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Kodali HP, Wyka KE, Costa SA, Evenson KR, Thorpe LE, Huang TTK. Association of Park Renovation With Park Use in New York City. JAMA Netw Open 2024; 7:e241429. [PMID: 38598241 PMCID: PMC11007573 DOI: 10.1001/jamanetworkopen.2024.1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/15/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Equity-driven citywide park redesign and renovation, such as the Community Parks Initiative (CPI), has the potential to increase park use and opportunities for physical activity in underserved communities. Objective To evaluate changes in patterns of park use following park redesign and renovation in low-income New York City (NYC) neighborhoods. Design, Setting, and Participants The Physical Activity and Redesigned Community Spaces study was a prospective quality improvement preintervention-postintervention study design with matched control parks. Thirty-three intervention and 21 control neighborhood parks were selected based on specific criteria related to poverty rates, population growth, and population density in park neighborhoods and not having received more than $250 000 in investment in the past 2 decades. Data were collected at baseline (prerenovation) and 2 follow-up points (3 months and 1 year post renovation) between June 5 and December 4 from 2016 to 2022. Participants were individuals observed as users of study parks. Intervention The CPI, which involved the redesign and renovation of neighborhood parks by the municipal government of New York City. Main Outcomes and Measures Main outcomes encompassed park use and physical activity levels assessed using the well-validated System for Observing Play and Recreation in Communities. Park use was quantified by total number of park users, categorized by age group (≤20 years vs ≥21 years), sex, and physical activity level (sitting or standing vs walking or vigorous activity). Changes in outcomes between groups were compared via the generalized estimation equation. Results A total of 28 322 park users were observed across 1458 scans. At baseline, 6343 of 10 633 users (59.7%) were 20 years or younger, 4927 of 10 632 (46.3%) were female and 5705 (53.7%) were male, and 4641 of 10 605 (43.8%) were sitting or standing. Intervention parks showed more net park users compared with control parks from baseline to the final follow-up (difference-in-difference relative rate ratio, 1.69 [95% CI, 1.22-2.35] users/scan; P = .002). The association was driven by a significant increase in adult users at intervention parks and overall decrease in all users at control parks. Park users engaging in sitting or standing at intervention parks increased (difference, 4.68 [95% CI, 1.71-7.62] users/scan; P = .002) and park users engaging in walking or vigorous physical activity at control parks decreased (difference, -7.30 [95% CI, -10.80 to -4.26] users/scan; P < .001) over time. Conclusions and Relevance In this quality improvement study, park redesign and renovation were positively associated with park use in low-income neighborhoods. However, park renovations may need to be accompanied by other programmatic strategies to increase physical activity.
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Affiliation(s)
- Hanish P. Kodali
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York
- NYU-CUNY Prevention Research Center, New York, New York
| | - Katarzyna E. Wyka
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York
- NYU-CUNY Prevention Research Center, New York, New York
| | - Sergio A. Costa
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York
- NYU-CUNY Prevention Research Center, New York, New York
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill
| | - Lorna E. Thorpe
- NYU-CUNY Prevention Research Center, New York, New York
- Department of Population Health, Grossman School of Medicine, New York University (NYU), New York, New York
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York
- NYU-CUNY Prevention Research Center, New York, New York
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Jurgilevich A, Käyhkö J, Räsänen A, Pörsti S, Lagström H, Käyhkö J, Juhola S. Factors influencing vulnerability to climate change-related health impacts in cities - A conceptual framework. ENVIRONMENT INTERNATIONAL 2023; 173:107837. [PMID: 36921561 DOI: 10.1016/j.envint.2023.107837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Climate change will have adverse impacts on human health, which are amplified in cities. For these impacts, there are direct, indirect, and deferred pathways. The first category is well-studied, while indirect and deferred impacts are not well-understood. Moreover, the factors moderating the impacts have received little attention, although understanding these factors is critical for adaptation. We developed a conceptual framework that shows the pathways of climate impacts on human health, focusing specifically on the factors of urban environment moderating the emergence and severity of these health impacts. Based on the framework and literature review, we illustrate the mechanisms of direct, indirect, and deferred health impact occurrence and the factors that exacerbate or alleviate the severity of these impacts, thus presenting valuable insights for anticipatory adaptation. We conclude that an integrated systemic approach to preventing health risks from climate change can provide co-benefits for adaptation and address multiple health risks. Such an approach should be mainstreamed horizontally to all sectors of urban planning and should account for the spatiotemporal aspects of policy and planning decisions and city complexity.
