Associations of green and blue spaces with visual acuity in youths from Shandong Province, China: A large population-based study

While growing evidence highlights the benefits of green and blue spaces for physical and mental health, their combined effects on youth visual acuity remain unclear. This study aimed to evaluate the associations of green and blue spaces with visual acuity in youths. We analyzed data from the 2023 Common Disease and Health Risk Factors Surveillance and Intervention Program among students in Shandong Province, China. Generalized linear mixed-effects models were employed to investigate the independent associations of green and blue spaces with visual acuity in youths. To explore potential interactions, an interaction term for green and blue spaces was incorporated. Quantile g-computation (Qgcomp) models were applied to evaluate their combined effects. Compared to the lowest quartile, higher quartiles (Q2, Q3, and Q4) of the normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), normalized difference water index (NDWI), and modified normalized difference water index (MNDWI) were significantly associated with improved visual acuity in both eyes. Additionally, each 0.1 unit increase in NDVI500, EVI500, NDWI500, and MNDWI500 was associated with 0.008 (95 % confidence interval [CI]: 0.007, 0.010), 0.003 (0.002, 0.004), 0.054 (0.028, 0.080), and 0.010 (0.002, 0.018) improvements in right-eye visual acuity, with similar findings for the left eye. A significant interaction was observed between NDVI and NDWI (all P for interaction < 0.001), and combined exposure to green and blue spaces was positively associated with visual acuity (all P < 0.001). Furthermore, demographic and lifestyle factors modified the associations of blue and green spaces with visual acuity levels in youths. Greater exposure to green and blue spaces may benefit visual health in youths, with potential interactive and combined effects. Implementing policies to enhance the availability of green and blue spaces around schools may offer opportunities to alleviate visual impairment in youths.