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. 2025 May;30(2):149-158.
doi: 10.1111/camh.12772. Epub 2025 Mar 21.

Associations between air pollution and surrounding greenness with internalizing and externalizing behaviors among schoolchildren

Uxue Zubizarreta-Arruti #  1   2   3   4 , Rosa Bosch #  3   5   6 , María Soler Artigas  1   2   3   4 , Judit Cabana-Domínguez  1   2   3   4 , Natalia Llonga  1   2   3   4 , Pau Carabí-Gassol  1   2   3   4 , Valeria Macias-Chimborazo  1   2 , Laura Vilar-Ribó  1   7 , Josep Antoni Ramos-Quiroga  1   2   3   8 , Mireia Pagerols  3   5   9 , Raquel Prat  3   5   10 , Cristina Rivas  5 , Èlia Pagespetit  5   11 , Júlia Puigbó  5 , Gemma Español-Martín  1   2   3   8 , Bruno Raimbault  12   13   14 , Antonia Valentín  12   13   14 , Jordi Sunyer  12   13   14 , Maria Foraster  15 , Mireia Gascón  12   13   14   16 , Miquel Casas  5   17 , Marta Ribasés  1   2   3   4 , Silvia Alemany  1   2   3
Affiliations

Associations between air pollution and surrounding greenness with internalizing and externalizing behaviors among schoolchildren

Uxue Zubizarreta-Arruti et al. Child Adolesc Ment Health. 2025 May.

Abstract

Background: Air pollution and greenness are emerging as modifiable risk and protective factors, respectively, in child psychopathology. However, research shows inconsistencies. Here, we examined associations between air pollution and surrounding greenness with internalizing and externalizing behaviors. In addition, the potential modifying role of the genetic susceptibility for these traits and socioeconomic status (SES) was explored.

Methods: This population-based study included 4485 schoolchildren aged 5-18 years from Spain. Internalizing and externalizing behaviors were assessed using the Child Behavior Checklist (CBCL). Average air pollution (NO2, PM2.5, PM10, PMcoarse, and PM2.5 absorbance) and surrounding greenness (NDVI within 100-m, 300-m, and 500-m buffers) school exposure were estimated for 12 months before outcome assessment. Genetic liability was assessed by computing polygenic risk scores (PRS) and SES was calculated using the Hollingshead Four-Factor Index. Associations were analyzed using negative binomial mixed-effects models.

Results: Although no associations survived multiple testing, we found that increases of 5.48 μg/m3 in PM10 and 2.93 μg/m3 in PMcoarse were associated with a 6% (Mean Ratio (MR) = 1.06; 95% CI: 1.01-1.12) and a 4% (MR = 1.04; 95% CI: 1.00-1.09) increase in internalizing behavior scores. A 0.1 increase in NDVI within a 100-m buffer was associated with a 6% decrease in externalizing behavior (MR = 0.94; 95% CI: 0.89-0.99). Neither differences by sex or age, or moderation effects by PRS or SES, were observed.

Conclusions: We found preliminary evidence of detrimental effects of air pollution on internalizing behavior and protective effects of greenness on externalizing behavior, which were not modified by sex, age, SES, or genetic liability. If confirmed, these results reinforce the need for improving air quality, especially around schools, as part of preventive strategies focused on childhood psychopathology.

Keywords: Air pollutants; aggressive; anxiety; child mental health; green spaces; polygenic risk scores.

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Conflict of interest statement

JAR‐Q was on the speakers' bureau and/or acted as a consultant for Biogen, Idorsia, Janssen‐Cilag, Novartis, Takeda, Bial, Sincrolab, Neuraxpharm, Novartis, BMS, Medice, Rubió, Uriach, Technofarma, and Raffo in the last 3 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Idorsia, Janssen‐Cilag, Rubió, Takeda, Bial, and Medice. The Department of Psychiatry, chaired by him, received unrestricted educational and research support from the following companies in the last 3 years: Exeltis, Idorsia, Janssen‐Cilag, Neuraxpharm, Oryzon, Roche, Probitas, Psious, and Rubió. The rest of the authors declare that they have no competing or potential conflicts of interest.

Figures

Figure 1
Figure 1
Forest plot depicting associations between physical environmental exposures and internalizing (left) and externalizing (right). Black color represents the results for the whole sample, sex‐stratified results are shown in orange while age‐stratified results are represented in blue. NDVI, normalized difference vegetation index; PM, particulate matter
See this image and copyright information in PMC

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