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Affiliation(s)
| | - Janina Käyhkö
- University of Helsinki, Environment and Ecosystems Research Programme, Finland
| | | | | | - Hanna Lagström
- University of Turku, Centre for Population Health Research and Turku University Hospital, Finland
| | - Jukka Käyhkö
- University of Turku, Department of Geography and Geology, Finland
| | - Sirkku Juhola
- University of Helsinki, Environment and Ecosystems Research Programme, Finland
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Kodali HP, Ferris EB, Wyka K, Evenson KR, Dorn JM, Thorpe LE, Huang TTK. The association of park use and park perception with quality of life using structural equation modeling. Front Public Health 2023; 11:1038288. [PMID: 36761118 PMCID: PMC9907326 DOI: 10.3389/fpubh.2023.1038288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction The literature is limited on the impact of neighborhood parks on quality of life (QoL) and the mechanism linking them. Methods In this paper, we applied the structural equation model to data from a cross-sectional sample of 650 participants in low-income communities of New York City, we examined the associations of neighborhood park use vs. park perception and QoL, and whether these associations were mediated through self-reported perceived stress. We also examined whether park use mediated the relationship between park perception and QoL. Results We found that park use had a significant but weak association with QoL (standardized β = 0.08, 95% confidence interval (CI): 0.02, 0.15, p = 0.02), but this relationship was not mediated by self-reported stress. Park perception was more strongly associated with QoL than park use (standardized β = 0.23, 95% CI: 0.16, 0.30, p < 0.01), and this was partly mediated by self-reported stress (indirect effect- standardized β = 0.08, 95% CI: 0.03, 0.13, p < 0.01) and, to a lesser extent, by park use (indirect effect- standardized β = 0.01, 95% CI: 0.00, 0.02, p = 0.01). Discussion Having well-perceived parks appears to be an important factor for QoL independent of park use, suggesting that quality parks may benefit everyone in a community beyond park users. This strengthens the argument in favor of increasing park investment as a strategy to improve population wellbeing.
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Affiliation(s)
- Hanish P. Kodali
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Emily B. Ferris
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Katarzyna Wyka
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Joan M. Dorn
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Lorna E. Thorpe
- Department of Population Health, School of Medicine, New York University, New York, NY, United States
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
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Coogan A, Kimpel C, Jones AC, Barroso J, Frechman E, Maxwell CA. Perspectives on Aging and End of Life Among Lower Socioeconomic Status (SES) Older Adults. J Appl Gerontol 2022; 41:1595-1603. [PMID: 35437036 DOI: 10.1177/07334648221081482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To explore the experiences of aging that influence perceptions of and receptivity to planning for aging and EOL among lower SES older adults. Methods: Supported by a frailty-focused communication educational aid, semi-structured interviews were conducted with 20 older adults residing in income-assisted housing. Follow-up interviews were conducted 2 weeks later. Descriptive content analysis was performed. Results: Participants mean age was 62.4, and 75% were African American. Six categories emerged to create a narrative of lower SES older adults' experiences, including (1) readiness to plan for aging and EOL, (2) interaction with the healthcare system, (3) daily life with insufficient resources, (4) the role of religiosity, (5) relationships with others, and (6) motivation and health status. Discussion: Life course vulnerabilities and struggles of lower SES older adults preclude opportunities to proactively plan for aging and EOL. Holistic interventions and innovative approaches are needed to address aging across the life course.
