Screening for Park Access during a Primary Care Social Determinants Screen
Abstract
:1. Introduction
2. Methods
2.1. Measures
2.1.1. Demographic Variables
2.1.2. Social Needs
2.1.3. Park Access
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- World Health Organization Social Determinants of Health. 2020. Available online: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health (accessed on 3 March 2020).
- Bedimo-Rung, A.L.; Mowen, A.J.; Cohen, D.A. The significance of parks to physical activity and public health: A conceptual model. Am. J. Prev. Med. 2005, 28 (Suppl. 2), 159–168. [Google Scholar] [CrossRef]
- Babey, S.H.; Hastert, T.A.; Yu, H.; Brown, E.R. Physical activity among adolescents. When do parks matter? Am. J. Prev. Med. 2008, 34, 345–348. [Google Scholar] [CrossRef]
- Mitchell, R.; Popham, F. Effect of exposure to natural environment on health inequalities: An observational population study. Lancet 2008, 372, 1655–1660. [Google Scholar] [CrossRef][Green Version]
- Lachowycz, K.; Jones, A.P. Does walking explain associations between access to greenspace and lower mortality? Soc. Sci. Med. 2014, 107, 9–17. [Google Scholar] [CrossRef] [PubMed]
- Kuo, M. How might contact with nature promote human health? Promising mechanisms and a possible central pathway. Front. Psychol. 2015, 6, 1093. [Google Scholar] [CrossRef] [PubMed]
- Hartig, R.; Mitchell, R.; de Vries, S.; Frumkin, H. Nature and health. Annu. Rev. Public Health 2014, 35, 207–228. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Wang, K.; Lombard, J.; Rundek, T.; Dong, C.; Gutierrez, C.M.; Byrne, M.M.; Toro, M.; Nardi, M.I.; Kardys, J.; Yi, L.; et al. Relationship of Neighborhood Greenness to Heart Disease in 249°405 US Medicare Beneficiaries. J. Am. Heart Assoc. 2019, 8, e010258. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Kuo, F.E.; Faber Taylor, A. A potential natural treatment for attention-deficit/hyperactivity disorder: Evidence from a national study. Am. J. Public Health 2004, 94, 1580–1586. [Google Scholar] [CrossRef]
- Engemann, K.; Pedersen, C.B.; Arge, L.; Tsirogiannis, C.; Mortensen, P.B.; Svenning, J.C. Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. Proc. Natl. Acad. Sci. USA 2019, 116, 5188–5193. [Google Scholar] [CrossRef][Green Version]
- James, P.; Hart, J.E.; Banay, R.F.; Laden, F. Exposure to greenness and mortality in a nationwide prospective cohort study of women. Environ. Health Perspect. 2016, 124, 1344–1352. [Google Scholar] [CrossRef][Green Version]
- Kondo, M.C.; Jacoby, S.F.; South, E.C. Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health Place 2018, 51, 136–150. [Google Scholar] [CrossRef] [PubMed]
- South, E.C.; Hohl, B.C.; Kondo, M.C.; MacDonlad, J.M.; Branas, C.C. Effect of Greening Vacant Land on Mental Health: A Citywide Randomized Controlled Trial. JAMA Netw. Open 2018, 1, e180298. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Donovan, G.H.; Michael, Y.L.; Gatziolis, D.; Prestemon, J.P.; Whitsel, E.A. Is tree loss associated with cardiovascular-disease risk in the Women’s Health Initiative? A natural experiment. Heal Place 2015, 36, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Seltenrich, N. Just What the Doctor Ordered: Using Parks to Improve Children’s Health. Environ. Health Perspect. 2015, 123, A254–A259. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Institute at the Golden Gate, ParkRx Census. Available online: https://www.parkrx.org (accessed on 6 April 2020).
