Inequality, green spaces, and pregnant women: Roles of ethnicity and individual and neighbourhood socioeconomic status

doi:10.1016/j.envint.2014.06.010

Environment International

Volume 71, October 2014, Pages 101-108

https://doi.org/10.1016/j.envint.2014.06.010 Get rights and content

Highlights

•
Limited evidence on impacts of green spaces on foetal growth
•
Higher residential surrounding greenness was associated with higher birth weight.
•
Such benefit was observed only for White British, but not those of Pakistani origin.
•
Subjects with lower individual and neighbourhood socioeconomic status benefited more.

Abstract

Evidence of the impact of green spaces on pregnancy outcomes is limited with no report on how this impact might vary by ethnicity. We investigated the association between residential surrounding greenness and proximity to green spaces and birth weight and explored the modification of this association by ethnicity and indicators of individual (maternal education) and neighbourhood (Index of Multiple Deprivation) socioeconomic status. Our study was based on 10,780 singleton live-births from the Born in Bradford cohort, UK (2007–2010). We defined residential surrounding greenness as average of satellite-based Normalized Difference Vegetation Index (NDVI) in buffers of 50 m, 100 m, 250 m, 500 m and 1000 m around each maternal home address. Residential proximity to green spaces was defined as living within 300 m of a green space with an area of ≥ 5000 m². We utilized mixed effects models to estimate adjusted change in birth weight associated with residential surrounding greenness as well as proximity to green spaces. We found a positive association between birth weight and residential surrounding greenness. Furthermore, we observed an interaction between ethnicity and residential surrounding greenness in that for White British participants there was a positive association between birth weight and residential surrounding greenness whereas for participants of Pakistani origin there was no such an association. For surrounding greenness in larger buffers (500 m and 1000 m) there were some indications of stronger associations for participants with lower education and those living in more deprived neighbourhoods which were not replicated for surrounding greenness in smaller buffer sizes (i.e. 50 m, 100 m, and 250 m). The findings for residential proximity to a green space were not conclusive. Our study showed that residential surrounding greenness is associated with better foetal growth and this association could vary between different ethnic and socioeconomic groups.

Introduction

Contact with green spaces has been shown to improve both perceived and objective physical and mental health and well-being (Bowler et al., 2010, Lee and Maheswaran, 2011). More recently, a limited number of studies have reported beneficial impacts of green spaces on pregnancy outcomes (Dadvand et al., 2012a, Dadvand et al., 2012b, Donovan et al., 2011, Laurent et al., 2013, McLennan et al., 2011). These studies reported some benefits of maternal residential surrounding greenness for foetal growth, reflected by higher birth weight and head circumference and lower risk of low birth weight and small for gestational age (Dadvand et al., 2012a, Dadvand et al., 2012b, Donovan et al., 2011, Laurent et al., 2013, McLennan et al., 2011).

Socioeconomic inequality in health has been shown to have a multilevel structure in that individual and neighbourhood socioeconomic status (SES) could have independent associations with the susceptibility of individuals to disease (Pickett and Pearl, 2001, Ross and Mirowsky, 2008). A growing body of evidence has reported that individual SES can modify the health benefits of green spaces (De Vries et al., 2003, Maas et al., 2009). In our previous studies of the impact of green spaces on pregnancy outcomes (Dadvand et al., 2012a, Dadvand et al., 2012c), we observed a larger benefit of green spaces for pregnant women with lower education qualifications (Dadvand et al., 2012a, Dadvand et al., 2012c). In this context, neighbourhood SES could also have a potential modifying effect on the association between green spaces and health.

The available studies on the potential modifying effect of ethnicity on health benefits of green spaces are scarce but suggestive of such an effect (Agyemang et al., 2007, Lee and Maheswaran, 2011). To our knowledge, there is no reported study on the modification of the association between green spaces and pregnancy outcomes by ethnicity.

This study aimed to investigate the association between contact with green spaces (in terms of residential surrounding greenness and proximity to green spaces) and foetal growth (in terms of birth weight) and to explore how this association might be modified by ethnicity and indicators of individual and neighbourhood SES.

Section snippets

Study population

This analysis was carried out as part of the Born in Bradford (BiB) study which has been described in detail elsewhere (Wright et al., 2013). Briefly, BiB is a longitudinal multiethnic community birth cohort study aiming to examine the impact of environmental, psychological and genetic factors on maternal and child health and wellbeing (Wright et al., 2013). Participants were pregnant women at 26–28 week gestation who registered at the Bradford Royal Infirmary. For those consenting, the baseline

Study population

Of 11,396 pregnancies with completed baseline questionnaires, 62 were stillbirth, 142 were multiple pregnancies, 345 did not have data on birth weight or gestational age at delivery, 49 were missing data on ethnicity, and 30 had missing data on education who were excluded from the analyses. Consequently, there were 10,780 pregnancies available for the analyses. Description of the characteristics of all included pregnancies as well as each ethnic category are presented in Table 1. While the

Discussion

We studied the impact of contact with green spaces on birth weight in a well-established cohort. The ethnic composition of this cohort with about 40% of participants being White British and 45% having Pakistani origin provided a unique opportunity to investigate, for the first time, the influence of ethnicity on the beneficial impact of green spaces on pregnancy outcomes that also adds to the scarce evidence on ethnic inequality in health benefits of green spaces. This study is also one of the

Conclusion

While our findings for residential proximity to green spaces were not conclusive, we observed a positive association between residential surrounding greenness and birth weight, which was evident only in White British participants and not in those of Pakistani origin. Our findings were also suggestive for stronger associations between residential surrounding greenness in larger buffers (i.e. neighbourhood greenness) and birth weight for more deprived participants which was not evident for

Conflict of interest

Authors declare that they have no conflicts of interests to disclose.

Acknowledgements

Born in Bradford is only possible because of the enthusiasm and commitment of the Children and Parents in BiB. We are grateful to all the participants, health professionals and researchers who have made Born in Bradford happen. This study was conducted as part of PHENOTYPE project (Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe) (www.phenotype.eu) funded by the European Commission Seventh Framework Programme (Grant No. 282996).

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Inequality, green spaces, and pregnant women: Roles of ethnicity and individual and neighbourhood socioeconomic status

Highlights

Abstract

Introduction

Section snippets

Study population

Study population

Discussion

Conclusion

Conflict of interest

Acknowledgements

Health Place

Int J Cardiol

Environ Int

Health Place

Atmos Environ B Urban Atmos

Am J Clin Nutr

Health Place

Health Place

Health Place

Lancet

Ann Epidemiol

Environ Res

Am J Kidney Dis

Ethnic differences in the effect of environmental stressors on blood pressure and hypertension in the Netherlands

BMC Public Health

Prenatal exposure to fine particulate matter and birth weight: variations by particulate constituents and sources

Epidemiology

Environmental inequalities among children in Europe—evaluation of scientific evidence and policy implications

Eur J Public Health

The association of daily physical activity and birth outcome: a population-based cohort study

Eur J Epidemiol

A systematic review of evidence for the added benefits to health of exposure to natural environments

BMC Public Health

Surrounding greenness and exposure to air pollution during pregnancy: an analysis of personal monitoring data

Environ Health Perspect

Surrounding greenness and pregnancy outcomes in four Spanish birth cohorts

Environ Health Perspect

Particulate air pollution and fetal growth: a multi-country evaluation of effect and heterogeneity

Environ Health Perspect

Natural environments-healthy environments? An exploratory analysis of the relationship between greenspace and health

Environ Plan A

Urban atlas

Towards a local sustainability profile — European common indicators