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Affiliation(s)
- Anne Coogan
- 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine Kimpel
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Abigail C Jones
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Julie Barroso
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Erica Frechman
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Cathy A Maxwell
- 16194Vanderbilt University School of Nursing, Nashville, TN, USA
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Hitch L, Sillice MA, Kodali H, Wyka KE, Peña JO, Huang TT. Factors associated with mask use in New York City neighborhood parks during the COVID-19 pandemic: A field audit study. J Infect Public Health 2022; 15:460-465. [PMID: 35249842 PMCID: PMC8855606 DOI: 10.1016/j.jiph.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mask use is a cost-effective measure to decrease COVID-19 transmission. Mask mandates intend to increase mask compliance but are often ambiguous when it comes to public outdoor spaces. METHODS We used a field audit study to examine mask use in New York City neighborhood parks during COVID-19. 1453 park visitors were observed in 13 parks during July-August 2020 using a modified and validated park use audit tool (System for Observing Play and Recreation in Communities) that included items on general and proper mask use (i.e., mask covering both nose and mouth). Generalized estimating equation regression was used to determine the association between proper mask use and demographic (sex and age) and behavioral (physical and social activity) variables, while adjusting for community-level covariates. RESULTS Overall, 39.0% of park visitors used masks (24.4% properly, 14.6% improperly). Females (p = 0.023), adults (p = 0.025), and seniors (p = 0.006) showed higher rates of proper mask use compared to males and younger visitors. Physical and social activity were not significantly associated with proper mask use. CONCLUSION There is a need for improved messaging regarding the proper use of masks among males and younger people. This is particularly important for future surges of new COVID-19 variants or other public health crises similar to COVID-19. Future research should focus on developing and evaluating targeted public health messages regarding mask use.
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Affiliation(s)
- Lisa Hitch
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.
| | - Marie A Sillice
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.
| | - Hanish Kodali
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.
| | - Katarzyna E Wyka
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.
| | - Javier Otero Peña
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA; Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA.
| | - Terry Tk Huang
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.
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Otero Peña JE, Kodali H, Ferris E, Wyka K, Low S, Evenson KR, Dorn JM, Thorpe LE, Huang TTK. The Role of the Physical and Social Environment in Observed and Self-Reported Park Use in Low-Income Neighborhoods in New York City. Front Public Health 2021; 9:656988. [PMID: 33959584 PMCID: PMC8095666 DOI: 10.3389/fpubh.2021.656988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022] Open
Abstract
Physical and social environments of parks and neighborhoods influence park use, but the extent of their relative influence remains unclear. This cross-sectional study examined the relationship between the physical and social environment of parks and both observed and self-reported park use in low-income neighborhoods in New York City. We conducted community- (n = 54 parks) and individual-level (n = 904 residents) analyses. At the community level, observed park use was measured using a validated park audit tool and regressed on the number of facilities and programmed activities in parks, violent crime, stop-and-frisk incidents, and traffic accidents. At the individual level, self-reported park use was regressed on perceived park quality, crime, traffic-related walkability, park use by others, and social cohesion and trust. Data were collected in 2016–2018 and analyzed in 2019–2020. At the community level, observed park use was negatively associated with stop-and-frisk (β = −0.04; SE = 0.02; p < 0.05) and positively associated with the number of park facilities (β = 1.46; SE = 0.57; p < 0.05) and events (β = 0.16; SE = 0.16; p < 0.01). At the individual level, self-reported park use was positively associated with the social cohesion and trust scale (β = 0.02; SE = 0.01; p < 0.05). These results indicate that physical and social attributes of parks, but not perceptions of parks, were significantly associated with park use. The social environment of neighborhoods at both community and individual levels was significantly related to park use. Policies for increasing park use should focus on improving the social environment of parks and surrounding communities, not only parks' physical attributes. These findings can inform urban planning and public health interventions aimed at improving the well-being of residents in low-income communities.
