A Comparative Analysis of Adults' Perceptions of Sense of Community
A Walk in The Park: What’s Community Got to Do with It? A Comparative Analysis of Adults’ Perceptions of Sense of Community at Sentinel Peak and Tumamoc Hill, Tucson, Arizona
Item Type text; Electronic Dissertation
Authors Lewis, Deanna Lyn
Publisher The University of Arizona.
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Download date 07/10/2021 16:59:41
Link to Item http://hdl.handle.net/10150/631378
A WALK IN THE PARK: WHAT’S COMMUNITY GOT TO DO WITH IT? A COMPARATIVE ANALYSIS OF ADULTS’ PERCEPTIONS OF SENSE OF COMMUNITY AT SENTINEL PEAK AND TUMAMOC HILL, TUCSON, ARIZONA
by
Deanna Lyn Lewis
______Copyright © Deanna Lyn Lewis 2018
A Dissertation Submitted to the Faculty of the
MEL & ENID ZUCKERMAN COLLEGE OF PUBLIC HEALTH
In Partial Fulfillment of the Requirements
For the Degree of
DOCTOR OF PUBLIC HEALTH
In the Graduate College
THE UNIVERSITY OF ARIZONA
2018
A WALK IN THE PARK
2 A WALK IN THE PARK
STATEMENT BY AUTHOR
This dissertation has been submitted in partial fulfillment of the requirements for an advanced degree at the University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library.
Brief quotations from this dissertation are allowable without special permission, provided that an accurate acknowledgement of the source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the copyright holder.
SIGNED: Deanna Lyn Lewis
3 A WALK IN THE PARK
ACKNOWLEDGEMENTS
First and foremost, I’d like to thank my mother, Dolores, for bringing our family to
Tucson, Arizona in August 1979. At the age of 17 I was certain my mother had lost her mind by relocating the family from rural, southern New Hampshire to the sweltering desert. It was the most foreign place I had ever been. Little did I know her decision would forever change the trajectory of my life. The experiences, your support, and your love have helped mold me into who I am today.
To my family, friends, colleagues, and mentors, those for whom I have deep respect: you have always treated me with respect and supported me, and I am forever grateful.
Dolores Hoerning, Denise Lewis, Jason Lewis, Bill Hoerning, Bree Hoerning, Will
Hoerning, Aubree Hoerning, Anna Nowosielski, James Lewis and Harold Hoerning. Steve
Rabkin, Lisa Eilerman, Nellie Blunt, Pam Lotke, Jane Mohler, Ilana Addis, Alex Cronin,
Cynthia Thomson, John Ehiri, Erin Dokter, David Garcia, Deirdre Demers, Kelly Heslin, Sarah
David, Alicia Swift, Michelle (Scanze) Riccio, Martha Gebhardt, Monica Vasquez, Sofia
Gomez, Zeenat Majal, Reann Iva Davis, Robyn Blust, Kristin Myren, Hilary Rees, Denise Roe,
Andrea Howerton, Ellen (Shelly) Santos, Michele Scanze, Holly Bryant, Patrick Sims, Juliet
Charron, Marlene Field, Mark Austein, Corky Poster, Lilly Morales, Adam Block, Carlitta
Burrel, Gabby Huffer, Genesis Florendo, Kevin Ferreria, Chris Tisch, Stephanie Springer,
Michael Tearne, Lorraine Verela, Kathleen Crist, Suzanna Trejo, Nicole Bergier, Maria Fajardo,
Rose Evans, Jen Hoefle-Olsen, Michelle Higgins, Teresa Graham-Brett, Kendall Washington-
White, Sherard Williams, Sidney Pettygrove, Donna Knight, Lili Chavez, Andrea Holm, Leslie
Dupont, Renae Kargleder, Laura Baker, Nancy Avery, Diana Benson, Diane Wygal, Betsy
Cacchione, Scott Hanes, the Himmel Athletics Crew (Caryn Isom Fraser & Co., Lisa Anne &
4 A WALK IN THE PARK
Ash Trudinger-Smith and Co., Michelle Renzetti & Phil Brown and Maya, Ahni & Jude, Don
Hubman & Deborah Rubens, Jim Edwards & Trish Aldridge, Jorge Gutierrez, Emily Kornff,
John Douglass & Jill Onken, Sesaly Stamps, The Providence Clan, Lori Kindler& Ken Youens-
Clark & Co., Ashely Nowe & Kevin Cotter, Doremy Tong, Patty Atkins, Heidi Costello & Steve
Wilson, and Ken Harvey), Kerstin Reinschmidt, Nicolette Teufel-Shone, Sam Sabo, Jill
Guernsey De Zapien, Cecilia Rosales, Rafe Sagarin, Courtney Nation, Cynthia Grant, Luis
Ortega, Sheronda Jordan, Rowan Frost, Heather Celani, Amy Zuckerman, Rachel Almburg, Aziz
Abdul, Mershack Andoh, Allen Gula, Blake Scott, Cole Hoover, Solomiya Romanivna, The
Caffe Luce Crew (Kyle, Brit, Clint, Terrell, Teresa, Brandi, Gary, Jessica, Branden, and
Gayland), Brandy McClain & Co., Andrew Goode, Greg Haft, Amy Muchna, Ian Philabaum,
Libby Salerno, Michelle Crow, Laura Boylard, Diego Martinez and Alex.
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DEDICATION
My tenure with the Tucson Fire Department (TFD) allowed to me experience my community through a lens that I could not have imagined. For example, early on I learned that childhood drownings peak in Tucson during the summer months and are 100% preventable.
About this kind of preventable tragedy, former Surgeon General C. Everett Koop said, “If a disease were killing our children at the rate unintentional injuries are, the public would be outraged and demand that this killer be stopped” (1995). While the National Safe Kids Coalition was in full swing, I worked with Captain Randy Ogden in TFD’s public education section. Our mission was to prevent childhood drownings and unintentional childhood injuries. During this time I discovered public health in the context of primary prevention efforts to reduce and eliminate unintentional injuries and deaths and became committed to public health as my professional path.
This paper is dedicated my family members, my friends, and my community members who lost their lives to pressing public health issues: David Monahan, Tracey Dixon, Andre
Washington, Denise Ann Lewis, James Walter Lewis, Anna Nowosielski, Lisa Weber-Grondin,
Jared Grondin, Emily Kornff, and Eric Ogden.
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Table of Contents
LIST OF FIGURES ...... 11
LIST OF TABLES...... 12
ABSTRACT ...... 14
Keywords: ...... 15
INTRODUCTION ...... 16
GEOGRAPHIC REGION AND STUDY SITE DESCRIPTORS ...... 16
PHYSICAL ACTIVITY ON TUMAMOC HILL ...... 19
TUMAMOC HILL SITE OBSERVATIONS (INFORMAL) ...... 20
2013 PILOT STUDY OVERVIEW ...... 21
2013 Pilot Study Results ...... 22
A WALK IN THE PARK ...... 24
SPECIFIC AIM 1 ...... 25
Hypothesis 1: ...... 26
SPECIFIC AIM 2 ...... 26
Hypothesis 2: ...... 26
SPECIFIC AIM 3 ...... 26
Hypothesis 3.a: ...... 26
Hypothesis 3.b: ...... 26
Hypothesis 3.c: ...... 27
CHAPTER 1: THE INFLUENCE OF POLICY, SOCIAL, ECOLOGICAL, AND INDIVIDUAL FACTORS ON
HEALTH BEHAVIOR AND COMMUNITY-BASED HEALTH PROMOTION ...... 28
BACKGROUND: PHYSICAL INACTIVITY AND OBESITY ...... 28
THE SOCIAL-ECOLOGICAL ENVIRONMENT AND BEHAVIOR CHANGE ...... 30
THEORETICAL FRAMEWORK ...... 32
CONCEPTUAL FRAMEWORK ...... 32
7 A WALK IN THE PARK
CHAPTER 2: COMMUNITY-BASED RESEARCH: A LABORATORY FOR PUBLIC HEALTH STUDENT
RESEARCH TRAINING ...... 36
ABSTRACT ...... 36
INTRODUCTION ...... 37
RESEARCH SITES ...... 38
PARTICIPANTS...... 39
METHODS ...... 40
Measuring Physical Activity Levels in Public Open Spaces ...... 40
System of Observing Play and Recreation in Communities (SOPARC)...... 40
Instructional Goals ...... 41
Instructional Activities ...... 42
Week 1: Orientation and SOPARC instrument training ...... 42
Week 2: Field research and beta testing ...... 42
Week 3: Assessment ...... 43
Weeks 4-12: Data collection and analysis...... 44
RESULTS ...... 44
DISCUSSION ...... 46
Strengths ...... 48
Limitations ...... 48
CONCLUSION ...... 48
CHAPTER 3: A WALK IN THE PARK: WHAT’S COMMUNITY GOT TO DO WITH IT? ...... 50
ABSTRACT ...... 50
INTRODUCTION ...... 51
Hypothesis 1: ...... 52
Hypothesis 2: ...... 53
Hypothesis 3.a: ...... 53
Hypothesis 3.b: ...... 53
Hypothesis 3.c: ...... 53
8 A WALK IN THE PARK
METHODS ...... 53
Research Sites ...... 53
Recruitment Process and Study Participants ...... 54
Sentinel Peak ...... 54
Tumamoc Hill ...... 55
Informed consent...... 55
Study Instruments and Administration ...... 56
Sense of Community Index-2 Instrument (see Appendix D) ...... 56
Self-Efficacy Instrument (see Appendix E) ...... 56
Health and Wellbeing Instrument (see Appendix F) ...... 57
Intervention ...... 58
Statistical analysis ...... 58
RESULTS ...... 59
Participant enrollment ...... 59
Sentinel Peak participants ...... 60
Tumamoc Hill participants ...... 60
Baseline Results ...... 62
Sense of Community, Health and Well-Being, and Self-Efficacy Instrument Results ...... 62
Post-Intervention Results ...... 63
Sense of Community, Health and Well-Being and Self-Efficacy Instrument Results ...... 63
Change in Sense of Community and Sense of Community Indices ...... 64
Change in Self-Efficacy ...... 65
Changes in Health and Wellbeing ...... 66
Gender and Sense of Community ...... 66
Public Health Significance ...... 67
Health Promotion ...... 67
Maternal and Child Health ...... 68
DISCUSSION ...... 69
Social Ecological Environment ...... 70
Sense of Community ...... 72
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Self-Efficacy ...... 73
Strengths ...... 74
Limitations ...... 75
CONCLUSION ...... 77
CHAPTER 4: STUDY SUMMARY FOR A WALK IN THE PARK: WHAT’S COMMUNITY GOT TO DO
WITH IT? ...... 79
Hypothesis 1: ...... 80
Hypothesis 2: ...... 81
Hypothesis 3a: ...... 81
Hypothesis 3b: ...... 81
Hypothesis 3c: ...... 82
IMPLICATIONS...... 82
REFERENCES: ...... 83
APPENDIX A: LEWIS, 2013; UNPUBLISHED DRAFT ...... 102
APPENDIX B: LETTERS OF SUPPORT ...... 110
APPENDIX C: SOPARC INSTRUMENT ...... 122
APPENDIX D: SENSE OF COMMUNITY INDEX-2 (SCI-2) INSTRUMENT ...... 123
APPENDIX E: SELF EFFICACY INSTRUMENT ...... 124
APPENDIX F: HEALTH AND WELLBEING INSTRUMENT ...... 125
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List of Figures
FIGURE 1. MAP OF ARIZONA. THIS FIGURE ILLUSTRATES TUCSON, ARIZONA IN THE CONTEXT OF THE U.S.
