Physical Activity, Social Isolation, Stress, Psychological
Conditions
Keywords
Parks, Well-being, Stress, Physical Activity, Nature, Greenspace
Brief summary
The SHINE study is a randomized controlled study of the effect of a park-based family support group on multiple outcomes (including stress and physical activity) in a low income population.
Detailed description
Despite mounting evidence that nature matters for human health, we are not aware of any prospective intervention trials looking at the use of nature as a health intervention. Like other protective factors, such as the presence of a caring adult, safe play places, greater stimulation, the presence of green-space in a child's life has been empirically linked to greater resilience. Nature has been proposed as a buffer to stress through several pathways: by providing a space for friends and families to gather (thereby increasing social support and improving family relationships), by increasing opportunities for physical activity, and by improving cognition. Research to date suggests that participation in outdoor activities facilitates a sense of connectedness to place. This sense of attachment may also provide a form of social support. Families served by Children's Hospital Oakland Primary Care Clinic experience high levels of stress. As a safety-net clinic, the primary care clinic serves a diverse set of patients, with a common thread of poverty. The Stay Healthy In Nature program was developed to encourage stress management skills through play and physical activity in parks. The program uses a combination of facilitated and independent outings into local parks to encourage sustained behavior change and measurable health benefits.
Interventions
BEHAVIORALFamily outings
Participants will be invited to three weekly outings to local parks, case management and support in getting to nature. Participants will be offered transportation to the outings and s meal at local nature destinations. Programming at the park will include a picnic and walk with nature exploration, and will be facilitated by park and clinic staff.
BEHAVIORALPark prescription
Participants will receive a map of local parks, and the recommendation to be physically active outdoors three days a week in nature.
DEVICEPedometry
Participants will record their daily pedometry.
BEHAVIORALCase Management
Participants will receive a phone call to list potential barriers to participating in nature outings, and will talk through solutions with an investigator. Participants will be offered assistance with transportation if necessary.
Sponsors
East Bay Regional Park District
National Recreation and Park Association
University of California, San Francisco
UCSF Benioff Children's Hospital Oakland
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
4 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Child must be 4 years and older, a patient in our clinic, physically able, available for follow up, able to answer questionnaire * Caregiver must be 18 or older, legal guardian, physically able, able for follow up, able to answer questionnaire
Exclusion criteria
* Enrolled in a weight loss program, unable to be physically active, unable to give informed consent, unable to follow up for study duration.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Stress | 3 months | measured through the Perceived Stress Score10 (PSS10) over 0, 1 and 3 months. The PSS10 is a ten item, validated instrument which ranges from 0-40. Each item on the instrument is summed to create a total score. Higher values correspond with higher stress. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Park Visits Per Week | 1 month | Self-reported number of park visits in the last week, measured at 0, 1, and 3 months. |
| Change in Minutes of Moderate Physical Activity Per Day | 3 months | Parents will report their physical activity in terms of minutes of moderate physical activity in the week before follow up at 0, 1, and 3 months out. Pedometers were also given to participants. Of note, because of poor follow through with returning pedometer data, this variable was not analyzed in the study results. |
| Change in Cortisol Level in Parents | 3 months | Salivary cortisol from parents |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Park Prescription Park prescription, pedometry.
Park prescription: Participants will receive a map of local parks, and the recommendation to be physically active outdoors three days a week in nature.
Pedometry: Participants will record their daily pedometry. | 56 |
| Park Prescription and Family Outings Park prescription, pedometry, case management and 3 weekly family outings.
Family outings: Participants will be invited to three weekly outings to local parks, case management and support in getting to nature. Participants will be offered transportation to the outings and s meal at local nature destinations. Programming at the park will include a picnic and walk with nature exploration, and will be facilitated by park and clinic staff.
Park prescription: Participants will receive a map of local parks, and the recommendation to be physically active outdoors three days a week in nature.
Pedometry: Participants will record their daily pedometry.
