Promoting physical activity in high-poverty neighborhood parks: A cluster randomized controlled trial

"If children don't feel safe, they won't come back": A qualitative exploration of parents' perceptions of health coordinators in a family-based programme in socially disadvantaged communities

Background

Families residing in disadvantaged communities encounter inequalities that restrict their engagement in physical activity. Family-based interventions and health coordinators have been proposed as promising approaches to encourage physical activity among parents and children. However, there is a paucity of knowledge regarding family experiences of such programmes and the ways health coordinators facilitate continued participation in programmes delivered in disadvantaged communities. The study aimed to explore parents' perceptions of health coordinators in a family-based physical activity programme, Open Activities, delivered in disadvantaged communities in Sweden.

Study design

An exploratory design with a qualitative ethnographic approach.

Methods

Multiple methods, including 12 interviews, 15 observations and field notes, and prolonged researcher engagement between February 2022 and December 2023, were used to obtain complementary insights into parents' perceptions and experiences in the Open Activities programme. Data was analysed using reflexive thematic analysis.

Results

A main theme and three sub-themes emerged from the analysis. The sub-themes reflect participants' perceptions of how health coordinators provide a sense of safety for parents and children, making them feel appreciated and motivated to continue participating in the programme. The sub-themes also reflect the struggles that families encounter with security and social disorders in their neighbourhoods and how these difficulties influence their participation in outdoor activities and trust in outside people, including health coordinators. This required health coordinators to demonstrate a deep commitment to their communities, cultivate trust and fairness, and take a more assertive role in enforcing rules and ensuring respect.

Conclusion

The involvement of health coordinators, aware of the issues facing disadvantaged communities, could represent a promising avenue for advancing health equity through physical activity. Failure to consider the potential of health coordinators to promote safety can compromise programmes' sustainability and even exacerbate existing disparities.

Motivation for Physical Activity in Low-Income Adults: An Integrative Literature Review

AIM

To explore, review and assess the literature on motivation for physical activity in low-income adults to inform future research and clinical interventions.

DESIGN

An integrative review of the literature on motivation for physical activity in low-income adults.

METHODS

Whittemore and Knaul's five-stage methodological approach for integrative reviews was utilised. Studies written in English that focused primarily on low-income adults discussed physical activity and included a component of motivation or drive were included. The Johns Hopkins Evidence Level and Quality Guide was used to assess the quality of the studies.

DATA SOURCES

PubMed, CINAHL, PsycINFO, SPORTDiscuss and Google Scholar from 1 January 2018 - 23 August 2024.

RESULTS

A total of 20 studies met the inclusion criteria. Three main categories of factors impacting physical activity in low-income adults were identified: (1) motivators for physical activity, (2) barriers for physical activity (3) and items that were both a motivator and a barrier. Despite the key role nurses play in promoting health and wellness, studies conducted by nurses or employing nursing interventions were notably absent.

CONCLUSION

This integrative literature review highlights the need for more information about what motivates low-income adults to be more physically active.

IMPLICATIONS FOR THE PROFESSION

Understanding the experience of low-income adults with physical activity is integral to meeting their needs and facilitating increased physical activity. Future research should utilise nursing theories and interventions to improve physical activity levels among low-income adults.

IMPACT

This study addressed physical inactivity in low-income adults. More information is needed about motivation for physical activity. This information will impact researchers and clinicians.

REPORTING METHOD

The search strategy and reporting method were consistent with PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Go-along interview assessment of community health priorities for neighborhood renewal

Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus.

Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review

Nature prescriptions are gaining popularity as a form of social prescribing in support of sustainable health care. This systematic review and meta-analysis aims to synthesise evidence on the effectiveness of nature prescriptions and determine the factors important for their success. We searched five databases from inception up to July 25, 2021. Randomised and non-randomised controlled studies featuring a nature prescription (ie, a referral or an organised programme, by a health or social professional, to encourage spending time in nature) were included. Two reviewers independently conducted all steps of study selection; one reviewer collected summary data from published reports and conducted the risk of bias assessment. Random-effect DerSimonian-Laird meta-analyses were conducted for five key outcomes. We identified 92 unique studies (122 reports), of which 28 studies contributed data to meta-analyses. Compared with control conditions, nature prescription programmes resulted in a greater reduction in systolic blood pressure (mean difference -4·82 mm Hg [-8·92 to -0·72]) and diastolic blood pressure (mean difference -3·82 mm Hg [-6·47 to -1·16). Nature prescriptions also had a moderate to large effect on depression scores (post-intervention standardised mean difference -0·50 [-0·84 to -0·16]; change from baseline standardised mean difference -0·42 [-0·82 to -0·03]) and anxiety scores (post-intervention standardised mean difference -0·57 [-1·12 to -0·03]; change from baseline standardised mean difference -1·27 [-2·20 to -0·33]). Nature prescriptions resulted in a greater increase in daily step counts than control conditions (mean difference 900 steps [790 to 1010]) but did not improve weekly time of moderate physical activity (mean difference 25·90 min [-10·26 to 62·06]). A subgroup analysis restricted to studies featuring a referring institution showed stronger effects on depression scores, daily step counts, and weekly time of moderate physical activity than the general analysis. Beneficial effects on anxiety and depression scores were mainly provided by interventions involving social professionals whereas beneficial effects on blood pressures and daily step counts were provided mainly by interventions involving health professionals. Most studies have a moderate to high risk of bias. Nature prescription programmes showed evidence of cardiometabolic and mental health benefits and increases in walking. Effective nature prescription programmes can involve a range of natural settings and activities and can be implemented via social and community channels, in addition to health professionals.

The Impact of the Social Determinants of Human Health on Companion Animal Welfare

The social determinants of health (SDH) focus on the social, physical and economic factors that impact human health. Studies have revealed that animal guardians face a range of challenges in attaining positive welfare outcomes for their companion animals, which can be influenced by socioeconomic and environmental factors. Despite this, there is a lack of research specifically exploring the relationship between SDH and animal welfare outcomes. Given that the SDH impact on humans, which in turn directly impacts on their companion animal, it is important to adapt an SDH framework for companion animal welfare by characterising the impact of the SDH on companion animal guardians in their attempts to care for their animals and, by extension, the associated welfare outcomes. This paper explores how these human health determinants may impact animal welfare and the possible challenges that may arise for the guardian when attempting to meet their companion animal's welfare needs. By integrating the SDH with other key frameworks, including the five domains model of animal welfare, through multidisciplinary collaboration, this framework can be used to inform future programs aiming to improve animal welfare.

The Effectiveness of Interventions to Increase Participation and Physical Activities in Parks: A Systematic Review of the Literature

Although a variety of interventions in many countries have been developed to increase park use and to improve public participation in physical activities in parks, knowledge of their overall effectiveness is lacking. A systematic literature review was undertaken to further understand the effectiveness of various interventions that aim to increase the use of parks and physical activity participation in parks. This systematic review utilized the standard Preferred Reporting Items for Systematic Reviews and Meta-Analysis procedure, and of the 3801 studies identified, 60 studies were reviewed in-depth, with 44 studies assessed for quality of evidence and risk of bias. Most of the 44 reviewed studies found that various interventions had positive impacts on park use and physical activity participation in parks. Interventions were classified into both demand and supply, with more studies focusing on the supply side. The strongest evidence on the effectiveness of various interventions was found for park prescriptions; safe access to parks; playgrounds, and park renovation and renewal/design. However, the assessment of quality of evidence and risk of bias showed that most studies suffer from potential biases and evidence weaknesses, suggesting a need to further establish external validity.

