Our research

SURREAL is based on three central concepts: the urban health system, exposome and inequality.

Urban Health System

How do urban stressors impact cardiovascular and mental health?

We will investigate the urban health system by focusing on interactions between people and their social, cultural, ecological and economic milieu. In doing so, we will examine how urban stressors, such as, pollution, unhealthy food cues, a lack of green space and stressful experiences, impact the cardiovascular health, mental health, brain development and life aging of urban dwellers.

By taking into account both environmental and individual factors, we hope to develop a deeper understanding of the weaknesses found in our urban health system.
Every characteristic of someone's living environment is important to measure.

Exposome

Identifying a variety of environmental exposures

Instead of investigating a single environmental exposure in isolation in a specific timeframe, we embrace the exposome concept. This means examining how variations in environmental exposures over the life-course, starting as early as the prenatal period, impact health.
We can use new technologies to measure people's environment.

Advanced methods to measure the effect of environment on behavior

With the help of new technologies and large data-sets, we will measure the changes that have occurred over time to people’s environments, behaviour and health. Moreover, we are also interested in examining how potential changes to an urban environment may modify future behaviour. By using Virtual Reality experiments, we hope to explore potential solutions for improving our urban health system.

Inequality

Investigate the health consequences of inequalities in inner cities

To inform policy on how to tackle inner-city inequalities, we will develop a deeper understanding of the complex interplays that lead to significant disparities in mental health, cardiovascular health and life expectancy. We will use a systems approach to analyse how your socioeconomic status influences your level of exposure to urban stressors as well as your resources to recover from distress.
By using a systems approach, we investigate these complex relationships with a holistic perspective in mind. We use innovative conceptualisation and methodology to fill the current gaps.

Research on the individual and population level

At the individual level, we will examine how to develop interventions to improve the health standards of people living in low SES neighborhoods. Citizen science and co-creation processes will be used to develop a strong collaborative relationship between researchers and participants to improve the efficacy and legitimacy of interventions.

On a wider population level, we will improve current urban health models by addressing the lack of data on the movements of people, the type of exposures people face and the lack of equity assessments.

Our key objectives

Develop an in-depth understanding of the equity impact of urban environmental exposures to health behavior (physical activity, dietary intake) and health outcomes (stress, cardiometabolic).
Analyzing the impact of changes in life stage as well as changes in and of residential environments on health and health equity using a systems approach.
Develop and assess interventions in the urban health system that involve residents and co-creation practices to reduce exposures to environmental stressors, to enhance healthy behaviors and to reduce health inequalities


Identifying, implementing and developing methods that involve the most promising portable sensing technique and virtual reality tools for exposure measurement and recording of momentary and daily cardiovascular and mental health states.
Train 15 Early Stage Researchers as future professionals via research, network-wide activities, secondments and collaborative learning in practice to participate in the urban health system and to integrate knowledge in order to improve health and health equity.

Publications

2025

Kosīte D, Gueltzow M, Frank van Lenthe FJ, Beenackers MA, Oude Groeniger J. Would intervening on financial strain reduce inequalities in mental health between renters and homeowners. Health Place 2025;92:103434. DOI: 10.1016/j.healthplace.2025.103434.

Kosīte D, Van Lenthe FJ, Nieuwenhuijsen MJ, Beenackers MA. Preventing common mental health problems by increasing neighbourhood socioeconomic status: a mental health impact assessment in Rotterdam, the Netherlands. Eur J Public Health 2025;35(1):72-78. DOI: 10.1093/eurpub/ckae222.

Mishra S, Vaartjes I, Van der Schouw YT, Bijnens EM, Boer JMA, Downward GS, Vermeulen RCH, Verschuren WMM, Nawrot TS, Timmermans EJ. Air pollution exposure and incidence of cardiometabolic diseases: exploring the modigying role of dietary antioxidant intake in adults. Health Place 2025;93:103453. DOI: 10.1016/j.healthplace.2025.103473.

Mustansar T, Timmermans EJ, Silva AI, Bijnens EM, Lefebvre W, Saenen ND, Vanpucke C, Nawrot TS, Vaartjes I. Socioeconomic inequalities and ambient air pollution exposure in school-aged children living in an affluent society: an analysis on individual and aggregated data in Belgium. Health Place 2025;93:103473. DOI: 10.1016/j.healthplace.2025.103473.

Mustansar T, Van den Brekel L, Timmermans EJ, Agyemang C, Vaartjes I. Air pollution exposure disparities among ethnic groups in high-income countries: a scoping review. Environ Res 2025;267:120647. DOI: 10.1016/j.envres.2024.120647.

Ramos Velásquez A, Guevara M, Armengol JM, Rodriguez-Rey D, Mueller N, Cirach M, Khomenka S, Nieuwenhuijsen M. Health impact assessment of urban and transport developments in Barcelona: a case study. Health Place 2025;91:103406. DOI: 10.1016/j.healthplace.2024.103406.

