{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:25:12Z","timestamp":1791584712282,"version":"4.3.4"},"reference-count":58,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Canadian Institutes of Health Research (CIHR) Foundation","award":["143222"],"award-info":[{"award-number":["143222"]}]},{"award":["143222"],"award-info":[{"award-number":["143222"]}],"id":[{"id":"https:\/\/ror.org\/01gavpb45","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: We examined whether higher access to parks and greenspace is independently associated with an increase in physical activity and lower rates of obesity when neighbourhood walkability is accounted for and whether neighbourhood walkability and park access have synergistic effects on these outcomes. Materials and Methods: We used cross-sectional data from the Canadian Community Health Survey between 2007 and 2014 for adults aged 20 to 74 in Ontario, Canada. Neighbourhood-level park access exposures included size of parks and number of parks within 800 m of residential areas, and neighbourhood walkability was based on a validated index. The main outcomes were physical activity during leisure time (LPA), both leisure and transportation physical activity (LTPA), and obesity. Descriptive and multivariate logistic regression analyses were conducted, stratified by age groups, accounting for sex, income, ethnicity, and season. Results: Among 41,945 respondents, park access was associated with higher LPA and LTPA, with effects modified by neighbourhood walkability (p &lt; 0.001). Physical activity was highest in neighbourhoods with high walkability and park access and lowest in low walkability areas without parks. In highly walkable neighbourhoods, \u22651 small- or medium-sized park was associated with 29% higher odds of LPA (OR: 1.29, 95%CI: 1.21\u20131.37) and 48% higher odds of LTPA (OR: 1.48, 95%CI: 1.38\u20131.57) than low walkability\/no park access. In contrast, associations were modest in low-walkability neighbourhoods (4\u20137%). High walkability was also associated with lower obesity and marked reductions when combined with very high access to large parks (OR: 0.72, 95%CI: 0.55\u20130.94). Findings were consistent across age groups. Conclusions: High neighbourhood walkability was the strongest predictor of physical activity and lower obesity risk, with park access providing additional benefits primarily in already walkable environments. These findings suggest that population health interventions targeting urban design need to consider the combined benefits of neighbourhood walkability and park access on health.<\/jats:p>","DOI":"10.3390\/ijerph23060787","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T08:22:56Z","timestamp":1781684576000},"page":"787","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Park Size, Access and Neighbourhood Walkability with Physical Activity and Obesity: A Cross-Sectional Analysis"],"prefix":"10.3390","volume":"23","author":[{"given":"Ghazal S.","family":"Fazli","sequence":"first","affiliation":[{"name":"Department of Geography, Geomatics, and the Environment, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada"},{"name":"ICES, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0926-8234","authenticated-orcid":false,"given":"Jane","family":"Polsky","sequence":"additional","affiliation":[{"name":"Statistics Canada, Ottawa, ON K1A 0T6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Johns","sequence":"additional","affiliation":[{"name":"Map Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON M5B 1X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Gozdyra","sequence":"additional","affiliation":[{"name":"ICES, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Luo","sequence":"additional","affiliation":[{"name":"ICES, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian L.","family":"Booth","sequence":"additional","affiliation":[{"name":"ICES, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"},{"name":"Map Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON M5B 1X2, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/osp4.115","article-title":"Association of Built Environment Characteristics with Adiposity and Glycaemic Measures","volume":"3","author":"Lee","year":"2017","journal-title":"Obes. Sci. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ngom, R., Gosselin, P., Blais, C., and Rochette, L. (2016). Type and Proximity of Green Spaces Are Important for Preventing Cardiovascular Morbidity and Diabetes\u2014A Cross-Sectional Study for Quebec, Canada. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13040423"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.envres.2018.06.030","article-title":"The Health Benefits of The Great Outdoors: A Systematic Review and Meta-Analysis of Greenspace Exposure and Health Outcomes","volume":"166","author":"Jones","year":"2018","journal-title":"Environ. