title: Access to urban green spaces and behavioural problems in children: Results from the GINIplus and LISAplus studies.
abstract: OBJECTIVE
  We investigated whether objectively measured access to urban green spaces is associated with behavioural problems in 10-year old children living in Munich and its surrounding areas.
  
  
  METHODS
  Behavioural problems were assessed in the GINIplus and LISAplus 10-year follow-up between 2006 and 2009 using the Strengths and Difficulties Questionnaire. Access to green spaces was defined using the distance from a child's residence to the nearest urban green space. Associations between access to urban green spaces and behavioural problems were assessed using proportional odds and logistic regression models in 1932 children with complete exposure, outcome and covariate data.
  
  
  RESULTS
  The distance between a child's residence and the nearest urban green space was positively associated with the odds of hyperactivity/inattention, especially among children with abnormal values compared to children with borderline or normal values (odds ratio (OR)=1.20 (95% confidence interval (CI)=1.01-1.42) per 500 m increase in distance). When stratified by sex, this association was only statistically significant among males. Children living further than 500 m away from urban green spaces had more overall behavioural problems than those living within 500 m of urban green spaces (proportional OR=1.41 (95% CI=1.06-1.87)). Behavioural problems were not associated with the distance to forests or with residential surrounding greenness.
  
  
  CONCLUSIONS
  Poor access to urban green spaces was associated with behavioural problems in 10-year old children. Results were most consistent with hyperactivity/inattention problems.
authors: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany; Division of Metabolic and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors: Iana
authors: I
authors: Markevych
authors: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany; Institute for Medical Informatics, Biometrics and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors: Carla M T
authors: CM
authors: Tiesler
authors: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
authors: Elaine
authors: E
authors: Fuertes
authors: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
authors: Marcel
authors: M
authors: Romanos
authors: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: Payam
authors: P
authors: Dadvand
authors: Centre for Research in Environmental Epidemiology, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors: Mark J
authors: MJ
authors: Nieuwenhuijsen
authors: Research Institute, Department of Paediatrics, Marien-Hospital Wesel, Wesel, Germany.
authors: Dietrich
authors: D
authors: Berdel
authors: Division of Paediatric Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors: Sibylle
authors: S
authors: Koletzko
authors: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany. Electronic address: heinrich@helmholtz-muenchen.de.
authors: Joachim
authors: J
authors: Heinrich
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002648:Child; D002947:Cities; D004777:Environment; D005260:Female; D005843:Geography; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data*
keywords: Behavioural problems; Child health; Green space; Greenness; Mental health; Strengths and Difficulties Questionnaire