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Journal article
Association between exposure to the natural environment, rurality, and attention-deficit hyperactivity disorder in children in New Zealand: a linkage study
The Lancet. Planetary health, v 3(5), pp E226-E234
01 May 2019
PMID: 31128768
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Several small experimental studies and cross-sectional observational studies have shown that exposure to the natural environment might protect against attention-deficit hyperactivity disorder (ADHD) or moderate the symptoms of ADHD in children. We aimed to assess whether exposure to the natural environment protects against ADHD and whether this hypothesised protective effect varies across a child's life course.
Methods We did a longitudinal study with data collected from all children born in New Zealand in 1998, excluding those without an address history, those who were not singleton births, and those who died or emigrated before 18 years of age. We used Statistics New Zealand's Integrated Data Infrastructure to identify children with ADHD and to define covariates. ADHD was defined according to hospital diagnosis or pharmacy records (two or more prescriptions for ADHD drugs). Exposure to green space for each year of a child's life (from gestation to 18 years of age) was estimated at the meshblock level (the smallest geographical unit for which the New Zealand Census reports data) using normalised difference vegetation index (NDVI), and land-use data from Landcare Research New Zealand. We used logit models to assess the associations between ADHD prevalence and minimum, maximum, and mean lifetime NDVI, as well as rural living, controlling for sex, ethnicity, mother's educational level, mother's smoking status, mother's age at parturition, birth order, antibiotic use, and low birthweight.
Findings Of the 57 450 children born in New Zealand in 1998, 49 923 were eligible and had available data, and were included in the analysis. Children who had always lived in a rural area after 2 years of age were less likely to develop ADHD (odds ratio [OR] 0.670 [95% CI 0.461-0.974), as were those with increased minimum NDVI exposure after age 2 years (standardised OR for exposure vs first quartile: second quartile 0.841 [0.707-0.999]; third quartile 0.809 [0.680-0.963]; fourth quartile 0.664 [0.548-0.805]). In early life (prenatal to age 2 years), neither rural living nor NDVI were protective against ADHD. Neither mean nor maximum greenness was significantly protective against ADHD.
Interpretation Rurality and increased minimum greenness were strongly and independently associated with a reduced risk of ADHD. Increasing a child's minimum lifetime greenness exposure, as opposed to maximum or mean exposure, might provide the greatest increment of protection against the disorder. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
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Details
- Title
- Association between exposure to the natural environment, rurality, and attention-deficit hyperactivity disorder in children in New Zealand: a linkage study
- Creators
- Geoffrey H. Donovan - Massey UniversityYvonne L. Michael - Drexel UniversityDemetrios Gatziolis - Pacific Northwest Research StationAndrea't Mannetje - Massey Univ, Ctr Publ Hlth Res, Wellington, New ZealandJeroen Douwes - Massey University
- Publication Details
- The Lancet. Planetary health, v 3(5), pp E226-E234
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000525909900011
- Other Identifier
- 991019167470704721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Environmental Sciences
- Public, Environmental & Occupational Health