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e198209","DOI":"10.1001\/jamanetworkopen.2019.8209","article-title":"Association of Urban Green Space with Mental Health and General Health among Adults in Australia","volume":"2","author":"Feng","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1289\/ehp.1510363","article-title":"Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study","volume":"124","author":"James","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.envint.2019.04.047","article-title":"Complex Relationships between Greenness, Air Pollution, and Mortality in a Population-based Canadian Cohort","volume":"128","author":"Crouse","year":"2019","journal-title":"Environ. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.envres.2017.06.028","article-title":"Exploring Pathways Linking Greenspace to Health: Theoretical and Methodological Guidance","volume":"158","author":"Markevych","year":"2017","journal-title":"Environ. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Deng, Y., Liang, J., and Chen, Q. (2023). Greenway Interventions Effectively Enhance Physical Activity Levels\u2014A Systematic Review with Meta-analysis. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1268502"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/s44360-025-00011-y","article-title":"Wearable Data Link Urban Green Space to Physical Activity","volume":"1","author":"Lu","year":"2026","journal-title":"Nat. Health"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Jennings, V., and Bamkole, O. (2019). The Relationship between Social Cohesion and Urban Green Space: An Avenue for Health Promotion. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16030452"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1088\/1748-9326\/ac0e61","article-title":"The Roles of Residential Greenness in the Association between Air Pollution and Health: A Systematic Review","volume":"16","author":"Son","year":"2021","journal-title":"Environ. Res. Lett."},{"key":"ref_12","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide Trends in Body-Mass Index, Underweight, Overweight, and Obesity from 1975 to 2016: A Pooled Analysis of 2416 Population-based Measurement Studies in 128.9 Million Children, Adolescents, and Adults. Lancet, 390, 2627\u20132642."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1077","DOI":"10.1016\/S2214-109X(18)30357-7","article-title":"Worldwide Trends in Insufficient Physical Activity from 2001 to 2016: A Pooled Analysis of 358 Population-Based Surveys with 1.9 Million Participants","volume":"6","author":"Guthold","year":"2018","journal-title":"Lancet Glob. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"509","DOI":"10.2105\/AJPH.2005.072447","article-title":"Contribution of Public Parks to Physical Activity","volume":"97","author":"Cohen","year":"2007","journal-title":"Am. J. Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.2105\/AJPH.2007.129064","article-title":"Park Size, Distance, and Features and Physical Activity","volume":"98","author":"Kaczynski","year":"2008","journal-title":"Am. J. Public Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.2105\/AJPH.93.9.1583","article-title":"Relative Influences of Environmental Correlates of Walking","volume":"93","author":"Donovan","year":"2003","journal-title":"Am. J. Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.jshs.2018.11.002","article-title":"Associations Between Park Features and Physical Activity: A Systematic Review","volume":"8","author":"Zhang","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Shen, J., Cui, J., Li, M., Clarke, C.V., Gao, Y., and An, R. (2021). Green Space and Physical Activity in China: A Systematic Review. Sustainability, 13.","DOI":"10.3390\/su132313368"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Laezza, L., De Dominicis, S., and Brondino, M. (2024). Reassessing green exercise research: Unveiling methodological gaps and pathways for progress. Front. Sports Act. Living, 6.","DOI":"10.3389\/fspor.2024.1449059"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"106959","DOI":"10.1016\/j.envint.2021.106959","article-title":"Chronic disease and where you live: Built and natural environment relationships with physical activity, obesity, and diabetes","volume":"158","author":"Frank","year":"2022","journal-title":"Environ. Int."