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Article(id=1241675631906320446, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241675628051755031, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404547, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1714406400000, receivedDateStr=2024-04-30, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968139864, onlineDateStr=2026-03-20, pubDate=1732464000000, pubDateStr=2024-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968139864, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968139864, creator=13701087609, updateTime=1773968139864, updator=13701087609, issue=Issue{id=1241675628051755031, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='22', pageStart='4033', pageEnd='4224', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773968138945, creator=13701087609, updateTime=1773968595676, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241677543783322543, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241675628051755031, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241677543783322544, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241675628051755031, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4107, endPage=4115, ext={EN=ArticleExt(id=1241675632216698954, articleId=1241675631906320446, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effect of green space exposure combined with outdoor exercise duration on negative emotions of primary and secondary school students, Jiangsu, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effects of green space exposure combined with outdoor exercise duration on negative emotions (depression, anxiety and stress) among primary and secondary school students in Jiangsu Province.

Methods

A total of 19 903 primary and secondary school students in Jiangsus Province who met the criteria were randomly selected for inclusion in this study. Through the questionnaire survey, the demographic data of the research subjects and the information of negative emotions were collected. The annual average value of the Normalized Vegetation Index (NDVI) of the school environment of the study subjects was used as the spatial measurement of green space. A logistic regression model was used to evaluate the association between green space exposure and outdoor exercise duration and negative emotions.

Results

The detection rates of depression, anxiety and stress were 13.2% (2 631), 21.9% (4 367) and 9.7% (1 927) of the 19 903 participants, respectively. The range of NDVI is (0.19, 0.52); The correlation between green space exposure and outdoor exercise duration, individually or in combination, and the detection rate of negative emotions was generally similar in both regional and gender subgroups.

Conclusion

Expanding the exposure of green space and increasing the time of outdoor exercise can help alleviate the negative emotions of primary and secondary school students, and the research on green space exposure can provide effective measures for school health and psychological services.

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目的

研究绿地空间暴露联合户外运动时长对江苏省中小学生负性情绪（抑郁、焦虑、压力）的影响。

方法

进行以学校为单位的分层整群抽样，根据经济状况随机选择江苏省19 903名符合标准的中小学生纳入本次研究。通过问卷调查，收集研究对象的人口学资料及负性情绪信息；将研究对象所在学校环境的归一化植被指数(NDVI)的年均值作为绿地空间测量值。采用logistic回归模型评估绿地空间暴露和户外运动时长与负性情绪的关联。

结果

19 903名研究对象抑郁、焦虑、压力症状的检出率分别为13.2%(2 631名)、21.9%(4 367名)、9.7%(1 927名)；NDVI的范围为(0.19,0.52)；不论是地区还是性别亚组绿地空间暴露和户外运动时长单独或联合与负性情绪检出率的相关性总体上是相似的,呈负向关联。

结论

扩大绿地空间暴露范围与增加学生户外运动时长有助于缓解中小学生负性情绪，推进绿地空间暴露的研究可为学校卫生心理服务提供有效措施。

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杨婕，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=z/X/oEbjNugaLlNjw0lpkQ==, magXml=vO+ljCRQ7jQYlVVmS6kfIQ==, pdfUrl=null, pdf=CaLrJQpSBhSru/+uTdOLQQ==, pdfFileSize=880980, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=L4Icbe3VeKkPlVeY/bDE5w==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=xwKmL7dAQ6dnD5FxwirlVg==, mapNumber=null, authorCompany=null, fund=null, authors=

汤佳雯（2000—），女，硕士在读，研究方向：公共卫生（儿童青少年心理健康）

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汤佳雯（2000—），女，硕士在读，研究方向：公共卫生（儿童青少年心理健康）

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汤佳雯（2000—），女，硕士在读，研究方向：公共卫生（儿童青少年心理健康）

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Environmental Pollution, 2023, 317: 120746., articleTitle=Associations between greenspace surrounding schools and lipid levels in Chinese children and teenagers, refAbstract=null), Reference(id=1241826546848170205, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, doi=null, pmid=null, pmcid=null, year=2024, volume=249, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=［16］, rfOrder=17, authorNames=Mansouri R, Lavigne E, Talarico R, journalName=Environmental Research, refType=null, unstructuredReference=Mansouri R, Lavigne E, Talarico R, et al. Residential surrounding greenness and the incidence of childhood asthma: Findings from a population-based cohort in Ontario, Canada［J］. Environmental Research, 2024, 249: 118316., articleTitle=Residential surrounding greenness and the incidence of childhood asthma: Findings from a population-based cohort in Ontario, Canada, refAbstract=null), Reference(id=1241826546961416418, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, doi=null, pmid=null, pmcid=null, year=2023, volume=18, issue=1, pageStart=655, pageEnd=null, url=null, language=null, rfNumber=［17］, rfOrder=18, authorNames=Chen Y, Zhang Z, Zhu Q, journalName=Journal of Orthopaedic Surgery and Research, refType=null, unstructuredReference=Chen Y, Zhang Z, Zhu Q. The effect of an exercise intervention on adolescent idiopathic scoliosis:a network meta-analysis［J］. Journal of Orthopaedic Surgery and Research, 2023, 18(1): 655., articleTitle=The effect of an exercise intervention on adolescent idiopathic scoliosis:a network meta-analysis, refAbstract=null), Reference(id=1241826547066274024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, doi=null, pmid=null, pmcid=null, year=2023, volume=39, issue=10, pageStart=1225, pageEnd=1231, url=null, language=null, rfNumber=［18］, rfOrder=19, authorNames=汪妍, 彭畅, 程君菡, journalName=中国公共卫生, refType=null, unstructuredReference=汪妍，彭畅，程君菡，等．中国5省在校中学生自杀行为流行状况及其与抑郁、焦虑关联［J］．中国公共卫生, 2023, 39(10): 1225-1231., articleTitle=中国5省在校中学生自杀行为流行状况及其与抑郁、焦虑关联, refAbstract=null), Reference(id=1241826547229851883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, doi=null, pmid=null, pmcid=null, year=2023, volume=39, issue=10, pageStart=1225, pageEnd=1231, url=null, language=null, rfNumber=［18］, rfOrder=20, authorNames=Wang Y, Peng C, Cheng JH, journalName=Chinese Journal of Public Health, refType=null, unstructuredReference=Wang Y, Peng C, Cheng JH, et al. Prevalence of and impact of depression and anxiety on suicidal behaviors among high school students:a cross-sectional survey in five provinces,China［J］. Chinese Journal of Public Health, 2023, 39(10): 1225-1231. (In Chinese), articleTitle=Prevalence of and impact of depression and anxiety on suicidal behaviors among high school students:a cross-sectional survey in five provinces,China, refAbstract=null), Reference(id=1241826547338903790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, doi=null, pmid=null, pmcid=null, year=2023, volume=32, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=［19］, rfOrder=21, authorNames=Sakhvidi MJZ, Mehrparvar AH, Sakhvidi FZ, journalName=Current Opinion in Environmental Science& Health, refType=null, unstructuredReference=Sakhvidi MJZ, Mehrparvar AH, Sakhvidi FZ, et al. Greenspace and health, wellbeing, physical activity, and development in children and adolescents: An overview of the systematic reviews［J］. Current Opinion in Environmental Science& Health, 2023,32:100445., articleTitle=Greenspace and health, wellbeing, physical activity, and development in children and adolescents: An overview of the systematic reviews, refAbstract=null)], funds=[Fund(id=1241826542863581250, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, awardId=BE2021617, language=CN, fundingSource=江苏省重点研发计划（社会发展）专项(BE2021617), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241826533313151591, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, xref=1., ext=[AuthorCompanyExt(id=1241826533321540200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, companyId=1241826533313151591, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210009, China), AuthorCompanyExt(id=1241826533329928809, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, companyId=1241826533313151591, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京医科大学公共卫生学院，江苏　南京　210009)]), AuthorCompany(id=1241826533392843374, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, xref=2., ext=[AuthorCompanyExt(id=1241826533401231982, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, companyId=1241826533392843374, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.江苏省疾病预防控制中心儿童青少年健康促进所)])], figs=[ArticleFig(id=1241826540070175692, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=EN, label=Fig.1, caption=Joint association between green space exposure and outdoor exercise and negative emot, figureFileSmall=MuGrTaSzioXo7X7tAPoyTg==, figureFileBig=TqA/tOvFgP79Yg4fvsX+0A==, tableContent=null), ArticleFig(id=1241826540187616214, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=CN, label=图1, caption=绿地空间暴露和户外运动与负性情绪的联合关联, figureFileSmall=MuGrTaSzioXo7X7tAPoyTg==, figureFileBig=TqA/tOvFgP79Yg4fvsX+0A==, tableContent=null), ArticleFig(id=1241826540321833957, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=EN, label=Table 1, caption=

