Associations between Green Space Surrounding Kindergartens and Hyperactivity Behaviors among Chinese Preschool Children

Background: Attention deficit hyperactivity disorder (ADHD) affects approximately 2–7% of children worldwide and has become a global public health concern. The health effects of green space on ADHD in young children are unclear. We investigated associations between school-surrounding greenness and hyperactivity behaviors in preschool children. Methods: We performed a cross-sectional analysis using data of 66,678 preschool children (mean age: 3.53 years) from an on-going cohort in Shenzhen, China. The greenness surrounding kindergartens was measured using satellite-derived Normalized Difference Vegetation Index (NDVI) values at buffers of 250 m, 500 m, and 1000 m. Children’s hyperactivity behaviors were measured using the validated Conners’ Parent Rating Scale-Revised. We used generalized linear mixed models to assess the associations of greenness exposure with hyperactivity behaviors with adjustment for a variety of covariates. Results: Exposure to higher school-surrounding greenness was associated with lower prevalence of hyperactivity behaviors. In fully adjusted models, the odds ratio of hyperactivity behaviors in relation to an IQR (0.1) increase in NDVI at the 250 m buffer was 0.91 [confidence interval (CI): 0.84,0.98]. Consistent results were observed for greenness at the 500 m and 1000 m buffers. The negative association between greenness and hyperactivity behaviors was more pronounced in boys than in girls. Conclusions: Our findings suggest that higher levels of school-surrounding green spaces are associated with a lower risk of hyperactivity behaviors in preschool children.