- Coffey, J.S.; Gauderer, L. When pediatric primary care providers prescribe nature engagement at a State Park, do children “fill” the prescription? Ecopsychology 2016, 8, 207–214. [Google Scholar] [CrossRef][Green Version]
- Zarr, R.; Cottrell, L.; Merrill, C. Park Prescription (DC Park Rx): A New Strategy to Combat Chronic Disease in Children. J. Phys. Act. Health. 2017, 14, 1. [Google Scholar] [CrossRef]
- Hoffman, J.; Frerichs, L.; Story, M.; Jones, J.; Gaskin, K.; Apple, A.; Skinner, A.; Armstrong, S. An Integrated clinic-community partnership for child obesity treatment: A randomized pilot trial. Pediatrics 2018, 141, e20171444. [Google Scholar] [CrossRef][Green Version]
- Razani, N.; Niknam, K.; Wells, N.M.; Thompson, D.; Hills, N.K.; Kennedy, G.; Gilgoff, R.; Rutherford, G.W. Clinic and park partnerships for childhood resilience: A prospective study of park prescriptions. Health Place 2019, 57, 179–185. [Google Scholar] [CrossRef]
- Razani, N.; Morshed, S.; Kohn, M.A.; Wells, N.M.; Thompson, D.; Alqassari, M.; Agodi, A.; Rutherford, G.W. Effect of park prescriptions with and without group visits to parks on stress reduction in low-income parents: SHINE randomized trial. PLoS ONE 2018, 13, e0192921. [Google Scholar] [CrossRef][Green Version]
- Ng, K.S.T.; Sia, A.; Ng, M.K.W.; Tan, C.T.Y.; Chan, H.Y.; Tan, C.H.; Rawtaer, I.; Feng, L.; Mahendran, R.; Larbi, A.; et al. Effects of horticultural therapy on Asian older adults: A randomized controlled trial—Clinical Trial. Int. J. Environ. Res. Public Health 2018, 15, 1705, PMID 30096932. [Google Scholar] [CrossRef][Green Version]
- Müller-Riemenschneider, F.; Nicholas Petrunoff, N.; Yao, J.; Ng, A.; Sia, A.; Ramiah, A.; Wong, M.; Han, J.; Bee Choo Tai, B.C.; Uijtdewilligen, L. Effectiveness of prescribing physical activity in parks to improve health and wellbeing—The park prescription randomized controlled trial. Int. J. Behav. Nutr. Phys. Act. 2020, 17, 42. [Google Scholar] [CrossRef] [PubMed]
- Gottlieb, L.M.; Hessler, D.; Long, D.; Laves, E.; Burns, A.R.; Amaya, A.; Sweeney, P.; Schudel, C.; Adler, N.E. A Randomized Trial on Screening for Social Determinants of Health: The iScreen Study. Pediatrics 2014, 134, e1611–e1618. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Harris, P.A.; Taylor, R.; Thielke, R.; Payne, J.; Gonzalez, N.; Conde, J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009, 42, 377–381. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Gottlieb, L.M.; Hessler, D.; Long, D.; Laves, E.; Burns, A.R.; Amaya, A.; Sweeney, P.; Schudel, C.; Adler, N.E. Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial. JAMA Pediatr. 2016, 170, e162521. [Google Scholar] [CrossRef] [PubMed]
- Tilt, J.H.; Unfried, T.M.; Roca, B. Using objective and subjective measures of neighborhood greenness and accessible destinations for understanding walking trips and BMI in Seattle, Washington. Am. J. Health Promot. 2007, 21 (Suppl. 4), 371–379. [Google Scholar] [CrossRef]
- Estabrooks, P.A.; Glasgow, R.E.; Dzewaltowski, D.A. Physical activity promotion through primary care. JAMA 2003, 289, 2913–2916. [Google Scholar] [CrossRef]
- Gordon-Larsen, P.; Nelson, M.C.; Page, P.; Popkin, B.M. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics 2006, 117, 417–424. [Google Scholar] [CrossRef][Green Version]
- Boone-Heinonen, J.; Casanova, K.; Richardson, A.S.; Gordon-Larsen, P. Where can they play? Outdoor spaces and physical activity among adolescents in U.S. urbanized areas. Prev. Med. 2010, 51, 295–298. [Google Scholar] [CrossRef][Green Version]
- Wen, M.; Zhang, X.; Harris, C.D.; Holt, J.B.; Croft, J.B. Spatial Disparities in the Distribution of Parks and Green Spaces in the USA. Ann. Behav. Med. 2013, 45 (Suppl. 1), S18–S27. [Google Scholar] [CrossRef][Green Version]
- Razani, N.; Hills, N.K.; Thompson, D.; Rutherford, G.W. The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the US. Int. J. Environ. Res. Public Health 2020, 17, 701. [Google Scholar] [CrossRef][Green Version]
- Hordyk, S.R.; Hanley, J.; Richard, E. "Nature is there; its free": Urban greenspace and the social determinants of health of immigrant families. Health Place 2015, 34, 74–82. [Google Scholar] [CrossRef] [PubMed]
- Wells, N.; Evans, G.W. Nearby nature: A buffer of life stress among rural children. Environ. Behav. 2003, 35, 311–330. [Google Scholar] [CrossRef]
- Jennings, V.; Baptiste, A.K.; Osborne Jelks, N.; Skeete, R. Urban Green Space and the Pursuit of Health Equity in Parts of the United States. Int. J. Environ. Res. Public Health 2017, 14, 1432. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Duncan, D.T.; Kawachi, I.; White, K.; Williams, D.R. The geography of recreational open space: Influence of neighborhood racial composition and neighborhood poverty. J. Urban Health 2013, 90, 618–631. [Google Scholar] [CrossRef][Green Version]
