title: Green and blue spaces and behavioral development in Barcelona schoolchildren: the BREATHE project.
abstract: BACKGROUND
  Green spaces have been associated with improved mental health in children; however, available epidemiological evidence on their impact on child behavioral development is scarce.
  
  
  OBJECTIVE
  We investigated the impact of contact with green spaces and blue spaces (beaches) on indicators of behavioral development and symptoms of attention deficit/hyperactivity disorder (ADHD) in schoolchildren.
  
  
  METHODS
  This study was based on a sample of 2,111 schoolchildren (7-10 years of age) from 36 schools in Barcelona in 2012. We obtained data on time spent in green spaces and beaches and Strengths and Difficulties Questionnaires (SDQ) from parents, and ADHD/DSM-IV questionnaires from teachers. Surrounding greenness was abstracted as the average Normalized Difference Vegetation Index (NDVI) in buffers of 100 m, 250 m, and 500 m around each home address. Proximity to green spaces was defined as living within 300 m of a major green space (≥ 0.05 km2). We applied quasi-Poisson mixed-effects models (with school random effect) to separately estimate associations between indicators of contact with green spaces and SDQ and ADHD total and subscale scores.
  
  
  RESULTS
  We generally estimated beneficial associations between behavioral indicators and longer time spent in green spaces and beaches, and with residential surrounding greenness. Specifically, we found statistically significant inverse associations between green space playing time and SDQ total difficulties, emotional symptoms, and peer relationship problems; between residential surrounding greenness and SDQ total difficulties and hyperactivity/inattention and ADHD/DSM-IV total and inattention scores; and between annual beach attendance and SDQ total difficulties, peer relationship problems, and prosocial behavior. For proximity to major green spaces, the results were not conclusive.
  
  
  CONCLUSIONS
  Our findings support beneficial impacts of contact with green and blue spaces on behavioral development in schoolchildren.
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Elmira
authors.initials: E
authors.lastname: Amoly
authors.forename: Payam
authors.initials: P
authors.lastname: Dadvand
authors.forename: Joan
authors.initials: J
authors.lastname: Forns
authors.forename: Mónica
authors.initials: M
authors.lastname: López-Vicente
authors.forename: Xavier
authors.initials: X
authors.lastname: Basagaña
authors.forename: Jordi
authors.initials: J
authors.lastname: Julvez
authors.forename: Mar
authors.initials: M
authors.lastname: Alvarez-Pedrerol
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
mesh_terms: D000388:Air; D000393:Air Pollutants / Q000009:adverse effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced / Q000453:epidemiology*; D002648:Child; D002947:Cities; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010944:Plants; D011998:Recreation; D012111:Residence Characteristics; D012574:Schools; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D000393:Air Pollutants