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Affiliation(s)
- Javier E Otero Peña
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States.,Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Hanish Kodali
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Emily Ferris
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Katarzyna Wyka
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Setha Low
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Joan M Dorn
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, United States
| | - Lorna E Thorpe
- Department of Population Health, School of Medicine, New York University, New York, NY, United States
| | - Terry T K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Ferris EB, Wyka K, Evenson KR, Dorn JM, Thorpe L, Catellier D, Huang TTK. Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods. JMIR Form Res 2021; 5:e18591. [PMID: 33759799 PMCID: PMC8294636 DOI: 10.2196/18591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/30/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
Longitudinal, natural experiments provide an ideal evaluation approach to better understand the impact of built environment interventions on community health outcomes, particularly health disparities. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. This paper shares practical lessons learned from the Physical Activity and Redesigned Community Spaces (PARCS) study, which is an evaluation of the impact of a citywide park renovation initiative on physical activity, psychosocial health, and community well-being. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants' needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color.
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Affiliation(s)
- Emily B Ferris
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Katarzyna Wyka
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Joan M Dorn
- Sophie Davis Biomedical Education Program, City University of New York School of Medicine, New York, NY, United States
| | - Lorna Thorpe
- Department of Population Health, School of Medicine, New York University, New York, NY, United States
| | - Diane Catellier
- Research Triangle Institute, Research Triangle Park, Durham, NC, United States
| | - Terry T-K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Swierad EM, Huang TTK. It Starts with a Conversation: The Importance of Values as Building Blocks of Engagement Strategies in Community-Centered Public Health Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2940. [PMID: 33805614 PMCID: PMC7999502 DOI: 10.3390/ijerph18062940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
This study examined the life-motivating values of residents in underserved minority communities to inform the development of community engagement strategies. Semi-structured interviews were conducted to explore the main research questions: (1) what were the values of research participants, and (2) what did they consider important in their lives? The participants included twenty-seven ethnically diverse individuals living in low-income neighborhoods in New York City (NYC). Thematic analysis was performed to identify common themes and patterns related to the values that participants considered important in their lives. Three broad themes were identified: (1) benevolence; (2) universalism, and (3) self-direction. Benevolence implies a sense of belonging as the central meaning in life; community engagement strategies focused on this value emphasize concern for the welfare of loved ones. Community engagement strategies focused on universalism emphasize social justice and concern for the environment and the world. Finally, community engagement strategies focused on self-direction seek to satisfy participants' needs for control, autonomy, and mastery. This study introduces the Value-Based Framework for Community-Centered Research. It illustrates how value exploration is central to a community-centered approach to public health research and can be an important first step for designing studies that are better aligned with community needs and contexts. Such an approach can also help to co-create a "research identity" with community members and integrate their values into a project's purpose, thereby increasing community ownership and engagement in the study.
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Affiliation(s)
- Ewelina M. Swierad
- Neurology Department, Columbia University Irving Medical Center, New York, NY 10033, USA;
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA
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Kaczynski AT, Hughey SM, Stowe EW, Wende ME, Hipp JA, Oliphant EL, Schipperijn J. ParkIndex: Validation and application of a pragmatic measure of park access and use. Prev Med Rep 2020; 20:101218. [PMID: 33354490 PMCID: PMC7744752 DOI: 10.1016/j.pmedr.2020.101218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/08/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
Composite metrics integrating park availability, features, and quality for a given address or neighborhood are lacking. The purposes of this study were to describe the validation, application, and demonstration of ParkIndex in four diverse communities. This study occurred in Fall 2018 in 128 census block groups within Seattle(WA), Brooklyn(NY), Raleigh(NC), and Greenville County(SC). All parks within a half-mile buffer were audited to calculate a composite park quality score, and select households provided data about use of proximal parks via an online, map-based survey. For each household, the number of parks, total park acreage, and average park quality score within one half-mile were calculated using GIS. Logistic regression was used to identify a parsimonious model predicting park use. ParkIndex values (representing the probability of park use) were mapped for all study areas and after scenarios involving the addition and renovation/improvement of parks. Out of 360 participants, 23.3% reported visiting a park within the past 30 days. The number of parks (OR = 1.36, 95% CI = 1.15-1.62), total park acreage (OR = 1.13, 95% CI = 1.07-1.19), and average park quality score (OR = 1.04, 95% CI = 1.01-1.06) within one half-mile were all associated with park use. Composite ParkIndex values across the study areas ranged from 0 to 100. Hypothetical additions of or renovations to study area parks resulted in ParkIndex increases of 22.7% and 19.2%, respectively. ParkIndex has substantial value for park and urban planners, citizens, and researchers as a common metric to facilitate awareness, decision-making, and intervention planning related to park access, environmental justice, and community health.
