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Background: Evidence from developed countries on the association between greenspace and childhood respira-tory health has been inconsistent whilst such evidence is largely lacking in the developing world where rapid urbanization is occurring. This study aimed to investigate the associations between surrounding greenness, air pollution and respiratory health among pre-school children in a rapidly developing city in China.

Methods: We recruited 2920 pre-school children in Taiyuan city. Greenness exposure was represented by the Normalized Difference Vegetation Index (NDVI) which combined estimations based on a weighted mean that children spend time both in kindergarten and home (75% home, 25% kindergarten). Air pollution exposures were estimated from a land-use-regression model which was also calculated based on a weighted mean as with greenness. Logistic regression was performed to assess the relationships between greenness, air pollution and respiratory symptoms.

Results: Greenness had negatively impacted respiratory health among pre-school children in Taiyuan city, particularly for current dry cough at night. A 0.1-unit increment for NDVI300m was associated with an Odds Ratio (OR) of 2.45 (95%CI: 1.33-4.53) for dry cough at night. The associations were robust after adjusting for air pollution and road condition. No statistically significant associations were found between air pollution and any symptoms. The mediating effect of air pollution on dry cough at night with greenness was not observed.

Conclusion: Our study found that within different buffers, a higher level of greenness was consistently associated with a higher risk of dry cough at night among pre-school children. This finding has indicated that environmental policies on urban greening should be scientifically justified to protect respiratory health among young children.