multiple baseline covariates measured in 2023, informed by previous research \u0026sup2;\u0026sup1;,\u0026sup2;\u0026sup2;⁾. The following ten variables were included in the models: age, sex, alcohol consumption, employment status, household income, educational attainment, household composition, marital status, prefecture of residence, and baseline health satisfaction. Age was categorized into five groups (65\u0026ndash;69, 70\u0026ndash;74, 75\u0026ndash;79, 80\u0026ndash;84, and \u0026ge;\u0026thinsp;85 years). Sex was classified as male or female. Alcohol consumption and employment status were each dichotomized (yes/no). Household income was grouped into three categories (\u0026lt;\u0026thinsp;3\u0026nbsp;million JPY, \u0026lt;\u0026thinsp;5\u0026nbsp;million JPY, and \u0026ge;\u0026thinsp;5\u0026nbsp;million JPY). Educational attainment was categorized as junior high school, high school, or vocational school/university/junior college. Household composition was classified as living with others or living alone, and marital status was classified as married or unmarried. We accounted for regional variation, using the prefecture of residence (47 categories) as a covariate. Additionally, baseline health satisfaction, measured in 2023, was included in the models to adjust for prior health status.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were first calculated to summarize participants\u0026rsquo; baseline characteristics. The distribution of each variable was examined overall and compared by the binary health satisfaction outcome (high vs. low). Similarly, the proportion of participants who did and did not engage in physical activity was assessed. The primary analysis employed causal mediation analysis to estimate the mediating role of physical activity in the relationship between neighborhood environments and health satisfaction. Unlike traditional mediation approaches, causal mediation analysis allows the inclusion of exposure\u0026ndash;mediator interaction terms and provides effect estimates within a counterfactual framework \u0026sup2;\u0026sup3;\u003csup\u003e,\u003c/sup\u003e\u0026sup2;⁴⁾. We estimated the marginal total effect (TE), natural indirect effect (NIE), and natural direct effect (NDE). The TE represents the overall effect of neighborhood environment on health satisfaction. The NIE reflects the portion of the effect mediated through physical activity, whereas the NDE represents the effect not mediated by physical activity. For each effect, regression coefficients (B) and 95% confidence intervals (95% CI) were calculated. Additionally, we computed the proportion mediated (PM) to quantify the proportion of the total effect explained by the mediating pathway. All statistical analyses were conducted using R version 4.4.2.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eThe analytic sample comprised 1,043 older adults. After dichotomizing health satisfaction at the median, 432 participants (41.4%) were classified as having low health satisfaction and 611 (58.6%) as having high health satisfaction (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOverall, 252 participants (24.2%) reported social participation. The proportion of social participation was significantly higher in the high health satisfaction group than in the low health satisfaction group (28.5% vs. 18.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A total of 651 participants (62.4%) perceived high neighborhood greenness; this proportion was 65.0% in the high health satisfaction group and 58.8% in the low group (p\u0026thinsp;=\u0026thinsp;0.049). Physical activity was reported by 554 participants (53.1%) and was significantly more prevalent among those with high health satisfaction than among those with low health satisfaction (60.6% vs. 42.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among the covariates, household income was significantly associated with health satisfaction (p\u0026thinsp;=\u0026thinsp;0.004), whereas the other covariates showed no significant associations.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 presents the distribution of physical activity. Social participation was more common among participants who engaged in physical activity than among those who did not (29.1% vs. 18.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, high perceived neighborhood greenness was more prevalent among participants who engaged in physical activity than among those who did not (65.7% vs. 58.7%, p\u0026thinsp;=\u0026thinsp;0.023). Age, alcohol consumption, and employment status were also significantly associated with physical activity, whereas sex, household income, educational attainment, household composition, and marital status were not.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of the causal mediation analysis are shown in Table\u0026nbsp;3. For social participation, the NDE on health satisfaction was 0.099 (95% CI: 0.031\u0026ndash;0.168), indicating a statistically significant direct association. The NIE mediated through physical activity was also significant (0.017; 95% CI: 0.004\u0026ndash;0.032). The TE was 0.117 (95% CI: 0.046\u0026ndash;0.189), indicating a significant overall link between social participation and health satisfaction. The proportion mediated was 14.6%, suggesting that part of the association was explained through physical activity. In contrast, for perceived neighborhood greenness, the NDE (0.052; 95% CI: \u0026minus;0.011\u0026ndash;0.112), NIE (0.009; 95% CI: \u0026minus;0.002\u0026ndash;0.022), and TE (0.061; 95% CI: \u0026minus;0.003\u0026ndash;0.123) all included zero in their confidence intervals, indicating no statistically significant association with health satisfaction. Although the proportion mediated