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Affiliation(s)
- Andrew T. Kaczynski
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, United States
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, United States
| | - S. Morgan Hughey
- Department of Health and Human Performance, College of Charleston, United States
| | - Ellen W. Stowe
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, United States
| | - Marilyn E. Wende
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, United States
| | - J. Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, NC State University, United States
- Center for Geospatial Analytics, NC State University, United States
| | - Elizabeth L. Oliphant
- Department of Parks, Recreation, and Tourism Management, NC State University, United States
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Kjellström S, Andersson AC, Samuelsson T. Professionals' experiences of using an improvement programme: applying quality improvement work in preschool contexts. BMJ Open Qual 2020; 9:e000933. [PMID: 32830121 PMCID: PMC7445333 DOI: 10.1136/bmjoq-2020-000933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improvement work can be used in preschools to enrich outdoor environment for children's better health. Effective improvement work can facilitate the necessary changes, but little is known about professionals' experiences of participation in improvement interventions. The aim was to evaluate how preschool staff experience quality improvement work, using the Breakthrough Series Collaborative improvement programme, to enhance outdoor environments. METHODS An improvement intervention using a breakthrough collaborative was performed at 9 preschools in Sweden and examined with a longitudinal mixed method design. Staff completed questionnaires on 4 occasions (n=45 participants) and interviews took place after the intervention (n=16 participants). RESULTS The intervention was successful in the sense that the staff were content with the learning seminars, and they had triggered physical changes in the outdoor environment. They integrated the quality improvement work with their ordinary work and increasingly involved the children. The staff tested improvement tools but did not find them entirely appropriate for their work, because they preferred existing methods for reflection. CONCLUSIONS The challenges in quality improvement work seem to be similar across contexts. Using the Breakthrough Series Collaborative in a public health intervention is promising but needs to be integrated with preunderstandings, current reflections and quality tools and models.
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Affiliation(s)
- Sofia Kjellström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | | | - Tobias Samuelsson
- School of Education and Communication, Jönköping University, Jönköping, Sweden
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Pearson AL, Pfeiffer KA, Gardiner J, Horton T, Buxton RT, Hunter RF, Breeze V, McDade T. Study of active neighborhoods in Detroit (StAND): study protocol for a natural experiment evaluating the health benefits of ecological restoration of parks. BMC Public Health 2020; 20:638. [PMID: 32380967 PMCID: PMC7204306 DOI: 10.1186/s12889-020-08716-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes. METHODS The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models. DISCUSSION Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods. STUDY REGISTRATION Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI 48824 USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, 27R Intramural Rec Sports- Circle, 308 West Circle Drive, East Lansing, MI 48824 USA
| | - Joseph Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, Room B601, East Lansing, MI 48824 USA
| | - Teresa Horton
- Department of Anthropology, Northwestern University, 1810 Hinman Ave, Evanston, IL 60208 USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, 209 Nesbitt Biology Building, Ottawa, ON K1S 5B6 Canada
| | - Ruth F. Hunter
- Centre for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN Northern Ireland, UK
| | - Victoria Breeze
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI 48824 USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, 1810 Hinman Ave, Evanston, IL 60208 USA