Characteristics | Total | % | Unmet Need | (%) | p-Value |
---|---|---|---|---|---|
n | n | ||||
Child’s gender | 0.054 b | ||||
Male | 409 | 59 | (14) | ||
Female | 471 | 53 | 91 | (19) | |
Child’s age | 0.511 b | ||||
0 to 4 | 545 | 89 | (16) | ||
1 to 5 | 206 | 41 | (20) | ||
6 to 12 | 71 | 12 | (17) | ||
Child’s race and ethnicity | 0.753 a | ||||
White non-Hispanic | 34 | −3.8 | 5 | (15) | |
Hispanic | 255 | −33.6 | 44 | (17) | |
Black non-Hispanic | 287 | −39.4 | 63 | (18) | |
Black Hispanic | 54 | −7.5 | 13 | (24) | |
Asian | 35 | −5 | 10 | (29) | |
Pacific Islander | 6 | −0.9 | 2 | (33) | |
Native American or Alaskan Native | 6 | −0.7 | 0 | 0 | |
Other | 66 | −9 | 14 | (1) | |
Caregiver gender | 0.293 b | ||||
Male | 95 | 20 | (21) | ||
Female | 765 | −88.9 | 128 | (17) | |
Caregiver age | 0.013 b | ||||
18 to 24 | 185 | 23 | (12) | ||
25 to 34 | 352 | 78 | (22) | ||
35 to 44 | 229 | 32 | (14) | ||
45 and above | 76 | 12 | (16) | ||
Highest level of education | 0.016 b | ||||
Less than high school | 233 | −27.3 | 54 | (23) | |
High school graduate | 478 | −56 | 74 | (15) | |
College or graduate school | 142 | −16.7 | 19 | (13) | |
Federal poverty level | 0.005 b | ||||
Above federal poverty level | 226 | 24 | (11) | ||
At or below federal poverty level | 528 | 100 | (19) | ||
Number of social needs (out of 14) median and IQR | 2 (1–4) |
Item | n | (% of Total) | Prioritized Access to Parks and Playgrounds | p-value |
---|---|---|---|---|
Running out of food before you had money or food stamps to buy more | 397 | (45) | 7 | <0.001 * |
Not having enough money to pay your utility bills, such as electric, gas, water, or phone | 381 | (43) | 10 | <0.001 * |
Trouble finding a job | 248 | (28) | 4 | <0.001 ** |
Medical bills | 232 | (26) | 3 | <0.001 ** |
Not having a place to live for example, concerns about eviction, foreclosure, staying with friends/family, and current homelessness | 219 | (25) | 2 | <0.001 ** |
Lack of access to green spaces/parks/playgrounds | 151 | (17) | 33 | n/a |
No health insurance | 150 | (17) | 3 | <0.001 ** |
Unhealthy living environments, for example, problems such as mold, insects, rats or mice, excess trash | 147 | (17) | 6 | |
Being cut off or denied from programs that provide income supports to your family, such as CalFresh (food stamps) or CalWorks (welfare) | 143 | (16) | 4 | |
No primary care or regular general doctor | 116 | (13) | 3 | |
Other concerns with your housing | 114 | (13) | 4 | |
Disability-related impairment interfering with ability to work | 96 | (11) | 3 | |
Accessing mental health care for you or another caregiver in your household | 63 | (7) | 3 | |
Problems with a current or former job, such as unpaid wages, worker’s compensation, wrongful termination, discrimination or harassment, or needing unemployment insurance | 53 | (6) | 0 | <0.001 ** |
Concerns about pregnancy-related work benefits | 19 | (2) | 0 |
Parameter | Odds Ratio | 95% Confidence Interval | p-Value |
---|---|---|---|
Family living at or below the federal poverty level | 1.96 | (1.16–3.31) | 0.012 |
Child’s gender female | 1.31 | (0.87–1.98) | 0.183 |
Child’s age | 1.02 | (0.98–1.08) | 0.264 |
Child’s race and ethnicity | |||
White (Comparison) | – | – | – |
Hispanic White | 0.7 | (0.23–2.10) | 0.527 |
Black | 1.35 | (0.72–2.55) | 0.35 |
Hispanic Black | 1.03 | (0.30–3.49) | 0.961 |
Asian | 1.59 | (0.423–6.01) | 0.49 |
Pacific Islander | 0.51 | (0.05–5.63) | 0.584 |
Other | 1.05 | (0.31–3.55) | 0.942 |
Caregiver’s gender female | 0.53 | (0.98–1.08) | 0.228 |
Caregiver’s age | 0.99 | (0.29–0.97) | 0.04 |
Caregiver’s level of education less than high school | 1.71 | (1.17–2.49) | 0.005 |
Family living at or below the federal poverty level | 1.96 | (1.16–3.31) | 0.012 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Razani, N.; Long, D.; Hessler, D.; Rutherford, G.W.; Gottlieb, L.M. Screening for Park Access during a Primary Care Social Determinants Screen. Int. J. Environ. Res. Public Health 2020, 17, 2777. https://doi.org/10.3390/ijerph17082777
Razani N, Long D, Hessler D, Rutherford GW, Gottlieb LM. Screening for Park Access during a Primary Care Social Determinants Screen. International Journal of Environmental Research and Public Health. 2020; 17(8):2777. https://doi.org/10.3390/ijerph17082777
Chicago/Turabian StyleRazani, Nooshin, Dayna Long, Danielle Hessler, George W. Rutherford, and Laura M. Gottlieb. 2020. "Screening for Park Access during a Primary Care Social Determinants Screen" International Journal of Environmental Research and Public Health 17, no. 8: 2777. https://doi.org/10.3390/ijerph17082777