was 13.9%, the mediating effect of physical activity was not statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis longitudinal study examined the mediating role of physical activity in the associations between older adults\u0026rsquo; neighborhood social and natural environments and health satisfaction. The findings indicate that social participation was significantly associated with health satisfaction, and that part of this association was mediated through physical activity. In contrast, perceived neighborhood greenness showed a positive but nonsignificant association with health satisfaction, and the mediating effect of physical activity was not statistically supported. These results suggest that a neighborhood\u0026rsquo;s social environment may exert a relatively greater influence on subjective health in later life than a neighborhood\u0026rsquo;s natural environment. The observed association between social participation and health satisfaction is consistent with previous research showing links between social participation and self-rated health among older adults \u0026sup2;⁵⁾. Furthermore, longitudinal evidence has shown that engagement in leisure activities and physical activity improves subjective well-being \u0026sup2;⁶⁾. These findings, therefore, extend the literature by demonstrating, within a longitudinal framework, that physical activity partially mediates the relationship between social participation and health satisfaction. The consistency with previous research supports the validity of the current analysis and strengthens the plausibility of the identified pathway.\u003c/p\u003e \u003cp\u003eThis study finds that social participation influences health satisfaction, in part, through physical activity. Previous research has shown that social participation is associated with a lower risk of functional disability among older adults \u0026sup2;⁷⁾, suggesting that engagement in social activities may promote physical functioning, potentially through increased opportunities for movement and exercise embedded in social roles and community participation. Thus, the neighborhood social environment may contribute to health not only through psychological support but also through behavioral pathways involving physical activity. This interpretation is consistent with studies demonstrating that social engagement affects self-rated health through functional activities of daily living \u0026sup2;⁸⁾. Such findings indicate that social involvement enhances functional activity, in turn improving health perceptions. The pathway identified in the present study\u0026mdash;social participation \u0026rarr; physical activity \u0026rarr; health satisfaction\u0026mdash;aligns with this conceptual framework.\u003c/p\u003e \u003cp\u003eFurthermore, previous research has reported that greater diversity of social participation among older adults is associated with maintaining physical activity levels and improved subjective health\u0026sup2;⁷⁾, suggesting that social engagement links activity behaviors and health perceptions. Importantly, the present study extends this body of literature by formally testing this mechanism using causal mediation analysis within a longitudinal design. The identification of a statistically significant indirect effect of physical activity empirically supports the behavioral pathway underlying the association between the neighborhood social environment and health satisfaction, highlighting this study's novel contribution.\u003c/p\u003e \u003cp\u003eAlthough perceived neighborhood greenness was positively associated with health satisfaction, the mediating effect of physical activity was not statistically significant. This suggests that the neighborhood\u0026rsquo;s natural environment may not necessarily influence health satisfaction through increased physical activity. Instead, greenness may operate through alternative, nonbehavioral pathways. Natural environments have been found to contribute to subjective health through psychological restoration and stress reduction mechanisms that are independent of activity levels. Previous studies have reported that residential greenness is associated with better subjective and mental health outcomes; however, these associations are not fully explained by physical activity \u0026sup2;⁹⁾. Furthermore, evidence from older adults indicates that access to green spaces is positively associated with psychological well-being, whereas associations with physical activity are less consistent \u0026sup3;⁰⁾. These findings are consistent with the literature, suggesting that the health benefits of a neighborhood\u0026rsquo;s natural environment may arise from multiple pathways beyond physical activity. These results highlight the complexity of environmental influences on health satisfaction and underscore the importance of considering diverse mechanisms when evaluating the role of natural environments in healthy aging.\u003c/p\u003e \u003cp\u003eThis study has several strengths. First, the use of a two-wave longitudinal design allowed for partial establishment of temporal ordering between neighborhood environment, physical activity, and health satisfaction. Second, multiple baseline covariates including age, socioeconomic factors, and health-related behaviors\u0026mdash;were adjusted in the statistical models, enhancing internal validity and reducing potential confounding. Third, both the neighborhood social and natural environments were examined simultaneously in the same individuals, enabling comparison of their relative contributions to health satisfaction. Additionally, the use of a nationwide sample of community-dwelling older adults improves the stability of estimates and supports some external validity.