Comparison of the detection rate of negative emotions among primary and secondary school students inJiangsu Province with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
特征调查人数抑郁症状
是
n(%)		否
n(%)		χ2
t/F		P值
年龄(岁）19 90314.0±2.413.0±2.532.0<0.001
BMI(kg/m2)19 90321.7±4.421.0±4.40.5<0.001
睡眠时间(h)19 9037.1±2.28.1±1.918.9<0.001
性别4.80.029
男10 3581 317(50.1)9 041(51.5)
女9 5451 314(49.9)8 231(47.7)
城乡62.9<0.001
城区10 3541 558(59.2)8 796(50.9)
郊县9 5491 073(40.8)8 476(49.1)
学段398.7<0.001
小学7 044514(19.5)6 530(37.8)
初中6 705957(36.4)5 748(33.3)
高中4 851886(33.7)3 965(23.0)
职业高中1 303274(10.4)1 029(6.0)
家庭类型43.4<0.001
单亲家庭3 177495(18.8)2 682(15.5)
核心家庭8 8201 155(43.9)7 665(44.4)
大家庭6 247716(27.2)5 531(32.0)
其他家庭1 659265(10.1)1 394(8.1)
发育情况（是否遗精/月经）248.5<0.001
否10 9151 068(40.6)9 847(57.0)
是8 9881 563(59.4)7 425(43.0)
是否住宿118.6<0.001
否16 2911 953(74.2)14 338(83.0)
是3 612678(25.8)2 934(17.0)
父亲学历21.7<0.001
小学及以下1 008182(6.9)826(4.8)
初中及以上18 8952 449(93.1)16 446(95.2)
母亲学历36.0<0.001
小学及以下1 779317(12.0)1 462(8.5)
初中及以上18 1242 314(88.0)15 810(91.5)
被动吸烟（过去7天）478.1<0.001
否10 2491 877(71.3)8 327(48.5)
是9 654754(28.7)8 900(51.5)
养过宠物29.2<0.001
否6 749770(29.3)5 979(34.6)
是13 1541 861(70.7)11 293(65.4)
特征调查人数焦虑症状
是
n(%)		否
n(%)		χ2
t/F		P值
年龄(岁）19 90313.7±2.512.9±2.52.4<0.001
BMI(kg/m2)19 90321.5±4.421.0±4.53.1<0.001
睡眠时间(h)19 9037.4±2.18.1±1.927.0<0.001
性别27.0<0.001
男10 3582 121(48.6)8 237(53.0)
女9 5452 246(51.4)7 299(47.0)
城乡39.9<0.001
城区10 3542 456(56.2)7 898(50.8）
郊县9 5491 911(43.8)7 638（49.2）
学段343.8<0.001
小学7 0441 069(24.5)5 975(38.5)
初中6 7051 551(35.5)5 154(33.2)
高中4 8511 388(31.8)3 463(22.3)
职业高中1 303359(8.2)944(6.1)
家庭类型27.2<0.001
单亲家庭3 177750(17.2)2 427(15.6)
核心家庭8 8201 910(43.7)6 910(44.5)
大家庭6 2471 280(29.3)4 967(32.0)
其他家庭1 659427(9.8)1 232(7.9）
发育情况（是否遗精/月经）268.3<0.001
否10 9151 919(43.9)8 996(57.9)
是8 9882 448(56.1)6 540(42.1)
是否住宿143.4<0.001
否16 2913 305(75.7)12 986(83.6)
是3 6121 062(24.3)2 550(16.4)
父亲学历37.0<0.001
小学及以下1 008299(6.8)709(4.6)
初中及以上18 8954 068(93.2)14 827(95.4)
母亲学历45.7<0.001
小学及以下1 779503(11.5)1 276(8.2)
初中及以上18 1243 864(88.5)14 260(91.8)
被动吸烟（过去7天）799.8<0.001
否10 2493 074(70.4)7 175(46.2)
是9 6541 299(29.6)8 361(53.8)
养过宠物52.8<0.001
否6 7491 280(29.3)5 469(35.2)
是13 1543 087(70.7)10 067(64.8)
特征调查人数压力症状
是
n(%)		否
n(%)		χ2
t/F		P值
年龄(岁）19 90313.6±2.513.1±2.52.4<0.001
BMI(kg/m2)19 90321.6±4.521.0±4.40.02<0.001
睡眠时间(h)19 9037.3±2.38.0±1.932.2<0.001
性别3.50.062
男10 358964(50.0)9 394(52.3)
女9 545963(50.0)8 582(47.7)
城乡22.3<0.001
城区10 3541 101(57.1)9 253(51.5)
郊县9 549826(42.9)8 732(48.5)
学段114.8<0.001
小学7 044489(25.4)6 555(36.5)
初中6 705680(35.3)6 025(33.5)
高中4 851616(32.0)4 235(23.6)
职业高中1 303142(7.4)1 161(6.5)
家庭类型27.8<0.001
单亲家庭3 177340(17.6)2 837(15.8)
核心家庭8 820817(42.4)8 003(44.5)
大家庭6 247558(29.0)5 689(31.6)
其他家庭1 659212(11.0)1 447(8.0)
发育情况（是否遗精/月经）62.2<0.001
否10 915893(46.3)10 022(55.8)
是8 9881 034(53.7)7 954(44.2)
是否住宿36.6<0.001
否16 2911 480(76.8)14 811(82.4)
是3 612447(23.2)3 165(17.6)
父亲学历9.00.03
小学及以下1 008125(6.5)883(4.9)
初中及以上18 8951 802(93.5)17 093(95.1)
母亲学历24.4<0.001
小学及以下1 779231(12.0)1 548(8.6)
初中及以上18 1241 696(88.0)16 428(91.4)
被动吸烟（过去7天）369.3<0.001
否10 2491 393(72.3)8 856(49.3)
是9 654534(27.7)9 120(50.7)
养过宠物16.6<0.001
否6 749573(29.7)6 176(34.4)
是13 1541 354(70.3)11 800(65.6)
), ArticleFig(id=1241826540435080171, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=CN, label=表1, caption=

