Prescribing Time in Nature for Human Health and Well-Being: Study Protocol for Tailored Park Prescriptions.

Background: eHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health via tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients. Methods: The GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes (n = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate. Discussion: The goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes.

Exploring public values through Twitter data associated with urban parks pre- and post- COVID-19.

Since school and business closures due to the evolving COVID-19 outbreak, urban parks have been a popular destination, offering spaces for daily fitness activities and an escape from the home environment. There is a need for evidence for parks and recreation departments and agencies to base decisions when adapting policies in response to the rapid change in demand and preferences during the pandemic. The application of social media data analytic techniques permits a qualitative and quantitative big-data approach to gain unobtrusive and prompt insights on how parks are valued. This study investigates how public values associated with NYC parks has shifted between pre- COVID (i.e., from March 2019 to February 2020) and post- COVID (i.e., from March 2020 to February 2021) through a social media microblogging platform -Twitter. A topic modeling technique for short text identified common traits of the changes in Twitter topics regarding impressions and values associated with the parks over two years. While the NYC lockdown resulted in much fewer social activities in parks, some parks continued to be valued for physical activity and nature contact during the pandemic. Concerns about people not keeping physical distance arose in parks where frequent human interactions and crowding seemed to cause a higher probability of the coronavirus transmission. This study demonstrates social media data could be used to capture park values and be specific per park. Results could inform park management during disruptions when use is altered and the needs of the public may be changing.

Trauma and Transgression in Nature-Based Leisure.

The following article contains language, including discussion of racialized trauma, violent oppression, and more, that could trigger strong emotions and other physiological reactions. Our intent is not to retraumatize anyone, but to instead center the voices and experiences of people who have transgressed significant historical trauma and long sought lasting change and equitable outcomes for all.

Neighborhood Built Environment Impacts Park Use of Diverse, Low-Income Mothers With Their Children.

Built environment features, including parks, often exacerbate health disparities. We examined built environment perceptions and park use among a population at high risk for negative physical health outcomes: racially diverse, low-income mothers across the United States. Perceived safety from crime and living near a park were associated with more frequent park use for mothers with their children, and neighborhood walkability was linked to longer park visits. However, only 40% of mothers lived within a 10-minute walk of a park, and overall perceptions of walkability and safety from crime were low. To enhance physical activity and health of low-income mothers with their children, investments are needed to close disparities in park access and improve neighborhood safety.

Land use diversity and park use in New York City.

Neighborhood parks and mixed-use land development are both understood to be important independent contributors to physical activity levels. It has been hypothesized that mixed-use land development could increase park use as a result of mixed-use neighborhoods being consistently activated throughout the day, but the results of previous research on this question have been inconsistent and the mediational role of neighborhood activation has not been tested. This study leverages data from Google Places Popular Times and the National Establishment Time Series to directly test the mediational role of the daily temporal distribution of neighborhood activation, to construct a novel measure of commercial activity diversity, and to help disentangle built-environment density from commercial diversity. Park use data was measured from 10,004 systematic observations of 20 neighborhood parks in New York City in the spring and summer of 2017. The hypothesis that commercial activity diversity is positively associated with park use was not supported in any models. However, a positive relationship between built-environment density and park use was found, which may help to explain prior inconsistent findings.

Effects of Crime Type and Location on Park Use Behavior.

INTRODUCTION: Crime and the fear of crime can be a barrier to park use, and locations of crimes can have varied effects. Unsafe areas in or around the park, around the residence, or along the route to the park can alter park use behavior. Our study aimed to examine associations between objective measures of types and location of crimes and park use behaviors. METHODS: In 2013 we surveyed a sample (N = 230) of residents in Greensboro, North Carolina, about park use, with responses matched to objective crime and spatial measures. We measured all crimes and violent crimes near home, near the closest park, and along the shortest route between home and park. By using ordered and binary logistic modeling, we examined the relationships between the locations of crime and park use and duration of park visit, park rating, and never visiting parks. Additional models included distance to the closest park. RESULTS: Increased crime in parks and near home was associated with fewer park visits. Greater violent crime in all locations was related to fewer park visits. Park ratings were lower for parks with high violent crime rates. CONCLUSION: Given the importance of parks as settings for outdoor recreation and physical activity, crime may have a detrimental effect on physical activity and, therefore, public health.

