ABSTRACT: Importance:Emerging research suggests that factors associated with the built environment, including artificial light, air pollution, and noise, may adversely affect children's mental health, while living near green space may reduce stress. Little is known about the combined roles of these factors on children's stress. Objective:To investigate associations between components of the built environment with personal and home characteristics in a large cohort of children who were assessed for perceived stress. Design, Setting, and Participants:In this cohort study, a total of 2290 Southern California Children's Health Study participants residing in 8 densely populated urban communities responded to detailed questionnaires. Exposures of artificial light at night (ALAN) derived from satellite observations, near-roadway air pollution (NRP) determined from a dispersion model, noise estimated from the US Traffic Noise Model, and green space from satellite observations of the enhanced vegetation index were linked to each participant's geocoded residence. Main Outcomes and Measures:Children's stress was assessed at ages 13 to 14 years and 15 to 16 years using the 4-item Perceived Stress Scale (PSS-4), scaled from 0 to 16, with higher scores indicating greater perceived stress. Measurements were conducted in 2010 and 2012, and data were analyzed from February 6 to August 24, 2019. Multivariate mixed-effects models were used to examine multiple exposures; modification and mediation analyses were also conducted. Results:Among the 2290 children in this study, 1149 were girls (50%); mean (SD) age was 13.5 (0.6) years. Girls had significantly higher perceived stress measured by PSS-4 (mean [SD] score, 5.7 [3.4]) than boys (4.9 [3.2]). With increasing age (from 13.5 [0.6] to 15.3 [0.6] years), the mean PSS-4 score rose from 5.6 (3.3) to 6.0 (3.4) in girls but decreased for boys from 5.0 (3.2) to 4.7 (3.1). Multivariate mixed-effects models examining multiple exposures indicated that exposure to secondhand smoke in the home was associated with a 0.85 (95% CI, 0.46-1.24) increase in the PSS-4 score. Of the factors related to the physical environment, an interquartile range (IQR) increase in ALAN was associated with a 0.57 (95% CI, 0.05-1.09) unit increase in the PSS-4 score together with a 0.16 score increase per IQR increase of near-roadway air pollution (95% CI, 0.02-0.30) and a -0.24 score decrease per IQR increase of the enhanced vegetation index (95% CI, -0.45 to -0.04). Income modified the ALAN effect size estimate; participants in households earning less than $48?000 per year had significantly greater stress per IQR increase in ALAN. Sleep duration partially mediated the associations between stress and both enhanced vegetation index (17%) and ALAN (18%). Conclusions and Relevance:In this cohort study, children's exposure to smoke at home in addition to residential exposure to ALAN and near-roadway air pollution were associated with increased perceived stress among young adolescent children. These associations appeared to be partially mitigated by more residential green space. The findings may support the promotion of increased residential green spaces to reduce pollution associated with the built environment, with possible mental health benefits for children.