不同特征的江苏省中小学生负性情绪检出率比较［n(%),］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征调查人数抑郁症状
是
n(%)		否
n(%)		χ2
t/F		P值
年龄(岁）19 90314.0±2.413.0±2.532.0<0.001
BMI(kg/m2)19 90321.7±4.421.0±4.40.5<0.001
睡眠时间(h)19 9037.1±2.28.1±1.918.9<0.001
性别4.80.029
男10 3581 317(50.1)9 041(51.5)
女9 5451 314(49.9)8 231(47.7)
城乡62.9<0.001
城区10 3541 558(59.2)8 796(50.9)
郊县9 5491 073(40.8)8 476(49.1)
学段398.7<0.001
小学7 044514(19.5)6 530(37.8)
初中6 705957(36.4)5 748(33.3)
高中4 851886(33.7)3 965(23.0)
职业高中1 303274(10.4)1 029(6.0)
家庭类型43.4<0.001
单亲家庭3 177495(18.8)2 682(15.5)
核心家庭8 8201 155(43.9)7 665(44.4)
大家庭6 247716(27.2)5 531(32.0)
其他家庭1 659265(10.1)1 394(8.1)
发育情况（是否遗精/月经）248.5<0.001
否10 9151 068(40.6)9 847(57.0)
是8 9881 563(59.4)7 425(43.0)
是否住宿118.6<0.001
否16 2911 953(74.2)14 338(83.0)
是3 612678(25.8)2 934(17.0)
父亲学历21.7<0.001
小学及以下1 008182(6.9)826(4.8)
初中及以上18 8952 449(93.1)16 446(95.2)
母亲学历36.0<0.001
小学及以下1 779317(12.0)1 462(8.5)
初中及以上18 1242 314(88.0)15 810(91.5)
被动吸烟（过去7天）478.1<0.001
否10 2491 877(71.3)8 327(48.5)
是9 654754(28.7)8 900(51.5)
养过宠物29.2<0.001
否6 749770(29.3)5 979(34.6)
是13 1541 861(70.7)11 293(65.4)
特征调查人数焦虑症状
是
n(%)		否
n(%)		χ2
t/F		P值
年龄(岁）19 90313.7±2.512.9±2.52.4<0.001
BMI(kg/m2)19 90321.5±4.421.0±4.53.1<0.001
睡眠时间(h)19 9037.4±2.18.1±1.927.0<0.001
性别27.0<0.001
男10 3582 121(48.6)8 237(53.0)
女9 5452 246(51.4)7 299(47.0)
城乡39.9<0.001
城区10 3542 456(56.2)7 898(50.8）
郊县9 5491 911(43.8)7 638（49.2）
学段343.8<0.001
小学7 0441 069(24.5)5 975(38.5)
初中6 7051 551(35.5)5 154(33.2)
高中4 8511 388(31.8)3 463(22.3)
职业高中1 303359(8.2)944(6.1)
家庭类型27.2<0.001
单亲家庭3 177750(17.2)2 427(15.6)
核心家庭8 8201 910(43.7)6 910(44.5)
大家庭6 2471 280(29.3)4 967(32.0)
其他家庭1 659427(9.8)1 232(7.9）
发育情况（是否遗精/月经）268.3<0.001
否10 9151 919(43.9)8 996(57.9)
是8 9882 448(56.1)6 540(42.1)
是否住宿143.4<0.001
否16 2913 305(75.7)12 986(83.6)
是3 6121 062(24.3)2 550(16.4)
父亲学历37.0<0.001
小学及以下1 008299(6.8)709(4.6)
初中及以上18 8954 068(93.2)14 827(95.4)
母亲学历45.7<0.001
小学及以下1 779503(11.5)1 276(8.2)
初中及以上18 1243 864(88.5)14 260(91.8)
被动吸烟（过去7天）799.8<0.001
否10 2493 074(70.4)7 175(46.2)
是9 6541 299(29.6)8 361(53.8)
养过宠物52.8<0.001
否6 7491 280(29.3)5 469(35.2)
是13 1543 087(70.7)10 067(64.8)
特征调查人数压力症状
是
n(%)		否
n(%)		χ2
t/F		P值
年龄(岁）19 90313.6±2.513.1±2.52.4<0.001
BMI(kg/m2)19 90321.6±4.521.0±4.40.02<0.001
睡眠时间(h)19 9037.3±2.38.0±1.932.2<0.001
性别3.50.062
男10 358964(50.0)9 394(52.3)
女9 545963(50.0)8 582(47.7)
城乡22.3<0.001
城区10 3541 101(57.1)9 253(51.5)
郊县9 549826(42.9)8 732(48.5)
学段114.8<0.001
小学7 044489(25.4)6 555(36.5)
初中6 705680(35.3)6 025(33.5)
高中4 851616(32.0)4 235(23.6)
职业高中1 303142(7.4)1 161(6.5)
家庭类型27.8<0.001
单亲家庭3 177340(17.6)2 837(15.8)
核心家庭8 820817(42.4)8 003(44.5)
大家庭6 247558(29.0)5 689(31.6)
其他家庭1 659212(11.0)1 447(8.0)
发育情况（是否遗精/月经）62.2<0.001
否10 915893(46.3)10 022(55.8)
是8 9881 034(53.7)7 954(44.2)
是否住宿36.6<0.001
否16 2911 480(76.8)14 811(82.4)
是3 612447(23.2)3 165(17.6)
父亲学历9.00.03
小学及以下1 008125(6.5)883(4.9)
初中及以上18 8951 802(93.5)17 093(95.1)
母亲学历24.4<0.001
小学及以下1 779231(12.0)1 548(8.6)
初中及以上18 1241 696(88.0)16 428(91.4)
被动吸烟（过去7天）369.3<0.001
否10 2491 393(72.3)8 856(49.3)
是9 654534(27.7)9 120(50.7)
养过宠物16.6<0.001
否6 749573(29.7)6 176(34.4)
是13 1541 354(70.3)11 800(65.6)
), ArticleFig(id=1241826540577686521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=EN, label=Table 2, caption=