Neighborhood characteristics associated with park use and park-based physical activity among children in low-income diverse neighborhoods in New York City.

Urban parks provide spaces and facilities for children's physical activity (PA) and can be a free resource in low-income communities. This study examined whether neighborhood characteristics were associated with children's park use and park-based moderate-to-vigorous PA (MVPA) in low-income diverse communities and how associations differed between ethnic groups. Data on park visits and MVPA came from 16,402 children 5-10-years old directly observed using the System for Observing Play and Recreation in Communities in 20 parks in low-income neighborhoods with majority Latino or Asian populations in New York City. Neighborhood characteristics included land use mix (LUM), street audits, crime rates, and an area deprivation index. We employed Poisson and negative binomial models to estimate effects of neighborhood-level variables on the number of children observed in parks and engaging in MVPA, overall and by ethnicity. Results for Asian, Latino, and African American children indicated that higher levels of LUM and pedestrian-friendly streets were associated with greater numbers of children in parks and higher MVPA across all three groups. For Asian and Latino children only, quality of environment was positively associated with MVPA, whereas level of deprivation and crime rates in the surrounding neighborhood were negatively associated with children's park-based MVPA. In contrast, a park's access to public transportation was negatively associated with number of all children observed and engaging in MVPA. Study findings suggest that park-based MVPA interventions can be informed by understanding how neighborhood characteristics facilitate and constrain park use and park-based MVPA.

Parental Preference for Park Attributes Related to Children's Use of Parks in Low-Income, Racial/Ethnic Diverse Neighborhoods.

Public parks offer free and easy access to spaces for outdoor recreation, which is essential for children's outdoor play and physical activity in low-income communities. Because parks and playgrounds contribute to children's physical, social, and emotional development, it is critical to understand what makes them attractive and welcoming for families with young children. Parents can be a key determinant to children visiting parks, with their preferences influencing whether or not families visit parks in their neighborhoods. Our study examined attributes associated with parental preferences for parks in low-income diverse communities in New York City, New York, and Raleigh-Durham, North Carolina, USA. Parents' responses were grouped into 10 categories using content analysis, with four key preference themes identified: physical attributes, experiences, social environment, and amenities. Physical attributes (i.e., playgrounds, sports fields, green spaces) were most desired among all groups. A significant difference across race/ethnic groups was found in New York but not in Raleigh-Durham. In New York, Latino parents had a strong preference for experience attributes (i.e. safety, safe facilities, cleanliness), which differed from other groups. Examining only Latino parents across both cities, we found no significant difference in preferences between the two cities. Although there is no one-size-fits-all approach to encourage park use, our finding suggests facilities and park safety are modifiable ways local government agencies could design and maintain parks that would be preferred by parents for their children. Future research should examine how neighborhood context may influence parent preferences related to parks.

Use of SOPARC to assess physical activity in parks: do race/ethnicity, contextual conditions, and settings of the target area, affect reliability?

BACKGROUND: Since its introduction in 2006, SOPARC (Systematic Observation of Play and Recreation in Communities) has become a fundamental tool to quantify park visitor behaviors and characteristics. We tested SOPARC reliability when assessing race/ethnicity, physical activity, contextual conditions at the time of observation, and settings of target areas to understand its utility when trying to account for individual characteristics of users. METHODS: We used 4725 SOPARC observations completed simultaneously by two independent observers to evaluate intraclass correlation and agreement rate between the two observers when trying to assess sex, age group, race/ethnicity, and level of physical activity of urban park users in different park settings. Observations were in 20 New York City parks during Spring and Summer 2017 within the PARC3 project. RESULTS: Observers counted 25,765 park users with high interobserver reliability (ICC = .94; %Agreement.75). Reliability scores were negatively affected by the population being observed, the intensity of physical activity, and the contextual conditions and settings of the target area at the time of observation. Specific challenges emerged when assessing the combination of physical activity and race/ethnicity. CONCLUSIONS: SOPARC training should aim to improve reliability when assessing concurrent measures such as physical activity, race/ethnicity, age, and sex. Similarly, observing crowded park areas with many active users areas may require more observation practice hours.

