One of the primary goals of the Healthy Parks Healthy People (HPHP) program, located in the San Francisco Bay Area, is to offer group-based physical activities in natural settings. These activities arefor racially and ethnically diverse groups of individuals as an “upstream” strategy for improving health. This study investigated the health impact of selected two-hour HPHP Bay Area events that targeted low-income racial and ethnic minority groups using physiological and self-reported measures of stress and related variables. Study participants (N=52) in the selected HPHP Bay Area events donated saliva and filled out psychological measures of perceived stress (PSS-4; Cohen et al.) and mood state (I-PANAS-SF; Thompson, 2007) at the beginning and the end ofa two-hour guided walk in green spaces. Moreover, a measure of perceived restoration (SRRS; Han, 2007) was completed at the end ofthe walk. Study participants wore a physical activity self-monitoring device (Garmin Vivofit 2) to capture their step count and heart rate during the event. Stress, both measured by the analysis of salivary cortisol and self-reported perceived stress, significantly decreased over the course of the event (p<.0$) and there was a significant increase in positive mood (p<.05). The monitoring device also indicated that individuals were engaged in moderate levels of physical activity during the guided walks (x =8,990 steps, HR 95 bpm). The results encourage further development of nature-based health interventions to mitigate stress. Such interventions may be especially appropriate for low-income, urban, racial and ethnic minority groups that likely experience increased levels of stress due to social inequities and poor living conditions.

Continuous glucose monitoring (CGM) improves glycemic outcomes in children with type 1 diabetes (T1D) and is recommended for regular use. However, it is unclear how families use CGM and if they are using it to its greatest potential. In this study, 193 caregivers of children with T1D using CGM (mean age 9.3±2.8 years, 44% female, 10% ethnic minority, 92% using insulin pump) were recruited throughout the United States by social media to complete a cross-sectional survey about their real-time CGM use. Many children (70%) wore the sensor “all of the time,” with 77% using CGM ≥22 of the last 30 days. Most caregivers (93%) had a CGM feature to see their child’s data remotely in real time; 87% of those who used this feature viewed their child’s data at least once a day when their child was not with them. Though nearly all knew about CGM alert functions, only 73% set alerts for hyperglycemia and 80% for hypoglycemia “all the time.” Frequent retrospective review of CGM data was less common, with only 64% uploading and reviewing data at least monthly. Since starting CGM, most caregivers reported a decrease in their child’s glycated hemoglobin (A1c) (64%) and reduced frequency and severity of hypoglycemia (78%) and hyperglycemia (72%). In regression analysis (adjusted for age, duration of T1D, gender, minority status, caregiver education, geographic region, and pump use), younger age was associated with decrease in A1c (OR 0.78, 95% CI 0.67, 0.92) and decrease in hyperglycemia (OR 0.70, 95% CI 0.58, 0.84). Longer duration of CGM use was associated with decrease in hypoglycemia (OR 2.0, 95% CI 1.0, 4.1). Seventy-two percent reported CGM is “essential,” and 53% felt the greatest benefit is seeing data in real time. In summary, caregivers utilize real-time CGM functions (remote monitoring, alerts) more frequently than they retrospectively review data. Future studies should focus on how caregivers use real-time and retrospective CGM data to make T1D management decisions in order to optimize use of the technology. Disclosure J.C. Wong: Advisory Panel; Self; Tidepool Project. Research Support; Self; Dexcom, Inc. F. Abdulhussein: None. B.J. Yeung: None. E.J. Velazquez: None. Funding Dexcom, Inc.