Independent associations between green space and outdoor activities with depressive symptoms in subgroups

, figureFileSmall=null, figureFileBig=null, tableContent=
因素抑郁症状
地区亚组
城区郊县
模型1模型2模型3模型1模型2模型3
NDVI0.41(0.37~0.46)0.64(0.57~0.72)0.64(0.57~0.72)0.07(0.06~0.08)0.10(0.09~0.11)0.10(0.09~0.11)
分组
Q1111111
Q20.79(0.77~0.80)0.81(0.80~0.83)0.81(0.80~0.83)1.35(1.33~1.38)1.17(1.15~1.19)1.16(1.14~1.19)
Q30.71(0.70~0.72)0.80(0.79~0.81)0.80(0.79~0.81)1.27(1.24~1.29)1.15(1.13~1.17)1.15(1.12~1.17)
Q40.81(0.79~0.82)0.83(0.82~0.83)0.87(0.85~0.88)0.73(0.72~0.75)0.77(0.75~0.78)0.76(0.75~0.78)
户外运动分组
不超过2小时111111
因素抑郁症状
性别亚组
男女
模型1模型2模型3模型1模型2模型3
超过2小时0.96(0.95~0.97)0.96(0.95~0.97)0.96(0.95~0.97)0.85(0.84~0.86)0.91(0.89~0.92)0.90(0.89~0.91)
NDVI0.29(0.26~0.33)0.30(0.27~0.34)0.30(0..27~0.34)0.12(0.11~0.14)0.24(0.22~0.28)0.24(0.21~0.27)
分组
Q1111111
Q21.15(1.13~1.17)1.09(1.07~1.11)1.09(1.07~1.11)0.90(0.88~0.91)0.84(0,83~0.85)0.84(0.82~0.85)
Q30.87(0.85~0.88)0.87(0.85~0.88)0.87(0.85~0.88)0.83(0.82~0.84)0.87(0.85~0.88)0.86(0.85~0.88)
Q40.81(0.80~0.82)0.84(0.83~0.86)0.84(0.83~0.86)0.68(0.67~0.70)0.76(0.75~0.78)0.76(0.75~0.77)
户外运动分组
不超过2小时111111
超过2小时0.99(0.98~0.99)1.01(0.99~1.02)1.00(0.99~1.01)0.83(0,82~0.84)0.88(0.87~0.89)0.88(0.87~0.89)
), ArticleFig(id=1241826540707708933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=CN, label=表2, caption=

亚组人群中绿地空间暴露和户外运动时长与抑郁症状的独立关联

, figureFileSmall=null, figureFileBig=null, tableContent=
因素抑郁症状
地区亚组
城区郊县
模型1模型2模型3模型1模型2模型3
NDVI0.41(0.37~0.46)0.64(0.57~0.72)0.64(0.57~0.72)0.07(0.06~0.08)0.10(0.09~0.11)0.10(0.09~0.11)
分组
Q1111111
Q20.79(0.77~0.80)0.81(0.80~0.83)0.81(0.80~0.83)1.35(1.33~1.38)1.17(1.15~1.19)1.16(1.14~1.19)
Q30.71(0.70~0.72)0.80(0.79~0.81)0.80(0.79~0.81)1.27(1.24~1.29)1.15(1.13~1.17)1.15(1.12~1.17)
Q40.81(0.79~0.82)0.83(0.82~0.83)0.87(0.85~0.88)0.73(0.72~0.75)0.77(0.75~0.78)0.76(0.75~0.78)
户外运动分组
不超过2小时111111
因素抑郁症状
性别亚组
男女
模型1模型2模型3模型1模型2模型3
超过2小时0.96(0.95~0.97)0.96(0.95~0.97)0.96(0.95~0.97)0.85(0.84~0.86)0.91(0.89~0.92)0.90(0.89~0.91)
NDVI0.29(0.26~0.33)0.30(0.27~0.34)0.30(0..27~0.34)0.12(0.11~0.14)0.24(0.22~0.28)0.24(0.21~0.27)
分组
Q1111111
Q21.15(1.13~1.17)1.09(1.07~1.11)1.09(1.07~1.11)0.90(0.88~0.91)0.84(0,83~0.85)0.84(0.82~0.85)
Q30.87(0.85~0.88)0.87(0.85~0.88)0.87(0.85~0.88)0.83(0.82~0.84)0.87(0.85~0.88)0.86(0.85~0.88)
Q40.81(0.80~0.82)0.84(0.83~0.86)0.84(0.83~0.86)0.68(0.67~0.70)0.76(0.75~0.78)0.76(0.75~0.77)
户外运动分组
不超过2小时111111
超过2小时0.99(0.98~0.99)1.01(0.99~1.02)1.00(0.99~1.01)0.83(0,82~0.84)0.88(0.87~0.89)0.88(0.87~0.89)
), ArticleFig(id=1241826542263795727, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=EN, label=Table 3, caption=

Independent associations between green space and outdoor activities with anxiety symptoms in subgroups