Evaluating physical activity interventions for socioeconomically disadvantaged adults through the RE-AIM framework: A systematic review of experimental and non-/quasi-experimental trials

The promotion of physical activity in people from lower social strata is a public health priority. Previous reviews of physical activity interventions among socioeconomically disadvantaged adults have focused on intervention effectiveness without considering their translation into practice. This review utilised the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) to (1) evaluate the extent to which experimental and non-/quasi-experimental trials of interventions to promote physical activity among socioeconomically disadvantaged adults report on issues of internal and external validity and (2) to provide recommendations for future intervention studies. Four databases were searched through June 2021. We included studies published in English or German since 2000 that tested physical activity interventions for socioeconomically disadvantaged adults. Two researchers coded all studies using a validated RE-AIM data extraction tool with 61 indicators referring to internal and external validity. Binary coding (yes = 1/no = 0) was applied to calculate the number and percentage of studies reporting each of the indicators. We included 39 studies of which 22 were non-/quasi-experimental trials. Indicators of reach were most frequently reported (59.2%), followed by implementation (38.9%) and efficacy/effectiveness (28.9%). Dimensions related to external validity were least frequently reported (adoption: 21.9%, maintenance: 17.8%). Few differences were found between experimental and non-/quasi-experimental trials. Analysis showed overall poor reporting of components related to internal and external validity. We recommend that future research should increase attention on reporting indicators of internal and external validity to facilitate their translation and implementation into real world settings. Trial registration: The review was registered with PROSPERO (CRD42021283688).

Engaging citizen scientists to build healthy park environments in Colombia

Colombia's Recreovía program offers community-based free physical activity (PA) classes in parks. We evaluated built and social environmental factors influencing Recreovía local park environments, and facilitated a consensus-building and advocacy process among community members, policymakers and academic researchers aimed at improving uptake and impact of the Recreovía program. We used a mixed-methods approach, with individual and contextual PA measurements and a resident-enabled participatory approach (the Our Voice citizen science engagement model). Recreovía participants were likely to be women meeting PA recommendations, and highly satisfied with the Recreovía classes. Reported facilitators of the Recreovía included its role in enhancing social and individual well-being through PA classes. Reported barriers to usage were related to park maintenance, cleanliness and safety. The Our Voice process elicited community reflection, empowerment, advocacy and action. Our Voice facilitated the interplay among stakeholders and community members to optimize the Recreovía program as a facilitator of active living, and to make park environments more welcoming.

Randomized Informational Intervention and Adult Park Use and Park-Based Physical Activity in Low-Income, Racially Diverse Urban Neighborhoods

BACKGROUND

Neighborhood parks are important locations to encourage and stimulate physical activity (PA) among the urban population. This study aims to evaluate the impact of an informational intervention on adult park use and PA behaviors in 3 low-income, racially diverse urban neighborhoods in Minneapolis, MN.

METHOD

The study employed a household-level randomized controlled trial and collected baseline and follow-up data from 171 participants. Within each neighborhood, participants were randomized to an informational intervention or to a no-intervention comparison. Intervention households received monthly, neighborhood-specific newsletters about park-based PA opportunities, park program brochures, trail maps, and activity guides.

RESULTS

The average treatment effect of the newsletter intervention was positive yet moderated by respondent age. For a 20-year-old resident, treatment was associated with 0.97 (P < .05) additional park visits and 31.24 (P < .05) additional minutes of park-based PA over a 3-day recall period. For 40-year-old respondents, these positive effects are smaller at 0.36 (P < .05) additional visits and 4.66 (P < .05) additional minutes, respectively.

CONCLUSIONS

An intervention to increase awareness about park-based PA opportunities and benefits increased self-reported park visits and in-park PA among adults who lived in low-income, racially diverse neighborhoods.

Effects of park-based interventions on health-related outcomes: A systematic review

Increasing use of parks for physical activity has been proposed for improving population health, including mental health. Interventions that aim to increase park use and park-based physical activity include place-based interventions (e.g., park renovations) and person-based interventions (e.g., park-based walking or exercise classes). Using adapted methods from the Community Guide, a systematic review (search period through September 2019) was conducted to evaluate the effectiveness of park-based interventions among adults. The primary outcomes of interest were health-related, including physical and mental health and moderate-to-vigorous physical activity. Twenty-seven studies that met review criteria were analyzed in 2019 and 2020. Seven person-based studies included generally small samples of specific populations and interventions involved mostly exercise programming in parks; all but one had an average quality rating as "high" and all had at least one statistically significant outcome. Of the 20 place-based interventions, 7 involved only 1 or 2 parks; however, 7 involved from 9 to 78 parks. Types of interventions were predominantly park renovations; only 5 involved park-based exercise programming. Most of the renovations were associated with increased park-level use and physical activity, however among those implementing programming, park-level effects were more modest. Less than half of the place-based intervention studies had an average quality rating of "high." The study of parks as sites for physical activity interventions is nascent. Hybrid methods that combine placed-based evaluations and cohort studies could inform how to best optimize policy, programming, design and management to promote health and well-being.