SOUTHWEST...... 17
FIGURE 2. MAP OF THE TUCSON MOUNTAIN RANGES. THIS FIGURE ILLUSTRATES THE LOCATION OF THE TUCSON
MOUNTAINS ADJACENT TO TUCSON, ARIZONA...... 17
FIGURE 3. TOPOGRAPHICAL MAP OF TUMAMOC HILL AND SENTINEL PEAK. THIS FIGURE ILLUSTRATES THE
PROXIMITY OF TUMAMOC HILL TO SENTINEL PEAK, BOTH WITHIN THE TUCSON MOUNTAIN RANGE...... 17
FIGURE 4. PHYSICAL INACTIVITY TRENDS IN PIMA COUNTY, 2004-2011...... 29
FIGURE 5. OBESITY TRENDS IN PIMA COUNTY, 2004-2011...... 29
FIGURE 6. ECOLOGICAL MODELS BY BRONFENBRENNER, 1994 [L] AND SALLIS ET AL., 2006 [R]...... 32
FIGURE 7. CONCEPTUAL FRAMEWORK: THE INFLUENCE OF POLICY, SOCIAL, ECOLOGICAL, AND INDIVIDUAL
FACTORS ON HEALTH BEHAVIOR (D. LEWIS). (THE DOTTED LINES WITH ARROWS REPRESENT THE
PROPOSED STUDY’S INVESTIGATION OF ADULT USERS’ PERCEPTIONS OF SENSE OF COMMUNITY WITH SELF-
EFFICACY TOWARDS PHYSICAL ACTIVITY AND ASSOCIATED HEALTH IMPLICATIONS.) ...... 33
FIGURE 8. INSTRUCTIONAL DESIGN...... 40
FIGURE 9. COMPARISON OF ACTIVITY TYPES AT TUMAMOC HILL AND SENTINEL PEAK BETWEEN RATER ONE
AND RATER TWO...... 46
FIGURE 10. CONSOLIDATED STANDARDS OF REPORTING TRIALS (CONSORT) DIAGRAM OF PARTICIPANT
ENROLLMENT...... 59
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List of Tables
TABLE 1. TUMAMOC HILL AND SENTINEL PEAK GEOGRAPHIC DESCRIPTORS...... 19
TABLE 2. TUMAMOC HILL OBSERVATIONS ON DEMOGRAPHICS AND ACTIVITY TYPE, JUNE 4, 2013 [0430-0730
HOURS]...... 20
TABLE 3. TUMAMOC HILL AND CITY OF TUCSON (COT) RACIAL COMPOSITION COMPARISON BETWEEN
TUMAMOC HILL OBSERVATIONS [JUNE 4, 2013] AND TUCSON 2010 U.S. CENSUS DATA...... 21
TABLE 4. NOVEMBER 2013 DEMOGRAPHIC CHARACTERISTICS BY SITE (MISSING DATA INCLUDED)...... 23
TABLE 5. RESEARCH SITE DESCRIPTORS...... 38
TABLE 6. DISTRIBUTION OF UNDERGRADUATE PARTICIPANTS BY GENDER AND YEAR IN SCHOOL...... 39
TABLE 7. INTER-RATER RELIABILITY, USING CHI-SQUARE, AT TUMAMOC HILL...... 45
TABLE 8. INTER-RATER RELIABILITY, USING CHI-SQUARE, AT SENTINEL PEAK...... 45
TABLE 9. MEAN ACTIVITY LEVELS PER SITE (MEASURED IN KCAL/KG AND METS AND ROUNDED TO THE NEAREST
WHOLE)...... 46
TABLE 10. RESEARCH SITE DESCRIPTORS...... 54
TABLE 11. SENTINEL PEAK AND TUMAMOC HILL PARTICIPANT DESCRIPTIVE CHARACTERISTICS...... 61
TABLE 12. BASELINE (PRE) COMPARISON OF SENSE OF COMMUNITY AND SENSE OF COMMUNITY INDICES,
HEALTH AND WELLBEING, AND SELF-EFFICACY (MEAN VALUES) AT SENTINEL PEAK AND TUMAMOC HILL
...... 62
TABLE 13. SENTINEL PEAK AND TUMAMOC HILL POST-INTERVENTION (POST) COMPARISON OF SENSE OF
COMMUNITY AND SENSE OF COMMUNITY INDICES, HEALTH AND WELLBEING, AND SELF-EFFICACY (MEAN
VALUES)...... 63
TABLE 14. SENTINEL PEAK AND TUMAMOC HILL SENSE OF COMMUNITY BASELINE AND POST-INTERVENTION
COMPARISON OF SENSE OF COMMUNITY INDICES AND OVERALL SENSE OF COMMUNITY MEAN (BETWEEN
AND WITHIN BOTH SITES)...... 65
TABLE 15. CHANGE IN SENTINEL PEAK AND TUMAMOC HILL PARTICIPANTS MEAN SELF-REPORTED SELF-
EFFICACY FROM BASELINE TO POST-INTERVENTION ...... 65
TABLE 16. COMPARISON OF MEAN CHANGE FROM BASELINE TO STUDY END IN HEALTH AND WELLBEING
BETWEEN SENTINEL PEAK AND TUMAMOC HILL ...... 66 12 A WALK IN THE PARK
TABLE 17. SENTINEL PEAK AND TUMAMOC HILL GENDER AND SENSE OF COMMUNITY BASELINE (PRE) AND
POST-INTERVENTION COMPARISON OF GENDER AND OVERALL MEAN OF SENSE OF COMMUNITY...... 67
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Abstract
Public spaces such as parks can be associated with greater physical activity among community members. Physical activity within public spaces can be assessed with validated tools such as the System for Observing Play and Recreation in Communities (SOPARC). However, the instrument is labor-intensive to administer. Novel approaches, such as rigorous training for student-supported data collection, can assure ample sampling to assess differences in physical activity among public spaces. Further, promoting walking and walkable communities in public open spaces has been shown to increase physical activity levels for U.S. adults. Self-efficacy and social connections are two behavioral constructs known to improve leisure time physical activity and ultimately improve health outcomes. We conducted a quasi-experimental study using pre/post surveys with a convenience sample of men and women ages 18 years and older identified at a public park (Sentinel Peak) and a public open space (Tumamoc Hill). The study investigated adult users’ perceptions of sense of community, self-efficacy, and health and wellbeing. After identifying Sentinel Peak as the site with a lower SOPARC score, a walking intervention was developed to promote physical activity at this site; Tumamoc Hill served as the comparison site. The intervention group consisted of adults who met once a week to walk for 30
– 60 minutes over the course of 16 weeks. The comparison group consisted of adults from
Tumamoc Hill who, based on our earlier research, demonstrated on average, a pattern of walking
1-2 times per week for 30-60 minutes. A comparative analysis of sense of community, self- efficacy for physical activity, and health and wellbeing was conducted between the two sites.
Change in physical activity between the two sites was not measured, nor was it a hypothesis for this research. A total of 33 participants (Sentinel Peak, n=13; Tumamoc Hill, n=20) completed pre and post surveys. The majority of the participants were women (women, n=25; men, n=8);
14 A WALK IN THE PARK
79% were white, 15% were Hispanic, 3% were Native American, and 3% identified as other.
The overall mean age was similar across sites (50.8 years at Sentinel Peak and 49.4 years at
Tumamoc Hill). The post-intervention results show a statistically significant difference
(p=<0.0001) in participants’ perceptions of sense of community between Sentinel Peak and
Tumamoc Hill. At study end, there were no differences between the site participants’ perceptions of self-efficacy or health and wellbeing. The findings of the study suggest that participation in a walking group may promote sense of community among walking group members and that an adult’s perceptions of sense of community may be a determinant for engagement in physical activity, such as walking, within public parks and public open spaces.
Keywords: sense of community, physical activity, public open spaces, walking, self-efficacy, system for observing play and recreation in communities (SOPARC)
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Introduction
In 1979 Tucson became my new home (Figure 1) (Maps of the World, 2015). The population was approximately 330,000 (520,000, 2010 Census) and my family was nestled in the
Tucson basin surrounded by four distinct mountain ranges (Figure 2) (Arizona Daily Star,
2012). As a young adult, I took an interest in outdoor recreation, and trail running and hiking were my primary forms of physical activity. Several years later, when I became more serious about health and wellness, I discovered Tumamoc Hill. It was “famous” among locals, known as a challenging hill to walk or run with its steep inclines and switchbacks. In May 2013, a friend/colleague and I were running Tumamoc, and we were fascinated by the nature and volume of people walking and running it. Right there we decided to conduct a study to answer this question: “What’s the attraction to Tumamoc Hill?”
Geographic Region and Study Site Descriptors
The Tucson Mountain Range, located on the western side of Tucson, Arizona, houses both Tumamoc Hill and Sentinel Peak (Figure 3) (McGarvin, 2001; Phillips, 1976; Schmahl,
Cordivari, Eubank, & Horvath, 2013). More than 4,000 years ago, at the base of Sentinel Peak, the Santa Cruz River flowed year-round (Doelle, 2015). It provided ample water for irrigation and agriculture, becoming the oldest agricultural site in North America (Potteiger, 2017). This agricultural oasis fostered community development and attracted diverse inhabitants, with indigenous peoples providing sustainable living conditions (Doelle, 2015). Tumamoc Hill and
Sentinel Peak have historical significance as open spaces facilitating social and ecological connections among and between community members in the Southwest.
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Figure 1. Map of Arizona. This figure illustrates Tucson, Arizona in the context of the U.S. Southwest.
Figure 2. Map of the Tucson mountain ranges. This figure illustrates the location of the Tucson Mountains adjacent to Tucson, Arizona.
Figure 3. Topographical map of Tumamoc Hill and Sentinel Peak. This figure illustrates the proximity of Tumamoc Hill to Sentinel Peak, both within the Tucson Mountain Range.
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Today, we still see people flocking to Tumamoc Hill and Sentinel Peak, but for reasons other than agriculture. Sentinel Peak, also known as “A” Mountain, is a designated City of
Tucson public park and is adorned with the iconic “A” that faces downtown Tucson. Annually, thousands of residents and visitors drive, bike, hike or walk to the top for a view of the Sonoran
Desert and the city center. The meandering and scenic drive up “A” Mountain hosts several locations to view a morning sunrise or to capture the city’s night lights.
Tumamoc Hill is known as much for its iconic desert research laboratory as it is for physical activity, primarily walking. Walkers (and runners) meander 1.5 miles from the base to the top of the hill (3 miles round trip). The grade is easy on the bottom and steeper on the upper road (17.9% slope), with a rise and fall of 730 feet elevation (Desert Laboratory on Tumamoc
Hill, 2018; Tumamoc Hill Walkers, 2015).
Differences between the two locations are numerous (Table 1). Sentinel Peak is under city purview, whereas Tumamoc Hill is under state and county jurisdiction. Owned and operated by the University of Arizona College of Science in partnership with Pima County, Tumamoc is an ecological reserve and desert laboratory. As a result, there is no public vehicle use in this location. Sentinel Peak has vehicular traffic given its public access status during normal business hours; therefore, increased safety concerns abound for walkers, hikers, and cyclists. In contrast,
Tumamoc Hill (3,108’), much steeper than Sentinel Peak (2,897’), imposes a different type of barrier for use: a higher degree of difficulty (Lewis, et al., 2013); whereas the lack of vehicular traffic serves as a facilitator of walking (McCormack, Rock, Toohey, & Hignell, 2010; Lockett,
Willis, & Edwards, 2005). Given the two examples of public open spaces--a public park compared to a desert laboratory/ecological reserve--Tumamoc Hill experiences significantly
18 A WALK IN THE PARK more walking as a form of physical activity than Sentinel Peak. What is the nature of this phenomenon?
Table 1. Tumamoc Hill and Sentinel Peak Geographic Descriptors.
Parent Range: Elevation Address Restrictions Hours of Tucson Distance Coordinates Operation Mountains Tumamoc Hill 3,108 ft. (947 1675 W. Anklam No motorized Mon-Fri: University of m) Rd., Tucson, AZ 85745 vehicles before 7:30AM Arizona and 3.2-mile No pets, no and after Pima County paved road 32°12′46″N 111°00′22″W cyclists 5:30PM Open Space [out and Weekends: All back, from hours entrance]
Sentinel Peak 2,897 ft. 1501 S. Sentinel Peak Rd., Tucson, None Mon-Sat: City of Tucson (883 m) AZ 85745 9AM-8PM Public Park 2.0-mile Sunday: 9AM- paved road 32°12′38.16″N110°59′30.12″W 6PM [out and back loop, from entrance]
Physical Activity on Tumamoc Hill
Walking activity on Tumamoc Hill is in part influenced by the Tumamoc Walkers, a local, community-based organization. The Tumamoc Walkers are an informal group of community members whose mission is to ensure continued access to Tumamoc Hill for public use and physical activity. The Tumamoc Walkers offer some insight into potential trends regarding community use of this site. On their website, they make the following three observations: 1) There are slightly more female than male walkers; 2) most walkers are over 30 years of age; and 3) the ethnicity of walkers is about the same in terms of ratio as the demographic breakdown of the City of Tucson (Tumamoc Hill Walkers, 2015). That said, there had been no public health or epidemiological studies examining either Tumamoc Hill or Sentinel
19 A WALK IN THE PARK
Peak to investigate these statements. This provided an opportunity to informally investigate such assertions using basic field observation techniques.
Tumamoc Hill Site Observations (informal)
On June 4, 2013, a graduate and an undergraduate student collected data on Tumamoc
Hill over a period of three hours. A total of 262 unique person observations were made all at the top of Tumamoc Hill (Table 2). Based on visual observations, 183 individuals presented as female and 79 presented as male; 90% were walking and 10% were running at the time of observation. Using the Tumamoc Walkers’ statements as ad hoc hypotheses, we could informally confirm the following: there were more females than males engaging in physical activity, there were more walkers than runners, and the demographics of the walkers (on June 4, 2013) were similar to the 2010 U.S. Census racial composition of Tucsonans (Table 3), although the percentage of African Americans on Tumamoc Hill was higher than the 2010 U.S. Census, and the percentage of Asians and Hispanics on Tumamoc Hill was slightly lower than the U.S.
Census (U.S. Department of Commerce, 2017). The need for additional, validated data prompted further investigation.
Table 2. Tumamoc Hill Observations on Demographics and Activity Type, June 4, 2013 [0430-0730 hours].
Ethnicity Total (%) Male Female Run Walk Caucasian 123 47.0 36 87 Hispanic 113 43.1 34 79 African American 7 2.7 2 5 Native American 6 2.3 2 4 Asian 10 3.8 2 8 Other 3 1.1 3 0 Total 262 100 79 (30.1%) 183 (69.9%) 25 237
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Table 3. Tumamoc Hill and City of Tucson (COT) racial composition Comparison between Tumamoc Hill observations [June 4, 2013] and Tucson 2010 U.S. Census data.
