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This study examined the association of exposure to green and blue spaces with lung function in children, and assessed the mediation effect of air pollution and physical activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study used data from the Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). Residential Normalised Difference Vegetation Index (NDVI) at different buffers (100, 250 and 500\u2005m), the accessibility to urban green spaces (UGS) within 400 and 800\u2005m and the minimum distance to the nearest UGS and to the nearest blue spaces were assessed at birth, 4, 7 and 10\u2005years of age. Three life-course measures were calculated: averaged exposure, early-life exposure (birth) and exposure trend over time (change in exposure). Forced vital capacity (FVC), forced expiratory volume in 1\u2005s (FEV<jats:sub>1<\/jats:sub>) and forced expiratory flow between 25% and 75% of FVC (FEF<jats:sub>25\u201375%<\/jats:sub>) at 10\u2005years were used as outcomes. To assess associations, linear regression models and path analysis were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 3278 children. The adjusted models showed that increasing the NDVI exposure over time within 100\u2005m of the child's residence was associated with higher values of FEV<jats:sub>1<\/jats:sub>(L) and FEF<jats:sub>25\u201375%<\/jats:sub>(L\u00b7s<jats:sup>\u22121<\/jats:sup>) (\u03b2 0.01, 95% CI 0.0002\u20130.03 and \u03b2 0.02, 95% CI 0.001\u20130.05, respectively). No significant associations were observed for the remaining measures of exposure, and no mediation effect was found for pollution or physical activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increasing exposure to greenness at close proximity from residences was associated with improved lung function. While the mechanism remains unknown, this study brings evidence that city greening may improve children's respiratory health.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.03024-2021","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T05:45:47Z","timestamp":1658987147000},"page":"2103024","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Green and blue spaces and lung function in the Generation XXI cohort: a life-course approach"],"prefix":"10.1183","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-9085","authenticated-orcid":false,"given":"Diogo","family":"Queiroz Almeida","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5762-7814","authenticated-orcid":false,"given":"In\u00eas","family":"Paci\u00eancia","sequence":"additional","affiliation":[]},{"given":"Carla","family":"Moreira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1175-242X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Cavaleiro Rufo","sequence":"additional","affiliation":[]},{"given":"Andr\u00e9","family":"Moreira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-5299","authenticated-orcid":false,"given":"Ana Cristina","family":"Santos","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4699-6571","authenticated-orcid":false,"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[]},{"given":"Ana Isabel","family":"Ribeiro","sequence":"additional","affiliation":[]}],"member":"81","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"2024102103020590000_60.6.2103024.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032013-182443"},{"key":"2024102103020590000_60.6.2103024.2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.landurbplan.2016.09.024","article-title":"Defining greenspace: multiple uses across multiple disciplines","volume":"158","author":"Taylor","year":"2017","journal-title":"Landscape Urban Plann"},{"key":"2024102103020590000_60.6.2103024.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijheh.2011.05.001"},{"key":"2024102103020590000_60.6.2103024.4","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/MOP.0000000000000465","article-title":"Environment, susceptibility windows, development, and child health","volume":"29","author":"Wright","year":"2017","journal-title":"Curr Opinion Pediatr"},{"key":"2024102103020590000_60.6.2103024.5","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205752"},{"key":"2024102103020590000_60.6.2103024.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61379-8"},{"key":"2024102103020590000_60.6.2103024.7","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S2213-2600(18)30529-0","article-title":"Lung function trajectories in health and disease","volume":"7","author":"Agusti","year":"2019","journal-title":"Lancet Respir Med"},{"key":"2024102103020590000_60.6.2103024.8","doi-asserted-by":"crossref","first-page":"726","DOI":"10.12688\/f1000research.11185.1","article-title":"Recent advances in understanding lung function development","volume":"6","author":"Mel\u00e9n","year":"2017","journal-title":"F1000Res"},{"key":"2024102103020590000_60.6.2103024.9","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00157-2020"},{"key":"2024102103020590000_60.6.2103024.10","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035205"},{"key":"2024102103020590000_60.6.2103024.11","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12931-018-0890-0","article-title":"Childhood asthma is associated with COPD and known asthma variants in COPDGene: a genome-wide association study","volume":"19","author":"Hayden","year":"2018","journal-title":"Respir Res"},{"key":"2024102103020590000_60.6.2103024.12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s40572-018-0179-y","article-title":"A review of epidemiologic studies on greenness and health: updated literature through 2017","volume":"5","author":"Fong","year":"2018","journal-title":"Curr Environ Health Rep"},{"key":"2024102103020590000_60.6.2103024.13","doi-asserted-by":"crossref","first-page":"148605","DOI":"10.1016\/j.scitotenv.2021.148605","article-title":"How can vegetation protect us from air pollution? 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