Association between Urban Greenspace and Health: A Systematic Review of Literature

The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases—PubMed/Medline and Excerpta Medica dataBASE (EMBASE)—were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological limitations of the included studies, the results have shown almost univocally that urban greenspaces harbour potentially beneficial effects on physical and mental health and well-being.

Improved Street Walkability, Incivilities, and Esthetics Are Associated with Greater Park Use in Two Low-Income Neighborhoods

Parks may provide opportunities for people to increase their physical activity and improve health. Yet, parks are generally less plentiful and underutilized in low-income urban neighborhoods compared with more advantaged neighborhoods. Renovations within and around parks may improve park utilization but the empirical evidence supporting this relationship is scarce. This study assessed the impact of greenspace, housing, and commercial investments on street characteristics (walkability, amenities, incivilities/poor esthetics) and park use by examining park use over time in two low-income neighborhoods in Pittsburgh, PA (n = 17 parks), before and after neighborhood-based renovations that were primarily centered in one neighborhood. We used systematic observation of parks, park use, and street blocks surrounding parks to examine the impact of neighborhood changes on park use. We used difference-in-differences to test whether park use and street characteristics surrounding the parks improved more in the intervention neighborhood than in the comparison neighborhood. We also used zero-inflated negative binomial regression with interactions by time to test whether changes in street characteristics were associated with changes in park use over time. We found that improved walkability, incivilities, and esthetics surrounding parks in socioeconomically disadvantaged neighborhoods were associated with greater park use and may help increase visits to underutilized parks.

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.

Will the children use it?-A RE-AIM evaluation of a local public open space intervention involving children from a deprived neighbourhood

Knowledge on how to improve public open spaces in deprived neighbourhoods to increase active living among children is scarce and comprehensively evaluated public open space interventions are needed. Firstly, the aim was to explore if involving 39 local fifth-grade children (10-11 years old) from a deprived neighbourhood in creating playable installations in a public open space influenced their use of this space. Secondly, we wanted to explore if the Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was useful for evaluating different stages in the intervention project. RE-AIM was applied through a convergent mixed-methods triangulation design using survey, accelerometer, GPS, and interviews as data sources. Effectiveness outcomes revealed that on average the space was used less by the 39 children after the intervention. The implementation and maintenance dimensions revealed aspects of why most children involved in the project did not use the space after intervention. The evaluation cast light on children's perceptions of their role, and importance of maintenance when the intervention was completed. In future, all dimensions of built environmental projects would benefit from being planned and evaluated in a collaboration with all project partners using an evaluation framework integrated and applied from the beginning of the project.

The mediating role of perceived crime in gender and built environment associations with park use and park-based physical activity among park users in high poverty neighborhoods

Women use parks less for physical activity than men, and explanations include gendered concerns regarding personal safety and access to walking paths. This study conducted mediation analyses to examine the effects of gender and presence of park walking path on park use, participation in park programs, and park-based physical activity through the hypothesized mediator (perception of crime). The sample included 3213 park users from 48 parks in high poverty neighborhoods in Los Angeles surveyed between 2013 and 2015; park-level factors were assessed through systematic observations of study parks. Women reported fewer park visits than men in the last 7 days (β = -0.17, p = 0.02) and had significantly higher perceived crime (β = 0.12, p < 0.0001) and perceived crime partially mediated the gender association with park visits (βgender, direct = -0.09, p = 0.19; βgender, indirect = -0.07, p < 0.0001). Similarly, the existence of a walking path in the park was significantly related to increased park use (β = 0.27, p = 0.006) and a lower level of perceived crime (β = -0.25, p = 0.0034) and perceived crime partially mediated the association of walking path with park visits (βwalking path, direct = 0.18, p = 0.10; βwalking path, indirect = 0.15, p = 0.005). The associations between gender, walking path, and park-based exercise and program participation were not meaningfully mediated by perceived crime. Among park users in majority Latino, high poverty neighborhoods, addressing crime concerns are likely necessary to increase park use among women and adults whose parks do not have a walking path. For park-based exercise and participation in park programs, gendered preferences regarding park-based physical activity should be explored.

