Science and Research

Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China

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 29494 (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.
  • Yang, B. Y.
  • Zeng, X. W.
  • Markevych, I.
  • Bloom, M. S.
  • Heinrich, J.
  • Knibbs, L. D.
  • Dharmage, S. C.
  • Lin, S.
  • Jalava, P.
  • Guo, Y.
  • Jalaludin, B.
  • Morawska, L.
  • Zhou, Y.
  • Hu, L. W.
  • Yu, H. Y.
  • Yu, Y.
  • Dong, G. H.
Publication details
DOI: 10.1001/jamanetworkopen.2019.17862
Journal: JAMA Netw Open
Pages: e1917862 
Number: 12
Work Type: Original
Location: CPC-M
Disease Area: General Lung and Other
Partner / Member: HMGU, LMU
Access-Number: 31851349
See publication on PubMed

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