Associations of exposure to green space with problem behaviours in preschool-aged children

Jiaqiang Liao, Shaoping Yang, Wei Xia, Anna Peng, Jinzhu Zhao, Yuanyuan Li, Yimin Zhang, Zhengmin Qian, Michael G. Vaughn, Mario Schootman, Bin Zhang, Shunqing Xu

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17 Citations (Scopus)


Background: Limited evidence is available regarding the association of green-space exposure with childhood behavioural development. This study aimed to investigate the associations of exposure to green space with multiple syndromes of behavioural development in preschool children. Methods: This cross-sectional study was conducted in Wuhan, China from April 2016 to June 2018. We recruited a sample of 6039 children aged 5-6 years from 17 kindergartens located in five urban districts of the city. We measured the greenness using average Normalized Difference Vegetation Index (NDVI) within a circular buffer area of 100 metres surrounding the central point of residences and kindergartens. We calculated the residence- kindergarten-weighted greenness by assuming that children spent 16 hours per day at home and 8 hours at kindergarten. The problem behaviours of children were evaluated at kindergarten using the Childhood Behavioral Checklist (CBCL) and standardized into problem behavioural T scores. Linear mixed-effect models and linear-regression models were used to estimate the associations. Results: We observed decreases in problem behaviours associated with kindergarten and residence-kindergarten-weighted surrounding greenness in preschool children. For example, a one-interquartile range increase in kindergarten and residence-kindergartenweighted NDVI was associated with decreased T scores for total behaviour by -0.61 [95% confidence interval (CI): -1.09, -0.13) and -0.49 (95% CI -0.85, -0.12), anxiety and depression by -0.65 (95% CI: -1.13, -0.17) and -0.46 (95% CI: -0.82, -0.10), aggressive behaviour by -0.53 (95% CI: -1.01, -0.05) and -0.38 (95% CI: -0.75, -0.02) and hyperactivity and attention deficit by -0.54 (95% CI: -1.01, -0.07) and -0.48 (95% CI: -0.83, -0.12), respectively. Stratified analyses indicated that the associations of green-space exposure with problem behaviours were stronger in boys than in girls. Conclusions: Children attending kindergartens with higher levels of surrounding green space exhibited better behavioural development. The mechanisms underlying these associations should be explored further.

Original languageEnglish
Pages (from-to)944-953
Number of pages10
JournalInternational journal of epidemiology
Issue number3
Publication statusPublished - 2021

Bibliographical note

Funding Information:
This work was supported by the National Natural Science Foundation of China (91643207, 91743103, 81372959 and 21437002), the National Key Research and Development Plan (2016YFC0206700) and the Fundamental Research Funds for the Central Universities, HUST (grant numbers: 2016YXZD043, 2015ZDTD047 and 2018KFYXMPT00).

Publisher Copyright:
© The Author(s) 2019.

All Science Journal Classification (ASJC) codes

  • Epidemiology


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