Park Marketing Strategies, Park Conditions, and Park Use: A Longitudinal National Study of Parks

BACKGROUND

Parks present opportunities for recreational physical activity and mental relaxation; however, they are underutilized.

METHODS

The authors examined how changes in management directly and indirectly impacted park use. Using a national sample of 169 parks sampled from 25 cities, the authors linked park management reported via surveys with systematic direct observation of park use, park-based physical activity, and park conditions observed during the spring/summers of 2014 and 2016. The authors used structural equation modeling to estimate longitudinal pathways from changes in park management and conditions to changes in park use.

RESULTS

Increases in subsidized meal offerings and greater use of marketing to promote park events predicted increased person-hours of total weekly park use. Pathways predicting park use varied across user and activity type.

CONCLUSION

The authors' findings suggest that changing park management practices combined with park conditions may promote park use.

Could nature help children rise out of poverty? Green space and future earnings from a cohort in ten U.S. cities

BACKGROUND

Growing up in poverty is associated with poor health, and the American Dream of upward mobility is becoming an illusion for many low-income children. But nearby green space can support academic achievement, creativity, and emotional regulation, and these traits might help children rise out of poverty.

OBJECTIVES

To examine the relationship between recent incomes of children born into poverty in the ten largest U.S. cities and densities of residential green space during childhood.

METHODS

We calculate park proximity, park acreage, new park development, and NDVI greenness for 1980-1990 from Landsat and Trust for Public Land data. We obtain the 2014 income for children born between 1978 and 1982 into families in poverty from The Opportunity Atlas cohort, aggregated at the tract level (n = 5849).

RESULTS

Conditional autoregressive (CAR) models of tracts show statistically significant associations between income rank and above-average levels of greenness but not between income rank and park measures, adjusting for individual and neighborhood confounders and spatial autocorrelation. We estimate that, over a 30-year career, children growing up in tracts with the most vegetative cover will earn cumulatively $28,000 more than children growing up in tracts with the least cover, on average. Tracts with lower than average levels of precipitation, higher disadvantage, higher population density, or higher annual temperatures do not show beneficial effects of green space.

CONCLUSIONS

Greenness may be weakly associated with children rising out of poverty in wetter, cooler, less-dense, more advantaged census tracts.

Association Between Government Health Insurance Status and Physical Activity in American Youth

BACKGROUND

Health insurance plans provide health programming access and affect physical activity levels in American youth, leading to health disparities in American children. The primary purpose of the current study was to investigate the relationship between health insurance status and physical activity level in American youth.

METHODS

A national, United States census weighted cross-sectional survey was performed analyzing 2002 noninstitutionalized children living in the United States between the ages of 10 to 18 years, equally split by age and sex, with state of residency and race/ethnicity proportional to the 2010 census distribution. Multiple linear regression was performed to investigate the relationship between insurance status and activity level (measured by HSS Pedi-FABS activity score) while controlling for relevant demographic and socioeconomic covariables.

RESULTS

HSS Pedi-FABS activity scores were normally distributed with a mean of 15.4±8.5 points (of 30 possible points). Patients with an insurance status of "government/Medicaid," "other," or "none" each demonstrated significantly lower physical activity scores (14.2±8.5 vs. 13.6±9.0 vs. 10.1±8.5) than children with private insurance (16.5±8.2) (one-way ANOVA with Dunnett-adjusted pairwise comparisons, P<0.001), which remained statistically significant while controlling for Area Deprivation Index, age, gender, race/ethnicity, and Body Mass Index (β=-1.8, P<0.001).

