From Awareness to Action: How Urban Greening and Climate Change Shape Student Health Perceptions in Higher Education

Responses to Reviewer 1 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

Response 1: Thank you for pointing this out. The term “its” refers to climate-resilient urban planning. Accordingly, we have revised the sentence to clarify this: “The implementation of climate-resilient urban planning has multifaceted benefits, including improving public health, mitigating climate risks, and promoting social equity.” You can find the revised version on the second page of the updated manuscript.

Comment 2: ”Check your formatting throughout the paper should there be a space here or not?”

Response 2: Agree. We’ve added a space.

Comment 3: ” It would be good to reference the knowledge-behavior gap again here.”

Response 3: Thank you for pointing this out. We’ve added the following text: “Attitude is defined as how an individual evaluates something, whether a person, an object, an event or a subject matter. These evaluations can be positive or negative or even contradictory (27). Behaviors are defined as the actions or of an individual such as a response to a stimulus (28). The expressed attitude of an individual does not necessarily lead to the respective action. For example, a person may have a positive attitude and also have the respected knowledge regarding recycling, but due to various reasons such as a lack of motivation or lack of available recycling bins, they may not proceed to the behavior. One way to bridge the gap between knowledge/attitude and action is through improved communication and active community engagement.”

Comment 4: ”What does this mean?”

Response 4: Thank you for pointing this out. Internet of Things (IoT) refers to a system of interconnected physical devices—such as sensors, machines, or tools—that collect and exchange data via the internet without requiring direct human input. We‘ve added the text: "The Internet of Things (IoT) refers to a system of interconnected physical devices—such as sensors, machines, or tools—that collect and exchange data via the internet without requiring direct human input.”

Comment 5: ” The literature section is good but perhaps a bit long compared to the amount of content on the survey results.”

Response 5: Thank you for pointing this out.

Comment 6: ”You mention staff here but the results only discuss responses from undergraduates, masters, and doctoral students. Should this be updated or are there staff results to include. Also, in the US context staff does not refer to faculty.”

Response 6: Thank you for pointing this out. The questionnaires were distributed exclusively to undergraduate, master’s, and doctoral students; no staff members were included in the study. Therefore, we have removed the word “staff” from the revised manuscript to accurately reflect the study population.

Comment 7: ” You mention targeted sampling here but on the next page you mention broad distribution via social media. Which was it?”

Response 7: Thank you for your comment. The sampling approach combined elements of both strategies. While the questionnaires were broadly distributed via social media, this was done specifically through student group chats and forums affiliated with our university. Therefore, the distribution was targeted in the sense that it reached defined groups of undergraduate, master’s, and doctoral students within our academic community.

Comment 8: ” Do most students live on campus or might they travel to campus from very different environments. How about staff? Do they live close to campus or commute?”

Response 8: Thank you for your question. No students reside on campus, as our university does not offer on-campus housing. All students commute from various areas across Athens to attend lectures. Similarly, academic and administrative staff members also travel from different parts of the city, with no central residential pattern associated with the campus.

Comment 9: ” What were your criteria here?”

Response 9: Thank you for your comment. The criteria for inclusion were straightforward: out of the 620 responses collected, we retained only the questionnaires that were fully completed. As stated in the revised manuscript, this resulted in a final sample of 453 complete and usable responses for analysis.

Comment 9: ” What were your criteria here?”

Response 9: Thank you for your comment. The criteria for inclusion were straightforward: out of the 620 responses collected, we retained only the questionnaires that were fully completed. As stated in the revised manuscript, this resulted in a final sample of 453 complete and usable responses for analysis.

Comment 10: ” What is the connection between this article and your comment about the response rate? The article does not appear to be about survey methodology.”

Response 10: Thank you for pointing this out. You are correct—the cited article is not directly related to survey methodology and was included in this context by mistake. The citation has been removed in the revised manuscript.

Comment 11: ” How so, based on the population in Athen in general or for the campus population. Students, staff?”

Response 11: Thank you for your question. The statement was based on the student population specifically, rather than the general population of Athens or the campus staff.

Comment 12: ”Does this reflect all responents?”

Response 12: Yes, this statement reflects all respondents included in the final sample.

Comment 13: ” Can you point to any positive examples at other institutions that are doing this?”

Response 13: Thank you for your comment. We have added a relevant example from another institution that has successfully implemented such initiatives in the revised manuscript, in order to strengthen our argument and provide a comparative perspective.

Comment 14: ” Is this correct? You mention research ethics strategies on page 8.”

Response 14: Yes, this is correct. The study followed the General Data Protection Regulation (GDPR) guidelines. All responses were anonymous, and participation was entirely voluntary, as noted on page 8 of the manuscript.

