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- Title
Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China.
- Authors
Yang, Bo-Yi; Zeng, Xiao-Wen; Markevych, Iana; Bloom, Michael S.; Heinrich, Joachim; Knibbs, Luke D.; Dharmage, Shyamali C.; Lin, Shao; Jalava, Pasi; Guo, Yuming; Jalaludin, Bin; Morawska, Lidia; Zhou, Yang; Hu, Li-Wen; Yu, Hong-Yao; Yu, Yunjiang; Dong, Guang-Hui
- Abstract
Key Points: Question: Is greenness surrounding schools and kindergartens associated with symptoms of attention-deficit/hyperactivity disorder among children? Findings: In this large cross-sectional study of 59 754 Chinese children, attendance at schools or kindergartens in greener areas was associated with lower odds of having attention-deficit/hyperactivity disorder symptoms. Meaning: These findings may be useful for policy makers and health care professionals to develop strategies (eg, planning for green spaces around schools and kindergartens) to mitigate the attention-deficit/hyperactivity disorder burden. This cross-sectional study evaluates the association between greenness surrounding schools or kindergartens and symptoms of attention-deficit/hyperactivity disorder among Chinese children. Importance: Few studies have investigated the association between greenness and childhood attention-deficit/hyperactivity disorder (ADHD). Objective: To evaluate the association between greenness surrounding schools or kindergartens and symptoms of ADHD in children. Design, Setting, and Participants: This population-based cross-sectional study was performed between April 2012 and January 2013 in 7 cities in northeastern China. This analysis included 59 754 children (aged 2-17 years) from 94 schools and kindergartens, who had resided in the study area for 2 years or longer. Data were analyzed from April 15, 2019, to October 10, 2019. Exposures: Greenness surrounding each child's school or kindergarten was estimated using 2 satellite image–derived vegetation indexes: the normalized difference vegetation index and the soil-adjusted vegetation index. Main Outcomes and Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) scales were used to measure ADHD symptoms (9 inattention symptoms and 9 hyperactivity-impulsivity symptoms). Parents or guardians rated the frequency of each of 18 ADHD symptoms during the preceding 6 months. Children with 6 or more symptoms of either inattention or hyperactivity-impulsivity were defined as having ADHD symptoms. Generalized linear mixed models were applied to estimate the association between greenness and ADHD symptoms. Results: The mean (SD) age of the 59 754 study participants was 10.3 (3.6) years, and 29 494 (49.4%) were girls. A total of 2566 participants (4.3%) had ADHD symptoms. Greenness levels differed substantially across schools and kindergartens. The normalized difference vegetation index within 500 m of a school or kindergarten ranged from −0.09 to 0.77. Greater greenness levels were associated with lower odds of ADHD symptoms. In covariate-adjusted models, a 0.1-unit increase in normalized difference vegetation index or soil-adjusted vegetation index within 500 m of a school or kindergarten was significantly associated with lower odds of ADHD symptoms (odds ratios, 0.87 [95% CI, 0.83-0.91] and 0.80 [95% CI, 0.74-0.86], respectively; P <.001 for both). The associations were robust in a series of sensitivity analyses. Conclusions and Relevance: These findings suggest that there may be a beneficial association between school-based greenness and ADHD symptoms in Chinese children. Future longitudinal and mechanistic studies are needed to confirm the findings of this cross-sectional analysis and further explore potential mechanisms of this association.
- Subjects
CHINA; ATTENTION; ATTENTION-deficit hyperactivity disorder; CONFIDENCE intervals; ELEMENTARY schools; IMPULSIVE personality; MIDDLE schools; QUESTIONNAIRES; RESEARCH funding; SCHOOL environment; SOCIOECONOMIC factors; CROSS-sectional method; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; CLUSTER sampling; SYMPTOMS
- Publication
JAMA Network Open, 2019, Vol 2, Issue 12, pe1917862
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.17862