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.

A Scoping Review of the Health Benefits of Nature-Based Physical Activity.

The health benefits of physical activity and spending time in nature are well established. However, youths and adults in the United States are not participating in sufficient levels of physical activity and are not spending much time outdoors. Recently, the need for equitable access to nature for all populations has been receiving more public health attention, though a specific focus on nature-based physical activity has been limited. The purpose of this scoping review is to operationalize the health benefits of nature-based physical activity in order to provide guidance for collaborations to program administrators, advocates, and researchers. Peer-reviewed literature is found in PubMed, Medline, Web of Science, and Google Scholar as well as in published reviews of the literature. The literature is divided into three categories of: 1) amount and location of nature-based components and physical activity; 2) added health benefits of exposure to nature-based components and physical activity; and 3) nature-based components and physical activity effect on non-white, marginalized, and vulnerable populations. This review supports and encourages multiple strategies to increase nature-based physical activity as this provides even greater benefit to health and wellness than exposure to nature or physical activity alone. Although many of the physical and mental health benefits of nature and physical activity are well established, additional research is needed to better understand the relationship between exposure to nature and nature-based physical activity, which will require greater investment and support from funding agencies.

A longitudinal examination of improved access on park use and physical activity in a low-income and majority African American neighborhood park.

This study sought to evaluate the impact of street crossing infrastructure modifications on park use and park-based physical activity in a low-income and African American community. A five-lane major highway created an access barrier between low-income housing units and the local neighborhood park in Columbia, Missouri. The installation of a signalized pedestrian crosswalk provided an opportunity to conduct a natural experiment to examine the effect of improved safe access upon community active living behaviors. Direct observation using SOPARC was collected prior to the crosswalk instillation in June 2012, after the crosswalk installation in June 2013 and again as a follow up in June 2014 during the same two-week period to assess changes in total park use and total energy expenditure by age, gender and race/ethnicity. Analysis of covariance models, controlling for temperature examined changes in total counts and total energy expenditure using pairwise Sidak post-hoc comparisons. Total park use increased from 2012 (n=2080) to 2013 (n=2275) and remained constant in 2014 (n=2276). However, despite increases in safe access and overall park use, there was a significant decrease in total energy expenditure following the installation of the crosswalk that was sustained in 2014. This study shows that increasing safe access to parks primarily positively influences park use but not park-based physical activity. While improved safe access is encouraging greater park use, there is a need for future research to examine additional factors such as social support, programming and environmental changes to engage community members in park-based physical activity.

The Impact of a Signalized Crosswalk on Traffic Speed and Street-Crossing Behaviors of Residents in an Underserved Neighborhood.

Infrastructure improvements such as pedestrian crosswalks that calm traffic and increase access to physical activity opportunities could alleviate important barriers to active living in underserved communities with outdated built environments. The purpose of this study was to explore how the built environment influences street-crossing behaviors and traffic speeds in a low-income neighborhood with barriers to active living in Columbia, Missouri. In 2013, a signalized pedestrian crosswalk and 400-ft-long median was constructed along a busy 5-lane, high-speed arterial highway linking low-income housing with a park and downtown areas. Data collection occurred prior to June 2012, and after June 2013, completion of the project at the intervention site and control site. Direct observation of street-crossing behaviors was performed at designated intersections/crosswalks or non-designated crossing points. Traffic volume and speed were captured using embedded magnetic traffic detectors. At the intervention site, designated crossings increased at the new crosswalk (p < 0.001), but not at non-designated crossings (p = 0.52) or designated crossings at intersections (p = 0.41). At the control site, there was no change in designated crossings (p = 0.94) or non-designated crossings (p = 0.79). Motor vehicles traveling above the speed limit of 35 mph decreased from 62,056 (46 %) to 46,256 (35 %) (p < 0.001) at the intervention site and increased from 57,891 (49 %) to 65,725 (59 %) (p < 0.001) at the control site. The installation of a signalized crosswalk facilitated an increase in safe street crossings and calmed traffic volume and speed in an underserved neighborhood. We believe these findings have significant public health implications that could be critical to advocacy efforts to improve infrastructure projects in similar communities.

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.