Skip to Main Content
Association between exposure to the natural environment, rurality, and attention-deficit hyperactivity disorder in children in New Zealand: a linkage studyAuthor(s): Geoffrey Donovan; Yvonne L Michael; Demetrios Gatziolis; Andrea' t Mannetje; Jeroen Douwes
Source: Lancet Planet Health. 3: e226-e234.
Publication Series: Scientific Journal (JRNL)
Station: Pacific Northwest Research Station
PDF: Download Publication (341.0 KB)
DescriptionBackground: 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 57450 children born in New Zealand in 1998, 49923 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.
- Visit PNW's Publication Request Page to request a hard copy of this publication.
CitationDonovan, Geoffrey H.; Michael, Yvonne L.; Gatziolis, Demetrios; Mannetje, Andrea 't; Douwes, Jeroen. 2019. Association between exposure to the natural environment, rurality, and attention-deficit hyperactivity disorder in children in New Zealand: a linkage study. Lancet Planet Health. 3: e226-e234.
KeywordsGreenness, mental health, behavior, life course, NDVI, longitudinal.
- An empirical test of the biodiversity hypothesis: Exposure to plant diversity is associated with a reduced risk of childhood acute lymphoblastic leukemia
- Vegetation diversity protects against childhood asthma: results from a large New Zealand birth cohort
- Fire and children: learning survival skills
XML: View XML