title: Association between greenness, urbanicity, and birth weight.
abstract: BACKGROUND
  More than half of the world's population lives in urban environments. Due to urban related factors (e.g. higher air pollution), urban residents may face higher risk of adverse health outcomes, while access to green space could benefit health.
  
  
  OBJECTIVE
  We explored associations between urban and green land-use and birth weight.
  
  
  METHODS
  Connecticut, U.S., birth certificate data (2000-2006) were acquired (n=239,811), and land-use data were obtained from the National Land Cover Database. We focused on three land-uses; urban space, urban open space, and green space (i.e. forest, shrub, herbaceous, and cultivated land). We estimated fractions of greenness and urbanicity within 250 m from residence. A linear mixed effects model was conducted for birth weight and a logistic mixed effects model for low birth weight (LBW) and small for gestational age (SGA).
  
  
  RESULTS
  An interquartile range (IQR) increment in the fraction of green space within 250 m of residence was associated with 3.2g (95% Confidence Interval [0.4, 6.0]) higher birth weight. Similarly, an IQR increase in green space was associated with 7.6% [2.6, 12.4] decreased risk of LBW. Exposure to urban space was negatively correlated with green space (Pearson correlation=-0.88), and it showed negative association with birth outcomes. Results were generally robust with different buffer sizes and controlling for fine particles (PM2.5) and traffic.
  
  
  CONCLUSIONS
  We found protective associations by green space on birth outcomes. Increasing green space and/or reducing urban space (e.g. the greening of city environments) may reduce the risk of adverse birth outcomes such as LBW and SGA. Populations living in urban environments will grow in the next half century, and allocation of green space among urban areas may play a critical role for public health in urban planning.
authors.affiliation: Yale University, School of Forestry and Environmental Studies, 195 Prospect Street, New Haven, CT 06511, USA. Electronic address: keita.ebisu@aya.yale.edu.
authors.forename: Keita
authors.initials: K
authors.lastname: Ebisu
authors.affiliation: Yale University, School of Public Health, Department of Biostatistics, 60 College Street, New Haven, CT 06520, USA.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Holford
authors.affiliation: Yale University, School of Forestry and Environmental Studies, 195 Prospect Street, New Haven, CT 06511, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bell
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000706:statistics & numerical data*; D001724:Birth Weight; D003237:Connecticut / Q000453:epidemiology; D003247:Conservation of Natural Resources / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014507:Urbanization / Q000639:trends*
keywords: Birth weight; Built environment; Environmental epidemiology; Green space; Urbanicity