TY - JOUR
T1 - The association between residential green space in childhood and development of attention deficit hyperactivity disorder
T2 - A population-based cohort study
AU - Thygesen, Malene
AU - Engemann, Kristine
AU - Holst, Gitte J.
AU - Hansen, Birgitte
AU - Geels, Camilla
AU - Brandt, Jørgen
AU - Pedersen, Carsten B.
AU - Dalsgaard, Søren
N1 - Funding Information:
The authors thank A. Timmermann and A.M. Closter for data administrative help. The study was funded by grants from Aarhus University Research Foundation (AUFF-E-2015-FLS-8-61), research training supplement from the Graduate School of Health Sciences at Aarhus University, and The Lundbeck Foundation (iPSYCH grant R102-A9118 and R155-2014-1724). Data management was supported by Centre for Integrated Register-based Research at Aarhus University (CIRRAU). J.B., C.B.P., and C.G. are supported by NordForsk, under the Nordic Programme on Health and Welfare (NordicWelfAir grant 75007). C.B.P. and K.E. are supported by the Novo Nordisk Foundation (Big Data Centre for Environment and Health, grant NNF17OC0027864). J.B., C.B.P., M.T., and S.D. are supported by the National Institutes of Health (R01ES026993). S.D. is additionally supported by the Novo Nordisk Foundation (grant 22018), the European Commission (Horizon 2020, grant 667302), and Helsefonden (grant 19-8-0260).
Publisher Copyright:
© 2020, Public Health Services, US Dept of Health and Human Services. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - BACKGROUND: Access to green space has been hypothesized to have a beneficial impact on children’s mental well-being and cognitive development. The underlying mechanisms of the mental health benefits of green space are not fully understood, but different pathways have been suggested, such as the psychologically restoring capacities of green space, the ability to facilitate physical activity and social cohesion, and the mitigation of exposure to air pollution. OBJECTIVES: In this nationwide cohort study, we investigated associations between residential green space in early childhood and a clinical diagnosis of attention deficit hyperactivity disorder (ADHD). METHODS: The cohort included individuals, who were born in Denmark between 1992 and 2007 (n = 814,689) and followed for a diagnosis of ADHD from age 5, during the period 1997–2016. We used the normalized difference vegetation index (NDVI) as a measure of vegetation greenness surrounding each residential address in a quadratic area of 210 m × 210 m in which the residence was located in the center of the quadrate. Individual exposure to green space was calculated as the average of NDVI surrounding each individual’s residential address (or addresses if more than one) between birth and the fifth birthday. Multilevel modeling was used to estimate the incidence rate ratios (IRRs) with 95% confidence intervals (CI) for ADHD, according to exposure level and adjusted for calendar time, age, sex, parental socioeconomic status, neighborhood level socioeconomic status, and urbanicity. RESULTS: Individuals living in areas defined by sparse green vegetation (lowest decile of NDVI) had an increased risk of developing ADHD, com-pared with individuals living in areas within the highest decile of NDVI (IRR = 1:55; 95% CI: 1.46, 1.65). Adjusting for the known confounders atte-nuated the result, but the association remained (IRR = 1:20; 95% CI: 1.13, 1.28). CONCLUSION: Our findings suggest that lower levels of green space in residential surroundings, during early childhood, may be associated with a higher risk of developing ADHD.
AB - BACKGROUND: Access to green space has been hypothesized to have a beneficial impact on children’s mental well-being and cognitive development. The underlying mechanisms of the mental health benefits of green space are not fully understood, but different pathways have been suggested, such as the psychologically restoring capacities of green space, the ability to facilitate physical activity and social cohesion, and the mitigation of exposure to air pollution. OBJECTIVES: In this nationwide cohort study, we investigated associations between residential green space in early childhood and a clinical diagnosis of attention deficit hyperactivity disorder (ADHD). METHODS: The cohort included individuals, who were born in Denmark between 1992 and 2007 (n = 814,689) and followed for a diagnosis of ADHD from age 5, during the period 1997–2016. We used the normalized difference vegetation index (NDVI) as a measure of vegetation greenness surrounding each residential address in a quadratic area of 210 m × 210 m in which the residence was located in the center of the quadrate. Individual exposure to green space was calculated as the average of NDVI surrounding each individual’s residential address (or addresses if more than one) between birth and the fifth birthday. Multilevel modeling was used to estimate the incidence rate ratios (IRRs) with 95% confidence intervals (CI) for ADHD, according to exposure level and adjusted for calendar time, age, sex, parental socioeconomic status, neighborhood level socioeconomic status, and urbanicity. RESULTS: Individuals living in areas defined by sparse green vegetation (lowest decile of NDVI) had an increased risk of developing ADHD, com-pared with individuals living in areas within the highest decile of NDVI (IRR = 1:55; 95% CI: 1.46, 1.65). Adjusting for the known confounders atte-nuated the result, but the association remained (IRR = 1:20; 95% CI: 1.13, 1.28). CONCLUSION: Our findings suggest that lower levels of green space in residential surroundings, during early childhood, may be associated with a higher risk of developing ADHD.
UR - http://www.scopus.com/inward/record.url?scp=85098629771&partnerID=8YFLogxK
U2 - 10.1289/EHP6729
DO - 10.1289/EHP6729
M3 - Article
C2 - 33351671
AN - SCOPUS:85098629771
SN - 0091-6765
VL - 128
JO - Environmental Health Perspectives
JF - Environmental Health Perspectives
IS - 12
M1 - 127011
ER -
