Factors associated with visiting freshwater blue space: The role of restoration and relations with mental health and well-being

Blue space exposure may benefit health and well-being, but salutogenic effects remain underexplored in non-coastal and non-urban areas, as do correlates of visit frequency to freshwater blue space (FBS). We mailed a questionnaire to adults in 40 small towns in central and northeast Pennsylvania, USA, with varying proximity to the region's primary waterbody to assess FBS visits, benefits and barriers of visiting, restoration experienced, and mental health and well-being (perceived stress, general mental health, life satisfaction). We used multivariate multinomial regression to examine predictors of FBS visit frequency and linear and logistic regression to evaluate associations of FBS visit frequency with health outcomes, using mixed effects models that accounted for spatial clustering. Of 10,871 mailed questionnaires, 1,122 individuals (11%) responded and provided information to characterize FBS visits. Responders were older than non-responders but did not differ by sex or community setting. Nearly one-fifth (19%) never visited FBS, and 27%, 35%, and 19% reported low, moderate, and high visit frequency, respectively. Correlates of visit frequency included perceived proximity, higher education, younger age, better self-reported health, and more frequent physical activity. Relaxation/stress-relief was identified as the most important benefit to visiting FBS, and among the 868 individuals who visited FBS, restoration was associated with visit frequency. FBS visit frequency was associated with perceived stress, but not mental health or life satisfaction. Findings highlight the socioeconomic patterning of FBS visits, the importance of access in facilitating visits, and reveal opportunities to develop FBS access points that increase its use, bringing potential restorative benefits.