Responses to Reviewer 2 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions.

Response 1: Thank you for the feedback. We have updated the manuscript by incorporating more recent literature (2020–2024) related to urban greening and eco-anxiety, in order to strengthen both the background and discussion sections.

Comment 2: ” The rationale for focusing solely on university students (vs. broader urban populations) needs clearer justification.”

Response 2: Thank you for your comment. We have now clarified the rationale in the revised manuscript. University students were chosen as the focus of this study because they represent the next generation of decision-makers, professionals, and community leaders, and their attitudes toward sustainability and climate-related challenges are particularly important.

Comment 3: ”Purposive sampling introduces selection bias. Justify this choice and discuss limitations”

Response 3: Thank you for your comment. Upon review, we acknowledge that the term purposive sampling was inaccurately used in the original manuscript. The sampling approach we followed was more accurately described as convenience sampling, as the questionnaire was distributed online through student group chats and social media platforms affiliated with the university. We have corrected this in the revised manuscript to avoid misinterpretation and removed the reference to purposive sampling.

Comment 4: ”Pilot testing details (sample size, revisions made) are vague. Include pre-test reliability metrics.”

Response 4: Thank you for your comment. A pilot study was not conducted prior to the main data collection phase. However, the questionnaire was carefully designed based on existing literature and validated instruments, and it was reviewed internally to ensure clarity and relevance for the target population.

Comment 5: ”The IRB statement “Not applicable” conflicts with the claim that ethical guidelines were followed. Clarify ethical approval status.”

Response 5: Thank you for your comment. Please find attached the Letter of Ethical Compliance. As stated in the manuscript, the study followed ethical guidelines in accordance with the General Data Protection Regulation (GDPR), ensuring anonymity and voluntary participation.

Comment 6: ”Report effect sizes, confidence intervals, and p-values for chi-square/regression analyses to strengthen inferential claims.”

Response 6: Thank you for your comment. All p-values based on the one-way ANOVA analysis have been added in the revised manuscript to strengthen the inferential claims. We have updated the results section accordingly to ensure greater transparency and statistical clarity.

Comment 7: ” Provide a concrete example (proposed indicators, validation process) rather than a conceptual mention.”

Response 7: Thank you for your comment. At this stage, no formal validation process or standardized indicators have been implemented, as the study was exploratory in nature. We acknowledge this as a limitation and have now clarified it in the revised manuscript.

Comment 8: ”Reference successful case studies (campus sustainability programs) to ground recommendations.”

Response 8: Thank you for your comment. In response, we have added references to successful case studies of campus sustainability programs in the revised manuscript, in order to better ground our recommendations and provide practical examples.

Responses to Reviewer 3 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

Response 1: Thank you for the feedback. The abstract has been revised to include the study sample size (n = 453) and key statistical findings, as suggested.

Comment 2: ”The current Introduction is too broad and unfocused. It covers many frameworks in a short span, which could dilute focus. The mention of resilience thinking, nature-based solutions, and identity theory all at once risks being theoretically scattered . While each is relevant, the integration could be tighter, for instance, explicitly linking how these frameworks inform the study’s design or hypotheses. Additionally, the introduction primarily provides background. I would recommend revising it to bring it closer to your research topic. It could also more clearly articulate the specific research gap or question.”

Response 2: Thank you for the detailed feedback. The Introduction has been revised to better integrate the relevant theoretical frameworks, clearly articulate the research gap, and state the research question more explicitly, as suggested.

Comment 3: ”The literature review in the Introduction, while broad, reads more as a list of concepts rather than a cohesive narrative leading to the study rationale. It jumps from one topic to another (health benefits to equity to governance to technology) in separate paragraphs, which can feel segmented. Each sub-section is individually clear, but the linkages between them could be more explicit. For instance, the transition from ecosystem services framework to identity theory in the text is abrupt . You introduce identity theory at the very end of the theoretical perspectives section without elaboration until the Discussion.”

Response 3: Thank you for your insightful comment. Revisions have been made to the literature review section in the revised manuscript to improve the flow and coherence between concepts. We have strengthened the transitions between key frameworks and clarified the connection between ecosystem services and identity theory. Additionally, identity theory is now introduced earlier and more thoroughly, to ensure its relevance is clearly established from the outset.

Comment 4:”Beyond the Introduction, the SDGs are not discussed in the Results or Discussion. The integration is primarily conceptual and upfront. You could strengthen this by explicitly reflecting on how your findings support progress toward those SDGs. (We thank the reviewer for the valuable observation. A paragraph has been added to the Discussion section to explicitly reflect on how the findings relate to and support progress toward the Sustainable Development Goals (SDGs).)”