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Arifwidodo, S.D., Chandrasiri, O., Rasri, N., Sirawarong, W., Rattanawichit, P., and Sangyuan, N. (2022). Association between Park Visitation and Physical Activity among Adults in Bangkok, Thailand. Sustainability, 14.","DOI":"10.3390\/su141912938"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ratanawichit, P., Arifwidodo, S.D., and Anambutr, R. (2025). Neighbourhood Walkability, Recreational Walking, and their Associations with Physical Activity and Well-Being in Bangkok, Thailand. Urban Sci., 9.","DOI":"10.3390\/urbansci9050154"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Arifwidodo, S.D., Chandrasiri, O., and Rueangsom, P. (2025). Is Proximity to Parks Associated with Physical Activity and Well-Being? Insights from 15-Minute Parks Policy Initiative in Bangkok, Thailand. Sustainability, 17.","DOI":"10.3390\/su17167457"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1001\/jama.2016.5898","article-title":"Association of Neighborhood Walkability with Change in Overweight, Obesity, and Diabetes","volume":"315","author":"Creatore","year":"2016","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Glazier, R.H., Creatore, M.I., Weyman, J.T., Fazli, G., Matheson, F.I., Gozdyra, P., Moineddin, R., Kaufman-Shriqui, V., and Booth, G.L. (2014). Density, Destinations or Both? A Comparison of Measures of Walkability in Relation to Transportation Behaviors, Obesity and Diabetes in Toronto, Canada. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0085295"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"104799","DOI":"10.1016\/j.envint.2019.04.070","article-title":"Interaction Between Neighborhood Walkability and Traffic-Related Air Pollution on Hypertension and Diabetes: The CANHEART Cohort","volume":"132","author":"Howell","year":"2019","journal-title":"Environ. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e000908","DOI":"10.1136\/bmjdrc-2019-000908","article-title":"Neighborhood Walkability and Pre-Diabetes Incidence in a Multiethnic Population","volume":"8","author":"Fazli","year":"2020","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1136\/jech-2018-210510","article-title":"Neighbourhood walkability and the incidence of diabetes: An inverse probability of treatment weighting analysis","volume":"73","author":"Booth","year":"2019","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"302","DOI":"10.2337\/dc12-0777","article-title":"Unwalkable neighborhoods, poverty, and the risk of diabetes among recent immigrants to Canada compared with long-term residents","volume":"36","author":"Booth","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e013146","DOI":"10.1161\/JAHA.119.013146","article-title":"Association Between Neighborhood Walkability and Predicted 10-Year Cardiovascular Disease Risk: The CANHEART (Cardiovascular Health in Ambulatory Care Research Team) Cohort","volume":"8","author":"Howell","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1146\/annurev.publhealth.27.021405.102100","article-title":"An Ecological Approach to Creating Active Living Communities","volume":"27","author":"Sallis","year":"2006","journal-title":"Annu. Rev. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.landurbplan.2018.08.007","article-title":"Who has access to urban vegetation? A spatial analysis of distributional green equity","volume":"181","author":"Nesbitt","year":"2019","journal-title":"Landsc. Urban Plan."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.landurbplan.2016.05.017","article-title":"A Complex Landscape of Inequity in Access to Urban Parks: A Literature Review","volume":"153","author":"Rigolon","year":"2016","journal-title":"Landsc. Urban Plan."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.landurbplan.2018.05.026","article-title":"Inequities in the Quality of Urban Park Systems: An Environmental Justice Investigation of Cities in the United States","volume":"178","author":"Rigolon","year":"2018","journal-title":"Landsc. Urban Plan."},{"key":"ref_35","unstructured":"Kondo, M.C., Fluehr, J.M., McKeon, T., and Branas, C.C. (2020). Urban Green Space and its Impact on Human Health. Curr. Environ. Health Rep., 7."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s12966-017-0613-9","article-title":"Systematic Literature Review of Built Environment Effects on Physical Activity and Active Transport\u2014An Update and New Findings on Health Equity","volume":"14","author":"Smith","year":"2017","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zhai, Y., Li, D., Wang, D., and Shi, C. (2020). Seniors\u2019 Physical Activity in Neighborhood Parks and Park Design Characteristics. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00322"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Veitch, J., Carver, A., Abbott, G., Giles-Corti, B., Timperio, A., and Salmon, J. (2015). How active are people in metropolitan parks? An observational study of park visitation in Australia. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-1960-6"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"103605","DOI":"10.1016\/j.landurbplan.2019.103605","article-title":"Subtypes of Park Use and Psychological Benefits among Older Adults","volume":"190","author":"Li","year":"2019","journal-title":"Landsc. Urban Plan"},{"key":"ref_40","unstructured":"Statistics Canada (2026, February 21). Dissemination Area (DA). Available online: https:\/\/www12.statcan.gc.ca\/census-recensement\/2021\/ref\/dict\/az\/definition-eng.cfm?ID=geo021."