Tumamoc Hill observations COT Tucson 2010 U.S. Census Ethnicity Percentage (%) Percentage (%) Caucasian 47.0 47.2 Hispanic 43.1 41.6 African American 2.7 5.0 Native American 2.3 2.7 Asian 3.8 2.9
2013 Pilot Study Overview
The follow-up to this informal study resulted in “A Comparative Analysis of Physical
Activity Levels in a Designated Recreational Park Versus a Designated Open Space in the
Tucson Mountain Ridge: A Closer Look at Sentinel Peak and Tumamoc Hill Users”(Lewis, et al., 2013). The study was a University of Arizona IRB-approved pilot research pilot study. Using survey questionnaires, we collected data from runners and walkers at both locations. These surveys were designed to obtain basic demographic information, the primary reason individuals were participating in walking or running, and their typical duration and frequency of use of the public space. Questions relating to basic demographics, such as gender and ethnicity, were modeled after similar questions in the 2010 Census. Questions regarding physical and mental health were modeled after similar questions in the National Health and Nutrition Examination
Survey (NHANES)1. A sentry-style count of visitors was obtained at the entrance of each site. A combined total of 1,008 users passed through the entrances into each geographic area. The inclusion criteria for participating in the study included runners and walkers 18 years and older.
Participation was voluntary, and each participant signed an informed consent agreement. Study
1 The National Health & Nutrition Examination Survey (NHANES) assesses the health and nutritional status of adults and children in the United States. Retrieved from https://www.cdc.gov/nchs/nhanes/index.htm. 21 A WALK IN THE PARK participants had the option to take the survey in either English or Spanish, as well as the option to have the survey questions read to them.
2013 Pilot Study Results
Of the 1,008 users, 39% (n=393: Sentinel Peak, n=24; Tumamoc Hill n=369) participated in the survey questionnaire (Table 4). Overall, there were twice as many women as men, and approximately half of the participants were non-Hispanic white, with Hispanics comprising the second largest race/ethnic group. The findings from this pilot study formally supported two of the three Tumamoc Walkers’ claims (the ad hoc hypotheses): 1) There were slightly more female than male participating in physical activity in these public spaces during the timeframe of the study; and 2) most walkers were over 30 years of age. Additional findings indicated the majority of participants (53%; n=196) used these public open spaces to walk or run for 30-60 minutes
(61%) 1-2 times per week. Participants identified various reasons for using the public open spaces. The top three reasons were to improve health (46.5%); to enjoy the beauty of the outdoor space (20.4%); and to walk (15.1%). Lastly, the majority of participants were accompanied by friends or a partner.
In line with the principles of community-based participatory research (Minkler &
Wallerstein, 2011), the results including the response rate and the overall receptiveness of community members to participate in this research were reported back to the community via social media.
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Table 4. November 2013 Demographic Characteristics by Site (Missing Data Included). Variable Sentinel Peak Tumamoc Hill (n = 24) (n = 369) Year of Birth, mean ± SD 1975 ± 17 1969 ± 14 Age in years, mean ± SD 38 ± 17 44 ± 14 Gender, n (%) Male (n=121) 11 (45.8%) 110 (29.8%) Female (n=257) 11 (45.8%) 246 (66.7%) Other (n=1) 1(4.2%) 0 (0.0%) Missing (n=14) 1 (4.2%) 13 (3.5%) Race, n (%) White 12 (50.0%) 166 (45.0%) African American 0 (0.0%) 12 (3.3%) Asian 0 (0.0%) 7 (1.9%) American Indian/Alaska Native 0 (0.0%) 10 (2.7%) Native Hawaiian/Pacific Islander 0 (0.0%) 1 (0.3%) Latino/Latina 7 (29.2%) 119 (32.3%) Two or more 0 (0.0%) 7 (1.9%) Other 0 (0.0%) 8 (2.2%) Missing 5 (20.8%) 39 (10.6%) Ethnicity, n (%) Hispanic or Latino 8 (33.3%) 156 (42.3%) Non-Hispanic or Latino 14 (58.3%) 183 (49.6%) Missing 2 (8.3%) 30 (8.1%)
In spring 2016, a local non-profit organization and a public health undergraduate student intern partnered to produce a short (5 minute) video titled The People of Tumamoc Hill. The video was uploaded May 27, 2016 on the YouTube social media platform. As of December 7,
2018, the video has had 1, 291 views. The video includes brief interviews with walkers and runners, the City Council member for Ward 1, a founding member of the Tumamoc Walkers, a representative from a local non-profit, and the director/producer of the video. While the video was in development, the first letters of support and encouragement to continue investigating this social phenomenon were provided by numerous stakeholders, including the City of Tucson Vice
Mayor and Ward 1 Councilor, Regina Romero; several letters of support ensued (Appendix B).
23 A WALK IN THE PARK
The nature of this research is defined as much by community engagement as it is by scientific methods. The pilot study, its results, and local support served as the foundation for the research that followed: “A walk in the park: what’s community got to do with it?”
A Walk in the Park
Walking and walkable communities have become national, state, and local priorities
(U.S. Department of Health and Human Services, 2015) due to the epidemic proportions of morbidity and mortality associated with physical inactivity and obesity (Lee et al., 2012).
Research shows that public parks and recreational spaces encourage physical activity (Godbey,
Mowen, & Ashburn, 2010; Bedimo-Rung, Mowen, & Cohen, 2005), which is vital for optimal health (Warburton, Nicol, & Bredin, 2006; Morris, Heady, U.S. Department of Health and
Human Services, 2012). The Pima County Health Department’s (PCHD) community improvement plan (CHIP), in alignment with the state health improvement plan (SHIP), has prioritized healthy lifestyles for all residents in order to reduce the burden of obesity statewide
(Pima County Community Health ACTION Network [CHAT], 2013; Arizona Department of
Health Services, 2014). Further, built environments, such as public parks, can enhance sense of community among residents (Francis, Giles-Corti, Wood, & Knuiman, 2012). Initiatives to improve walkability within communities have historically focused on better design, greater accessibility, and designated safety features, rather than social determinants (Nathan, Wood, &
Giles-Corti, 2014; Sallis, Floyd, Rodriguez, & Saelens, 2012). Empirical data suggest that an increase in adult physical activity levels can be expected through support of individual behavior change as well as group physical activity interventions (Baker & Francis, 2015; Kassavou,
Turner, & French, 2013). However, limited data exist to evaluate the relationship between social connectedness and physical activity, and no data of this nature exist for Pima County adult
24 A WALK IN THE PARK residents (CHAT, 2013). Results from a comparative analysis conducted by Lewis (2013) in
Tucson, Arizona revealed that adult users preferred the public open space compared to the public park for walking. These data suggest that not only do open space users participate in physical activity more frequently than public park users in these designated built environments, but also that open space users are more likely to develop a pattern of maintenance for physical activity.
“A walk in the park: what’s community got to do with it?” proposes to build upon the comparative analysis conducted by Lewis (2013) and offers the following objectives for comparing users and their physical activity at a public park or public open space: 1) to conduct a direct observation assessment of users and their physical activity at Sentinel Peak and Tumamoc
Hill, 2) to evaluate and compare adult perceptions of sense of community at both sites, 3) to evaluate and compare adults’ self-efficacy for physical activity at both sites, 4) to evaluate adult perceptions of their health and well-being at both sites, and 5) to determine whether a walking group intervention will enhance sense of community in public open space, understanding that sense of community is a motivator for physical activity among adults (Baker, Francis, Soares,
Weightman, & Foster, 2011; Baker & Francis, 2015; Chavis & Wandersman, 1990; Cohen,
2004; Duncan & McAuley, 1993; Heitzmann & Kaplan, 1988; Kaczynski & Glover, 2012).
Given preliminary data supporting higher rates of physical activity (e.g., walking and running) at
Tumamoc Hill as compared to Sentinel Peak, we will complete the following aims:
Specific Aim 1
Conduct a direct observation evaluation of the physical activity environment at the two public open spaces, Sentinel Peak and Tumamoc Hill, using System of Observing Play and
Recreation in Communities (SOPARC) instrument (Appendix C).
25 A WALK IN THE PARK
Hypothesis 1:
Tumamoc Hill’s SOPARC score for physical activity behavior will be greater than
Sentinel Peak’s SOPARC score for physical activity behavior. Informed by data from the
SOPARC assessment, Specific Aim 2 will be conducted.
Specific Aim 2
Implement a sixteen-week evidence-based walking group intervention among adults at the space with the lower SOPARC score.
Hypothesis 2:
After sixteen weeks (post-intervention), sense of community will increase significantly at the public space where the walking intervention was implemented.
Specific Aim 3
Evaluate adults’ self-efficacy related to physical activity and sense of health and well- being at baseline and 16 weeks post-study enrollment at a public park (Sentinel Peak) and a public open space (Tumamoc Hill).
Hypothesis 3.a:
At baseline, adults’ self-efficacy related to physical activity and sense of health and well- being will be significantly greater for adults located at Tumamoc Hill as compared to adults located at Sentinel Peak.
Hypothesis 3.b:
Post-intervention, adults’ self-efficacy related to physical activity and sense of health and well-being will not be different between the two study sites (intervention site will demonstrate increases in self-efficacy related to physical activity and sense of health and well-being).
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Hypothesis 3.c:
Sense of Community will be associated with an increase in self-efficacy for physical activity overall.
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Chapter 1: The Influence of Policy, Social, Ecological, and Individual Factors on Health
Behavior and Community-Based Health Promotion
Background: Physical Inactivity and Obesity
Physical inactivity, a major driver of weight gain, plagues adults to the degree that two out of three adults suffer from overweight or obese conditions (Lee et al., 2012; U.S. Department of Health and Human Services [HHS], 2015). In Pima County, Arizona, approximately 20% of adults are physically inactive (HHS, 2010; Pima County Community Health ACTION Network
[CHAT], 2013). On average, Pima County trends lower than Arizona and the United States in the percentage of the adult population that report inactivity; however, between 2004 and 2011, the level of physical inactivity and obesity continued to escalate (Figures 4 and 5) (Arizona
Department of Health Services [AZDHS], 2014; CHAT, 2013). Despite the benefits, 46% of adults in Arizona do not meet the recommended guidelines for moderate or vigorous physical activity (Arizona Department of Health Services, 2014), a likely contributing factor to rising obesity prevalence rates. Obesity is a precursor and independent risk factor for numerous chronic diseases such as diabetes and heart disease, which continue to be leading causes of death and disability (Morris, Pollard, Everitt, Chave, & Semmence, 1980; Lee et al., 2012; Warburton,
Nicol, & Bredin, 2006). Physical inactivity places Arizona adults at risk for premature death
(Chobanian et al., 2003; Lee et al., 2012; Paffenbarger & Hyde, 1984).
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Figure 4. Physical Inactivity Trends in Pima County, 2004-2011.
Figure 5. Obesity trends in Pima County, 2004-2011.
A potential barrier to physical activity is that only 38% of Arizona adults have access to public parks (Arizona Department of Health Services, 2014). Empirical data suggest that the physical environment, such as public parks and public open spaces, significantly contributes to
29 A WALK IN THE PARK physical activity. The evidence further implicates public parks and public open spaces as healthy places where people congregate to engage in recreational, leisure and physical activity (Bedimo-
Rung, Mowen, & Cohen, 2005; Cohen et al., 2007; Giles-Corti et al., 2005; Godbey & Mowen,
2010; McCormack, Rock, Toohey, & Hignell, 2010; Sallis, Floyd, Rodríguez, & Saelens, 2012).
In general, adults seek out accessible, affordable and safe places such as public parks and public open spaces in order to satisfy their need for leisure time physical activity (LTPA), such as walking (Arizona Outdoor Recreation Coordinating Commission, 2013). Walking is the premier activity shown to have universal appeal to promote physical activity (Haskell et al., 2007; Pate et al.,1995). Finally, accessible public parks and public open spaces provide venues to promote walking and foster social connections (Kim & Kaplan, 2004; Lund, 2002; McMillan & Chavis,
1986; Peters, Elands, & Buijs, 2010).
The Social-Ecological Environment and Behavior Change
The social ecological environment of public parks and public open spaces plays an important role in contributing to social connections (Sallis et al., 2006). The associations between social connections within public spaces have been shown to be stronger determinants for physical activity than the physical environment itself (Sallis, Bauman, & Pratt, 1998).
Additionally, data have suggested that socially connected adults have increased physical activity levels, which have contributed to lower levels of morbidity and mortality (Siegel, Brackbill, &
Heath, 1995). Social connectedness can be assessed through the Sense of Community Index
(SCI-2), a tool developed for the social sciences; the SCI-2 measures multiple domains of adults’ perceptions of community (McMillan & Chavis, 1986; McMillan, 1996; Peterson, Speer, &
McMillan, 2008). Despite the availability of this effective tool, the measurement of adults’ perceptions and experiences of public parks and public open spaces has seldom been explored
30 A WALK IN THE PARK
(Wood, Frank, & Giles-Corti, 2010; Kim & Kaplan, 2004). Social support and social support networks offer well-established associations between increased adult physical activity and positive health outcomes (Stokols, 1996). To better understand the social ecological implications in public parks and public open spaces, adults’ perceptions of sense of community will be measured as a proxy for social connectedness.
An individual’s ability to change behavior is determined to a great extent by self-efficacy, which is the confidence one feels about accomplishing a task. Self-efficacy, regarded as the most significant determinant in the maintenance of a new behavior, is an important internal gauge.