CONCLUSIONS

Government/Medicaid health insurance status and lack of health care coverage are associated with low levels of physical activity in American children, even while controlling for socioeconomic confounders. Collaborative work between health care providers and community/ school-based programs may be a reasonable approach to expanding access to recreation, organized sports, and physical activity for publicly and uninsured children.

LEVEL OF EVIDENCE

Level II-Prognostic Study.

Perceptions of Nature and Access to Green Space in Four Urban Neighborhoods

Health benefits have been linked to spending time outdoors in nature and green space. However, there is some evidence of inequities to accessing safe outdoor space, particularly in low-resource communities. The primary aim of this study is to assess attitudes towards nature and use of green space in urban areas. A secondary aim is to describe perceptions of physician-initiated nature prescriptions that target local pediatric populations. We conducted six focus group interviews with 42 residents who were guardians or caretakers of children living in low-resource neighborhoods in Philadelphia, PA. We analyzed interview data using a conventional content analysis approach. Three major themes emerged: (1) perceived benefits of being in nature (physical and mental health benefits), (2) barriers to time spent in nature (unsafe and undesirable conditions of local parks), and (3) desired features of outdoor green spaces (amenities that would increase park use). Additionally, we describe participants’ reactions to the idea of a pediatrician-delivered prescription for outdoor green space exposure for a child in their care. Adherence to nature prescriptions programs may hinge on local green space resources, as well as experiential and perceptual barriers and facilitators to nature and park accessibility among caregivers tasked with fulfilling a nature prescription for a child in their care.

Park Use and Park-Based Physical Activity in Low-Income Neighborhoods

Routine physical activity is important for everyone, and most urban areas have an infrastructure of neighborhood parks that are intended to serve as a setting for recreation and leisure. However, parks are not used proportionally by all age groups, genders, and socioeconomic groups. This paper explores factors associated with park use by different age and gender groups in low-income neighborhoods in Los Angeles, CA. We found that women's visits to parks generally centered around children, whereas men's visits were more likely to be associated with their own physical activity. Barriers for seniors are associated with limited facilities and programming that meet their needs. Park managers should consider park renovations that include social meeting places, comfortable sitting areas, and walking paths to better serve women and seniors.

ParkIndex: Using Key Informant Interviews to Inform the Development of a New Park Access Evaluation Tool

The relationship between park availability, physical activity, and positive health outcomes has been documented across the globe. However, studying how people access parks and why they use the parks is difficult due to a lack of consensus with respect to measurement approaches and assessment of park environments. Establishing a parsimonious method and tool for quantifying both park availability and park quality represents a major step that could advance park and physical activity research and practice. This paper describes phase one of the effort to develop such a measurement tool, known as ParkIndex. ParkIndex is a two-year National Institutes of Health (NIH)-funded study to create an evidence-based tool that will assist citizens and professionals in understanding and using information regarding community park access and use. Phase one consisted of key informant interviews conducted with research and practice leaders to inform development and provide insight on the essential foundations of ParkIndex. Twelve professionals from practice and academia, including parks and recreation, landscape design, and public health sectors, were interviewed in fall 2016. Key informants were interviewed on four topics concerning the content, value, feasibility, and dissemination of ParkIndex. Trained research assistants employed double, emergent, open, and axial coding methods to develop key themes and concepts to guide phase 2 and further development of ParkIndex. Key themes throughout the interviews included measures for park use, including distance, safety, neighborhood characteristics, route and travel mode to park, and overall park characteristics. Park elements discussed included quality of, and availability of, amenities, activity spaces, programming, and park management, as well as the context of the park and the engagement of the local community. Respondents determined that ParkIndex could benefit park planning and community development and provide for a standardized method for evaluating park access. Interviews and themes offer parks and public health practitioners and researchers-and this specific ParkIndex development team-the opportunity to refine and evaluate measures to be included in a comprehensive park access and use tool. Key informants repeatedly referenced the need, especially within parks and recreation management, for consistent, reliable, and valid measures of park access and use, such as ParkIndex seeks to provide. We believe a well-conceived, integrated index will at the very least allow for greater comparison between parks and park systems and at best will facilitate the many park stakeholders to best design, maintain, program, research, and advocate for their local parks.

