title: A cross-sectional analysis of the effects of residential greenness on blood pressure in 10-year old children: results from the GINIplus and LISAplus studies.
abstract: BACKGROUND
  According to Ulrich's psychoevolutionary theory, contact with green environments mitigates stress by activating the parasympathetic system, (specifically, by decreasing blood pressure (BP)). Experimental studies have confirmed this biological effect. However, greenness effects on BP have not yet been explored using an observational study design. We assessed whether surrounding residential greenness is associated with BP in 10 year-old German children.
  
  
  METHODS
  Systolic and diastolic BPs were assessed in 10 year-old children residing in the Munich and Wesel study areas of the German GINIplus and LISAplus birth cohorts. Complete exposure, outcome and covariate data were available for 2,078 children. Residential surrounding greenness was defined as the mean of Normalized Difference Vegetation Index (NDVI) values, derived from Landsat 5 TM satellite images, in circular 500-m buffers around current home addresses of participants. Generalized additive models assessed pooled and area-specific associations between BP and residential greenness categorized into area-specific tertiles.
  
  
  RESULTS
  In the pooled adjusted model, the systolic BP of children living at residences with low and moderate greenness was 0.90 ± 0.50 mmHg (p-value = 0.073) and 1.23 ± 0.50 mmHg (p-value = 0.014) higher, respectively, than the systolic BP of children living in areas of high greenness. Similarly, the diastolic BP of children living in areas with low and moderate greenness was 0.80 ± 0.38 mmHg (p-value = 0.033) and 0.96 ± 0.38 mmHg (p-value = 0.011) higher, respectively, than children living in areas with high greenness. These associations were not influenced by environmental stressors (temperature, air pollution, noise annoyance, altitude and urbanisation level). When stratified by study area, associations were significant among children residing in the urbanised Munich area but null for those in the rural Wesel area.
  
  
  CONCLUSIONS
  Lower residential greenness was positively associated with higher BP in 10 year-old children living in an urbanised area. Further studies varying in participants' age, geographical area and urbanisation level are required.
authors.forename: Iana
authors.initials: I
authors.lastname: Markevych
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Thiering
authors.forename: Elaine
authors.initials: E
authors.lastname: Fuertes
authors.forename: Dorothea
authors.initials: D
authors.lastname: Sugiri
authors.forename: Dietrich
authors.initials: D
authors.lastname: Berdel
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.forename: Andrea
authors.initials: A
authors.lastname: von Berg
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Bauer
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany. heinrich@helmholtz-muenchen.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
mesh_terms: D000397:Air Pollution / Q000706:statistics & numerical data; D001794:Blood Pressure / Q000502:physiology*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004777:Environment; D005260:Female; D005858:Germany; D006801:Humans; D008019:Life Style; D008297:Male; D009622:Noise; D014504:Urban Health / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data; D014507:Urbanization; D044465:White People