Building evidence to reduce inequities in youth physical activity and obesity: Introduction to the Physical Activity Research Center (PARC) Special Section.

This guest editorial introduces the rationale and goals of the Physical Activity Research Center. It provides an overview of the five papers in this Special Section plus six commissioned studies intended to inform advocacy efforts.

How Does Park Use and Physical Activity Differ between Childhood and Adolescence? A Focus on Gender and Race-Ethnicity.

Physical activity typically declines between childhood and adolescence. Despite urban parks being a great venue for physical activity, children change both the frequency of park use and their park use habits as they age into adolescence. However, little is known about how these differences vary by gender and how distinct race/ethnicity groups differentially change their park habits. This study analyzed the differences in park use and per capita energy expenditure between children and teenagers of different gender and race/ethnicity backgrounds. Using the System for Observing Play and Recreation in Communities (SOPARC), systematic observations were conducted in 20 New York City parks in 2017, located in low-income areas with high presence of Latino or Asian residents. A total of 9963 scans in 167 distinct target areas counted 16,602 children (5-10 years old) and 11,269 teenagers (11 or older). Using adjusted marginal means, we estimated the number of park users of each age range, gender, and race/ethnicity expected to be found in each park activity setting. Teenagers of both genders and most race/ethnicity groups were less likely to be in a park and had lower per capita energy expenditure, compared with children. The difference in park attendance was greater than the difference in per capita energy expenditure. Dissimilarities were clearly gendered and race/ethnicity dependent. Asian and Latino females showed the greatest divergence between childhood and adolescence. African American boys were the only group to show a positive age contrast in park attendance and per capita energy expenditure.

Short-term associations between objective crime, park-use, and park-based physical activity in low-income neighborhoods.

Crime and safety perceptions are commonly cited barriers to park use and physical activity (PA). Given the importance of parks as settings for outdoor recreation and physical activity, the presence of crime may have a detrimental effect on public health. This study uses objective police crime reports and observational park use data to assess type of crime and the time when the crime was committed effects on park user behaviors in 20 parks located in low-income neighborhoods in New York City. The System for Observing Play and Recreation in Communities (SOPARC) was used to assess the number of park users and their physical activity during 78 park visits in Spring 2017. The association between crime rates and park use was assessed using two types of crimes (violent and property crimes). The timing of the crime was assessed using the crimes committed within periods of one week, one month, and three months prior to the visit to the park. By including objective measures of crime together with the exact time on which they were committed, we were able to analyze the short and long term effects of crime on park behavior. Overall, there was a consistent negative association between crime and park use. This relationship was stronger at the 1 month and 3 months' period and weaker at the 1-week period. Violent crimes were strongly associated with lower park use, and crimes proved to be associated with child park use to a greater degree. Girls were more affected by crime than boys.

Policy and Practice-Relevant Youth Physical Activity Research Center Agenda.

BACKGROUND: The Physical Activity Research Center developed a research agenda that addresses youth physical activity (PA) and healthy weight, and aligns with the Robert Wood Johnson Foundation's Culture of Health. This paper summarizes prioritized research studies with a focus on youth at higher risk for inactive lifestyles and childhood obesity in urban and rural communities. METHODS: Systematic literature reviews, a survey, and discussions with practitioners and researchers provided guidance on research questions to build evidence and inform effective strategies to promote healthy weight and PA in youth across race, cultural, and economic groups. RESULTS: The research team developed a matrix of potential research questions, identified priority questions, and designed targeted studies to address some of the priority questions and inform advocacy efforts. The studies selected examine strategies advocating for activity-friendly communities, Play Streets, park use, and PA of youth in the summer. A broader set of research priorities for youth PA is proposed. CONCLUSION: Establishing the Physical Activity Research Center research agenda identified important initial and future research studies to promote and ensure healthy weight and healthy levels of PA for at-risk youth. Results will be disseminated with the goal of promoting equitable access to PA for youth.