(Marcus et al., 1998; Marcus, Eaton, Rossi, & Harlow, 1994; Marcus, Rakowski, & Rossi, 1992;
Marcus, Selby, Niaura, & Rossi, 1992; Marcus & Simkin, 1994; Mendoza-Vasconez, Marquez,
Benitez, & Marcus, 2018; Prochaska & Marcus, 1994). Therefore, assessing self-efficacy pre- and post-intervention will allow us to assess changes in the individual’s level of self-confidence in the context of the physical activity intervention.
To satisfy their need for physical activities such as walking, many adults seek out accessible, affordable and safe places such as public parks and public open spaces (Godbey,
Mowen, & Ashburn, 2010). The evidence suggests public parks and public open spaces facilitate social environments by providing space for adults to congregate (Peters, Elands, & Buijs, 2010).
Consequently, social interactions transpire, and social norms, such as physical activity in public spaces, develop. These phenomena compel us to investigate and better understand social-related facilitators that may promote physical activity in public spaces. This study will expand the use of the sense of community research into the domain of public parks and public open spaces to better understand the social implications on physical activity and self-efficacy and to enhance our understanding of barriers to underutilized spaces.
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Theoretical Framework
New developments in research have resulted in theoretical shifts in approaches to improve health outcomes for adults. Individual behavior change theories are becoming secondary to social-ecological theories, whereby the focus centers on the multiple levels of influence on behavior change (Sallis et al., 2006). Contemporary ecological models of health behavior such as the Ecological Model of Four Domains of Active Living (Sallis et al., 2006) represent the emerging body of research derived from the ecological systems theory presented by the developmental psychologist, Urie Bronfenbrenner, who asserted that research needed to take place in real-life settings (Bronfenbrenner, 1994). Hence, both Bronfenbrenner’s ecological model and Sallis’ ecological model of four domains (Figure 6) will be used as the foundation for the development and design of our conceptual framework.
Figure 6. Ecological models by Bronfenbrenner, 1994 [L] and Sallis et al., 2006 [R].
Conceptual framework
A social-ecological approach to the improvement of health outcomes emphasizes the importance of the links between the physical and social environments (Stokols, 1996;
Bronfenbrenner, 1994). A framework designed to address the multifactorial influences has the
32 A WALK IN THE PARK greatest potential to affect behavior (Cohen & Swift, 1999; Cohen, Chavez, & Chehimi, 2010).
Specifically, social and environmental factors represent the most potent influence on behavior
(Baranowski, Anderson, & Carmack, 1998). Drawing upon key elements of “An Ecological
Approach to Creating More Physically Active Communities” (Sallis et al., 2006), our conceptual framework establishes various levels of influence between individual users in the natural environment and their perceptions of the social environment in walkable public spaces (Stokols,
1996; Cohen & Swift, 1999). A better understanding of the influences that affect adult physical activity behavior will allow us to tailor more effective physical activity interventions. We assert that using a social-ecological approach as our conceptual framework (Figure 7) offers the most appropriate model, shifting the focus from individual behavior change to leveraging the facilitators in the social-ecological environment.
Figure 7. Conceptual Framework: The influence of policy, social, ecological, and individual factors on health behavior (Deanna L. Lewis). (The dotted lines with arrows represent the proposed study’s investigation of adult users’ perceptions of sense of community with self- efficacy towards physical activity and associated health implications.)
As a preliminary investigation to explore the feasibility for evaluating the role of place in facilitating physical activity among Tucson residents, we conducted a qualitative survey at two
33 A WALK IN THE PARK local public spaces. The comparative analysis conducted in 2013 (Lewis, et al., 2013) in Tucson,
Pima County, Arizona evaluated potential differences of adults who used a public park as compared to the adults who used the public open space. Results revealed differences between adult users. Overall, the adult users preferred the public open space compared to the public park for the activity of walking. Of 393 total participants, the majority indicated they used the public open space to walk 30-60 minutes once or twice a week to improve their health. Fifty-three percent (n=196) of the public open space users walked or ran once or twice per week compared to 29% (n=7) of public park users who walked or ran once or twice per week. Sixty-two percent
(n=223) of open spaces users compared to 40% (n=10) of public park users indicated having used the space for more than one year. These data suggest that not only did the public open space users engage in walking or running more frequently than the public park users at these sites, but also that the public open space users are more likely to develop a pattern for maintenance of physical activity over time. Beyond individual preferences, physical activity levels within the public spaces are thought to be influenced by their design (Sallis, Floyd, Rodriguez, & Saelens,
2012). While a standardized assessment of the sites was not conducted in the preliminary investigation, restrictions for motorized vehicle use and a safe multi-use path in the public open space were identified as facilitating increased frequency of physical activity at the public open space as compared to the public park (McKenzie, Cohen, Sehgal, Williamson, & Golinelli, 2006;
McCormack, Rock, Toohey, & Hignell, 2010). While the initial survey suggested that differences exist in public space use by gender, ethnicity, and age, several unanswered questions remain. For example, what is the sense of community and/or social connectedness around these spaces? Does sense of community or social connectedness influence physical activity? As the open spaces hold potential to promote physical activity, it is important that we better understand
34 A WALK IN THE PARK the barriers and facilitators of physical activity within open spaces so those barriers or facilitators can be modified to increase physical activity within the local population who have access to public open spaces.
Initiatives such as Healthy People 2020 and the Surgeon General’s STEP IT UP program focus on walking and health improvement. However, limited research exists on the perceptions of sense of community by users of public parks and public open spaces, self-efficacy, and the relationships to physical activity. The discovery of a correlation between sense of community, self-efficacy, and physical activity in public spaces would contribute significantly to research and interventions aimed at promoting physical activity for adults.
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Chapter 2: Community-Based Research: A Laboratory for Public Health Student Research
Training
Abstract
Training undergraduate, non-STEM students in quality research methods is an essential element of preparing the next generation of public health scholars and practitioners. Using a student-centric learning model, undergraduates in public health were provided standardized training in field-based data collection methods that centered on the administration of the System for Observing Play and Recreation in Communities (SOPARC) tool and followed a structured instructional design and standardized training plan. Over a 15-week semester, 28 students completed 12 weeks of data collection at two community sites, Tumamoc Hill and Sentinel Peak, recreation areas in Tucson, Arizona. Across 6,711 observations of individual-level physical activity data collected at the two sites over the entire observational period, interrater chi-square reliability showed high rate agreement of 0.624 and 0.651 for the two sites. These results show that integration of learning in real-time academic research is viable and yields robust data for investigation while enriching student education and advancing skills for future professional application.
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Introduction
Science, Technology, Engineering, and Math (STEM)-based field research education has become increasingly important especially in research-intensive universities (Pfund et al., 2012).
Educating non-STEM undergraduate students using student-centric learning pedagogy in tandem with ongoing scientific research provides a rich educational environment (Dewey, 1998; Giles &
Eyler, 1994; Giles, 1987; Knowles, Holton, & Swanson, 2012; Kolb & Kolb, 2005; Kolb, 2014).
By engaging non-STEM students in the acquisition and development of professional skills, educational potential can be optimized, while simultaneously achieving university research goals
(Fink, 2013). A STEM-based skill set can offer non-STEM students critical thinking and problem-solving skills that may be transferrable across academic disciplines and into the workforce. Undergraduate field research provides opportunities to facilitate the development of students’ knowledge, skills and experience to include scientific knowledge, research skills, communication skills, time management, leadership, professionalism, responsible conduct of research, and career development (Calhoun, Ramiah, Weist, & Shortell, 2008; Chauvin,
Anderson, & Bowdish, 2001; Forrest, Martin, Holve, & Millman, 2009; Kennedy & Moore,
2001; Straus et al., 2011). This chapter describes a successful undergraduate educational field research program in a non-STEM, elective course at the University of Arizona’s Mel and Enid
Zuckerman College of Public Health.
The 3-week training and evaluation process of this 15-week field research program was informed by a backward design approach (McTighe & Thomas, 2003; Wiggins & McTighe,
1998). Using both an informal (community-based learning) and formal (classroom-type) approach facilitated a novel program design that included various assessments during the training period to improve student skills attainment (Blumenfeld, Soloway, Marx, Krajcik, Guzdial, &
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Palincsar, 1991). Inter-rater reliability was selected as the performance indicator to assess student learning (Wiggins & McTighe, 1998). Inter-rater reliability compared and assessed the consistency of the data collected by two independent undergraduate students at the end of the study.
Research sites
The research sites Tumamoc Hill and Sentinel Peak in Tucson, Arizona were selected based on a pilot study that was conduct in 2013 (Lewis, et al., 2013). The pilot study was a comparative analysis of two public open spaces (Table 5) using a survey questionnaire to obtain information on user demographics, activity types and reasons for using the site(s). Sentinel Peak, also known as "A" Mountain, is a recreational park run by the City of Tucson Parks and
Recreation Department; Tumamoc Hill is an active research site and ecological reserve owned and managed by The University of Arizona.
Table 5. Research Site Descriptors. Elevation Address Restrictions Hours of Distance Coordinates Operation Tumamoc Hill 3,108 ft. (947 m) 1675 W. Anklam No motorized Mon-Fri: before University of Rd., Tucson, AZ 85745 vehicles 7:30AM and Arizona 3.2-mile paved No pets, no after 5:30PM Ecological road [out and 32°12′46″N 111°00′22″W cyclists Weekends: All Reserve back, from hours entrance]
Sentinel Peak 2,897 ft. (883 m) 1501 S. Sentinel Peak Rd., Tucson, None Mon-Sat: 9AM- City of Tucson AZ 85745 8PM Public Park 2.0-mile paved Sunday: 9AM- road [out and 32°12′38.16″N110°59′30.12″W 6PM back loop, from entrance]
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Participants
Undergraduate public health students were recruited from an elective, non-STEM, upper- division, undergraduate course. The students were offered 100 extra credit points by their instructor to complete 15 volunteer hours and write a reflection paper of their experience. The student volunteers were primarily sophomores and juniors (79%), with nearly twice as many females as compared males (Table 6). A total of 28 undergraduates participated in the field research project over a period of 15 weeks.
Table 6. Distribution of undergraduate participants by gender and year in school. Number of students
Gender n= 28 %
Male 10 36
Female 18 64
Year in School
Freshman 2 7
Sophomore 8 29
Junior 14 50
Senior 4 14
Students were required to complete three designated instructional activities (Figure 8) using the
System for Observing Play and Recreation in Communities (SOPARC) tool (Evenson, Jones,
Holliday, Cohen, & McKenzie, 2016).
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Primary Outcomes Core Domains Instructional Activities
Site Analysis Increase Knowledge Orientation & Training
Field Research & Beta- Data Acquisition Skill Development Testing
Applied Research Inter-Rater Reliability Evaluation Methods
Figure 8. Instructional Design. Methods
Measuring Physical Activity Levels in Public Open Spaces
System of Observing Play and Recreation in Communities (SOPARC)
The SOPARC instrument (Appendix C) is a validated, direct observational tool for assessing public space or park users’ physical activity including activity modes/types (ranging from sedentary to walking, vigorous/jogging/running, etc.) as well as the age, gender, and race/ethnicity of the park users. It is based on momentary time sampling techniques to capture and code users (McKenzie, Cohen, Sehgal, Williamson, & Golinelli, 2006). The SOPARC instrument has been widely used to assess physical activity in parks of various sizes, different locations, different seasons and months, and varying number of target areas (Evenson, Jones,
Holliday, Cohen, & McKenzie, 2016). Our research centered on feasibility for instrument administration as well as testing the inter-rater reliability of the SOPARC instrument in two community settings in Tucson, Arizona. For this study, the SOPARC instrument was used during the month of February, which included various weather patterns, and data were recorded during various times of day and various days of the week (Appendix D). Each site had one designated
40 A WALK IN THE PARK target area for observing users. Finally, the SOPARC instrument was used to support Specific
Aims 1 and 2 and either support or refute hypothesis 1.
Instructional Goals
The instructional goal was to teach the students how to use the SOPARC tool to observe, measure, and document the physical activity levels of users of a public park and public open space. Using the SOPARC tool as an adjunctive instrument facilitated the development of the student’s observational skills and prepared the students for field research and data collection.
Using a backward design for the course development (Figure 8) included: 1) identifying the primary learning outcomes; 2) identifying the core learning domains required to achieve the primary learning outcomes; and 3) developing assessments and instructional activities to teach core domains and assess student performance (Wiggins, Wiggins, & McTighe, 2005). Thus, our field research project was designed to facilitate the development of new knowledge in the areas of research integrity, informed consent, and scientific rigor. Students gained skills in survey methodology, instrument identification, and selection for assessing community-based physical activity, survey administration, data collection and management, and experience in field-based research implementation (Pickard, 2007; McKenzie, Cohen, Sehgal, Williamson, & Golinelli,
2006). The specifics of acquiring new knowledge, new skills, and new experiences in field research are described in relation to the instructional activities’ timeline (starting with week 1).
Once activities were complete, we evaluated the homogeneity of the data collected by the students using inter-rater reliability as a performance indicator. The presence of a high-level agreement between raters would indicate the degree in which there was consensus between raters
(Field, Burke, McAllister, & Lloyd, 2007).
