TY - JOUR
T1 - Urban greenspace and visual acuity in schoolchildren
T2 - a large prospective cohort study in China
AU - Bao, Wen-Wen
AU - Zhao, Yu
AU - Dadvand, Payam
AU - Jiang, Nan
AU - Chen, Gongbo
AU - Yang, Boyi
AU - Huang, Wenzhong
AU - Xiao, Xiang
AU - Liang, Jinghong
AU - Chen, Yican
AU - Huang, Shan
AU - Pu, Xueya
AU - Huang, Shaoyi
AU - Lin, Haotian
AU - Guo, Yuming
AU - Dong, Guanghui
AU - Chen, Yajun
N1 - Funding Information:
This project was funded by the Science and Technology Planning Project of Guangdong Province of China (No.2014A020220002; No.2016A020225002); the National Natural Science Foundation of China (No.81673193; No.82273650). We are grateful for the cooperation of all participants in this work who have generously spent their precious time and efforts help us, as well as all staff of Guangzhou Primary and Secondary School Health Promotion Center, to coordinate schoolchildren's physical examinations and the completion of questionnaires. ISGlobal acknowledges the support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.
Funding Information:
Yajun Chen and Wen-Wen Bao designed and supervised the study, and revised the manuscript. Yajun Chen applied for funding to support the COHERENCE project. Wen-Wen Bao and Yu Zhao analyzed the data, interpreted the results, drafted and revised the manuscript. Payam Dadvand, Boyi Yang, Wenzhong Huang, and Xiang Xiao revised the manuscript and provided technical consultation. Gongbo Chen provided the air pollution data. Wen-Wen Bao, Yu Zhao, Nan Jiang, Yicang Chen, Jinghong Liang, Shan Huang, Xueya Pu and Shaoyi Huang were responsible for raw data processing of the COHERENCE project. Haotian Lin, Yuming Guo, and Guanghui Dong critically revised the manuscript and helped interpret the data. All authors reviewed and approved the final manuscript.
Publisher Copyright:
© 2024 The Author(s)
PY - 2024/2
Y1 - 2024/2
N2 - Background: Greenspace is known to have a positive impact on human health and well-being, but its potential effects on visual acuity have not been extensively studied. Objectives: Our aim was to examine the relationship between long-term greenspace exposure and visual acuity in children, while also exploring the potential mechanisms in this association. Methods: We conducted this prospective cohort study based on the Children's growth environment, lifestyle, physical, and mental health development project (COHERENCE), which screened 286,801 schoolchildren in Guangzhou, China, starting in the 2016/17 academic year and followed them up for three academic years (2017/18-2019/20). Visual acuity was measured using a standardized logarithmic chart, and visual impairment was defined as visual acuity worse than 0.0 logarithm of the minimum angle of resolution (LogMAR) units in the better eye. We used the Normalized Difference Vegetation Index (NDVI), the Soil-Adjusted Vegetation Index (SAVI), and the Enhanced Vegetation Index (EVI) to assess the greenspace surrounding child's geocoded home and school at each visit. Results: Our analysis indicated that higher greenspace exposure was associated with greater visual acuity z-score at baseline and with slower decline in visual acuity z-score during the 3-year follow-up. An interquartile range increase in home-school-based NDVI 300m was associated with a 7% decrease [hazard ratios (HRs): 0.93, 95% confidence interval (CI): 0.92, 0.94] in the risk of visual impairment. We also found that air pollution, physical activity, outdoor time, and recreational screen time partially mediated the greenspace-visual acuity association. Conclusion: Our findings suggest that increasing greenspace exposure could benefit children's visual acuity development and reduce the risk of visual impairment by reducing air pollution and recreational screen time while increasing physical activity and outdoor time. All results could have potential policy implications, given the individual and societal burdens associated with visual impairment.
AB - Background: Greenspace is known to have a positive impact on human health and well-being, but its potential effects on visual acuity have not been extensively studied. Objectives: Our aim was to examine the relationship between long-term greenspace exposure and visual acuity in children, while also exploring the potential mechanisms in this association. Methods: We conducted this prospective cohort study based on the Children's growth environment, lifestyle, physical, and mental health development project (COHERENCE), which screened 286,801 schoolchildren in Guangzhou, China, starting in the 2016/17 academic year and followed them up for three academic years (2017/18-2019/20). Visual acuity was measured using a standardized logarithmic chart, and visual impairment was defined as visual acuity worse than 0.0 logarithm of the minimum angle of resolution (LogMAR) units in the better eye. We used the Normalized Difference Vegetation Index (NDVI), the Soil-Adjusted Vegetation Index (SAVI), and the Enhanced Vegetation Index (EVI) to assess the greenspace surrounding child's geocoded home and school at each visit. Results: Our analysis indicated that higher greenspace exposure was associated with greater visual acuity z-score at baseline and with slower decline in visual acuity z-score during the 3-year follow-up. An interquartile range increase in home-school-based NDVI 300m was associated with a 7% decrease [hazard ratios (HRs): 0.93, 95% confidence interval (CI): 0.92, 0.94] in the risk of visual impairment. We also found that air pollution, physical activity, outdoor time, and recreational screen time partially mediated the greenspace-visual acuity association. Conclusion: Our findings suggest that increasing greenspace exposure could benefit children's visual acuity development and reduce the risk of visual impairment by reducing air pollution and recreational screen time while increasing physical activity and outdoor time. All results could have potential policy implications, given the individual and societal burdens associated with visual impairment.
KW - Children
KW - Greenness
KW - Mediation
KW - Myopia
KW - Repeated measures
KW - Visual acuity
UR - http://www.scopus.com/inward/record.url?scp=85183053927&partnerID=8YFLogxK
U2 - 10.1016/j.envint.2024.108423
DO - 10.1016/j.envint.2024.108423
M3 - Article
C2 - 38241831
AN - SCOPUS:85183053927
SN - 0160-4120
VL - 184
JO - Environment International
JF - Environment International
M1 - 108423
ER -
