Stay Healthy In Nature Everyday: Family Nature Outings in a Low Income Population

Study Overview
=================
Brief Summary
-----------------
The SHINE study is a randomized controlled study of the effect of a park-based family support group on multiple outcomes (including stress and physical activity) in a low income population.

Detailed Description
-----------------
Despite mounting evidence that nature matters for human health, we are not aware of any prospective intervention trials looking at the use of nature as a health intervention. Like other protective factors, such as the presence of a caring adult, safe play places, greater stimulation, the presence of green-space in a child's life has been empirically linked to greater resilience. Nature has been proposed as a buffer to stress through several pathways: by providing a space for friends and families to gather (thereby increasing social support and improving family relationships), by increasing opportunities for physical activity, and by improving cognition. Research to date suggests that participation in outdoor activities facilitates a sense of connectedness to place. This sense of attachment may also provide a form of social support. Families served by Children's Hospital Oakland Primary Care Clinic experience high levels of stress. As a safety-net clinic, the primary care clinic serves a diverse set of patients, with a common thread of poverty. The Stay Healthy In Nature program was developed to encourage stress management skills through play and physical activity in parks. The program uses a combination of facilitated and independent outings into local parks to encourage sustained behavior change and measurable health benefits.

Official Title
-----------------
Stay Healthy In Nature Everyday: a Randomized Controlled Trial of the Effect of Family Nature Outings on Stress and Physical Inactivity in a Low Income Population

Conditions
-----------------
Stress, Psychological, Social Isolation, Physical Activity

Intervention / Treatment
-----------------
* Behavioral: Family outings
* Behavioral: Park prescription
* Device: Pedometry
* Behavioral: Case Management


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Child must be 4 years and older, a patient in our clinic, physically able, available for follow up, able to answer questionnaire Caregiver must be 18 or older, legal guardian, physically able, able for follow up, able to answer questionnaire Exclusion Criteria: Enrolled in a weight loss program, unable to be physically active, unable to give informed consent, unable to follow up for study duration.

Ages Eligible for Study
-----------------
Minimum Age: 4 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Park prescription<br>Park prescription, pedometry. | Behavioral: Park prescription<br>* Participants will receive a map of local parks, and the recommendation to be physically active outdoors three days a week in nature.<br>Device: Pedometry<br>* Participants will record their daily pedometry.<br>|
| Experimental: Park prescription and family outings<br>Park prescription, pedometry, case management and 3 weekly family outings. | Behavioral: Family outings<br>* Participants will be invited to three weekly outings to local parks, case management and support in getting to nature. Participants will be offered transportation to the outings and s meal at local nature destinations. Programming at the park will include a picnic and walk with nature exploration, and will be facilitated by park and clinic staff.<br>Behavioral: Park prescription<br>* Participants will receive a map of local parks, and the recommendation to be physically active outdoors three days a week in nature.<br>Device: Pedometry<br>* Participants will record their daily pedometry.<br>Behavioral: Case Management<br>* Participants will receive a phone call to list potential barriers to participating in nature outings, and will talk through solutions with an investigator. Participants will be offered assistance with transportation if necessary.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Stress | measured through the Perceived Stress Score10 (PSS10) over 0, 1 and 3 months. The PSS10 is a ten item, validated instrument which ranges from 0-40. Each item on the instrument is summed to create a total score. Higher values correspond with higher stress. | 3 months | 
| Change in Stress | measured through the Perceived Stress Score10 (PSS10), a ten item, validated instrument which ranges from 0-40. | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Park Visits Per Week | Self-reported number of park visits in the last week, measured at 0, 1, and 3 months. | 1 month | 
| Change in Minutes of Moderate Physical Activity Per Day | Parents will report their physical activity in terms of minutes of moderate physical activity in the week before follow up at 0, 1, and 3 months out. Pedometers were also given to participants. Of note, because of poor follow through with returning pedometer data, this variable was not analyzed in the study results. | 3 months | 
| Change in Cortisol Level in Parents | Salivary cortisol from parents | 3 months | 
| Change in Minutes of Moderate Physical Activity Per Day | Parents will report their physical activity in terms of minutes of moderate physical activity in the week before follow up at 0, 1months follow up. Pedometers were also given to participants. Of note, because of poor follow through with returning pedometer data, this variable was not analyzed in the study results. | 1 month | 
| Change in Cortisol Level in Parents | Salivary cortisol from parents | 1 month | 
| Change in Park Visits Per Week | Self-reported number of park visits in the last week, measured at 0, 1, and 3 months. | 3 month | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Parks, Well-being, Stress, Physical Activity, Nature, Greenspace