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Instructional Activities
Week 1: Orientation and SOPARC instrument training
Orientation was conducted over a two-hour block of time at the field research sites. To model the significance of standardization and facilitate consistency, each student was issued a research kit containing the following items: a university student researcher identification, a
SOPARC description and procedure manual, a SOPARC reference card, one clipboard, and two black ink pens. The student learning objectives were to 1) locate and identify the target observation areas; 2) demonstrate SOPARC procedures for direct observation (DeWalt &
DeWalt, 2002); and 3) properly document the observation on the SOPARC form. An example and description of the instrument procedures/protocols for use were included in the orientation phase of training and instruction. The procedures followed the training materials available for the
SOPARC instrument published in 2006 and available at https://activelivingresearch.org/sites/default/files/SOPARC_Protocols.pdf (McKenzie, Cohen,
Sehgal, Williamson, & Golinelli, 2006). The orientation and instruction included a walking tour at the field research sites to familiarize the students with the geographic locations and to provide first-hand knowledge of the environment. During orientation, the target areas at each site were identified, the SOPARC forms were reviewed, and protocols for observation were introduced, reviewed, and practiced (McKenzie, Cohen, Sehgal, Williamson, & Golinelli, 2006). Lastly, the concept of inter-rater agreement and its purpose was introduced to the students to provide context for the need for consistency, accuracy, and a standardized method of data collection.
Week 2: Field research and beta testing
The goal for the beta testing phase was to provide students with an experiential learning opportunity using the SOPARC instrument. A Direct Observational Procedure Skills (DOPS)
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(Profanter & Perathoner, 2015) approach was utilized by the instructor to teach and assess two primary processes. The first objective was to observe the students’ chronological order of functions in alignment with the SOPARC procedures. This would facilitate consistency between the students. Second, the students were assigned to Sentinel Peak as their beta-testing site to develop a familiarity with the site and practice using the SOPARC tool in the field research environment.
The students practiced direct observation skills and data recording skills in 60-minute sessions, with a minimum of three distinct sessions over the course of seven days to include weekdays, weekends, and morning, lunch, afternoon, and evening shifts in adherence to the
SOPARC procedures (McKenzie, Cohen, Sehgal, Williamson, & Golinelli, 2006). A total of 28 students completed 68 hours of beta testing.
Week 3: Assessment
The final assessment included a written examination and practicum assessing each student’s ability to properly apply the SOPARC procedures and protocols for direct observation research in a real-world environment. The assessment was administered on site and the written exam consisted of 20 questions that assessed students’ knowledge. To ensure the students were at the same level prior to actual data collection they were required to attain 100% on the written exam. The practicum portion was graded as a pass/fail using the DOPS method and required adherence to the direct observation protocols. A total of 27 students completed all aspects of the training process. All learning objectives were met by the students who successfully completed all the instructional activities.
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Weeks 4-12: Data collection and analysis.
Over the course of the next eight weeks the students covered 29 shifts and collected over
108 hours of data following the SOPARC protocols. Data were collected in 60-minute periods and included morning (7:30-8:30 a.m.), lunchtime (12:30-1:30 p.m.), afternoon (3:30-4:30 p.m.), and evening (5:30-6:30 p.m.) shifts. Additionally, all days of the week and weekends were included to capture a representative sample of the physical activity levels at both sites. Physical activity modes were selected from the standardized SOPARC listing to include jogging/running, walking, bicycling, standing, and sitting. Per the study protocol, all observations were made left to right to capture individuals as they entered the areas. The students were assigned to observational periods in tandem to assure student safety. Each student independently completed observations during the assigned time period, classifying individuals into one of three pre- defined categories of physical activity (sedentary, walking and vigorous). Each student was assigned as either “Rater One” or “Rater Two.” All documentation was recorded on official
SOPARC forms. Comparisons of rater’s SOPARC scores were evaluated for inter-rater reliability using chi-square (STATA 15.0).
Results
Based on the SOPARC tool documentation, the raters observed various types of physical activity including sitting, walking, running, and bicycling. The data collected and reported here represent a total of 6,711 unique observations. These data are represented independently for the two raters and separately by field site (Table 7 and Table 8), and identified by site name
(Tumamoc Hill and Sentinel Peak). We found a high level of agreement between raters at each site with no significant difference in the proportion of the activity types observed between Rater
One and Rater Two, at Sentinel Peak and Tumamoc Hill. Figure 9 provides a graphic depiction
44 A WALK IN THE PARK of the observational data of the activity types by site and rater. The results indicate there was a high level of agreement between raters at each site.
Given the rigorous training as well as the high reliability between raters, data relevant to assessing physical activity by site and between sites was considered robust. In evaluating the overall findings related to physical activity between the two sites, Tumamoc Hill was frequented by walkers (97%), while at Sentinel Peak the primary behavior observed was sitting (84%).
Lastly, Table 9 provides greater detail of the physical activity data collected at both sites, including the total metabolic equivalents of tasks (METs) and kilocalories (kcals) per site during the period of observation. On both accounts Tumamoc Hill demonstrated physical activity expenditure that more than doubled Sentinel Peak’s, indicating more physical activity occurs at
Tumamoc Hill compared to Sentinel Peak. In sum, the SOPARC scores for each site were 8,615
METs/273 kcal/kg at Tumamoc Hill and 4,281 METs/137 kcal/kg at Sentinel Peak.
Table 7. Inter-Rater Reliability, using chi-square, at Tumamoc Hill.
Tumamoc Hill Rater One Rater Two Total Activity Observations n % n % n % Sedentary 25 1.30 24 1.25 49 1.27 Walking 1,863 96.93 1,875 97.35 3,738 97.14 Vigorous 34 1.77 27 1.40 61 1.59 Total (n, %) 1,922 100 1,926 100 3,848 100 Chi2 0.651
Table 8. Inter-Rater Reliability, using chi-square, at Sentinel Peak.
Sentinel Peak Rater One Rater Two Total Activity Observations n % n % n % Sedentary 1,238 84.62 1,171 83.64 2,409 84.14 Walking 169 11.55 178 12.71 347 12.12 Vigorous 56 3.83 51 3.64 107 3.74 Total (n, %) 1,463 100 1,400 100 2,863 100
45 Tumamoc Hill Rater 1 Tumamoc Hill Rater 2 Tumamoc Hill Rater 1 TumamocA HillWALK Rater 2 IN THE PARK
Chi2 0.624
Sentinel Peak Rater 1 SentinelSentinel Peak Peak Rater Rater 2 1 TumamocSentinel Hill Rater Peak 1 Rater 2 Tumamoc Hill Rater 2
Sentinel Peak Rater 1 Sentinel Peak Rater 2 Sedentary Walking Vigorous Sedentary Walking Vigorous Figure 9. Comparison of activity types at Tumamoc Hill and Sentinel Peak between Rater One and Rater Two.
Sedentary Walking Vigorous Table 9. Mean activity levels per site (measured in kcal/kg and METs and rounded to the nearest whole). Sites Sedentary Walking Vigorous Total n= Sentinel Peak [SP] Observations, n= 1950 206 123 1979 Tumamoc Hill [TH] Observations, n= 29 2727 65 2821 SP kcal/kg 100 20 17.71 137 TH kcal/kg 2 262 9.36 273 SP METs 2925 618 738 4281 TH METs 44 8181 390 8615
Discussion
Employing an innovative research experience with undergraduate students provides a unique opportunity to measure undergraduate performance using a professional, validated research tool (McKenzie, Cohen, Sehgal, Williamson, & Golinelli, 2006). These results show that integrating learning with ongoing university sponsored research is a viable combination to improve learning outcomes. The formal assessment process delivered quantifiable results indicating the students had achieved a high level of competency as measured by a performance indictor: inter-rater agreement. To achieve a high level of agreement, the students demonstrated mastery in three core competencies: knowledge (instrument protocols and procedures), skills
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(direct observation), and applied research methods (application of the SOPARC instrument); and achieved three primary outcomes: two site evaluations were conducted, the data collected informed the next phase of the research study (Woolf, S., 2008), and the students achieved a high level of inter-rater agreement in applied field research techniques using SOPARC (McKenzie,
Cohen, Sehgal, Williamson, & Golinelli, 2006). Engaging non-STEM students in field research was shown to produce good outcomes in the students’ performance evaluation as measured by inter-rater reliability. Using inter-rater reliability with SOPARC has been reported in numerous studies. The literature review conducted by Evenson et al., (2016) states about 50% of the 24 distinct studies using SOPARC used inter-rater reliability for user characteristics and physical activity. The inter-rater reliability for this study was lower than the studies reported by Evenson et al. First, several of the studies used percent agreement, which was not possible for this study based on the protocols used for data collection in this study that included two raters collecting data in tandem via observation noting the two raters may not be observing an individual’s physical activity in the same order, especially when multiple individuals were present during an observation period. For example, there was an 87% agreement between raters, for number of individuals observed, in a study conducted by Cohen et al., 2011. Additionally, studies using
Cohen’s Kappa reported lower inter-rater reliability as compared to those studies using percent agreement. Using percent agreement in future studies may produce a higher inter-rater agreement and support the evaluation piece for rater training.
The rigor in methodological training of public health students to collect field-based data in the public space setting resulted in quality data collection. Overall, the student-generated data showed that SOPARC scores at Sentinel Peak were lower than those at Tumamoc Hill. Further, these data suggested that Tumamoc Hill compared to Sentinel Peak demonstrated higher levels
47 A WALK IN THE PARK of physical activity, on average, among adults using the public open space. The data collected will inform the next phase of the research study to answer the following question: Which research site had the lowest SOPARC score?
Strengths
Strengths of this work included application of standardized training protocols for
SOPARC, testing of inter-rater reliability between two student field researchers, the large sample of observations collected at two different public spaces, assessment across a variety of physical activities, and integration into academic learning.
Limitations
Limitations related to the high level of competency required for data collection performance resulted in two students requiring reinforcement of learning objectives, skill development, and re-assessment of the written examination and practicum. Additionally, some variance across observations is expected when multiple people pass through the target area at the same time, and raters may assign observations to multiple people in regard to physical activity category in differing order.
Conclusion
Research-intensive universities compete not only for national funding, but are expected to invent innovative solutions (Chirikov, 2016). To develop and promote student success, the university needs to create an environment that fosters intellectual curiosity through exciting and challenging learning opportunities. These learning opportunities must include new knowledge gained, new skill acquisition and new experiences to better prepare students for the workforce within and outside of academia. Transforming student learning in the classroom through applied research experiences adds a rich layer for non-STEM students. The backward design approach
48 A WALK IN THE PARK used in this project allowed the primary investigator to identify specific skill sets for the students and tailor the instructional design. To move forward on the research study, basic field researchers were needed to collect data that would later be used to inform the future direction of the research study. The skills identified and developed by the undergraduate students were in alignment with the Department of Labor’s (DOL) classification for a basic researcher. The students gained transferrable skills that can be stated on their resume, including research training, experience, and professional development. Additionally, the institution fulfills its commitment to developing classroom training and education that increases student capacity, provides experiential learning, and promotes best practices in research.
49 A WALK IN THE PARK
Chapter 3: A Walk in the Park: What’s community got to do with it?
Abstract
Building on data collected using the SOPARC instrument to assess physical activity at two public open spaces, we sought to promote physical activity at Sentinel Peak, the space with lower physical activity. Promoting walking and walkable communities in public open spaces has been shown to increase physical activity levels for U.S. adults. Self-efficacy and social connections have been shown to improve leisure time physical activity. We conducted a quasi- experimental study using pre/post surveys with a convenience sample of men and women ages
18 years and older, identified at a public park (Sentinel Peak) and a public open space (Tumamoc
Hill). The study performed a comparative study of adult users’ perceptions of sense of community, self-efficacy, and health and wellbeing across the two sites. The intervention group
(Sentinel Peak) consisted of adults who met once a week to walk for 30 – 60 minutes over the course of 16 weeks. The comparison group (Tumamoc Hill) consisted of adults who, based on a previous study, walk 1-2 times per week for 30-60 minutes. A total of 33 participants (Sentinel
Peak, n=13; Tumamoc Hill, n=20) completed pre and post surveys. The majority of the participants were women (women, n=25; men, n=8); and 79% were white, 15% were Hispanic,
3% were Native American, and 3% identified as other. The mean age at the intervention and comparison sites were 50.8 and 49.4 years, respectively. The post-intervention results show a statistically significant difference (p= <0.0001) in participants’ perceptions in sense of community between Sentinel Peak and Tumamoc Hill. There were no differences between the site participants’ perceptions of self-efficacy or health and wellbeing. The findings of the study suggest that walking groups promote an increase in sense of community and that adults’
50 A WALK IN THE PARK perceptions of sense of community may be a determinant for engagement in physical activity, such as walking, within public parks and public open spaces.
Introduction
Research shows that public parks and recreational spaces encourage physical activity
(Godbey, Mowen, & Ashburn, 2010; Bedimo-Rung, Mowen, & Cohen, 2005), which is vital for optimal health (U.S. Department of Health and Human Services, 2012). Further, built environments, such as public parks, can enhance sense of community among residents (Francis,
Giles-Corti, Wood, & Knuiman, 2012). Initiatives to improve walkability within communities have historically focused on better design, greater accessibility, and designated safety features, rather than on social determinants (Nathan, Wood, & Giles-Corti, 2014; Sallis, Floyd, Rodriguez,
& Saelens, 2012). Empirical data suggest that an increase in adult physical activity levels can be expected through support of individual behavior change as well as group physical activity interventions (Baker & Francis, 2015; Kassavou, Turner, & French, 2013). However, limited data exist to evaluate the relationship between social connectedness and physical activity, and no data of this nature exist for Pima County adult residents (CHAT, 2013).
