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Children's Health Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1308049

Residential Greenness and Birth Outcomes: Evaluating the Influence of Spatially Correlated Built-Environment Factors

Perry Hystad,1 Hugh W. Davies,2 Lawrence Frank,2,3 Josh Van Loon,2 Ulrike Gehring,4 Lillian Tamburic,2 and Michael Brauer2
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1College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA; 2School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; 3School of Community and Regional Planning, University of British Columbia, Vancouver, British Columbia, Canada; 4Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

Citation: Hystad P, Davies HW, Frank L, Van Loon J, Gehring U, Tamburic L, Brauer M. Residential Greenness and Birth Outcomes: Evaluating the Influence of Spatially Correlated Built-Environment Factors. Environ Health Perspect;

Received: 20 December 2013
Accepted: 10 July 2014
Advance Publication: 11 July 2014

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Background: Half the world’s population lives in urban areas. It is therefore important to identify characteristics of the built environment that are beneficial to human health. Urban greenness has been associated with improvements in a diverse range of health conditions, including birth outcomes; however, few studies have attempted to distinguish potential effects of greenness from those of other spatially correlated exposures related to the built environment.

Methods: We examined associations between residential greenness (measured using satellite-derived normalized difference vegetation index (NDVI) within 100 meters of study participants’ homes) and birth outcomes in a cohort of 64,705 singleton births (from 1999–2002) in Vancouver, British Columbia, Canada. We also evaluated associations after adjusting for spatially correlated built environmental factors that may influence birth outcomes, including exposure to air pollution and noise, neighborhood walkability, and distance to the nearest park.

Results: An interquartile increase in greenness [0.1 in residential NDVI] was associated with higher term birth weight (20.6 grams; 95% CI: 16.5, 24.7) and decreases in the likelihood of small for gestational age, very preterm (<30 weeks), and moderately preterm (30-36 weeks) birth. Associations were robust to adjustment for air pollution and noise exposures, neighborhood walkability, and park proximity.

Conclusions: Increased residential greenness was associated with beneficial birth outcomes in this population-based cohort. These associations did not change after adjusting for other spatially correlated built environment factors, suggesting that alternative pathways (e.g. psychosocial and psychological mechanisms) may underlie associations between residential greenness and birth outcomes.

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