Response 4: Thank you for the comment. A paragraph has been added to the Discussion section to explicitly address how the findings relate to and support progress toward the Sustainable Development Goals (SDGs).

Comment 5:”I also have a point regarding the questionnaire’s content validity. While informed by literature, it’s not clear if any established scales for eco-anxiety or pro-environmental behavior were used. You did not report any reliability metrics (e.g., Cronbach’s alpha) for your Likert-scale items. You should also share the questionnaire in the Appendix.”

Response 5: Thank you for your insightful comment. Established scales for eco-anxiety or pro-environmental behavior were not used in this study, as the primary aim was to assess the baseline level of students’ perceptions in order to inform the design of a second-phase intervention. The questionnaire was developed based on existing literature and adapted to the context of our academic community. Given the exploratory nature of the study, reliability metrics such as Cronbach’s alpha were not calculated at this stage. However, we acknowledge this as a limitation and have clarified it in the revised manuscript. Additionally, the full questionnaire has now been included in the Appendix.

Comment 6: ”Additionally, although inferential analyses were conducted, the paper does not present detailed statistical results (no p-values or coefficients are reported in the Results). This raises a concern that the analysis might not have been as deep as suggested, or at least not fully reported. For example, if a regression was run to find predictors of awareness, the reader doesn’t see which predictors were significant. Including a summary table of statistical tests would improve transparency.”

Response 6: Thank you for your comment. A summary table of the statistical tests, including p-values and relevant coefficients, has been added to the revised manuscript to improve transparency and better reflect the depth of the analysis.

Comment 7:”For example, when you describe differences between undergraduate and postgraduate responses, you do so qualitatively (“undergraduates showed higher X, while postgraduates emphasized Y”) without stating whether those differences were statistically significant. The reader is left to assume these are notable trends, but the magnitude or significance isn’t quantified. The paper would benefit from a table summarizing any significant associations (e.g., education level vs. response patterns) that were found.”

Response 7: Thank you for the feedback. A table summarizing the statistically significant associations, including differences between education levels and response patterns, has been added to the revised manuscript to enhance clarity and support the interpretation of results.

Comment 8: ”Additionally, the qualitative findings from open-ended responses are under-utilized in the Results. The Methods said themes like suggestions for improving greening were identified , but the Results section hardly quotes or specifically details these suggestions. While NVivo was used to identify themes, the results section doesn’t directly quote any participant responses or deeply discuss those themes.”

Response 8: Thank you for your observation. In response, we have expanded the Results section to better incorporate the qualitative findings from the open-ended responses. Direct participant quotes have been added to illustrate key themes—such as barriers to accessing green spaces, emotional benefits of greenery, and suggestions for improvement—identified through thematic analysis using NVivo.

Comment 9: ” The discussion would benefit from a bit more support from external literature when making claims. For example, the notion that undergraduates focus on self-soothing behaviors while postgraduates engage in collective action is plausible and consistent with identity theory, but the authors do not cite specific studies of this phenomenon in climate education contexts. Incorporating references to studies on climate activism in youth vs. older students, or on eco-anxiety leading to paralysis vs. action, could bolster these points.”

Response 9: Thank you for your comment. Relevant references have been added to the Discussion section in the revised manuscript to support the claims regarding behavioral differences between undergraduate and postgraduate students, and to better connect these observations with existing literature on climate activism and eco-anxiety.

Comment 9:”While the discussion addresses many implications, you could explicitly acknowledge any remaining limitations and their impact. The methods section listed limitations (single institution, self-report), but the discussion doesn’t revisit how these might affect interpretation.”

Response 9: Thank you for the observation. An additional paragraph has been added to the Discussion section to explicitly acknowledge the limitations related to the single-institution scope and the use of self-reported data, as well as their potential impact on the interpretation of the findings.

Comment 10:”Please specify how many participants were in the pilot test.”

Response 10: Thank you for your comment. A pilot study was not conducted prior to the main data collection. This has now been clarified in the revised manuscript.

Comment 11:”Please discuss whether the fact of limited access to greenery may have biased the responses. ”

Response 11: Thank you for your comment. We acknowledge that limited access to greenery in certain urban areas may have influenced participants’ perceptions and responses. This factor could introduce a contextual bias, particularly in self-reported attitudes toward urban greening and its perceived benefits. We have now addressed this potential limitation in the revised Discussion section, noting that participants’ lived experiences may shape their engagement with environmental topics.

Comment 12: ” Please specify when the data was collected.”

Response 12: Thank you for your comment. The data were collected between September and October 2024.

Comment 13: ”Please specify how many provided the optional open-ended response.”

Response 13: Thank you for your comment. A total of 150 participants provided a response to the optional open-ended question. This has now been specified in the revised manuscript.