“A walk in the park: what’s community got to do with it?” proposes to build upon the comparative analysis conducted by Lewis, et al., 2013 and offers the following objectives for comparing users and their physical activity at a public park and, alternately, an open space: 1) to conduct a direct observation assessment of users and their physical activity at Sentinel Peak and
Tumamoc Hill, 2) to evaluate and compare adult perceptions of sense of community at both sites,
3) to evaluate and compare adults’ self-efficacy for physical activity at both sites, 4) to evaluate adult perceptions of their health and well-being at both sites, and 5) to determine whether a walking group intervention will enhance sense of community in public open space,
51 A WALK IN THE PARK understanding that sense of community is a motivator for physical activity among adults (Cohen,
2004; Courneya, Plotnikoff, Hotz, & Birkett, 2000; Dishman, Sallis, & Orenstein, 1985; Duncan,
& McAuley, 1993; Resnick, Orwig, Magaziner, & Wynne, 2002; Sallis, Grossman, Pinski,
Patterson, & Nader, 1987). Given preliminary data supporting higher rates of physical activity
(e.g., walking and running) at Tumamoc Hill as compared to Sentinel Peak, we completed the following aims:
As discussed in Chapter 2, the System for Observing of Play and Recreation in
Communities (SOPARC) tool is a validated and reliable instrument used to capture physical activity in communities (McKenzie, Cohen, Sehgal, Williamson, & Golinelli, 2006). Based on the results in Chapter 2 (Table 9), whereby Sentinel Peak had a lower SOPARC score than
Tumamoc Hill, a walking group to support physical activity and possibly greater social connectedness was developed as the intervention to be tested at Sentinel Peak. Tumamoc Hill served as the comparison/“control condition” site.
Empirical data suggest that an increase in adult physical activity levels can be expected with support of group physical activity (Baker & Francis, 2015; Kassavou, Turner, & French,
2013). However, limited data exist to evaluate the relationship between social connectedness in public open spaces in the context of physical activity; no data of this nature exist for Pima
County residential adults. In this chapter the following hypotheses will be addressed:
Hypothesis 1:
Tumamoc Hill’s SOPARC score for physical activity behavior will be greater than
Sentinel Peak’s SOPARC score for physical activity behavior. Informed by data from the
SOPARC assessment, Specific Aim 2 will be conducted.
52 A WALK IN THE PARK
Hypothesis 2:
After sixteen weeks (post-intervention), sense of community will increase significantly at the public space where the walking intervention was implemented.
Hypothesis 3.a:
At baseline, adults’ self-efficacy related to physical activity and sense of health and well- being will be significantly greater for adults located at Tumamoc Hill as compared to adults located at Sentinel Peak.
Hypothesis 3.b:
Post-intervention, adults’ self-efficacy related to physical activity and sense of health and well-being will not be different between the two study sites (intervention site will demonstrate increases in self-efficacy related to physical activity and sense of health and well-being).
Hypothesis 3.c:
Sense of Community will be associated with an increase in self-efficacy for physical activity overall.
Methods
Research Sites
Research activities took place at Tumamoc Hill and Sentinel Peak, both public spaces located in the Tucson Mountain Range (Table 10). Tumamoc Hill is an 850-acre ecological reserve, an important research site for higher education, and a designated public open space managed by the University of Arizona and Pima County. Sentinel Peak is a 272-acre public park, the largest natural resource park in the City of Tucson. Both sites are accessible via paved roads.
Tumamoc Hill is accessible to the public for pedestrian traffic only, whereas Sentinel Peak allows motorized vehicles and bicycles on its paved road; however, vehicular access is restricted
53 A WALK IN THE PARK by gate closure during non-business hours. Both geographic areas are located within the city limits of Tucson, Pima County, Arizona.
Table 10. Research Site Descriptors. Elevation Address Restrictions Hours of Distance Coordinates Operation Tumamoc Hill 3,108 ft. (947 m) 1675 W. Anklam No motorized Mon-Fri: University of Rd., Tucson, AZ 85745 vehicles before 7:30AM Arizona 3.2-mile paved No pets, no and after Ecological road [out and 32°12′46″N 111°00′22″W cyclists 5:30PM Reserve back, from Weekends: All entrance] hours
Sentinel Peak 2,897 ft. (883 m) 1501 S. Sentinel Peak Rd., None Mon-Sat: City of Tucson Tucson, AZ 85745 9AM-8PM Public Park 2.0-mile paved Sunday: 9AM- road [out and 32°12′38.16″N110°59′30.12″W 6PM back loop, from entrance]
Recruitment Process and Study Participants
Participants were recruited using convenience sampling methods at each site. Participants had to be 18 years of age or older, able to walk, and willing to complete questionnaire/survey items independently or with assistance. No other eligibility criteria were applied. Recruitment was initiated in April 2017 and completed in February 2018. This study was approved by the
Human Subjects Protection Program (HSPP) as the administrative and regulatory support program to the Institutional Review Boards (IRBs) at the University of Arizona (IRB#
1704381677).
Sentinel Peak
Participants were recruited from within the geographic boundaries of Tucson City
Council Ward 1, where both Sentinel Peak and Tumamoc Hill are located. Recruitment materials were distributed throughout the various neighborhoods of Ward 1 and at the Mercado San
54 A WALK IN THE PARK
Agustín/Santa Cruz Farmer’s Market (an enterprise of the Community Food Bank of Southern
Arizona) and El Rio Community Health Center (ERCHC). Flyers also were distributed at the
Menlo Park Neighborhood Association’s annual yard sale, at one of the monthly association meetings, and at the Park Rx event held on Sentinel Peak on April 23, 2017 in collaboration with the National Park Service, Beyond Foundation, and ERCHC. However, the majority of participants enrolled not through these recruitment activities but on site via word of mouth and resulting snowball sampling, as existing participants recruited additional people.
Tumamoc Hill
The participants at Tumamoc Hill were recruited on-site through tabling events on seven different dates. Flyers were distributed at Tumamoc Hill during the Tumamoc Hill Buffelgrass
Abatement Day on April 15, 2017.
Informed consent
Tumamoc Hill participants were asked to complete the written questionnaire during tabling events either upon arrival at the site (the base of Tumamoc Hill) or after completing their physical activity on the hill. Sentinel Peak participants were asked to complete the written questionnaire upon arrival at one of the weekly walking groups. This ongoing recruitment spanned from week one to week seven of the walking group, and all participants, regardless of enrollment date, completed the post-survey 16 weeks after their enrollment date.
Prior to completing any study-related data collection, each participant received a printed consent form detailing the study. The forms were available in English, and all consent forms required the participants’ signature prior to study enrollment.
55 A WALK IN THE PARK
Study Instruments and Administration
All participants were asked to complete the following surveys: the Sense of Community
Index-2 instrument (Chavis, Hogge, McMillan, & Wandersman, 1986), the Self-Efficacy for
Physical Activity (SEPA) survey (Marcus, Selby, Niaura, & Rossi, 1992), and the Optum Short
Form Health Survey (SF-12v2), (Ware Jr, Kosinski, & Keller, 1996). The instruments were selected from published literature and supported the internal validity of the study by measuring the same behavioral constructs consistently throughout the research project. The study questionnaire included a demographic section and requested participants’ contact information for the 16-week post-intervention follow-up. All study questionnaires were completed on site using printed questionnaires, with study staff present to review the questionnaires for completeness.
Lastly, the questionnaires were only available in English.
Sense of Community Index-2 Instrument (see Appendix D)
Participants’ perceptions of sense of community were evaluated using the sense of community index-2 instrument (SCI) designed for the social sciences. The SCI is based on a theory of sense of community presented by McMillan and Chavis (1986) that stated that a sense of community was a perception with four elements: membership, influence, meeting needs, and a shared emotional connection. The instrument includes 24 items and takes an estimated 20 minutes to complete. The instrument responses are self-reported. Results of prior studies have demonstrated that the SCI has been a strong predicator of behaviors (such as participation) and is a valid measurement instrument (Chavis, Lee, & Acosta, 2008).
Self-Efficacy Instrument (see Appendix E)
Self-efficacy among participants was evaluated using the self-efficacy instrument designed to evaluate one’s confidence to carry out exercise (Marcus, Selby, Niaura, & Rossi,
56 A WALK IN THE PARK
1992). The instrument uses a five-point Likert scale, ranging from not at all confident to extremely confident (min. value=5, max value=25). The instrument includes five items and takes an estimated 10 minutes to complete. The information is self-reported.
Health and Wellbeing Instrument (see Appendix F)
Participants’ health and wellbeing was evaluated using the OPTUM SF-12v2 health survey instrument designed to evaluate the participants’ perceptions of their own health and wellbeing. The instrument uses a Likert scale, ranging from a minimum value of 12 to a maximum value of 53. The instrument includes 12 self-reported items that is summed for a single overall numerical estimate of health and well-being.
Instruments were completed at the public site at baseline after consent for study participation. After the sixteen-week period, participants completed the same Sense of
Community Index-2, self-efficacy questionnaire, and health and wellbeing surveys on-site, providing data for a comparative analysis of post-intervention as compared to baseline (pre- intervention) as well as change score evaluations between sites over time.
Study data were collected and managed using REDCap (Research Electronic Data
Capture) electronic data capture tools hosted at the University of Arizona (Harris, Taylor,
Thielke, Payne, Gonzalez, & Conde, 2009). REDCap is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and
4) procedures for importing data from external sources.
57 A WALK IN THE PARK
Intervention
The walking intervention and its components were designed using evidence-based programs with reported effectiveness for increasing physical activity among adults (Kahn et al.,
2002; Briss et al., 2000; Reis et al., 2016). The group walk (intervention) was led by the principal investigator for the duration of the study. There were no specific goals for gait speed or physical activity outside of the group walk, and the distance varied, whereby the initial walking distance was 0.4 miles and increased, over time, to 2 miles. The participants were advised in advance to wear hats and sunscreen to reduce the risk of sun exposure, and water was provided by the community partners to promote healthy hydration practices. The intervention group (Sentinel
Peak) met once per week at the Mercado San Agustin, coinciding in timing with the Santa Cruz
Farmer’s Market. By incorporating the walking group meeting place, day, and time of week into the existing infrastructure, community assets were leveraged (Kretzmann & McKnight, 1993).
Enrollment dates varied, but each participant’s enrollment period consisted of sixteen weeks. The initial walk included three participants; at maximum enrollment the number of participants equaled eighteen. After a total of 23 weeks, everyone had fully participated.
Statistical analysis
Statistical analysis was performed with R statistical software (R Core Team, 2013).
Analysis of variance (ANOVA) was used to compare pre- and post-intervention effects on sense of community index, self-efficacy instrument, and health and wellbeing instrument using the
“aov” function R statistical analysis. Paired t-tests were used to evaluate pre- and post- intervention effect on sense of community, sense of community indices, self-efficacy, and health and wellbeing.
58 A WALK IN THE PARK
Results
Participant enrollment
All participants qualifying for enrollment during the enrollment period were entered into the study. A total of 260 people were assessed for eligibility in the study (Figure 10). Of the 260, four were excluded for not meeting the age eligibility of at least 18 years, and 91 individuals declined to participate in the study for reasons unknown. The 165 enrolled adults were randomized by site (not by individual). The Sentinel Peak site had 20 participants and the
Tumamoc Hill site had 145 participants. Over the course of the study, seen participants at
Sentinel Peak and 125 participants at Tumamoc Hill were lost to follow-up. The reasons for lost to follow-up are unknown.
Enrollment
Assessed for eligibility (n=260)
Refused to participate (n=91) Excluded (n=4) ¨ Declined (n=91) ¨ Not meeting inclusion criteria (n=4; <18 y.o.)
Randomized by site of enrollment (n=165)
Allocation Sentinel Peak Tumamoc Hill Allocated to intervention (n=20) Allocated to intervention (n=145) ¨ Received allocated intervention (n=20) ¨ Received allocated intervention (n=145) ¨ Did not receive allocated intervention (n=0) ¨ Did not receive allocated intervention (n=0)
Follow-Up Lost to follow-up (n=7) Lost to follow-up (n=125)
Discontinued intervention (n= unknown) Discontinued intervention (n= unknown)
Analysis Analysed (n=13) Analysed (n=20)
Figure 10. Consolidated Standards of Reporting Trials (CONSORT) diagram of participant enrollment.
59 A WALK IN THE PARK
Sentinel Peak participants
At baseline, a total of n=20 (mean age=45.65 years) completed the study survey. There were more females (n=15) than males (n=5) and the predominant race/ethnicity was non-
Hispanic white (n=14); Hispanic (n=5) participants represented the second-most frequent race/ethnicity reported. At post-intervention, a total of n=13 (mean age=50.84 years) completed the post study survey; the total number of participants decreased by 35% (Table 11).
Tumamoc Hill participants
At the baseline, a total of n=145 (mean age=44.6 years) completed the study survey.
There were more females (n=104) than males (n=41) and the predominant race/ethnicity was non-Hispanic white (n=84); Hispanic (n=36) users represented the second-most frequent race/ethnicity reported At post-intervention a total of n=20 (mean age=49.4 years) completed the post study survey; the total number of participants decreased by 86% (Table 11).