Case Management: Participants will receive a phone call to list potential barriers to participating in nature outings, and will talk through solutions with an investigator. Participants will be offered assistance with transportation if necessary. | 100 |
| Total | 156 |
Baseline characteristics
| Characteristic | Park Prescription | Park Prescription and Family Outings | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 28 Participants | 50 Participants | 78 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 28 Participants | 50 Participants | 78 Participants |
| Race/Ethnicity, Customized African-American | 39 Participants | 59 Participants | 98 Participants |
| Race/Ethnicity, Customized Latino | 4 Participants | 21 Participants | 25 Participants |
| Race/Ethnicity, Customized Non-Latino White | 1 Participants | 5 Participants | 6 Participants |
| Race/Ethnicity, Customized Other (Native American, Middle Eastern, API) | 12 Participants | 17 Participants | 29 Participants |
| Region of Enrollment United States | 56 Participants | 100 Participants | 156 Participants |
| Sex: Female, Male Female | 34 Participants | 72 Participants | 106 Participants |
| Sex: Female, Male Male | 22 Participants | 28 Participants | 50 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 28 | 0 / 50 |
| other Total, other adverse events | 0 / 28 | 0 / 50 |
| serious Total, serious adverse events | 0 / 28 | 0 / 50 |
Outcome results
Primary
Change in Stress
measured through the Perceived Stress Score10 (PSS10) over 0, 1 and 3 months. The PSS10 is a ten item, validated instrument which ranges from 0-40. Each item on the instrument is summed to create a total score. Higher values correspond with higher stress.
Time frame: 3 months
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Stress | -1.48 units on a scale |
| Park Prescription and Family Outings | Change in Stress | -1.83 units on a scale |
Comparison: The study is powered for our primary outcome, caregiver stress as measured by the 10-item perceived stress s score (PSS10). Normative data from population samples show a mean PSS10 score of 13.2 points with a standard deviation of 6.35 points and a within-subject correlation coefficient of 0.77 over 2 weeks.We powered the study to detect a three point difference in the change of the PSS10. This effect size is consistent with other estimates of a clinically significant change.p-value: 0.6099t-test, 2 sided
Primary
Change in Stress
measured through the Perceived Stress Score10 (PSS10), a ten item, validated instrument which ranges from 0-40.
Time frame: 1 month
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Stress | -2.81 units on a scale |
| Park Prescription and Family Outings | Change in Stress | -1.90 units on a scale |
Secondary
Change in Cortisol Level in Parents
Salivary cortisol from parents
Time frame: 3 months
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Cortisol Level in Parents | -0.01 ug/dL |
| Park Prescription and Family Outings | Change in Cortisol Level in Parents | 0.01 ug/dL |
p-value: 0.1749t-test, 2 sided
Secondary
Change in Cortisol Level in Parents
Salivary cortisol from parents
Time frame: 1 month
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Cortisol Level in Parents | -0.01 ug/dL |
| Park Prescription and Family Outings | Change in Cortisol Level in Parents | 0.01 ug/dL |
Secondary
Change in Minutes of Moderate Physical Activity Per Day
Parents will report their physical activity in terms of minutes of moderate physical activity in the week before follow up at 0, 1months follow up. Pedometers were also given to participants. Of note, because of poor follow through with returning pedometer data, this variable was not analyzed in the study results.
Time frame: 1 month
Population: Minutes of moderate physical activity per average day in the week prior to follow up at 0, 1 and 3 months was measured. Below we list the mean within group change of minutes of moderate physical activity per day.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Minutes of Moderate Physical Activity Per Day | 20.72 minutes/day |
| Park Prescription and Family Outings | Change in Minutes of Moderate Physical Activity Per Day | 30.76 minutes/day |
Secondary
Change in Minutes of Moderate Physical Activity Per Day
Parents will report their physical activity in terms of minutes of moderate physical activity in the week before follow up at 0, 1, and 3 months out. Pedometers were also given to participants. Of note, because of poor follow through with returning pedometer data, this variable was not analyzed in the study results.
Time frame: 3 months
Population: Minutes of moderate physical activity per average day in the week prior to follow up at 0, 1 and 3 months was measured. Below we list the mean within group change of minutes of moderate physical activity per day.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Minutes of Moderate Physical Activity Per Day | 33.91 minutes/day |
| Park Prescription and Family Outings | Change in Minutes of Moderate Physical Activity Per Day | 18.58 minutes/day |
Secondary
Change in Park Visits Per Week
Self-reported number of park visits in the last week, measured at 0, 1, and 3 months.
Time frame: 1 month
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Park Visits Per Week | 1.81 park visits/week |
| Park Prescription and Family Outings | Change in Park Visits Per Week | 1.08 park visits/week |
p-value: 0.0085t-test, 2 sided
Secondary
Change in Park Visits Per Week
Self-reported number of park visits in the last week, measured at 0, 1, and 3 months.
Time frame: 3 month
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Park Prescription | Change in Park Visits Per Week | -1.48 park visits/week |
| Park Prescription and Family Outings | Change in Park Visits Per Week | -1.83 park visits/week |