Green spaces and spectacles use in schoolchildren in Barcelona.
Myopia is one of the major causes of low visual acuity during childhood, and hence of the need for spectacles. It is generally more prevalent in urban areas where children are often less exposed to green spaces than in rural areas. This study evaluated the association between exposure to green space and use of spectacles (as a surrogate measure for myopia) in a cohort of 2727 schoolchildren (7-10 years old) recruited from 39 primary schools in Barcelona (2012-2015). We assessed exposure to green spaces by characterizing outdoor surrounding greenness at home and school and during commuting using satellite data on greenness (Normalized Difference Vegetation Index). We also obtained data on the annual average time children spent playing in green spaces through questionnaires. Cross-sectional analyses were conducted based on prevalent cases of spectacles use at baseline data collection campaign and longitudinal analyses based on incident cases of spectacles use during the three-year period between the baseline and last data collection campaigns. An interquartile range (IQR) increase in exposure to green space at home (500m buffer) and school and during commuting was associated with respectively 14% (95% CI: 2%, 26%), 27% (95% CI: 6%, 44%), and 20% (95% CI: 5%, 33%) decrease in spectacles use in cross-sectional analyses. In longitudinal analyses, we observed a reduction of 23% (95% CI: 4%, 39%) and 34% (95% CI: 2%, 55%) associated with an IQR increase in greenness at home and school, respectively. Moreover, an IQR increase in time playing in green spaces was associated with a 28% (95% CI: 7%, 45%) reduction in the risk of spectacles use in the longitudinal analysis. Our observed reduced risk of spectacles use associated with higher contact with green space calls for more refined studies of the association between green spaces and refractive errors of visions.
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain. Electronic address: payam.dadvand@isglobal.org.
Payam
P
Dadvand
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; IMIM-Parc Salut Mar, Doctor Aiguader 88, 08003, Barcelona, Catalonia, Spain.
Jordi
J
Sunyer
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
Mar
M
Alvarez-Pedrerol
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
Albert
A
Dalmau-Bueno
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
Mikel
M
Esnaola
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Mireia
M
Gascon
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
Montserrat
M
De Castro Pascual
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
Xavier
X
Basagaña
Research School of Biology, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Ian G
IG
Morgan
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, 08003, Barcelona, Spain; Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Catalonia, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
Mark J
MJ
Nieuwenhuijsen
D002648:Child; D002947:Cities; D003430:Cross-Sectional Studies; D004777:Environment; D005139:Eyeglasses / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008137:Longitudinal Studies; D008297:Male; D012111:Residence Characteristics; D013030:Spain
Built environment; Eyeglasses; Myopia; Natural environment; Ophthalmology; Refractive errors; Urban environment