60 A WALK IN THE PARK
Table 11. Sentinel Peak and Tumamoc Hill Participant Descriptive Characteristics. Total Sentinel Peak Tumamoc Hill
pre, n=165 pre post pre post post, n=33 n=20 n=13 n=145 n=20 Gender Male 5 5 41 3 Female 15 8 104 17 Ethnicity pre post pre post White 14 10 84 16 African 0 0 9 0 American Hispanic 5 2 36 3 Native 1 1 1 0 American Asian 0 0 6 0 Mixed 0 0 3 0 Other 0 0 5 1 Indian (India) 0 0 1 0 Age pre post pre post Mean (yrs.) 45.65 50.84 44.6 49.4 SD 23.22 22.42 13.88 16.64 18-24 7 3 15 2 25-29 0 0 9 2 30-34 2 1 9 1 35-39 0 0 20 0 40-44 2 2 21 2 45-49 0 0 15 2 50-54 0 0 16 1 55-59 0 0 15 1 60-64 1 1 17 7 65-69 5 4 3 0 70-74 2 1 4 2 75-79 0 0 1 0 >79 1 1 0 0
61 A WALK IN THE PARK
Baseline Results
Sense of Community, Health and Well-Being, and Self-Efficacy Instrument Results
Table 12 shows baseline (pre) results for sense of community, health and wellbeing, and self-efficacy for physical activity at Sentinel Peak and Tumamoc Hill. A total of 165 participants
(Sentinel Peak, n=20; Tumamoc Hill, n=145) completed the sense of community, health and wellbeing, and self-efficacy surveys at baseline. Overall, the data indicate a statistically significant difference (p=0.033) in Sentinel Peak and Tumamoc Hill participants’ perceived
Sense of Community. Specifically, at baseline, Tumamoc Hill participants had a higher overall mean sense of community than Sentinel Peak participants (SP: x̅ =50, TH= x̅ =61.35, p value =
0.0452). The Tumamoc Hill participants as compared to Sentinel Peak participants, also had statistically significant higher values in the indices of membership (12.9 vs 10.7, respectively, p
= 0.02) and reinforcement of needs (15.9 vs 12.9, respectively, p = 0.001) (Table 12). At baseline there were no statistically significant differences between Tumamoc Hill and Sentinel
Peak participants’ perceptions of health and wellbeing or self-efficacy for physical activity.
Table 12. Baseline (pre) Comparison of Sense of Community and Sense of Community Indices, Health and Wellbeing, and Self- Efficacy (mean values) at Sentinel Peak and Tumamoc Hill Total Sentinel Peak Tumamoc Hill n=165 n=20 mean n=145 mean p-value Membership 18 10.667 145 12.855 *0.019
Reinforcement of Needs 19 12.895 145 15.883 *0.001 Influence 20 13.250 144 13.563 0.739
Indices Emotional Connection 18 13.556 145 15.255 0.100 Sense of Community 16 49.750 145 57.639 *0.033 Self-Efficacy 19 15.368 145 16.000 0.603 Health and Wellbeing 19 37.895 139 39.475 0.110 Note: n= less than 145 for Tumamoc Hill and less than 20 for Sentinel Peak before intervention due to missing values for some of the observations. p-values determined from ANOVA on mean values between the two sites. *Indicates statistical significance at the <0.05 level.
62 A WALK IN THE PARK
Post-Intervention Results
Sense of Community, Health and Well-Being and Self-Efficacy Instrument Results
Table 13 shows post-intervention results for sense of community, health and wellbeing, and self-efficacy at Sentinel Peak and Tumamoc Hill. A total of 33 participants (Sentinel Peak, n=13; Tumamoc Hill, n=20) completed the sense of community, health and wellbeing, and self- efficacy for physical activity surveys. Overall, the analysis of the data showed a statistically significant difference (p=<0.0001) in participants’ perceived Sense of Community between
Sentinel Peak and Tumamoc Hill. The Sentinel Peak participants had a higher overall sense of community compared to Tumamoc Hill post-intervention. Sentinel Peak, compared to Tumamoc
Hill, had higher values in the membership, reinforcement of needs, influence and emotional connection indices that were statistically significant.
At post-intervention, there were no differences between Tumamoc Hill and Sentinel Peak participants’ perceptions of health and wellbeing or self-efficacy (Table 13).
Table 13. Sentinel Peak and Tumamoc Hill Post-Intervention (post) Comparison of Sense of Community and Sense of Community Indices, Health and Wellbeing, and Self-Efficacy (mean values). Total Sentinel Peak Tumamoc Hill n=33 n=13 mean n=20 mean p-value Membership 13 18.615 20 12.150 *0.001
Reinforcement of Needs 13 18.846 20 15.500 *0.006 Influence 13 18.846 20 12.850 *0.001
Indices Emotional Connection 13 19.462 20 14.650 *0.001 Sense of Community 13 75.769 20 55.150 *0.001 Self-Efficacy 13 19.000 20 16.500 0.083 Health and Wellbeing 13 40.231 20 40.450 0.849 Note: p-values determined from ANOVA on mean values between the two sites. *Indicates statistical significance at the <0.05 level.
63 A WALK IN THE PARK
Change in Sense of Community and Sense of Community Indices
Table 14 shows a comparison of changes from baseline to post-intervention results for sense of community and the sense of community indices at Sentinel Peak and Tumamoc Hill.
Recall that, at the conclusion of the walking intervention period, Sentinel Peak participants reported higher levels in all four sense of community indices compared to Tumamoc Hill. The increases in all four categories of perceived sense of community at Sentinel Peak (baseline compared to post-intervention) were statistically significant and contributed to the overall higher sense of community reported by participants in the Sentinel Peak walking program at study end compared to study participants at Tumamoc Hill (Table 14). Interestingly, the results showed a decrease in the levels of reinforcement of needs and emotional connections among Tumamoc
Hill participants over time. The Sense of Community values of Sentinel Peak post-intervention exceeded the Sense of Community values of Tumamoc Hill at either baseline or study end.
Overall, there was a statically significant difference (p=<0.0001) between baseline and post- intervention in the sense of community index at Sentinel Peak as compared to Tumamoc Hill, controlling for baseline values. The Sentinel Peak walking group study completers demonstrated a statistically significant increase on mean sense of community values, whereas the Tumamoc
Hill study completers’ mean sense of community values indicated a statistically significant decrease over time among participants (Table 14).
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Table 14. Sentinel Peak and Tumamoc Hill Sense of Community Baseline and Post- Intervention Comparison of Sense of Community indices and overall Sense of Community mean (between and within both sites). Total Sentinel Peak Tumamoc Hill p-values N=33 n=13 n=20 between sites Indices Pre Post Pre Post Sentinel Peak Sentinel Peak Membership 11.15 *18.62 13.35 12.15 compared to compared to Reinforcement of Needs 12.54 *18.85 17.05 *15.50 Tumamoc Hill Tumamoc Hill Influence 13.38 *18.85 13.95 12.85 Emotional Connection 12.92 *19.46 17.00 *14.65
(baseline) (post-intervention) Overall Mean Pre x̅ =50 x̅ =61.35 p=*0.045 Overall Mean Post x̅ =75.77 x̅ =55.15 p=*<0.0001 p-value p=*<0.0001 p=*<0.0001 within each site Note: p-values determined from paired t-test on mean values between baseline and post-intervention *Indicates a statistically significant difference in change at the <0.05 level.
Change in Self-Efficacy
Table 15 shows change in mean self-efficacy among study completers from baseline to post-intervention at Sentinel Peak and Tumamoc Hill. There was a statistically significant increase in mean self-efficacy for physical activity values from baseline to study end at the
Sentinel Peak intervention site, whereas there was no change in the mean self-efficacy values of the Tumamoc Hill participants (Table 15).
Table 15. Change in Sentinel Peak and Tumamoc Hill Participants Mean Self-Reported Self-Efficacy from Baseline to Post-Intervention
Total n=33 Baseline Post-Intervention p < 0.05
Sentinel Peak n=13 14.92 19.0 *0.01
Tumamoc Hill n=20 17.15 16.5 0.38
Note: p-values determined from paired t-test on mean values between baseline and post- intervention *Indicates a statistically significant difference in change at the <0.05 level.
65 A WALK IN THE PARK
Changes in Health and Wellbeing
Table 16 shows the change from baseline to post-intervention results for self-reported health and wellbeing among Sentinel Peak and Tumamoc Hill participants. The results indicate there was an increase in the overall mean health and wellbeing scores at Sentinel Peak, which was borderline in statistical significance. The mean health and wellbeing scores of the Tumamoc
Hill participants decreased slightly; however, the change was not significant (Table 16). Overall, there was no significant difference in the mean change in self-reported health and wellbeing over time across the two groups.
Table 16. Comparison of Mean Change from Baseline to Study End in Health and Wellbeing between Sentinel Peak and Tumamoc Hill
Site n= Baseline Post-Intervention p < 0.05
Sentinel Peak n=13 38.69 40.23 *0.0518
Tumamoc Hill n=20 41.75 40.45 0.1506
Note: p-values determined from paired t-test on mean values between baseline and post- intervention *indicates a borderline statistically significant difference in change at the <0.05 level.
Gender and Sense of Community
Table 17 shows baseline and post-intervention results for gender and sense of community at Sentinel Peak and Tumamoc Hill. The effects of the intervention on Sentinel Peak participants’ perceptions sense of community by gender indicate that participation in the walking group intervention was associated with a statistically significant increase in the mean values of sense of community in both female and male participants (Table 17). Tumamoc Hill participants’
66 A WALK IN THE PARK perceptions of sense of community indicate there was a statistically significant decrease in the overall mean sense of community in female participants, yet there was no change in the overall mean sense of community in male participants at this site.
Table 17. Sentinel Peak and Tumamoc Hill Gender and Sense of Community Baseline (pre) and Post-Intervention Comparison of Gender and overall mean of Sense of Community.
Baseline Post-Intervention p < 0.05
Sentinel Peak (SP) n=20 n=13
female 47.875 74.75 *0.008
SP male 53.4 77.4 *0.02
Tumamoc Hill (TH) n=145 n=20
female 63.53 56.76 *0.006
TH male 49.0 46.0 0.42
Note: p-values determined from paired t-test on mean values between baseline and post- intervention *Indicates a statistically significant difference in change at the <0.05 level.
Public Health Significance
Health Promotion
The Task Force on Community Preventive Services (Task Force) “strongly recommends” social support interventions, in community settings, to increase physical activity levels. The development and implementation of new community-based health promotion approaches are needed to advance public health initiatives such as improving physical fitness among adults
(Kahn et al., 2002; Task Force on Community Preventive Services, 2002; US Department of
Health and Human Services, 2001). Our study revealed a statistically significant correlation
67 A WALK IN THE PARK between a once-a-week (x 16 weeks) walking group intervention in a public park and increases in adults’ perceptions of sense of community. These results reinforce the importance of social connections in a community context and contribute to the growing body of evidence supporting the health benefits of physical activity in public open spaces leading to healthy outcomes in adults.
Thus, planned group walks coupled with community-based initiatives such as the National Park
Service’s Park Rx program or Exercise as Medicine are interventions that can incrase the physical activity levels of adults and facilitate a reduction in morbidity and mortality associated with metabolic disease and/or obesity (Swisher, 2010; Kahn et al., 2002; Task Force on
Community Preventive Services, 2002; US Department of Health and Human Services, 2001).
Maternal and Child Health
Walking groups and women are an important facet in the conversation of morbidity and mortality associated with metabolic diseases and obesity. A study conducted by Brown et al.
(2013) found if women increased walk-to-work proportions, the average weight for women would be reduced, and weight reduction is known to be associated with decreases in body mass index (BMI) reducing morbidity and mortality rates (Brown et al., 2013). Therefore, gaining better insight into the design and implementation of a community-based physical activity intervention program targeting women would yield long-term health benefits. The results from our study illuminate a statistically significant increase between the four sense of community indices (membership, influence, meeting needs and a shared emotional connection) and a walking group intervention in a public open space among adult women. The results of each sense of community index represent a fractal necessary to extrapolate the multiple dimensions of social connections. As more studies are designed and implemented to capture the nature of social
68 A WALK IN THE PARK connections and physical activity in community settings, especially among women, a reliable and robust tool will be necessary to identify variables of social connections such as the SCI-2 survey.
The results of the SCI-2 survey in our study contributes empirical data that supports the robustness of this tool for application in public open spaces.
Discussion
Walking and walkable communities have become state and local priorities (U.S.
Department of Health and Human Services, 2015) due to the epidemic proportions of morbidity and mortality associated with physical inactivity and obesity. (Lee, et al., 2012). Research shows that public parks and recreational spaces encourage physical activity (Godbey, Mowen, &
Ashburn, 2010; Bedimo-Rung, Mowen, & Cohen, 2005), that is vital for optimal health
(Warburton, Nicol, & Bredin, 2006; U.S. Department of Health and Human Services, 2012).
Previous research suggests that group physical activity can serve to increase levels of adult physical activity (Baker & Francis, 2015; Kassavou, Turner, & French, 2013). Limited research exists on the perceptions of sense of community, self-efficacy, and the relationships to physical activity in users of public parks and public open spaces. In addition, prior to this work there was a paucity of data to evaluate group walking as a strategy to modify the behavioral constructs of social connectedness and self-efficacy in order to increase physical activity in open spaces. The discovery of a correlation between sense of community, self-efficacy, and physical activity in public spaces would contribute significantly to designing effective research strategies and interventions aimed at promoting physical activity for adults.