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Cato MS, Wyka K, Ferris EB, Evenson KR, Wen F, Dorn JM, Thorpe LE, Huang TTK. Correlates of accelerometry non-adherence in an economically disadvantaged minority urban adult population. J Sci Med Sport 2020; 23:746-752. [PMID: 32085979 DOI: 10.1016/j.jsams.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/14/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to examine socio-demographic and psychosocial correlates of non-adherence to an accelerometry protocol in an economically disadvantaged urban population. DESIGN Cross-sectional study. METHODS We analyzed 985 New York City adult participants aged 18-81 years from the Physical Activity and Redesigned Community Spaces (PARCS) study. Participants were asked to wear a hip-worn ActiGraph GT3X-BT accelerometer for one week. Adherent accelerometer wear was defined as ≥3 days of ≥8 h/day of wear over a 7-day period and non-adherent accelerometry wear was defined as any wear less than adherent wear from returned accelerometers. Examined correlates of adherence included sociodemographic and psychosocial characteristics (e.g., general physical/mental health-related quality of life, self-efficacy for exercise, stress, sense of community/neighborhood well-being, and social cohesion). RESULTS From the total sample, 636 (64.6%) participants provided adherent wear and 349 (35.4%) provided non-adherent wear. In multivariable analysis, younger age (odds ratio [OR] = 0.63, 95% confidence interval [CI]: 0.53-0.75), poorer health-related quality of life (OR = 0.80, 95% CI: 0.65-0.98 for physical health and OR = 0.77, 95% CI: 0.62-0.94 for mental health), lower sense of community (OR = 0.79, 95% CI: 0.62-1.00) and current smoking status (OR = 1.97, 95% CI: 1.35-2.86) were associated with non-adherent wear. CONCLUSIONS Non-adherent wear was associated with younger age, smoking, and lower self-reported physical/mental functioning and sense of community. This information can inform targeted adherence strategies to improve physical activity and sedentary behavior estimates from accelerometry data in future studies involving an urban minority population.
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Affiliation(s)
- Matthew S Cato
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, United States
| | - Katarzyna Wyka
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, United States
| | - Emily B Ferris
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, United States
| | - Kelly R Evenson
- Department of Epidemiology, Gilling's School of Global Public Health, University of North Carolina, United States
| | - Fang Wen
- Department of Epidemiology, Gilling's School of Global Public Health, University of North Carolina, United States
| | - Joan M Dorn
- School of Medicine, City University of New York, United States
| | - Lorna E Thorpe
- Department of Population Health, School of Medicine, New York University, United States
| | - Terry T-K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, United States.
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13
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Yi L, Wilson JP, Mason TB, Habre R, Wang S, Dunton GF. Methodologies for assessing contextual exposure to the built environment in physical activity studies: A systematic review. Health Place 2019; 60:102226. [PMID: 31797771 PMCID: PMC7377908 DOI: 10.1016/j.healthplace.2019.102226] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/14/2019] [Accepted: 09/26/2019] [Indexed: 01/07/2023]
Abstract
Growing research has integrated Global Positioning Systems (GPS), Geographic Information Systems (GIS), and accelerometry in studying effects of built environment on physical activity outcomes. This systematic review aimed to summarize current geospatial methods of assessing contextual exposure to the built environment in these studies. Based on reviewing 79 eligible articles, methods were identified and grouped into three main categories based on similarities in their approaches as follows: domain-based (67% of studies), buffer-based (22%), and activity space-based (11%). Additionally, technical barriers and potential sources of uncertainties in each category were discussed and recommendations on methodological improvements were made.
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Affiliation(s)
- Li Yi
- Spatial Sciences Institute, University of Southern California, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, United States.
| | - John P Wilson
- Spatial Sciences Institute, University of Southern California, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, United States
| | - Tyler B Mason
- Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90033, United States
| | - Rima Habre
- Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90033, United States
| | - Shirlene Wang
- Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90033, United States
| | - Genevieve F Dunton
- Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90033, United States
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14
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Browning MHEM, Rigolon A. Could nature help children rise out of poverty? Green space and future earnings from a cohort in ten U.S. cities. ENVIRONMENTAL RESEARCH 2019; 176:108449. [PMID: 31202477 DOI: 10.1016/j.envres.2019.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- Matthew H E M Browning
- University of Illinois at Urbana-Champaign, Department of Recreation, Sport and Tourism, 1206 S 4th Street, Champaign, IL, 61820, USA.