Contributions of Neighborhood Parks to Physical Activity in High-Poverty Urban Neighborhoods

Neighborhood parks are important venues for the urban population to do moderate-to-vigorous physical activity in leisure time. Parks can be particularly important for low-income neighborhoods, whose residents suffer from high rates of chronic diseases and may have less access to fee-based fitness exercise facilities. This study assessed the contribution of parks to local populations' physical activity in 48 high-poverty neighborhoods in the city of Los Angeles, using systematic observation of park use and surveys of park users and residents conducted between 2013 and 2015. We found that parks accounted for approximately 2.1% (between-park SD = 1.4%) of moderate physical activity time and 3.1% (between-park SD = 2.1%) of vigorous physical activity time of the local population, both of which were notably lower than the city-level average previously reported. Parks' contribution to physical activity was positively associated with park size (β = 0.13, p < 0.0001) and negatively associated with poverty (β = - 0.10, p < 0.0001) and local population density (β = - 0.25, p = 0.005). Parks in high-poverty neighborhoods in Los Angeles are underutilized, and more efforts are needed to fully realize their potential for population health.

Violent Crime and Park Use in Low-Income Urban Neighborhoods

INTRODUCTION

Crime and safety are often cited as potential hurdles to park use and park-based physical activity. Using comprehensive data sources including both objective and subjective measurements at the park level and the individual level, this study aimed to assess the association between crime rates and use of local parks in low-income urban neighborhoods.

METHODS

The authors observed 48 parks and conducted local resident surveys in low-income neighborhoods in Los Angeles during a 2-year study period (2013-2015). Crime data were geocoded within a 1-mile radius of parks' addresses and longitudinal models were fitted to estimate the association between crime rates and park use outcomes in 2017.

RESULTS

One gun-related violent crime per 10,000 people during the 6-month period prior to data collection was associated with an average of 13.5%-15.8% reduction in observed park use and park-based moderate to vigorous physical activity (p<0.05) in the 6-month observation period. The relationship was significant in seniors (33%-40% reduction) and adults (13%-18%), but insignificant for teenagers (2%-4%) and children (10%-12%). Homicide rates were also significantly related to lower self-reported park use (p<0.05).

CONCLUSIONS

Gun-related violent crimes have relatively long-term negative associations with population health by reducing utilization of outdoor park space. There can be additional population health benefits from controlling and reducing gun-related violent crimes beyond immediate impacts on public safety and mortality.

Gender Disparities in Park Use and Physical Activity among Residents of High-Poverty Neighborhoods in Los Angeles

INTRODUCTION

Physical inactivity is more prevalent among women than men and is related to poor health outcomes. Neighborhood parks constitute an important resource for physical activity (PA), however, previous studies of park users have found fewer women being physically active.

METHODS

We conducted a hierarchical mixed-effect regression analysis of the independent associations between gender and park use and PA among a population-based sample in high-poverty neighborhoods in Los Angeles. Data sources included 1) structured interviews with adults (≥18 years of age) in randomly selected households within 1 mile of study parks (n = 2,973), 2) systematic observations of study parks (n = 48), and 3) neighborhood characteristics from the 2010 U.S. Census.

RESULTS

After controlling for race/ethnicity, education, body mass index of 30 kg/m2 or greater, health status, proximity to park, having children under the age of 18, perceived park safety, estimated screen time, and park- and neighborhood-level variables, statistically significant differences were found between women and men on all outcomes. Compared with men, women reported fewer park visits in the past week (-0.28 times/week; p < .001) and shorter durations of a typical park visit (-11.11 min/visit; p < .001). Women were also less likely than men to report levels of PA that meet national guidelines (≥150 minutes of moderate to vigorous PA per week; risk difference = -0.06; p < .01) or to exercise in the park (risk difference = -0.13; p < .001) or elsewhere (risk difference = -0.13; p < .001).

CONCLUSIONS

Women living in high-poverty neighborhoods use parks less for PA than men. Improved park-level design, programming, and other policy interventions may be needed to mitigate disparities in park use and PA for all.