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Effect of park prescriptions with and without group visits to parks on stress reduction in low-income parents: SHINE randomized trial

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  • Nooshin Razani
  • Saam Morshed
  • Michael A Kohn
  • Nancy M Wells
  • Doug Thompson
  • Maoya Alqassari
  • Amaka Agodi
  • George W Rutherford

Abstract

Introduction: Exposure to nature may reduce stress in low-income parents. This prospective randomized trial compares the effect of a physician’s counseling about nature with or without facilitated group outings on stress and other outcomes among low-income parents. Materials and methods: Parents of patients aged 4–18 years at a clinic serving low-income families were randomized to a supported park prescription versus independent park prescription in a 2:1 ratio. Parents in both groups received physician counseling about nature, maps of local parks, a journal, and pedometer. The supported group received additional phone and text reminders to attend three weekly family nature outings with free transportation, food, and programming. Outcomes measured in parents at baseline, one month and three months post-enrollment included: stress (using the 40-point Perceived Stress Scale [PSS10]); park visits per week (self-report and journaling); loneliness (modified UCLA-Loneliness Scale); physical activity (self-report, journaling, pedometry); physiologic stress (salivary cortisol); and nature affinity (validated scale). Results: We enrolled 78 parents, 50 in the supported and 28 in the independent group. One-month follow-up was available for 60 (77%) participants and three-month follow up for 65 (83%). Overall stress decreased by 1.71 points (95% CI, -3.15, -0.26). The improvement in stress did not differ significantly by group assignment, although the independent group had more park visits per week (mean difference 1.75; 95% CI [0.46, 3.04], p = 0.0085). In multivariable analysis, each unit increase in park visits per week was associated with a significant and incremental decrease in stress (change in PSS10–0.53; 95% CI [-0.89, -0.16]; p = 0.005) at three months. Conclusion: While we were unable to demonstrate the additional benefit of group park visits, we observed an overall decrease in parental stress both overall and as a function of numbers of park visits per week. Paradoxically the park prescription without group park visits led to a greater increase in weekly park visits than the group visits. To understand the benefits of this intervention, larger trials are needed. Trial registration: ClinicalTrials.gov NCT02623855

Suggested Citation

  • Nooshin Razani & Saam Morshed & Michael A Kohn & Nancy M Wells & Doug Thompson & Maoya Alqassari & Amaka Agodi & George W Rutherford, 2018. "Effect of park prescriptions with and without group visits to parks on stress reduction in low-income parents: SHINE randomized trial," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-17, February.
    • Handle: RePEc:plo:pone00:0192921
    DOI: 10.1371/journal.pone.0192921
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    References listed on IDEAS

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    1. Fan, Yingling & Chen, Qian, 2012. "Family functioning as a mediator between neighborhood conditions and children's health: Evidence from a national survey in the United States," Social Science & Medicine, Elsevier, vol. 74(12), pages 1939-1947.
    2. de Vries, Sjerp & van Dillen, Sonja M.E. & Groenewegen, Peter P. & Spreeuwenberg, Peter, 2013. "Streetscape greenery and health: Stress, social cohesion and physical activity as mediators," Social Science & Medicine, Elsevier, vol. 94(C), pages 26-33.
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    1. Elizabeth P.D. Koselka & Lucy C. Weidner & Arseniy Minasov & Marc G. Berman & William R. Leonard & Marianne V. Santoso & Junia N. de Brito & Zachary C. Pope & Mark A. Pereira & Teresa H. Horton, 2019. "Walking Green: Developing an Evidence Base for Nature Prescriptions," IJERPH, MDPI, vol. 16(22), pages 1-18, November.
    2. Nooshin Razani & Dayna Long & Danielle Hessler & George W. Rutherford & Laura M. Gottlieb, 2020. "Screening for Park Access during a Primary Care Social Determinants Screen," IJERPH, MDPI, vol. 17(8), pages 1-9, April.
    3. Ashby Lavelle Sachs & Eva Coringrato & Nadav Sprague & Angela Turbyfill & Sarah Tillema & Jill Litt, 2022. "Rationale, Feasibility, and Acceptability of the Meeting in Nature Together (MINT) Program: A Novel Nature-Based Social Intervention for Loneliness Reduction with Teen Parents and Their Peers," IJERPH, MDPI, vol. 19(17), pages 1-16, September.
    4. Sus Sola Corazon & Ulrik Sidenius & Dorthe Varning Poulsen & Marie Christoffersen Gramkow & Ulrika Karlsson Stigsdotter, 2019. "Psycho-Physiological Stress Recovery in Outdoor Nature-Based Interventions: A Systematic Review of the Past Eight Years of Research," IJERPH, MDPI, vol. 16(10), pages 1-21, May.
    5. Mário Santos & Helena Moreira & João Alexandre Cabral & Ronaldo Gabriel & Andreia Teixeira & Rita Bastos & Alfredo Aires, 2022. "Contribution of Home Gardens to Sustainable Development: Perspectives from A Supported Opinion Essay," IJERPH, MDPI, vol. 19(20), pages 1-26, October.
    6. Michelle C. Kondo & Kehinde O. Oyekanmi & Allison Gibson & Eugenia C. South & Jason Bocarro & J. Aaron Hipp, 2020. "Nature Prescriptions for Health: A Review of Evidence and Research Opportunities," IJERPH, MDPI, vol. 17(12), pages 1-16, June.
    7. S.M. Labib & Faysal Kabir Shuvo & Matthew H. E. M. Browning & Alessandro Rigolon, 2020. "Noncommunicable Diseases, Park Prescriptions, and Urban Green Space Use Patterns in a Global South Context: The Case of Dhaka, Bangladesh," IJERPH, MDPI, vol. 17(11), pages 1-23, May.
    8. Reo Jones & Robin Tarter & Amy Miner Ross, 2021. "Greenspace Interventions, Stress and Cortisol: A Scoping Review," IJERPH, MDPI, vol. 18(6), pages 1-21, March.
    9. David H. Nelson & Susan L. Prescott & Alan C. Logan & Jeffrey S. Bland, 2019. "Clinical Ecology—Transforming 21st-Century Medicine with Planetary Health in Mind," Challenges, MDPI, vol. 10(1), pages 1-16, February.
    10. Ying Xu & Sarah Ann Wheeler & Alec Zuo, 2022. "The Effectiveness of Interventions to Increase Participation and Physical Activities in Parks: A Systematic Review of the Literature," IJERPH, MDPI, vol. 19(19), pages 1-20, October.
    11. Justine S. Sefcik & Michelle C. Kondo & Heather Klusaritz & Elisa Sarantschin & Sara Solomon & Abbey Roepke & Eugenia C. South & Sara F. Jacoby, 2019. "Perceptions of Nature and Access to Green Space in Four Urban Neighborhoods," IJERPH, MDPI, vol. 16(13), pages 1-13, June.

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