},{"key":"ref_41","unstructured":"DMTI Spatial Inc (2026, February 21). CanMap Parks and Recreation Dataset (Polygon), Available online: https:\/\/www.dmtispatial.com\/."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.2337\/dc10-2300","article-title":"Deriving Ethnic-Specific BMI Cutoff Points for Assessing Diabetes Risk","volume":"34","author":"Chiu","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"The World Health Organization (2004). Expert Consultation, Appropriate Body-Mass Index for Asian Populations and its Implications for Policy and Intervention Strategies. Lancet, 363, 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1177\/09727531241289486","article-title":"Why Your Brain Needs a Walk in the Park: Residential Greenspaces as the Next Frontier in Brain Research and Treatment","volume":"31","author":"Charan","year":"2024","journal-title":"Ann. Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"eaax0903","DOI":"10.1126\/sciadv.aax0903","article-title":"Nature and Mental Health: An Ecosystem Service Perspective","volume":"5","author":"Bratman","year":"2019","journal-title":"Sci. Adv."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1016\/S0140-6736(15)01284-2","article-title":"Physical Activity in Relation to Urban Environments in 14 Cities Worldwide: A Cross-Sectional Study","volume":"387","author":"Sallis","year":"2016","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jshs.2018.11.003","article-title":"Impact of Built Environment on Physical Activity and Obesity Among Children and Adolescents in China: A Narrative Systematic Review","volume":"8","author":"An","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bjsm.2009.058701","article-title":"The Development of a Walkability Index: Application to the Neighborhood Quality of Life Study","volume":"44","author":"Frank","year":"2010","journal-title":"Br. J. Sports Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Wasfi, R.A., Steinmetz-Wood, M., and Kestens, Y. (2017). Place matters: A longitudinal analysis measuring the association between neighbourhood walkability and walking by age group and population center size in Canada. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0189472"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1177\/0013916515614366","article-title":"The Paradox of Parks in Low-Income Areas: Park Use and Perceived Threats","volume":"48","author":"Cohen","year":"2016","journal-title":"Environ. Behav.Med."},{"key":"ref_51","unstructured":"World Obesity Federation (2026, February 22). Prevalence of Obesity. Available online: https:\/\/www.worldobesity.org\/about\/about-obesity\/prevalence-of-obesity."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.healthplace.2018.08.009","article-title":"Association Between Residential Self-Selection and Non-Residential Built Environment Exposures","volume":"54","author":"Howell","year":"2018","journal-title":"Health Place"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1080\/01944360608976724","article-title":"Self-selection in the Relationship between the Built Environment and Walking","volume":"72","author":"Handy","year":"2006","journal-title":"J. Am. Plan. Assoc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1080\/01441640802539195","article-title":"Examining Residential Self-Selection in Travel Behaviour","volume":"29","author":"Cao","year":"2009","journal-title":"Transp. Rev."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/bjsports-2018-099131","article-title":"Is the Time Right for Quantitative Public Health Guidelines on Sitting? A Narrative Review of Sedentary Behaviour Research Paradigms and Findings","volume":"53","author":"Stamatakis","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Xia, G., He, G., and Zhang, X. (2024). Assessing the Spatial Equity of Urban Park Green Space Layout from the Perspective of Resident Heterogeneity. Sustainability, 16.","DOI":"10.3390\/su16135631"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Oosterbroek, B., de Kraker, J., Huynen, M., and Martens, P. (2024). Participatory Design of Urban Green Spaces to Improve Residents\u2019 Health. Land, 13.","DOI":"10.3390\/land13010088"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.ufug.2015.05.007","article-title":"User Participation in Urban Green Spaces\u2014For the People or the Parks?","volume":"14","author":"Fors","year":"2015","journal-title":"Urban For. Urban Green."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/787\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T08:35:19Z","timestamp":1781685319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":58,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijerph23060787"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23060787","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}