Relationships between Characteristics of Urban Green Land Cover and Mental Health in U.S. Metropolitan Areas.

Urbanization increases risk for depression and other mental disorders. A growing body of research indicates the natural environment confers numerous psychological benefits including alleviation of mental distress. This study examined land cover types and landscape metrics in relation to mental health for 276 U.S. counties within metropolitan areas having a population of 1 million or more. County Health Rankings and Behavioral Risk and Factor Surveillance System (BRFSS) provided a measure of mental health. The 2011 National Land Cover Database (NLCD) provided data on green land cover types, from which seven landscape metrics were generated to characterize landscape patterns. Spearman's rho correlation and stepwise logistic regression models, respectively, were employed to examine bivariate and multivariate relationships. Models were adjusted for county population and housing density, region, race, and income to account for potential confounding. Overall, individual measures of landscape patterns showed stronger associations with mental health than percent total cover alone. Greater edge contrast was associated with 3.81% lower odds of Frequent Mental Distress (FMD) (Adjusted Odd's Ratio (AOR) = 0.9619, 95% CI = 0.9371, 0.9860). Shrubland cohesion was associated with greater odds of FMD (AOR = 1.0751, 95% CI = 1.0196, 1.1379). In addition, distance between shrubland cover was associated with greater odds of FMD (AOR = 1.0027, 95% CI = 1.0016, 1.0041). Although effect sizes were small, findings suggest different types of landscape characteristics may have different roles in improving mental health.

Shared use agreements and leisure time physical activity in North Carolina public schools.

Although increasing community access to public schools through shared use agreements (SUAs) has been a recommended strategy for promoting physical activity (PA) among national, state and local organizations, empirical evidence examining the efficacy of SUAs is limited. This study examined the degree of usage and production of PA among schools with shared use, and how variation in PA output is related to characteristics of the school, type of activity, facility type, and when activity occurs. Data were collected in 20 schools across North Carolina using System for Observing Play and Recreation in Communities (SOPARC) and Structured Physical Activity Surveys (SPAS) to assess PA in school athletic facilities during out of school time. Findings indicated that although schools had a policy of shared or open use, most facilities were empty during non-school hours. Hierarchal linear regression models also showed that formal programming was positively associated with both use and PA levels. Given the abundance of empty facilities, community groups in need of space to facilitate structured PA programs should pursue avenues of sharing facilities with public schools. Furthermore, to increase the efficacy of shared use, structured physical activity programs may be needed. Future studies are encouraged to further explore the effects of the specific types of shared use programs on PA production as well other aspects of the built environment surrounding schools.

Urban Vegetative Cover Fragmentation in the U.S.: Associations With Physical Activity and BMI.

INTRODUCTION: Urban vegetative cover provides a range of ecosystem services including contributions to human health and well-being. Urbanization exerts tremendous pressure on this natural resource, causing fragmentation and loss of urban greenspace. This study aimed to examine associations between vegetative cover fragmentation and physical activity and BMI at the county scale in the U.S. metropolitan statistical areas greater than 1 million in population. METHODS: National Land Cover Database 2006 and Behavioral Risk Factor Surveillance System 2008 provided land cover and human health data, respectively. Analyses were performed in 2013 at the county scale where the health data were reported. Spearman rank correlation and stepwise and hierarchical regression models were applied to estimate relationships between land cover and health variables. RESULTS: After controlling for median household income and race, greater forest edge density (ß=0.272, p<0.05) and larger size of herbaceous patches (ß=0.261, p<0.01) were associated with a higher percentage of participation in physical activity within counties. More connections between forest and developed area (ß=0.37, p<0.01) and greater edge density of shrubland (ß=0.646, p<0.001) were positively associated with a higher percentage of normal BMI (<25) within counties. CONCLUSIONS: Forest land cover and some degree of fragmentation are associated with population physical activity. Future studies should examine how built environments and varying land cover configurations influence physical activity and weight status.