\u003c/p\u003e \u003cp\u003eSeveral limitations should also be considered. Ideally, mediation analysis would involve three temporally separated measurements of exposure, mediator, and outcome; however, this study was based on two waves, which limits the temporal separation of the mediating pathway. Second, perceived neighborhood greenness was assessed using a subjective measure and may, therefore, reflect individual perception or psychological disposition rather than objective environmental conditions. Third, physical activity was measured using a self-reported single-item question, which may be subject to measurement error and social desirability bias.\u003c/p\u003e \u003cp\u003eGiven these limitations, future studies should incorporate objective environmental indicators and multiwave longitudinal designs to strengthen the mechanisms linking neighborhood environments, physical activity, and health satisfaction.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis longitudinal study examined the mediating role of physical activity in the associations between older adults' neighborhood social and natural environments and their health satisfaction. The findings demonstrated that social participation was positively associated with health satisfaction, and this association was partially mediated by physical activity. In contrast, perceived neighborhood greenness was positively associated with health satisfaction, but its mediating effect through physical activity was not significant. These results suggest that neighborhood social environments that promote social engagement may help maintain and improve health satisfaction by supporting active lifestyles among older adults. At the same time, the influence of neighborhood natural environments may operate through mechanisms beyond physical activity. Overall, fostering socially engaging neighborhood environments may represent an important strategy for promoting healthy aging.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethical Review Committee of Hana-no-Oka Hospital (approval number: 02045). Informed consent to participate was obtained electronically from all participants prior to completing the web-based survey.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funds have been granted. All authors reported no conflicts of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMY analysed and visualised the data and drafted the manuscript; TT,MKinterpreted the results and drafted the manuscript. All authors reviewed the article andapproved the submitted version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe secondary analysis in this study was conducted using individual-level data from the Survey on Satisfaction and Quality of Life, 2023 and 2024, conducted by the Cabinet Office of Japan. The data were provided by the SSJ Data Archive at the Center for Social Research and Data Archives, Institute of Social Science, The University of Tokyo. The datasets are available at https://doi.org/10.34500/SSJDA.1613 and https://doi.org/10.34500/SSJDA.1746\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset used to support the findings of this study is available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO Age\u0026ndash;friendly Environments. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/age-friendly-environments\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/age-friendly-environments\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO Healthy Ageing Report /. Healthy Ageing Decade 2020\u0026ndash;2030. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241515073\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241515073\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu, J., Luo, Y., Haller, W., Vander Mey, B. \u0026amp; Granberg, E. Neighborhood environments and self-rated health in Mainland China, Japan and South Korea. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e, e0204910 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang, B. et al. Residential exposure to natural outdoor environments and general health among older adults in Shanghai, China. \u003cem\u003eInt. J. Equity Health\u003c/em\u003e. \u003cb\u003e18\u003c/b\u003e, 178 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong, A. et al. Linking green space to neighborhood social capital in older adults: the role of perceived safety. \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e \u003cb\u003e207\u003c/b\u003e, 38\u0026ndash;45 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLestari, S. K., de Luna, X., Eriksson, M., Malmberg, G. \u0026amp; Ng, N. A longitudinal study on social support, social participation, and older Europeans' Quality of life. \u003cem\u003eSSM Popul. Health\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e, 100747 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantini, Z. I. et al. Formal social participation protects physical health through enhanced mental health: a longitudinal mediation analysis using three consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e \u003cb\u003e251\u003c/b\u003e, 112906 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, Q., Song, J., Liu, Z. \u0026amp; Shi, C. Green space and older adults' health: a scoping review. \u003cem\u003eInnov. Aging\u003c/em\u003e. \u003cb\u003e9\u003c/b\u003e, igaf119 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu, T., Nordin, N. A. \u0026amp; Aini, A. M. Urban green space and subjective well-being of older people: a systematic literature review. \u003cem\u003eInt. J. Environ. Res. Public. Health\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e, 14227 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerbolsheimer, F. et al. Neighborhood environment, social participation, and physical activity in