| | - Alessandro Rigolon
- University of Illinois at Urbana-Champaign, Department of Recreation, Sport and Tourism, 1206 S 4th Street, Champaign, IL, 61820, USA
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15
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Dubowitz T, Ghosh Dastidar M, Richardson AS, Colabianchi N, Beckman R, Hunter GP, Sloan JC, Nugroho AK, Collins RL. Results from a natural experiment: initial neighbourhood investments do not change objectively-assessed physical activity, psychological distress or perceptions of the neighbourhood. Int J Behav Nutr Phys Act 2019; 16:29. [PMID: 30917831 PMCID: PMC6438005 DOI: 10.1186/s12966-019-0793-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have assessed objectively measured physical activity (PA), active transportation, psychological distress and neighborhood perceptions among residents of a neighborhood before and after substantial improvements in its physical environment. Also, most research-to-date has employed study designs subject to neighborhood selection, which may introduce bias in reported findings. We built upon a previously enrolled cohort of households from two low-income predominantly African American Pittsburgh neighborhoods, matched on socio-demographic composition including race/ethnicity, income and education. One of the two neighborhoods received substantial neighborhood investments over the course of this study including, but not limited to public housing development and greenspace/landscaping. We implemented a natural experiment using matched intervention and control neighborhoods and conducted pre-post assessments among the cohort. Our comprehensive assessments included accelerometry-based PA, active transportation, psychological distress and perceptions of the neighborhood, with assessments conducted both prior to and following the neighborhood changes. In 2013, we collected data from 1003 neighborhood participants and in 2016, we re-interviewed 676 of those participants. We conducted an intent to treat analysis, with a difference-in-difference estimator using attrition weighting to account for nonresponse between 2013 and 2016. In addition, we derived an individual-level indicator of exposure to neighbourhood investment and estimated effect of exposure to investment on the same set of outcomes using covariate-adjusted models. RESULTS We observed no statistically significant differences in activity, psychological distress, satisfaction with one's neighborhood as a place to live or any of the other measures we observed prior to and after the neighborhood investments between the intervention and control neighborhoods or those exposed vs not exposed to investments. CONCLUSIONS Using this rigorous study design, we observed no significant changes in the intervention neighborhood above and beyond secular trends present in the control neighborhood. Although neighborhood investment may have other benefits, we failed to see improvement in PA, psychological distress or related outcomes in the low-income African American neighborhoods in our study. This may be an indication that improvements in the physical environment may not directly translate into improvements in residents' physical activity or health outcomes without additional individual-level interventions. It is also possible that these investments were not dramatic enough to spur change within the three year period. Additional studies employing similar design with other cohorts in other settings are needed to confirm these results. TRIAL REGISTRATION Trial Registration is not applicable since we did not prospectively assign individuals to a health-related intervention.
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Affiliation(s)
- Tamara Dubowitz
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA USA
| | | | | | | | - Robin Beckman
- RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Gerald P. Hunter
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA USA
| | | | - Alvin K. Nugroho
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA USA
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16
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Huang TTK, Aitken J, Ferris E, Cohen N. Design Thinking to Improve Implementation of Public Health Interventions: An Exploratory Case Study on Enhancing Park Use. DESIGN FOR HEALTH (ABINGDON, ENGLAND) 2019; 2:236-252. [PMID: 31773070 PMCID: PMC6879094 DOI: 10.1080/24735132.2018.1541047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/05/2018] [Accepted: 10/16/2018] [Indexed: 01/21/2023]
Abstract
Design thinking, a human-centred, iterative process to innovate solutions aligned with communities' tacit knowledge, has the potential to augment public health interventions. This paper presents a case study of a design thinking workshop to illustrate the process and methods to train public health researchers. A workshop was conducted to engage participants in a systematic, non-linear process of design thinking to design possible interventions to enhance use of renovated New York City parks. Participants engaged in exercises to rapidly craft proposals for park re-design. The process involved learning about design methods to overcome limitations of linear thinking and how design thinking can be applied to public health problems that require community input. The case study demonstrated the feasibility of training public health researchers in design thinking methods that can be applied to public health problems. With increased capacity, public health researchers could apply design thinking to community collaborations to develop solutions embedded in the unique contexts of the community.
