An Integrated Clinic-Community Partnership for Child Obesity Treatment: A Randomized Pilot Trial

Hoffman, Jessica; Frerichs, Leah; Story, Mary; Jones, Jason; Gaskin, Kiah; Apple, Annie; Skinner, Asheley Cockrell; Armstrong, Sarah

doi:10.1542/peds.2017-1444

Cited by 46 publications

(33 citation statements)

References 36 publications

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“…The body of experimental studies evaluating this practice has also started to build. The few experimental studies on park prescription programs to date have shown moderate adherence [9], increased physical activity [5], improved quality of life [10], and improved resilience in children who received park prescriptions [11]. A park prescription for the family demonstrated increased weekly park visits and lowered stress in parents [12].…”

Section: Ofmentioning

confidence: 99%

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

Razani

Hills

Thompson

et al. 2020

IJERPH

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We conducted secondary data analyses of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting. Data were collected at the prescribing visit (baseline) and at one and three months of follow up from 78 families. Family characteristics were identified at baseline; regression models were used to explore changes during follow up in associations of park use with knowledge, attitudes and perceived access to parks. At baseline, park users differed from non-users in demographics, knowledge of park locations, attitudes about the value of park visits, but not affinity for nature. Park users were also more likely than non-users to feel that their neighborhood was safe for children to play in. Changes in knowledge of park locations, nature affinity, and perceived access to parks were each significantly associated with increased park use by families at one and three months after the park prescription. Adjusting for age, gender, race, poverty, and US birth, increases in knowing the location of parks were associated with an increase of 0.27 weekly park visits (95% CI 0.05, 0.49; p = 0.016); increases in feeling a caregiver had money to visit parks were associated with 0.48 more weekly park visits (95% CI 0.28, 0.69; p < 0.001); increases in perceived money for park outings were associated with 0.24 increased park visits per week (95% CI 0.05, 0.42; p = 0.01); each unit increase in nature affinity was associated with 0.34 more weekly park visits (95% CI 0.09, 0.59; p = 0.007). In other words, knowing where to go, valuing nature, and having time, and money contributed to increased likelihood of visiting a park. We discuss in terms of health behavior theory how demographics, knowledge, attitudes and perceived barriers to park use can inform park prescription interventions.

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Section: Ofmentioning

confidence: 99%

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

Razani

Hills

Thompson

et al. 2020

IJERPH

View full text Add to dashboard Cite

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“…For example, Taveras et al are studying a community-clinic partnership that includes health coaches working in the community; initial results are favorable [15,16]. Furthermore, in line with USPSTF recommendations [11], Hoffman et al increased treatment contact hours by partnering with a local parks and recreation department to deliver physical activity interventions to children in an obesity program [17]. In addition to demonstrating feasibility, they increased physical activity and improved quality of life (without significant changes in weight status in this pilot).…”

Section: Community-clinic Partnerships To Address Pediatric Obesitymentioning

confidence: 99%

“…Consensus [18,19] and evidence [16,17] suggest communityclinic partnerships are necessary to address the increasing number of children with obesity, since independently each approach appears to be insufficient. The behavior change that clinicians hope to elicit "outside the clinic" necessitates engaging the community to support families attempting change.…”

Section: Community-clinic Partnerships To Address Pediatric Obesitymentioning

confidence: 99%

Community engagement and pediatric obesity: Incorporating social determinants of health into treatment

Skelton

Palakshappa

Moore

et al. 2019

J. Clin. Trans. Sci.

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Childhood obesity is a complex and multi-faceted problem, with contributors ranging from individual health behaviors to public policy. For clinicians who treat pediatric obesity, environmental factors that impact this condition in a child or family can be difficult to address in a clinical setting. Community-clinic partnerships are one method to address places and policies that influence a person’s weight and health; however, such partnerships are typically geared toward community-located health behavior change rather than the deeper social determinants of health (SDH), limiting effective behavioral change. Community-engaged research offers a framework for developing community-clinic partnerships to address SDH germane to obesity treatment. In this paper, we discuss the relationship between SDH and pediatric obesity treatment, use of community-clinic partnerships to address SDH in obesity treatment, and how community engagement can be a framework for creating and harnessing these partnerships. We present examples of programs begun by one pediatric obesity clinic using community-engagement principles to address obesity.

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“…An alternate strategy is to position park referrals not in competition with other priorities, but as a strategy to cope with other stressors. Indeed, the nature found in parks has been shown to buffer the effects of poverty on health outcomes in adults [4], housing insecurity among refugees [33], and the effects of stress on childhood adversity in children [19,34]. We suggest that park interventions seeking to buffer the negative effects of poverty on health outcomes be explicit in naming and accounting for inequity in access to greenspaces.…”

Section: Discussionmentioning

confidence: 92%

“…Experimental studies evaluating this practice also are on the rise. To date, the few experimental studies on park prescription programs have shown moderate adherence [17], increased physical activity [18], improved quality of life [19], and improved resilience in children who received park prescriptions [20]. Park prescriptions for families demonstrated increased weekly park visits and lowered stress in parents [21].…”

Section: Introductionmentioning

confidence: 99%

Screening for Park Access during a Primary Care Social Determinants Screen

Razani

Long

Hessler

et al. 2020

IJERPH

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While there is evidence that access to nature and parks benefits pediatric health, it is unclear how low-income families living in an urban center acknowledge or prioritize access to parks. Methods: We conducted a study about access to parks by pediatric patients in a health system serving low-income families. Adult caregivers of pediatric patients completed a survey to identify and prioritize unmet social and economic needs, including access to parks. Univariate and multivariate analyses were conducted to explore associations between lack of access to parks and sociodemographic variables. We also explored the extent to which access to parks competed with other needs. Results: The survey was completed by 890 caregivers; 151 (17%) identified “access to green spaces/parks/playgrounds” as an unmet need, compared to 397 (45%) who endorsed “running out of food before you had money or food stamps to buy more”. Being at or below the poverty line doubled the odds (Odds ratio 1.96, 95% CI 1.16–3.31) of lacking access to a park (reference group: above the poverty line), and lacking a high school degree nearly doubled the odds. Thirty-three of the 151 (22%) caregivers who identified access to parks as an unmet need prioritized it as one of three top unmet needs. Families who faced competing needs of housing, food, and employment insecurity were less likely to prioritize park access (p < 0.001). Conclusion: Clinical interventions to increase park access would benefit from an understanding of the social and economic adversity faced by patients.

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An Integrated Clinic-Community Partnership for Child Obesity Treatment: A Randomized Pilot Trial

Cited by 46 publications

References 36 publications

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

Community engagement and pediatric obesity: Incorporating social determinants of health into treatment

Screening for Park Access during a Primary Care Social Determinants Screen

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