older adults with lower limb osteoarthritis: a mediation analysis. \u003cem\u003eHealth Place\u003c/em\u003e. \u003cb\u003e68\u003c/b\u003e, 102513 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaudhury, H., Campo, M., Michael, Y. \u0026amp; Mahmood, A. Neighbourhood environment and physical activity in older adults. \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e \u003cb\u003e149\u003c/b\u003e, 104\u0026ndash;113 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalton, A. M., Wareham, N., Griffin, S. \u0026amp; Jones, A. P. Neighbourhood greenspace is associated with a slower decline in physical activity in older adults: a prospective cohort study. \u003cem\u003eSSM Popul. Health\u003c/em\u003e. \u003cb\u003e2\u003c/b\u003e, 683\u0026ndash;691 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZuo, W., Cheng, B., Feng, X. \u0026amp; Zhuang, X. Relationship between urban green space and mental health in older adults: mediating role of relative deprivation, physical activity, and social trust. \u003cem\u003eFront. Public. Health\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e, 1442560 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIdler, E. L. \u0026amp; Benyamini, Y. Self-rated health and mortality: a review of twenty-seven community studies. \u003cem\u003eJ. Health Soc. Behav.\u003c/em\u003e \u003cb\u003e38\u003c/b\u003e, 21\u0026ndash;37 (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJylh\u0026auml;, M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e \u003cb\u003e69\u003c/b\u003e, 307\u0026ndash;316 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalenkamp, H., Braam, A. W., Huisman, M. \u0026amp; Deeg, D. J. Seventeen-year time trend in poor self-rated health in older adults: changing contributions of chronic diseases and disability. \u003cem\u003eEur. J. Public. Health\u003c/em\u003e. \u003cb\u003e23\u003c/b\u003e, 511\u0026ndash;517 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBijani, A., Shah-Hosseini, Z., Hosseini, S. R., Ghadimi, R. \u0026amp; Mouodi, S. Self-rated health and its impact on survival of older adults. \u003cem\u003eAdv. Biomed. Res.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e, 45 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUeno, T. et al. Social participation and functional disability trajectories in the last three years of life: the Japan Gerontological Evaluation Study. \u003cem\u003eArch. Gerontol. Geriatr.\u003c/em\u003e \u003cb\u003e121\u003c/b\u003e, 105361 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanwell, N., Michel, S. \u0026amp; Senn, N. Greenspaces and health: scoping review of studies in Europe. \u003cem\u003ePublic. Health Rev.\u003c/em\u003e \u003cb\u003e45\u003c/b\u003e, 1606863 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalck, R. S., McDonald, S. M., Beets, M. W., Brazendale, K. \u0026amp; Liu-Ambrose, T. Measurement of physical activity in older adult interventions: a systematic review. \u003cem\u003eBr. J. Sports Med.\u003c/em\u003e \u003cb\u003e50\u003c/b\u003e, 464\u0026ndash;470 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIde, K. et al. Frequency of social participation by types and functional decline: a six-year longitudinal study. \u003cem\u003eArch. Gerontol. Geriatr.\u003c/em\u003e \u003cb\u003e112\u003c/b\u003e, 105018 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori, Y. et al. Built environments and frailty in older adults: the JAGES longitudinal study using mediation analysis. \u003cem\u003eJ. Am. Med. Dir. Assoc.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e, 1677\u0026ndash;1682 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanderWeele, T. J. \u003cem\u003eExplanation in causal inference: methods for mediation and interaction\u003c/em\u003e (Oxford University Press, 2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaron, R. M. \u0026amp; Kenny, D. A. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. \u003cem\u003eJ. Pers. Soc. Psychol.\u003c/em\u003e \u003cb\u003e51\u003c/b\u003e, 1173\u0026ndash;1182 (1986).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIchida, Y. et al. Does social participation improve self-rated health in the older population? A quasi-experimental intervention study. \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e \u003cb\u003e94\u003c/b\u003e, 83\u0026ndash;90 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng, C., Shi, Z., Tian, Y., Ma, C. \u0026amp; Sun, Q. Longitudinal associations between leisure activities and subjective happiness among middle-aged and older adults people in China: national cohort study. \u003cem\u003eFront. Public. Health\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e, 1441703 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanamori, S. et al. Social participation and the prevention of functional disability in older Japanese: the JAGES cohort study. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e9\u003c/b\u003e, e99638 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou, J. et al. Patterns of social participation among older adults and their association with self-rated health: the mediating role of activities of daily living. \u003cem\u003eAging Clin. Exp. Res.\u003c/em\u003e \u003cb\u003e37\u003c/b\u003e, 221 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou, J. et al. Patterns of social participation among older adults and their association with self-rated health: the mediating role of activities of daily living. \u003cem\u003eAging Clin. Exp. Res.\u003c/em\u003e \u003cb\u003e37\u003c/b\u003e, 221 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSugiyama, T., Leslie, E., Giles-Corti, B. \u0026amp; Owen, N. Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships? \u003cem\u003eJ. Epidemiol. Community Health\u003c/em\u003e. \u003cb\u003e62\u003c/b\u003e, e9 (2008).