Next Article in Journal
A Survey of Accidental Hypothermia Knowledge among Navy Members in China and the Implications for Training
Next Article in Special Issue
Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos
Previous Article in Journal
Erratum: Li, Z., et al. Smoking Prevalence and Associated Factors as well as Attitudes and Perceptions towards Tobacco Control in Northeast China. Int. J. Environ. Res. Public Health 2015, 12, 8606–8618
Article Menu

Export Article

Open AccessArticle
Int. J. Environ. Res. Public Health 2016, 13(3), 311;

Greenness and Birth Outcomes in a Range of Pennsylvania Communities

Robert Wood Johnson Foundation Health and Society Scholars Program, UC San Francisco and UC Berkeley, CA 94704, USA
Departments of Epidemiology and Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
Department of Forestry and Natural Resources, National Chiayi University, Chiayi City 60004, Taiwan
Departments of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
Center for Health Research, Geisinger Health System, Danville, PA 17822, USA
Author to whom correspondence should be addressed.
Academic Editor: Nelson Gouveia
Received: 26 January 2016 / Revised: 2 March 2016 / Accepted: 4 March 2016 / Published: 11 March 2016
Full-Text   |   PDF [807 KB, uploaded 11 March 2016]   |  


Living in communities with more vegetation during pregnancy has been associated with higher birth weights, but fewer studies have evaluated other birth outcomes, and only one has been conducted in the Eastern United States, in regions with a broad range, including high levels, of greenness. We evaluated associations between prenatal residential greenness and birth outcomes (term birth weight, small for gestational age, preterm birth, and low 5 min Apgar score) across a range of community types using electronic health record data from 2006–2013 from the Geisinger Health System in Pennsylvania. We assigned greenness based on mother’s geocoded address using the normalized difference vegetation index from satellite imagery. We used propensity scores to restrict the study population to comparable groups among those living in green vs. less-green areas. Analyses were adjusted for demographic, clinical, and environmental covariates, and stratified by community type (city, borough, and township). In cities, higher greenness (tertiles 2–3 vs. 1) was protective for both preterm (OR = 0.78, 95% CI: 0.61–0.99) and small for gestational age birth (OR = 0.73, 95% CI: 0.58–0.97), but not birth weight or Apgar score. We did not observe associations between greenness and birth outcomes in adjusted models in boroughs or townships. These results add to the evidence that greener cities might be healthier cities. View Full-Text
Keywords: greenness; pregnancy outcome; preterm birth; low birth weight; small for gestational age; propensity score; machine learning greenness; pregnancy outcome; preterm birth; low birth weight; small for gestational age; propensity score; machine learning

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

Supplementary material


Share & Cite This Article

MDPI and ACS Style

Casey, J.A.; James, P.; Rudolph, K.E.; Wu, C.-D.; Schwartz, B.S. Greenness and Birth Outcomes in a Range of Pennsylvania Communities. Int. J. Environ. Res. Public Health 2016, 13, 311.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics



[Return to top]
Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top