Comment 14:”Have you tested assumptions for the chi-square test?”

Response 14: Thank you for your comment. In the final version of the manuscript, a one-way ANOVA was used to analyze group differences. References to the chi-square test have been removed to accurately reflect the statistical methods applied.

Comment 15:”When talking about the index, you should discuss already existing initiatives. For example, the Climate Change and Health Vulnerability Indicators developed by the California Department of Public Health focus on assessing exposures, social vulnerability, and adaptive capacity. Similarly, the BRACE framework by the CDC helps health departments understand and respond to climate impacts on health. These tools assess vulnerabilities and impacts but do not provide a single numerical index reflecting individual perceptions.”

Response 15: Thank you for the helpful comment. A paragraph has been added to the revised manuscript to acknowledge existing initiatives, such as the Climate Change and Health Vulnerability Indicators and the BRACE framework. We also clarified how the proposed Climate Health Assessment Indicator offers a distinct contribution by focusing on individual perceptions.

Responses to Reviewer 4 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

Response 1: Thank you very much for your constructive observation. Following your suggestion, we have revised the Introduction to clearly present the importance of the study, its main objectives, and the overall structure of the manuscript. Furthermore, we have separated the theoretical discussion into a distinct Literature Review section to ensure clarity and proper organization, as recommended.

Comment 2:”This information is complemented by inferential statistical methods, including chi-square tests and regression analyses, to explore relationships between demographic variables and perceptions of urban greening. Qualitative responses from the open-ended questions were used thematically through NVivo software.”

Response 2: Thank you for the comment. We have adjusted the manuscript accordingly to more clearly describe the use of both quantitative and qualitative methods, as well as the role of descriptive statistics in summarizing key findings.

Comment 3: ”Regardless of these former intentions, in this document we don´t find any evidence of the proposed methodology except for the descriptive statistics. This is a huge limitation of the current paper. Thus, section “4. Discussion” is a mere list of percentages about some of the main “obvious” expected results. This is not enough to propose some new measures or behaviors or reflect about this issue”

Response 3: Thank you for the detailed and constructive feedback. Following your observations, we have substantially revised the Discussion section to go beyond a summary of descriptive statistics. The revised version now provides a more critical and integrated interpretation of the findings, clearly connecting them to the study’s theoretical framework and existing literature. Furthermore, we discuss the practical implications of the results and propose specific actions and recommendations. These additions aim to enhance the depth and relevance of the discussion in line with the study’s objectives.

Comment 4: ”Final conclusions are also too short and would be quite better to add both a “Managerial Impact” as well as “Society Impact” to reinforce the major impact of the study.”

Response 4: Thank you for the valuable suggestion. As recommended, the Conclusion section has been expanded to include both a Managerial Impact and a Societal Impact. These additions aim to highlight the practical relevance of the findings for decision-makers in academic and urban planning contexts, as well as the broader implications for society in terms of public health awareness, environmental engagement, and climate resilience.

Comment 5: ”References are appropriate but need to be corrected in line with the journal´s norms.”

Response 5: Thank you for the comment. The references have been reviewed and corrected to align with the journal’s formatting guidelines in the revised manuscript.

Responses to Reviewer 3 Comments 

1. Summary 

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files. 

Response 1: Thank you for the feedback. Relevant sources have been cited directly in the Discussion section.  

Comment 2: ” Your text in the Methods section still states that "A pilot test was conducted with a small group of respondents", which directly contradicts your response stating that "A pilot study was not conducted prior to the main data collection". This needs clarification or correction. If a pilot was conducted, you should state the number of participants.” 

Response 2: Thank you for pointing out this inconsistency. The Methods section has now been corrected to reflect the fact that no formal pilot study was conducted prior to the main data collection. The previous statement referring to a “pilot test” has been removed to ensure consistency with our response and actual methodology. 

Comment 3: ”Your response states the data collection period (September and October 2024), but this information is not included in the provided text” 

Response 3: Thank you for pointing out this inconsistency. A sentence has been added to the Methods section stating: “Data collection occurred over a four-week period between September and October 2024, during which reminders were sent weekly to encourage responses.” 

Responses to Reviewer 4 Comments 

1. Summary 

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files. 

Response 1: Thank you for highlighting this formatting issue. One of the two copies of the abstract has now been removed to ensure clarity and compliance with the journal’s structure. 

Comment 2: ”Introduction is not repeated but appears twice (the title).” 

Response 2: Thank you for pointing this out. The second occurrence of the “Introduction” heading has been revised and retitled as “Perceptions of Urban Greening as a Climate-Health Strategy” to better reflect the content of the section and avoid duplication.