Urban Greenness and Birth Outcomes in Atlanta, Georgia Open Access

Landon, Remy Gabrielle (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/p5547s28r?locale=en
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Abstract

Introduction: Increased greenness has been shown to decrease stress, improve social functioning, increase physical activity, decrease air pollution, and moderate ambient temperature. These effects have all, in turn, been associated with improved birth outcomes. Previous studies have found a generally protective effect of greenness on adverse birth outcomes in other locations, but have not evaluated the association in the Southeastern United States. I investigated the association between greenness and low birth weight-preterm birth (LPTB) in the novel setting of Atlanta, Georgia, a city unique for its racially and economically diverse population and high average greenness.

Methods: Data was obtained from a population-based vital records system for all live births in the 10-county Metropolitan Atlanta Region from 2005-2007 (n=164,748). Average greenness was calculated in a 250m buffer around the maternal residence using the Normalized Difference Vegetation Index (NDVI), derived from a Landsat 5 Thematic Mapper satellite image (30x30m resolution). Logistic regression was used to evaluate the association between average residential NDVI and LPTB, controlling for individual and neighborhood-level covariates.

Results: Significant effect modification by race was observed between White and Black women (p=0.0082). Among Black women, a significant quadratic relationship was observed between residential greenness and LPTB, with the highest risk of LPTB in the areas of highest greenness [NDVI OR: 1.07 (1.03, 1.12); NDVI2 OR: 1.31 (1.03, 1.66) per 1-IQR increase]. However, among White women, there was no significant association between residential greenness and LPTB [NDVI OR: 1.00 (0.94, 1.05); NDVI2 OR: 1.12 (0.81, 1.55) per 1-IQR increase]. Results were robust to changes in birth outcome, NDVI buffer size, and scale of neighborhood deprivation, as well as adjustment for additional covariates.

Discussion: The greenness-birth outcome association is not consistent across locations and can vary as a result of changing demographic and geographic factors. The null association among White women may be due to Atlanta's high average greenness, while the association among Black women is more complex and warrants further investigation.

Table of Contents

I. Introduction.............................................................................................................................1

The urban environment and health...................................................................................................1

Mental health benefits of increased greenness...................................................................................2

Physical health benefits of increased greenness.................................................................................6

Greenness and birth outcomes........................................................................................................9

Contributions of the present study.................................................................................................14

II. Methods...............................................................................................................................15

Birth cohort................................................................................................................................15

Residential greenness..................................................................................................................17

Individual and neighborhood-level covariates..................................................................................19

Statistical analyses......................................................................................................................20

III. Results...............................................................................................................................21

Descriptive analyses....................................................................................................................21

Main analyses.............................................................................................................................22

Sensitivity analyses.....................................................................................................................23

IV. Discussion...........................................................................................................................25

V. Conclusion............................................................................................................................28

VI. References..........................................................................................................................30

VII. Tables and Figures.............................................................................................................38

VIII. Appendix..........................................................................................................................47

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