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Do multiple sex/gender dimensions play a role in the association of green space and self-rated health? Model-based recursive partitioning results from the KORA INGER Study.
Int. J. Environ. Res. Public Health 20:5241 (2023)
Exposure to green space has a positive impact on health. Whether sex/gender modifies the green space-health association has so far only been studied through the use of a binary sex/gender category; however, sex/gender should be considered more comprehensively as a multidimensional concept based on theoretical approaches. We therefore explored whether sex/gender, operationalized through multiple sex/gender- and intersectionality-related covariates, modifies the green space-self-rated health association. We collected data from participants involved in the German KORA study (Cooperative Health Research in the Region of Augsburg) in 2019. Self-rated health was assessed as a one-question item. The availability of green spaces was measured subjectively as well as objectively. The multiple sex/gender- and intersectionality-related covariates were measured via self-assessment. To analyze the data, we used model-based recursive partitioning, a decision tree method that can handle complex data, considering both multiple covariates and their possible interactions. We showed that none of the covariates operationalizing an individual sex/gender self-concept led to subgroups with heterogeneous effects in the model-based tree analyses; however, we found effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective, although they did not show the intersectional structuring of sex/gender dimensions. In one identified subgroup, those with a lower education level or a feeling of discrimination based on social position showed a positive green space-self-rated health association, while participants with a higher education level or no feeling of discrimination based on social position had a high level of self-rated health regardless of the availability of green spaces. Model-based recursive partitioning has the potential to detect subgroups exhibiting different exposure-outcome associations, with the possibility of integrating multiple sex/gender- and intersectionality-related covariates as potential effect modifiers. A comprehensive assessment of the relevance of sex/gender showed effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Decision Trees ; Gender ; Green Spaces ; Intersectionality ; Model-based Recursive Partitioning ; Sex
ISSN (print) / ISBN
1661-7827
e-ISSN
1660-4601
Quellenangaben
Volume: 20,
Issue: 7,
Article Number: 5241
Publisher
MDPI
Publishing Place
Basel, Switzerland
Non-patent literature
Publications
Reviewing status
Peer reviewed