2024

Cail V, Oude Groeniger J, Beenackers MA, Van Lenthe FJ. Changes in perceived neighborhood social cohesion and self-assessed health: 17-year follow-up of the Dutch GLOBE study. Eur J Public Health 2024;34(6):1079-1085. DOI: 10.1093/eurpub/ckae168.

Cosemans C, Bongaerts E, Vanbrabant K, Brigitte R, Silva AI, Tommelein E, Poma G, Ameloot M, Nawrot TS, Plusquin M. Black carbon particles in human breast milk: assessing infant’s exposure. Front Public Health 2024;11:1333969. DOI: 10.3389/fpubh.2023.1333969.

Dahal U, Orru K, Orru H, Dijst M. Green dreams, local realities: complexities of the European Union’s energy transition to ensure local health and well-being in a fossil fuel-based industrial region. Environ Impact Assess Rev 2024;106:107520. DOI: 10.1016/j.eiar.2024.107520.

Ghanbari M, Dijst M, McCall R, Perchoux C. The use of Virtual Reality (VR) to assess the impact of geographical environments on walking and cycling: a systematic review. Int J Health Geogr 2024;23(1):15. DOI: 10.1186/s12942-024-00375-6.

Hlubek N, Koop Y, Wagtendonk A, Vaartjes I. Temporal trends in air pollution exposure across socioeconomic groups in The Netherlands. Int J Environ Res Public Health 2024;21(8):976. DOI: 10.3390/ijerph21080976.

Mishra S, Van der Stukken Cm Drury S, Nawrot TS, Martens DS. Prenatal air pollution exposure in relation to the telomere-mitochondrial axis of aging at birth: a systematic review. Environ Res 2024;244:117990. DOI: 10.1016/j.envres.2023.117990.

Montanari A, Wang L, Birenboim A, Chaix B. Urban environment influences on stress, autonomic reactivity and circadian rhythm: protocol for an ambulatory study of mental health and sleep. Front Public Health 2024;12:1175109. DOI: 10.3389/fpubh.2024.1175109.

Sleurs H, Silva AI, Bijnens EM, Dockx Y, Peusens M, Rasking L, Plusquin M, Nawrot TS. Exposure to residential green space and bone mineral density in young children. JAMA Netw Open 2024;7:e2350214. DOI: 10.1001/jamanetworkopen.2023.50214.

Van Beek JFE, Malisoux L, Klein O, Bohn T, Tharrey M, Van Lenthe FJ, Beenackers MA, Dijst M, Perchoux C. Longitudinal study of changes in greenness exposure, physical activity and sedentary behavior in the ORISCAV-LUX cohort study. In J Health Geogr 2024;23(1):14. DOI: 10.1186/s12942-024-00374-7.

2023

Fancello G, Vallée J, Sueur C, Van Lenthe FJ, Kestens Y, Montanari A, Chaix B. Micro urban spaces and mental well-being: measuring the exposure to urban landscapes along daily mobility paths and their effects on momentary depressive symptomatology among older population. Environ Int 2023;178:108095. DOI: 10.1016/j.envint.2023.108095.

Martens DS, An DW, Yu YL, Chori BS, Wang C, Silva AI, Wei FF, Liu C, Stolarz-Skrzypek K, Rajzer M, Latosinska A, Mischak H, Staessen JA, Nawrot TS, The FLEMENGHO Investigators. Association of air pollution with a urinary biomarker of biological aging and effect modification by vitamin K in the FLEMENGHO Prospective Population Study. Environ Health Perspect 2023;131(12):127011. DOI: 10.1289/EHP13414

2022

Dahal U, Veber T, Åström DA, Tamm T, Albreht L, Teinemaa E, Orru K, Orru H. Perinatal health inequalities in the industrial region of Estonia: a birth-registry-based study. Int J Environ Res Public Health 2022;19(18):11559. DOI: 10.3390/ijerph191811559.

Nieuwenhuijsen MJ, Barrera-Gómez J, Basagaña X, Cirach M, Daher C, Foraster Pulido M, Iungman T, Gasparrini A, Hoek G, De Hoogh K, Khomenko S, Khreis H, de Nazelle A, Ramos A, Rojas-Rueda D, Pereira Barboze E, Tainio M, Thondoo M, Tonne C, Woodcock J, Mueller N. Study protocol of the European Urban Burden of Disease Project: a health impact assessment study. BMJ Open 2022;12(1):e054270. DOI: 10.1136/bmjopen-2021-054270.

Veber T, Dahal U, Lang K, Orru K, Orru H. Industrial air pollution leads to adverse birth outcomes: a systematic review of different exposure metrics and health effects in newborns. Public Health Rev 2022:43:1604775. DOI: 10.3389/phrs.2022.1604775.
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