, figureFileSmall=null, figureFileBig=null, tableContent=
因素焦虑症状
地区亚组
城区郊县
模型1模型2模型3模型1模型2模型3
NDVI0.26(0.23~0.28)0.40(0.36~0.45)0.40(0.36~0.44)0.06（0.05~0.06）0.07(0.07~0.08)0.10(0.09~0.11)
分组
Q1111111
Q20.82(0.81~0.83)0.82(0.81~0.83)0.82(0.81~0.83)1.06(1.05~1.08)0.94(0.93~0.96)0.94(0.93~0.95)
Q30.73(0.72~0.73)0.80(0.79~0.81)0.80(0.79~0.81)1.29(1.27~1.31)1.15(1.13~1.17)1.14(1.13~1.16)
Q40.75(0.74~0.76)0.79(0.78~0.80)0.79(0.78~0.80)0.70(0.69~0.71)0.73(0.72~0.74)0.72(0.71~0.73)
户外运动分组
不超过2小时111111
超过2小时0.96(0.95~0.97)0.96(0.96~0.97)0.96(0.95~0.97)0.86(0.85~0.87)0.90(0.89~0.91)0.89(0.88~0.90)
因素焦虑症状
性别亚组
男女
模型1模型2模型3模型1模型2模型3
NDVI0.12(0.11~0.13)0.12(0.11~0.13)0.12(0.11~0.13)0.12(0.11~0.13)0.23(0.21~0.26)0.23(0.21~0.25)
分组
Q1111111
Q20.95(0.94~0.96)0.89(0.88~0.90)0.89(0.88~0.90)0.88(0.87~0.89)0.84(0,83~0.85)0.84(0.83~0.85)
Q30.88(0.87~0.89)0.87(0.86~0.88)0.87(0.86~0.88)0.88(0.87~0.89)0.90(0.89~0.91)0.90(0.89~0.91)
Q40.72(0.71~0.73)0.74(0.73~0.75)0.74(0.73~0.75)0.68(0.67~0.69)0.75(0.74~0.76)0.74(0.73~0.75)
户外运动分组
不超过2小时111111
超过2小时0.94(0.93~0.95)0.96(0.95~0.96)0.95(0.94~0.96)0.88(0.88~0.89)0.94(0.93~0.94)0.93(0.92~0.94)
), ArticleFig(id=1241826542385430552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=CN, label=表3, caption=

亚组人群中绿地空间暴露和户外运动时长与焦虑症状的独立关联

, figureFileSmall=null, figureFileBig=null, tableContent=
因素焦虑症状
地区亚组
城区郊县
模型1模型2模型3模型1模型2模型3
NDVI0.26(0.23~0.28)0.40(0.36~0.45)0.40(0.36~0.44)0.06（0.05~0.06）0.07(0.07~0.08)0.10(0.09~0.11)
分组
Q1111111
Q20.82(0.81~0.83)0.82(0.81~0.83)0.82(0.81~0.83)1.06(1.05~1.08)0.94(0.93~0.96)0.94(0.93~0.95)
Q30.73(0.72~0.73)0.80(0.79~0.81)0.80(0.79~0.81)1.29(1.27~1.31)1.15(1.13~1.17)1.14(1.13~1.16)
Q40.75(0.74~0.76)0.79(0.78~0.80)0.79(0.78~0.80)0.70(0.69~0.71)0.73(0.72~0.74)0.72(0.71~0.73)
户外运动分组
不超过2小时111111
超过2小时0.96(0.95~0.97)0.96(0.96~0.97)0.96(0.95~0.97)0.86(0.85~0.87)0.90(0.89~0.91)0.89(0.88~0.90)
因素焦虑症状
性别亚组
男女
模型1模型2模型3模型1模型2模型3
NDVI0.12(0.11~0.13)0.12(0.11~0.13)0.12(0.11~0.13)0.12(0.11~0.13)0.23(0.21~0.26)0.23(0.21~0.25)
分组
Q1111111
Q20.95(0.94~0.96)0.89(0.88~0.90)0.89(0.88~0.90)0.88(0.87~0.89)0.84(0,83~0.85)0.84(0.83~0.85)
Q30.88(0.87~0.89)0.87(0.86~0.88)0.87(0.86~0.88)0.88(0.87~0.89)0.90(0.89~0.91)0.90(0.89~0.91)
Q40.72(0.71~0.73)0.74(0.73~0.75)0.74(0.73~0.75)0.68(0.67~0.69)0.75(0.74~0.76)0.74(0.73~0.75)
户外运动分组
不超过2小时111111
超过2小时0.94(0.93~0.95)0.96(0.95~0.96)0.95(0.94~0.96)0.88(0.88~0.89)0.94(0.93~0.94)0.93(0.92~0.94)
), ArticleFig(id=1241826542528036900, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=EN, label=Table 4, caption=

Independent associations between green space and outdoor activities with stress symptoms in subgroups

, figureFileSmall=null, figureFileBig=null, tableContent=
因素压力症状
地区亚组
城区郊县
模型1模型2模型3模型1模型2模型3
NDVI0.08(0.07~0.09)0.16(0.14~0.19)0.16(0.14~0.19)0.06(0.05~0.06）0.07(0.07~0.08)0.07(0.06~0.08)
分组
Q1111111
Q20.69(0.68~0.70)0.69(0.68~0.71)0.69(0.68~0.70)1.06(1.05~1.08)0.94(0.93~0.96)0.94 (0.93~0.95)
Q30.57(0.56~0.58)0.65(0.64~0.66)0.65(0.64~0.66)1.29(1.27~1.31)1.15(1.13~1.17)1.14(1.13~1.16)
Q40.65(0.64~0.66)0.71(0.70~0.72)0.71(0.70~0.72)0.70(0.69~0.71)0.73(0.72~0.74)0.72(0.71~0.73)
户外运动分组
不超过2小时111111
超过2小时0.92(0.91~0.93)0.93(0.92~0.94)0.93(0.92~0.94)0.85(0.84~0.86)0.91(0.89~0.92)0.89(0.88~0.90)
因素压力症状
性别亚组
男女
模型1模型2模型3模型1模型2模型3
NDVI0.06(0.06~0.07)0.07(0.07~0.09)0.30(0.27~0.34)0.13(0.11~0.15)0.24(0.21~0.28)0.24(0.21~0.27)
分组
Q1111111
Q20.80(0.78~0.81)0.74(0.72~0.75)0.73(0.72~0.75)0.80(0.80~0.82)0.77(0.75~0.78)0.77(0.75~0.78)
Q30.66(0.65~0.67)0.65(0.64~0.66)0.65(0.64~0.66)0.76(0.74~0.77)0.77(0.76~0.79)0.77(0.76~0.79)
Q40.63(0.62~0.64)0.65(0.64~0.66)0.65(0.64~0.66)0.66(0.65~0.67)0.73(0.72~0.74)0.73(0.72~0.74)
户外运动分组
不超过2小时111111
超过2小时0.95(0.94~0.97)0.99(0.98~1.00)0.98(0.96~0.99)0.92(0.90~0.93)0.99(0.97~0.99)0.98(0.96~0.99)
), ArticleFig(id=1241826542637088813, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241675631906320446, language=CN, label=表4, caption=