Social and Environmental Factors Related to Boys' and Girls' Park-Based Physical Activity.

INTRODUCTION: Parks provide opportunities for physical activity for children. This study examined sex differences in correlates of park-based physical activity because differences may indicate that a standard environmental intervention to increase activity among children may not equally benefit boys and girls. METHODS: The System for Observation Play and Recreation in Communities was used to measure physical activity among 2,712 children and adolescents in 20 neighborhood parks in Durham, North Carolina, in 2007. Sedentary activity, walking, vigorous park activity, and energy expenditure were the primary outcome variables. Hierarchical logit regression models of physical activity were estimated separately for boys and girls. RESULTS: Type of activity area and presence of other active children were positively associated with boys' and girls' physical activity, and presence of a parent was negatively associated. A significant interaction involving number of recreation facilities in combination with formal activities was positively associated with girls' activity. A significant interaction involving formal park activity and young boys (aged 0-5 y) was negatively associated with park-based physical activity. CONCLUSION: Activity area and social correlates of park-based physical activity were similar for boys and girls; findings for formal park programming, age, and number of facilities were mixed. Results show that girls' physical activity was more strongly affected by social effects (eg, presence of other active children) whereas boys' physical activity was more strongly influenced by the availability of park facilities. These results can inform park planning and design. Additional studies are necessary to clarify sex differences in correlates of park-based physical activity.

Afterschool shared use of public school facilities for physical activity in North Carolina.

OBJECTIVE: To determine the status and common characteristics of shared use in public schools in North Carolina. METHOD: All public school principals (N=2,359) in North Carolina were invited to participate in an online survey (February - May, 2013) designed to provide baseline information about the extent and nature of shared use of school facilities. RESULTS: Responses (n=1182, 50.1%) indicated that most schools share their facilities (88.9%). Formal agreements were more common when schools shared gyms and outdoor athletic fields. Informal agreements were most common with playgrounds and track facilities. Schools with more low income or Black students were less likely to share facilities. For schools that did not share use of their facilities the most frequent reason was no outside groups had ever asked. CONCLUSION: Schools may be more accommodating to shared use partnerships. Community organizations seeking to use indoor school facilities or athletic fields should be prepared to complete a formal written agreement. Preconceived notions that schools are unwilling to share their facilities may be preventing community organizations from initiating shared use inquiries. Schools located in the middle tier of economic distress and schools with a greater concentration of Black students were less likely to share their facilities.

Disparities in built and natural features of urban parks: comparisons by neighborhood level race/ethnicity and income.

Known associations between the built environment and health outcomes have accelerated research examining racial/ethnic and income disparities in access to parks and other community features that support physical activity. Currently, it cannot be concluded that park characteristics are equal in quantity or condition across areas of disparate race/ethnicity and income composition. This study examined natural and built park characteristics across areas of different race/ethnicity and income composition to identify potential disparities. Twenty-one parks in Greensboro, NC (USA), located in minority or non-minority areas and in low or medium-high income areas were inventoried using a park audit tool and GIS. Parks were compared on number of activity areas, features, amenities, size, percent tree canopy, cleanliness, and condition. Independent sample t tests and Mann-Whitney tests were used to compare means of outcome variables. Fisher's exact tests were applied for categorical variables. Fewer wooded areas and more trash cans were found in low-income and minority areas as compared to medium-high income and non-minority areas. Low-income areas were found to have more picnic areas than their counterparts. Sitting and resting features in non-minority areas were found to be cleaner than those in minority areas. Results showed some evidence of disparities in park characteristics. Findings can inform park policy and design as well as renovations and maintenance procedures, particularly in specific areas where existing disparities were identified.

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment.

BACKGROUND: Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities. METHODS: Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011. RESULTS: Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses. CONCLUSIONS: These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy.