Association between greenspace exposure and emotional and behavioral problems in school-aged children

Objective  To explore the association between greenspace exposure and emotional and behavioral problems in school-aged children.

Methods  In 2019, a total of 2 802 students aged 6-12 years from five primary schools in Guangzhou, China were enrolled as study subjects by the stratified cluster random sampling method. The emotional and behavioral problems in the school-aged children were assessed by the Strengths and Difficulties Questionnaire (SDQ) designed for parents. The individual greenspace exposure was evaluated by the normalized difference vegetation index (NDVI) in combination with the daily activity patterns of the school-aged children. A generalized linear mixed model was used to analyze the relationship between individual greenspace exposure and SDQ scores, as well as emotional and behavioral problems in the school-aged children.

Results  The detection rates for overall difficulties, emotional symptoms, behavioral problems, hyperactivity, peer interaction problems, and abnormal prosocial behaviors were 7.7%, 5.1%, 10.1%, 13.5%, 13.2%, and 10.2%, respectively. After adjusting for confounding factors, hyperactivity scores in the school-aged children decreased by 0.11 to 0.18 for every increase of one interquartile range (IQR) of NDVI in the buffer zones of 300 m, 500 m, and 1 000 m. Additionally, for every increase of one IQR of NDVI in the buffer zone of 1 000 m, prosocial behavior scores increased by 0.11 (β=0.11, 95%CI: 0.02-0.21), and externalizing behavior scores decreased by 0.14 (β=-0.14, 95%CI: -0.29 to -0.01). For every increase of one IQR of NDVI in the buffer zone of 300 m, the odds ratio of externalizing behaviors was 0.78 (95%CI: 0.61-1.00). No individual characteristics (gender, age, per capita monthly household income, parental education, and outdoor activity duration) were found to have any modifying effects on the relationship between greenspace exposure and emotional and behavioral problems in school-aged children.

Conclusion  Increased greenspace exposure is associated with a lower risk of emotional and behavioral problems in school-aged children.