亚组人群中绿地空间暴露和户外运动时长与压力症状的独立关联

, figureFileSmall=null, figureFileBig=null, tableContent=
因素压力症状
地区亚组
城区郊县
模型1模型2模型3模型1模型2模型3
NDVI0.08(0.07~0.09)0.16(0.14~0.19)0.16(0.14~0.19)0.06(0.05~0.06）0.07(0.07~0.08)0.07(0.06~0.08)
分组
Q1111111
Q20.69(0.68~0.70)0.69(0.68~0.71)0.69(0.68~0.70)1.06(1.05~1.08)0.94(0.93~0.96)0.94 (0.93~0.95)
Q30.57(0.56~0.58)0.65(0.64~0.66)0.65(0.64~0.66)1.29(1.27~1.31)1.15(1.13~1.17)1.14(1.13~1.16)
Q40.65(0.64~0.66)0.71(0.70~0.72)0.71(0.70~0.72)0.70(0.69~0.71)0.73(0.72~0.74)0.72(0.71~0.73)
户外运动分组
不超过2小时111111
超过2小时0.92(0.91~0.93)0.93(0.92~0.94)0.93(0.92~0.94)0.85(0.84~0.86)0.91(0.89~0.92)0.89(0.88~0.90)
因素压力症状
性别亚组
男女
模型1模型2模型3模型1模型2模型3
NDVI0.06(0.06~0.07)0.07(0.07~0.09)0.30(0.27~0.34)0.13(0.11~0.15)0.24(0.21~0.28)0.24(0.21~0.27)
分组
Q1111111
Q20.80(0.78~0.81)0.74(0.72~0.75)0.73(0.72~0.75)0.80(0.80~0.82)0.77(0.75~0.78)0.77(0.75~0.78)
Q30.66(0.65~0.67)0.65(0.64~0.66)0.65(0.64~0.66)0.76(0.74~0.77)0.77(0.76~0.79)0.77(0.76~0.79)
Q40.63(0.62~0.64)0.65(0.64~0.66)0.65(0.64~0.66)0.66(0.65~0.67)0.73(0.72~0.74)0.73(0.72~0.74)
户外运动分组
不超过2小时111111
超过2小时0.95(0.94~0.97)0.99(0.98~1.00)0.98(0.96~0.99)0.92(0.90~0.93)0.99(0.97~0.99)0.98(0.96~0.99)
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绿地空间暴露联合户外运动时长对江苏省中小学生负性情绪的影响
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汤佳雯 1 , 张锡彦 1, 2 , 信义亮 2 , 王艳 2 , 杨文漪 2 , 项耀 2 , 王欣 2 , 张静杨 2 , 李佩璇 2 , 杨婕 1, 2
现代预防医学 | 儿少卫生与妇幼保健 2024,51(22): 4107-4115
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(22): 4107-4115
绿地空间暴露联合户外运动时长对江苏省中小学生负性情绪的影响
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汤佳雯1, 张锡彦1, 2, 信义亮2, 王艳2, 杨文漪2, 项耀2, 王欣2, 张静杨2, 李佩璇2, 杨婕1, 2
作者信息
  • 1.南京医科大学公共卫生学院，江苏　南京　210009
  • 2.江苏省疾病预防控制中心儿童青少年健康促进所

    • 汤佳雯（2000—），女，硕士在读，研究方向：公共卫生（儿童青少年心理健康）

通讯作者:

杨婕，E-mail:
Effect of green space exposure combined with outdoor exercise duration on negative emotions of primary and secondary school students, Jiangsu
Jia-wen TANG1, Xi-yan ZHANG1, 2, Yi-liang XIN2, Yan WANG2, Wen-yi YANG2, Yao XIANG2, Xin WANG2, Jing-yang ZHANG2, Pei-xuan LI2, Jie YANG1, 2
Affiliations
  • School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210009, China
出版时间: 2024-11-25 doi: 10.20043/j.cnki.MPM.202404547
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摘要
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目的

研究绿地空间暴露联合户外运动时长对江苏省中小学生负性情绪（抑郁、焦虑、压力）的影响。

方法

进行以学校为单位的分层整群抽样，根据经济状况随机选择江苏省19 903名符合标准的中小学生纳入本次研究。通过问卷调查，收集研究对象的人口学资料及负性情绪信息；将研究对象所在学校环境的归一化植被指数(NDVI)的年均值作为绿地空间测量值。采用logistic回归模型评估绿地空间暴露和户外运动时长与负性情绪的关联。

结果

19 903名研究对象抑郁、焦虑、压力症状的检出率分别为13.2%(2 631名)、21.9%(4 367名)、9.7%(1 927名)；NDVI的范围为(0.19,0.52)；不论是地区还是性别亚组绿地空间暴露和户外运动时长单独或联合与负性情绪检出率的相关性总体上是相似的,呈负向关联。

结论

扩大绿地空间暴露范围与增加学生户外运动时长有助于缓解中小学生负性情绪，推进绿地空间暴露的研究可为学校卫生心理服务提供有效措施。

绿地空间  /  户外运动  /  中小学生  /  负性情绪  /  回归模型
Objective

To study the effects of green space exposure combined with outdoor exercise duration on negative emotions (depression, anxiety and stress) among primary and secondary school students in Jiangsu Province.

Methods

A total of 19 903 primary and secondary school students in Jiangsus Province who met the criteria were randomly selected for inclusion in this study. Through the questionnaire survey, the demographic data of the research subjects and the information of negative emotions were collected. The annual average value of the Normalized Vegetation Index (NDVI) of the school environment of the study subjects was used as the spatial measurement of green space. A logistic regression model was used to evaluate the association between green space exposure and outdoor exercise duration and negative emotions.

Results

The detection rates of depression, anxiety and stress were 13.2% (2 631), 21.9% (4 367) and 9.7% (1 927) of the 19 903 participants, respectively. The range of NDVI is (0.19, 0.52); The correlation between green space exposure and outdoor exercise duration, individually or in combination, and the detection rate of negative emotions was generally similar in both regional and gender subgroups.

Conclusion

Expanding the exposure of green space and increasing the time of outdoor exercise can help alleviate the negative emotions of primary and secondary school students, and the research on green space exposure can provide effective measures for school health and psychological services.

Green space  /  Outdoor sports  /  Students  /  Negative emotions  /  Regression models
汤佳雯, 张锡彦, 信义亮, 王艳, 杨文漪, 项耀, 王欣, 张静杨, 李佩璇, 杨婕. 绿地空间暴露联合户外运动时长对江苏省中小学生负性情绪的影响. 现代预防医学, 2024 , 51 (22) : 4107 -4115 . DOI: 10.20043/j.cnki.MPM.202404547
Jia-wen TANG, Xi-yan ZHANG, Yi-liang XIN, Yan WANG, Wen-yi YANG, Yao XIANG, Xin WANG, Jing-yang ZHANG, Pei-xuan LI, Jie YANG. Effect of green space exposure combined with outdoor exercise duration on negative emotions of primary and secondary school students, Jiangsu[J]. Modern Preventive Medicine, 2024 , 51 (22) : 4107 -4115 . DOI: 10.20043/j.cnki.MPM.202404547
正文
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抑郁、焦虑、压力是常见的三种负性情绪，中小学时期往往是青少年生理和心理成长的关键时期，该过程的健康积累很大程度的决定了成年后的健康状态。近年来，中小学生负性情绪的发生率逐渐上升，该现象成为社会各界关注的重要课题[1]。
将绿地空间作为青少年心理健康暴露因素的研究甚少，但其作为暴露因素已在多项研究中被证实为人群健康的保护因素[2-3]。推动户外运动进校园是近期儿童青少年干预热点，适当户外运动有助于学生身心成长。为此，本研究分析江苏省中小学生绿地空间暴露联合户外运动与抑郁、焦虑、压力之间的关联，从而为今后有效解决青少年心理问题提供依据。
1　研究对象与方法
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1.1　研究对象
本研究使用2022年度江苏省儿童青少年心理健康监测和精准干预项目横断面调查数据，该调查覆盖了全省13个市。采用多阶段分层随机整群抽样方法，根据2021经济状况抽取城市GDP达20 000亿元以上的苏州市、10 000~20 000亿元的南通市、10 000亿元以下的连云港市，将苏州市9个区县、南通市5个区县、连云港市6个区县共19 903名符合标准的中小学生纳入本次研究并进行市级人数加权；将调查学校非毕业班年级中的小学四五年级、初中的初一初二年级、高中与职业高中的高一高二年级纳入本次研究，本次调查问卷已获得学校、学生及其监护人的知情同意。本研究已经通过南京医科大学附属脑科医院医学伦理委员会批准（批准文号：2022-KY095-02）。
1.2　主要研究内容与方法
1.2.1　调查问卷
使用2022年江苏省儿童青少年心理健康监测和精准干预项目工作手册内容进行问卷调查，问卷内容包括人口学基本信息：性别、身高、体重、年龄、学段（小学、初中、高中、职业高中）、城乡（城区、郊县）、睡眠时间、户外运动时间（是否超过2小时）、是否养过宠物等信息。
采用流调中心用抑郁量表(CES-D scale)，该量表是由Radloff等学者通过对大量临床文献及已有量表做因子分析提取而来，为评价当前抑郁症状的频度而设计[4]。分数越高抑郁程度越高，中文版CES-D量表在以往的研究中已被使用且证实其可靠性[5]。本次研究采用CES-D评分≥20分作为是否存在抑郁症状的划分标准。
由于抑郁症状在本次研究中已经使用CES-D量表进行评估，则采用抑郁－焦虑－压力量表(Depression，Anxiety and Stress Scale-21,DASS-21)中的两个分量表来测量另外两种负性情绪（焦虑、压力）的状态，该量表是由Lovibond等学者[6]编制的一套适用于中国青少年群体的自评量表，两个分量表分值越高代表越具有这种情绪；本次研究中采用焦虑量表评分≤7分作为是否存在焦虑症状的划分标准，压力量表评分≤14分作为是否存在压力症状的划分标准。
本次研究采用的CES-D 量表与DASS-21量表的两个分量表Cronbach α系数分别为0.879和0.942，Bartlett检验P<0.001，其信度与效度良好。
1.2.2　绿地空间暴露
目前，绿地空间暴露采用美国国家航天航空局(NASA)官方提供的有关中分辨率成像光谱仪卫星监测的公共数据库进行匹配，对研究对象所在学校环境的归一化植被指数暴露(Normalized Difference Vegetation Index,NDVI)进行估计。NDVI常作为评价和监测植被动态变化、土地覆盖变化、植被物候分析和生态环境监测的重要指标之一[7]。通过各学校所在地理位置的经纬度，对该学校绿色暴露程度进行估计。
1.2.3　户外运动
根据调查问卷中“户外运动时长”将结果分为“户外运动超过2小时”和“户外运动不超过2小时”进行研究。户外运动有利于儿童青少年的身心健康，可以促进青少年骨骼肌肉的发育[8]。有研究表明：增加户外运动时长有助于缓解青少年抑郁等负性情绪，并有利于培养其团队合作能力和社会适应能力[9]。
1.2.4　质量控制
运用科学的方法选择调查学校和研究对象，严格按照工作手册进行工作安排。各调查人员在调查工作开展前接受统一培训。做好工作时的入校安排，加强现场技术指导和远程工作协助，做好质量控制的每一环。
1.3　统计学处理
采用SPSS 26.0软件建立数据库并进行统计学描述分析，定性资料用百分率表示并用χ2检验比较不同变量组间差异；符合正态分布的定量资料用表示并运用独立样本t检验或方差分析比较上述指标的组间差异。运用ArcMap 10.8软件对NASA公共数据库进行处理并获得所需的各学校的NDVI年均值。以2022年问卷中CESD评分（是否存在抑郁症状）、DASS-21量表中的焦虑与压力评分（是否存在焦虑与压力症状）为因变量，以NDVI的年均值（分别以四分位数和连续变量的哑变量形式纳入模型）和问卷中户外运动时长（是否超过2小时）为自变量，采用多因素logistic回归模型分析绿地空间暴露和户外运动时长单独或联合与负性情绪之间的关联。建立模型进行混杂因素的调整，以监测点（城区和郊县）和性别分别进行分层分析，建立模型1控制年龄、性别、发育情况、体质指数、地区这些变量；模型2在模型1的基础上继续控制家庭类型、是否住宿、学段、父亲学历、母亲学历、被动吸烟（过去7天）、睡眠时长、是否养过宠物等变量；模型3在模型2的基础上继续控制户外运动时长或绿地空间暴露变量。为了建立绿地空间暴露和户外运动时长对负性情绪的联合关联，根据这两个变量的组合将参与者分为八组，应用多变量logistic回归模型对绿地空间暴露和户外运动时长之间的联合关联进行建模，模型a控制了年龄、性别、发育情况、体质指数、地区等变量，模型b在模型a的基础上继续控制家庭类型、是否住宿、学段、父亲学历、母亲学历、被动吸烟、睡眠时长、是否养过宠物等变量。运用双侧检验，检验水准α=0.05。
2　结果
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2.1　基本情况
