Background: Contact to green spaces has been associated with improved mental health and well-being; however, available evidence on the impact of green spaces on child behavioral development is scarce. Aim: To study the association between use of green spaces and behavioral indicators of neurodevelopment in primary school children. Methods: This study was based on a sample of 2407 schoolchildren (6-8 years) from 39 schools across Barcelona (2012) under the framework of BREATHE study. Parents were asked to fill a questionnaire including sociodemographic and household characteristics and child's frequency of green space use. Annual total time spent in green spaces was abstracted by multiplying the number of days and hours per day that children spent in green spaces during school days, weekends, and holidays. To evaluate the behavioral patterns we utilized Strengths and Difficulties Questionnaire (SDQ) filled by parents. We applied linear regression models to estimate the association between quartiles of the annual total time spent in green spaces and SDQ total and subscale scores, adjusted for parental education, occupation, marital status, and smoking, breastfeeding, child's sex, ethnicity, school level, and preterm birth. Results: Comparing the fourth quartile with the first quartile of annual total time spent in green spaces, we found a 0.9 (95% CI: 1.5, 0.3), 0.3 (95% CI: 0.5, 0.1), and 0.4 (95% CI: 0.5, 0.2) reduction in SDQ total, emotion, and peer scores respectively. For these associations we observed dose-response relationship across quartiles of annual time spent in green spaces. For hyperactivity, there was a dose-response relationship; however, the association for the fourth quartile was not statistically significant. For prosocial and conduct subscales the results were not conclusive. Conclusion: We found a moderate beneficial impact of contact to green spaces on behavioral development in schoolchildren, though adjustment for social context has not yet been completed.
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