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Affiliation(s)
- Terry T-K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
| | | | - Emily Ferris
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
| | - Nevin Cohen
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
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17
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Tseng E, Zhang A, Shogbesan O, Gudzune KA, Wilson RF, Kharrazi H, Cheskin LJ, Bass EB, Bennett WL. Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review. J Gen Intern Med 2018; 33:1990-2001. [PMID: 30206789 PMCID: PMC6206360 DOI: 10.1007/s11606-018-4619-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness. METHODS We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool. RESULTS Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias. DISCUSSION We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA.
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
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18
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Swierad EM, Huang TTK. An Exploration of Psychosocial Pathways of Parks' Effects on Health: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081693. [PMID: 30096851 PMCID: PMC6121520 DOI: 10.3390/ijerph15081693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 11/17/2022]
Abstract
Urban green space has been positively associated with psychological and physical health. However, the linkage between exposure to parks and health outcomes remains unclear. The current study examined the meanings that people assign to city parks, as a way to understand the pathways by which parks exert their effects on health. We conducted qualitative interviews with twenty culturally diverse residents in New York City. Thematic analysis was performed on the qualitative data. Results showed that all themes identified were related to parks fulfilling a basic human need for connection to (1) family, loved ones, and friends; (2) community and neighborhood; (3) self; and (4) nature. Based on these data, we proposed a human-centered framework for future research and interventions aimed at catalyzing parks as a vehicle to improve health and wellbeing. A human-centered approach emphasizes targeting the deep-seated needs and values of those we seek to engage and for whom health promotion and disease prevention efforts are designed. Our study shows that park transformations need to incorporate careful considerations of the human need for connection on multiple levels, so that park usage and its consequent health benefits may be optimized.
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Affiliation(s)
- Ewelina M Swierad
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
| | - Terry T K Huang
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
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High-intensity Interval Training and Continuous Aerobic Exercise Interventions to Promote Self-initiated Quit Attempts in Young Adults Who Smoke: Feasibility, Acceptability, and Lessons Learned From a Randomized Pilot Trial. J Addict Med 2018; 12:373-380. [PMID: 29762196 DOI: 10.1097/adm.0000000000000414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES While exercise significantly reduces craving for cigarettes, the effect of exercise on self-initiation of quit attempts is less known. Therefore, this randomized pilot study explored the effect of starting an exercise program on self-initiated quit attempts, and also the feasibility and acceptability of a novel exercise intervention, high-intensity interval training (HIIT), as compared with a more traditional continuous aerobic (CA) exercise intervention. METHODS Participants smoked (≥5 cigarettes/d), were aged 18 to 40 years, and wanted to increase their exercise. Participants were randomized into 1 of 3 groups: HIIT, CA, and delayed control. All participants attended follow-up visits at weeks 4, 8, and 12. Outcomes included measures of feasibility (eg, visit attendance) and acceptability (eg, satisfaction), and also changes in smoking behavior (eg, quit attempts during follow-up) and proxies to quit attempts (eg, positive affect). RESULTS Overall, there were no differences in terms of feasibility and acceptability between the HITT (n = 12) and CA (n = 9) groups. Based on both self-report and objective measurement, the exercise groups (HIIT and CA) increased their physical activity as compared with the delayed treatment group (n = 11). Compared with HIIT and delayed control, CA (n = 9) had significant favorable changes in positive affect (eg, at week 8, HIIT: +0.25 ± 2.21, delayed control: -5.11 ± 2.23, CA: +5.50 ± 2.23; P = 0.0153). CONCLUSIONS These observations suggest that HIIT is as feasible and acceptable as CA, though CA may have a more favorable effect on proxies to quit attempts (eg, positive affect). Fully powered studies are needed to examine the effect of HIIT versus CA on quit attempts.
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How Does the Urban Environment Affect Health and Well-Being? A Systematic Review. URBAN SCIENCE 2018. [DOI: 10.3390/urbansci2010021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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