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Environments, Mediation Analysis, well-being","lastPublishedDoi":"10.21203/rs.3.rs-9352721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9352721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eNeighborhood environments influence health in older adults; however, the mechanisms linking environmental factors to health outcomes remain insufficiently understood. In particular, few longitudinal studies have simultaneously examined the roles of social and natural environments and their potential pathways through health behaviors. This study aimed to investigate the longitudinal associations of neighborhood social and natural environments with health satisfaction in older adults and to examine whether physical activity mediates these relationships.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThis study used secondary data from a nationwide survey of community-dwelling older adults in Japan. A total of 1,043 participants aged 65 years or older were included in the analysis. Social participation was used as an indicator of the neighborhood social environment, and perceived green space around the residence was used as an indicator of the natural environment. Physical activity was assessed as a potential mediator, and health satisfaction was used as the outcome variable. Health satisfaction was dichotomized at the median. Causal mediation analysis was conducted to estimate the total effect, natural direct effect, and natural indirect effect through physical activity. The proportion mediated was also calculated. Analyses adjusted for demographic, socioeconomic, and lifestyle factors, including age, sex, alcohol use, employment status, household income, educational attainment, household composition, marital status, prefecture, and baseline health satisfaction.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAmong the participants, 432 (41.4%) were classified as having low health satisfaction and 611 (58.6%) as having high health satisfaction. Social participation was significantly associated with health satisfaction. The natural direct effect of social participation on health satisfaction was 0.099 (95% CI: 0.031\u0026ndash;0.168), and the indirect effect mediated by physical activity was 0.017 (95% CI: 0.004\u0026ndash;0.032). The total effect was 0.117 (95% CI: 0.046\u0026ndash;0.189), and the proportion mediated by physical activity was 14.6%. In contrast, perceived green space showed a positive but non-significant association with health satisfaction.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eSocial participation was longitudinally associated with higher health satisfaction among older adults, and part of this relationship was mediated by physical activity. These findings suggest that neighborhood social environments that promote social participation may support active lifestyles and contribute to better perceived health in later life.\u003c/p\u003e","manuscriptTitle":"Association Between Neighborhood Socionatural Environments and Health Satisfaction: A Longitudinal Mediation Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 07:09:59","doi":"10.21203/rs.3.rs-9352721/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T08:59:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T11:51:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-25T09:56:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T04:32:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T16:08:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T13:30:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132536087405890751377299443683659166350","date":"2026-04-20T06:50:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283542441777973212717618187316492111074","date":"2026-04-18T08:23:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80997039197754690398801786743902687383","date":"2026-04-18T07:56:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152525837908723504090993848803537542333","date":"2026-04-17T18:07:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T14:32:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309435480988367737165955954486885759019","date":"2026-04-17T12:50:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68391157032562827385179127047515821451","date":"2026-04-17T10:59:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161473070824519218462652397967308971076","date":"2026-04-17T04:57:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177385732985624653966604944687224043394","date":"2026-04-17T04:49:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141745200770158231330741699161028958216","date":"2026-04-17T04:18:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103847888086990745353074222330979641950","date":"2026-04-17T04:18:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-17T04:05:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-14T19:27:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-08T13:50:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T13:49:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-04-08T06:42:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0519a230-621d-4945-93e7-b621202ae5e2","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":66854243,"name":"Earth and environmental sciences/Environmental social sciences"},{"id":66854244,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2026-05-11T13:26:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 07:09:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9352721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9352721","identity":"rs-9352721","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}