本次研究共纳入19 903名研究对象，研究对象的年龄M(Q1,Q3)为13.1(10.7，15.6)；其中小学生人数占35.4%(7 044名)；男生占52.0%(10 358名)；城区学生占52.0%(10 354名)；睡眠时间均值为(7.1±2.2)小时；抑郁、焦虑、压力症状的检出率分别为13.2%(2 631名)、21.9%(4 367名)、9.7%(1 927名)。NDVI的取值范围为(0.19,0.52)，其M(Q1,Q3)为0.25（0.19，0.28）；户外运动时长超过2小时的研究对象占31.5%(6 271名)。
2.2　不同特征的江苏省中小学生抑郁、焦虑、压力症状的比较
不同年龄、体质指数、睡眠时间、性别、城乡、学段、家庭类型、发育情况、父母学历的中小学生负性情绪均有差异，中小学生是否住宿、是否养过宠物、是否被动吸烟（过去7天）也会使负性情绪产生差异，差异均存在统计学意义（P<0.05）。见表1。
2.3　NDVI或户外运动时长与江苏省中小学生抑郁、焦虑、压力症状的独立相关
以是否存在抑郁、焦虑、压力症状（否=0，是=1）为因变量，以NDVI的年均值（分别以四分位数和连续变量的哑变量形式纳入模型）和户外运动时长是否超过2小时（否=0，是=1）为自变量，建立模型1和模型2进行混杂因素调整。
多因素logistic回归模型分析结果显示，当以地区进行分层时，在城区学校的学生，与户外运动时长不超过2小时的中小学生相比，运动时长超过2小时的中小学生（模型3:OR抑郁=0.96,95% CI=0.95~0.97；OR焦虑=0.96，95% CI=0.95~0.97; OR压力=0.93，95% CI=0.92~0.94）检出负性情绪的风险较低；当以性别进行分层时，与NDVI的Q1组相比，女生Q4组压力症状风险相对较低，OR(95% CI)值分别为OR压力=0.73, 95% CI=0.72~0.74。见表2至表4。模型系数的Omnibus综合检验来判断模型：本法中模型1-3的Omnibus综合检验的P<0.001，模型整体有意义。
2.4　NDVI与户外运动时长与江苏省中小学生抑郁、焦虑、压力症状的联合关联
与“户外运动<2h+Q1”组的中小学生相比，“户外运动<2h+Q4”组的中小学生（模型b：OR抑郁=0.77,95% CI=0.76~0.78;OR焦虑=0.78，95% CI=0.77~0.79;OR压力=0.69，95% CI=0.68~0.70）和“户外运动≥2h+Q1”组的中小学生（模型a：OR抑郁=0.84,95% CI=0.83~0.86;OR焦虑=0.93,95% CI=0.91~0.94;OR压力=0.95,95% CI=0.93~0.96）负性情绪的检出率更低。见图1。模型系数的Omnibus综合检验来判断模型：本法中模型a-b的Omnibus综合检验的P<0.001，模型整体有意义。
3　讨论
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本文研究了绿地空间暴露和户外运动时长对江苏省中小学生负性情绪的影响。随着全球城市化进程的加快，世界各地的绿地空间面积将会有不同程度的减少[10],绿地空间在城市规划和建设中的作用尤其突出且城市环境已被认定为影响人群健康的一个关键因素[11-12]，有研究表明目前开展的绿地空间暴露研究对急性、慢性健康效应都有一定的作用[13]。目前，绿地空间暴露在国内外开展的多项调查中均有展露，Tsomokos等人发现绿地空间能够影响青少年的睡眠模式和睡眠健康[14]；我国学者发现我国青少年的血脂水平与学校周围的绿色空间暴露有关[15]；Mansouri等人发现了居住环境绿地空间程度增加会降低7-12岁儿童哮喘的发病风险[16]。此外，户外运动一直作为儿童青少年身心健康的热门干预措施[17]，在我们的研究中户外运动时长与江苏省中小学生的负性情绪存在直接关联，这与国外一项综述研究结果相一致[9]。
在本次研究中，江苏省中小学生抑郁、焦虑、压力症状的检出率分别为13.2%、21.9%、9.7%，低于国内各项研究数据[18]，这可能是由于江苏省作为我国东部地区发达省份之一，比较重视学生心理健康问题。研究结果显示，户外运动时长对女生负性情绪的效应更强，这可能与男女生理心理构成情况不同有关；江苏省郊县地区学校就读学生当中，NDVI对负性情绪的负向关联强于城区学校学生，这可能与江苏省城区城市化进程较快有关，郊县绿地面积大于城镇，郊县地区学生比城区学生更亲近绿地和自然环境；此外，研究结果显示户外运动时长>2h且NDVI越大越有利于中小学生心理健康的发展。为了谋求儿童青少年心理健康福祉，减少中小学生负性情绪危害，不论城区还是郊县地区，学校和家长需共同教育督促中小学生进行户外运动，尤其是绿地空间暴露相对较少的城区学校，学校等教育部门需要适当扩大学生绿地空间的暴露面积，促进中小学生心理健康发展。
本次调查将绿地空间暴露和户外运动时长联合研究时，绿地空间暴露较低且户外运动时长不足2小时的学生比绿地空间暴露较高且户外运动时长达到2小时的学生有更高的负性情绪检出率。大量研究表明，在整个儿童青少年时期加强户外运动和增强绿地空间暴露应该是降低心理疾病的重要干预措施[19]。
本次研究基于江苏省2022年中小学生横断面调查数据，样本量较大，可信度较高，探索绿地空间暴露和户外运动时长与青少年负性情绪关联的相关成果可为后续的专业研究提供线索和理论依据。同时，本次研究也存在一定的局限性：所采用的横断面调查数据，难以推断NDVI和户外运动时长与中小学生负性情绪的因果关系；其次，NDVI浓度值反映的是研究对象所在学校的绿地空间暴露情况，可能无法反映研究对象个体实际的暴露情况。
综上所述，绿地空间暴露和户外运动时长单独或联合与江苏省中小学生负性情绪检出率的相关性均存在负向关联。这一结论可为推进学校卫生心理服务提供有效措施，为研究人员后续揭示绿地面积和户外运动时长对负性情绪的影响及其机制提供有价值的信息。
基金
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  • 江苏省重点研发计划（社会发展）专项(BE2021617)
文献
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2024年第51卷第22期
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doi: 10.20043/j.cnki.MPM.202404547
  • 接收时间：2024-04-30
  • 首发时间：2026-03-20
  • 出版时间：2024-11-25
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  • 收稿日期：2024-04-30
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江苏省重点研发计划（社会发展）专项(BE2021617)
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    1.南京医科大学公共卫生学院，江苏　南京　210009
    2.江苏省疾病预防控制中心儿童青少年健康促进所

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
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