Green space at school and attention in primary school children in Belgium: A stratified matched case-control study

Green spaces help to adapt urban environments to warming and other global change challenges. At school, green playgrounds help to incorporate natural elements into the daily lives of children, potentially improving well-being and academic performance. This study analyzed relationships between green space within and around the school, the landscape context, and well-being and sustained attention in 526 fifth-grade children (10–11 years old) in 37 Belgian schools, using a matched case-control design. By design, school level greenness did not vary with school level socioeconomic status. Attention was measured with the d2 sustained-attention test and well-being with the KIDSCREEN-27 questionnaire. Results of generalized multilevel models fitted within a Bayesian framework showed that attention was higher in schools located in more urbanized environments and that attention primarily increased with socioeconomic status. In models that accounted for partial missing data, attention was higher and attention waning lower in schools with green playgrounds, but only in low naturalness landscapes, and these associations were most prominent in high SES schools. Overall, our study suggests that green space within the school may partially compensate limited exposure to green space in highly urbanized environments, with beneficial effects on attention and well-being. Greening existing school playgrounds is expected to benefit child development in urbanized environments while simultaneously improving urban green space cover, with health benefits that extend beyond the school boundaries.