AbstractGreen space has a variety of health benefits. However, little is known about its impact on autism, the fastest-growing neurodevelopmental disorder in children. This study examined the relationship between green space and childhood autism prevalence. Autism count data in 2010 were obtained for 543 of ~560 public elementary school districts in California. Multiple types of green space were measured in each school district, including percentages of forest, grassland, and average tree canopy and near-road tree canopy. Their associations with autism prevalence were evaluated with negative binomial regression models and spatial regression models. We observed inverse associations between several green space metrics and autism prevalence in school districts with high road density, the highly urbanized areas, but not in others. According to negative binomial regression models, adjusted rate ratios (RR) for the relationships in these school districts between autism prevalence and green space metrics in 10% increments were as follows: for forest, RR=0.90 (95% confidence interval [CI]: 0.84–0.95); for grassland, RR=0.90 (95% CI: 0.83–0.97); for average tree canopy, RR=0.89 (95% CI: 0.83–0.95), and for near-road tree canopy, RR=0.81 (95% CI: 0.73–0.91). These results suggest that increases of 10% in forest, grassland, average tree canopy and near-road tree canopy are associated with a decrease in autism prevalence of 10%, 10% 11% and 19%, respectively. In contrast, urban land and road density were positively associated with autism prevalence. The results of spatial regression models were consistent with those obtained by negative binomial models, except for grassland. Our study suggests that green space, specifically tree cover in areas with high road density, may influence autism prevalence in elementary school children beneficially. Further studies are needed to investigate a potential causal relationship, and the major mechanisms that may underlie the beneficial associations with green space, such as buffering traffic-related air pollution and noise.

Highlights•Autism rate was inversely associated with forest and near-road tree canopy.•Inverse associations were significant only in districts with high road density.•Urban area and road density were positively associated with autism rate.•Further study is needed to explore causation and mechanistic pathways.