The primary findings of this study suggest that the participants’ perceptions of sense of community and the sense of community indices showed significant change to support a role for walking groups to enhance sense of community, as was demonstrated among the walking group
69 A WALK IN THE PARK intervention participants (completers) at Sentinel Peak. The intervention appeared to increase self-efficacy for physical activity among Sentinel Peak adults. While the increase did not show a significant difference between the two sites at study end, it did suggest that walking interventions in public spaces with lower physical activity can bring self-efficacy up to levels closer to those at public spaces where physical activity is more frequent. Testing these approaches using a more robust approach to include: a larger sample and a longer study duration may result in more substantial differences between the groups.
Social Ecological Environment
Empirical data suggest that the physical environment significantly contributes to physical activity. However, the individual and social ecological environmental associations are stronger determinants (Siegel, Brackbill, & Heath, 1995). The evidence further implicates public parks and public open spaces as healthy places where people congregate to engage in recreational, leisure and physical activity (Cohen, McKenzie, Sehgal, Williamson, Golinelli, & Lurie, 2007).
In general, adults seek out accessible, affordable and safe places such as public parks and public open spaces in order to satisfy their need for leisure time physical activity (LTPA), such as walking (Arizona State University, 2013). Walking is the premier activity shown to have universal appeal to promote physical activity (U.S. Department of Health and Human Services,
2015). Additionally, accessible public parks and public open spaces provide venues to promote walking and foster social connections. (Peters, Elands, & Buijs, 2010). The social ecological environment of public parks and public open spaces also plays an important role in contributing to social connections (Sallis et al., 2006). The associations between social connections within public spaces have been shown to be stronger determinants for physical activity than the physical environment itself (Sallis, Bauman, & Pratt, 1998). Data have suggested socially connected
70 A WALK IN THE PARK adults have increased physical activity levels, which have contributed to lower levels of morbidity and mortality (Siegel, Brackbill, & Heath, 1995). This social connectedness can be assessed through the Sense of Community Index (SCI-2), a tool developed for the social sciences; the SCI-2 measures multiple domains of adults’ perceptions of community (McMillan,
1996). Despite the availability of this effective tool, the measurement of adults’ perceptions and experiences of public parks and public open spaces has seldom been explored (Wood, Frank, &
Giles-Corti, 2010; Kim & Kaplan, 2004). Social support and social support networks offer well- established associations between increased adult physical activity and positive health outcomes
(Stokols, Allen, & Bellingham, 1996).
Motivating people to walk is the most feasible, acceptable, and recognized intervention to increase physical activity and improve health outcomes (U.S. Department of Health and Human
Services, 2015; Bedimo-Rung, Mowen, & Cohen, 2005; Godbey, Mowen, & Ashburn, 2010).
Literature suggest that the physical environment significantly contributes to physical activity, although the individual and social ecological environmental associations were stronger determinants for physical activity (Siegel, Brackbill, & Heath, 1995). Implementing walking group programs in public parks and public open spaces holds promise to promote physical activity in readily available municipal and county recreation areas. Accessible public spaces such as parks and open spaces provide a venue to promote walking and foster social connections. For our research, the public spaces that were selected represent similar topography and geographic proximity. Yet even with these similarities, at baseline Tumamoc Hill had greater utilization than
Sentinel Peak. While this was not studied in depth, one might postulate that factors such as safety, traffic, and lighting may have explained some of the variance between the sites. Beyond this, our hypothesis suggested that sense of community may be another important factor. This
71 A WALK IN THE PARK study found that sense of community increased within the intervention group at Sentinel Peak; participants experienced greater social connections that were not dependent upon the physical space but on relationships within the space.
Sense of Community
To better understand the social ecological implications in public parks and public open spaces, adults’ perceptions of sense of community were measured as a proxy for social connectedness in this study. The Sense of Community Index-2 (SCI-2), is a tool used to measure sense of community for the social sciences and is comprised of four elements: membership, influence, meeting needs, and a shared emotional connection (McMillan, 1976; McMillan &
Chavis, 1986). The SCI-2 has been used extensively in the context of neighborhood public spaces, with results indicating that the quality of public open spaces in neighborhoods is strongly associated with a greater sense of community (Godbey, Mowen, & Ashburn, 2010; Bedimo-
Rung, Mowen, & Cohen, 2005; U.S. Department of Health and Human Services, 2015).
However, studies addressing physical activity, self-efficacy, and exercise behavior in various settings to include public spaces have relied on various social support and social behavior scales to investigate the benefits (or barriers) of social connections (Sallis, Grossman, Pinski, Patterson,
& Nader, 1987; Bruhn & Philips, 1984; Colletti & Brownell, 1982; Dishman, Sallis, &
Orenstein, 1985; House et al., 1985; Sarason, Levine, Basham, & Sarason, 1983; Wallston,
Alagna, DeVellis, & DeVellis, 1983; Zimet, Dahlem, Zimet, & Farley, 1988; Heitzmann &
Kaplan, 1988). This study demonstrates the use of the SCI-2 to assess sense of community and the sense of community indices in public open spaces not located in residential neighborhoods. A study conducted by Francis et al. (2012) was instrumental in applying the sense of community index (SCI) to assess the role of sense of community in public open spaces not located in
72 A WALK IN THE PARK residential neighborhoods. The results from that study support the use of the SCI to assess sense of community in public open spaces and set precedent for using the next iteration of the SCI, the
SCI-2, to do so. Hence, our study demonstrates the application of the SCI-2 in public open spaces (not located in neighborhoods), supporting the previous work done by Francis et al. and suggesting a new benefit of using the SCI-2 in public open spaces to assess the four sense of community indices: membership, influence, meeting needs, and a shared emotional connection
(Glanz & Bishop, 2010; Bandura, 1977; Bandura, 2004). Our findings suggest the four sense of community indices, as measured by SCI-2, have potential to influence behavior, such as walking, in public open spaces and further support the usefulness of the four sense of community indices
(Obstand White, 2004). Lastly, although this instrument has been translated into numerous languages and widely used in various regions of the world, our study used only the English version, which potentially limits the generalizability of our findings (McMillan, 1976; McMillan
& Chavis, 1986).
Self-Efficacy
Self-efficacy is a general construct used historically to predict behavior change
(Schwarzer, Bäßler, Kwiatek, Schröder, & Zhang, 1997; Luszczynska, Scholz, & Schwarzer,
2005; Scholz, Doña, Sud, & Schwarzer, 2002). In the context of classical theories, such as social cognitive theory (Bandura, 1977) and the transtheoretical model/stages of change (Prochaska &
Marcus, 1994), self-efficacy has been shown to be an important predictor of an individual’s ability to carry out physical activity and exercise (Marcus, Rakowski, & Rossi, 1992; Marcus,
Eaton, Rossi, & Harlow, 1994; Young, Plotnikoff, Collins, Callister, & Morgan, 2014; Mendoza-
Vasconez, Marquez, Benitez, & Marcus, 2018). The baseline (Table 12) and post-intervention
(Table 13) analysis for Sentinel Peak and Tumamoc Hill did not indicate a change in the
73 A WALK IN THE PARK participants’ perceptions of self-efficacy. Yet, in contrast, meta-analysis and systematic review, conducted by Ashford (2010), identified 27 physical activity intervention studies with overall findings indicating a small, but significant, relationship between physical activity interventions and self-efficacy. These findings are not consistent with the findings in our study. Of the 27 interventions included in the meta-analysis, only four were identified as an exercise program intervention (Perry, Rosenfeld, Bennett, & Potempa, 2007; Jones, Harris, Waller, & Coggins,
2005; McAuley, Bane, & Mihalko, 1995; McAuley, 1992), and of the four, only three were pre and post design (Jones, Harris, Waller, & Coggins, 2005; McAuley, Bane, & Mihalko, 1995;
McAuley, 1992). Perry’s (2007), a randomized study, included group walks as part of the intervention. Similar to the findings in this study, the participants in Perry’s study (2007) did not report a change in the self-efficacy score in either the intervention group or the comparison group. However, the social support score in the intervention group was greater and statistically significant compared to the comparison group. A finding of interest in Jones’ study (2005) suggest differences in self-efficacy for adults older than 55 years of age compared to younger age groups. The Jones’s study was also able to capture the mean self-efficacy for both completers and dropouts, whereas our study was not able to capture data for non-completers. The studies conducted by McAuley (1992 and 1995) use self-efficacy as an outcome measure to track changes over time in the context of exercise behavior. The findings of these studies implicate that a high level of self-efficacy supports physical activity and exercise in adults. However, social connections/social support variables were not captured in either study.
Strengths
The implications for behavior change maintenance are imbedded within this study by investigating how sense of community can increase the use of public open spaces to support
74 A WALK IN THE PARK physical activity. This study contributes to the much-needed empirical evidence necessary to better understand the factors that facilitate an increase in physical activity such as walking, and to better understand how sense of community effects physical activity and self-efficacy in public parks and public open spaces. The discovery of a correlation between sense of community and group physical activity in public spaces contributes to research and interventions aimed at promoting physical activity for adults. A study conducted by Kriska et al. (1986) demonstrated that older women who participated in the walking group significantly increased their physical activity levels over time. Therefore, for this study, if physical activity levels were measured over time, physical activity levels among participants would also increase over time.
Limitations
A primary limitation to this research was the substantial lost to follow-up, particularly in the comparison group on Tumamoc Hill. Sentinel Peak’s attrition rate was 35% compared to an
86% attrition rate at Tumamoc Hill. However, it is important to note that the Tumamoc Hill completers’ demographics (n=20) were similar to the Tumamoc Hill participants’ baseline demographics (n=125). It is also important to note that although the attrition rate at Tumamoc
Hill was high, survey completion was voluntary. Additionally, participant enrollment for the intervention group took longer than expected due to time constraints and limited resources for recruitment. The events we participated in were either not well attended and/or event attendees were not interested in participating in the study. Preferably engaging stakeholders earlier in the process so they are active in all phases of the research potentially leading to an increase in participation in future studies (Minkler, M. & Wallerstein, N., 2011).
Future studies should allocate more time for the participant recruitment process.
Targeting audiences such as healthcare providers to assist in recruiting potential study
75 A WALK IN THE PARK participants has the potential to increase community participation and representation.
Additionally, word of mouth has been shown to be a more effective recruitment tool as compared to passive approaches such as event flyers (Nguyên, Gauvin, Martineau, & Grignon, 2005).
Furthermore, this study was not designed to randomize by individuals, whereby enrolled participants would be randomized into either the comparison or intervention group. The lower
SOPARC score at baseline for Sentinel Peak afforded a greater predictor of increasing sense of community overtime, a difference that is unlikely if participants are randomly assigned to groups. Additionally, the presence of the Tumamoc Walkers may have been a predictor for higher sense of community at baseline given that their mission is to ensure continued access to
Tumamoc Hill for public use and physical activity. However, we do not know if any of the
Tumamoc Hill Walkers were participants in the study.
Additional limitations in this study involved the participants. Participants may have the propensity to self-report responses they think will be viewed as favorable by research staff, thereby introducing response bias into the study (Orne, 1962). Additionally, selection bias can occur when a participant self-selects into the study, which predisposes the study to a potential confounder favoring the more physically active or those who choose to participate already feeling more vested in their community (Nederhof, 1985). Using community partners and other stakeholders during the recruitment process may aid in reducing selection bias in future studies.
The absence of qualitative data may have limited the rigor of the final study design. For example, the attrition rate at Tumamoc Hill was 86%. Including qualitative methodology, such as focus groups, in future research could potentially help identify barriers to participation (and retention) and perhaps provide insight into more effective recruitment methods. Essentially, using a mixed methods approach for the continuation of this research has the potential to lead to
76 A WALK IN THE PARK a greater depth and breadth of understanding of the correlations between sense of community in public open spaces and physical activity.
Additionally, this study did not utilize any instrument to assess the physical activity levels of the intervention group participants pre- and post-intervention. There are several methods available to assess the physical activity levels of participants, such as self-report questionnaires, self-report logs/diaries, and accelerometers (Sylvia et al., 2013), each possessing various advantages and disadvantages for use.
Finally, the demographics indicate the sample study consisted of mostly women, and primarily white participants; therefore, the results of this study are not generalizable. Future studies will require greater diversity and a larger sample size.
Conclusion
The study’s findings suggest a group walking program increases sense of community among regular walkers in a public park (Sentinel Peak) as compared to a public open space
(Tumamoc Hill). Empirical data have shown that both public parks and open spaces encourage physical activity. For example, initiatives such as Healthy People 2020, the Surgeon General’s
STEP IT UP program, and the National Park Service’s Park Rx program focus on walking and health improvement. Empirical data also suggest that an increase in adult physical activity levels can be expected through support of individual behavior change as well as group physical activity interventions. The results of this study provide empirical data to support sense of community and the sense of community indices as additional factors associated with physical activity behavior of adults in public parks.
Few studies have addressed the association between perceptions of sense of community and engagement in physical activity in public open spaces (U.S. Department of Health and
77 A WALK IN THE PARK
Human Services, 1996; Haskell et al., 2007; U.S. Department of Health and Human Services,
2000; Siegel, Brackbill, & Heath, 1995; U.S. Department of Health and Human Services, 2015;
Doolittle & MacDonald, 1978). Limited data have suggested that the perceptions and experiences of a space may play a significant role in health and wellbeing (Ulrich, 1981 and
Ulrich, 1985). Yet measurement of perceptions in relation to the sense of community has seldom been explored as a determinant of engagement in physical activity within public spaces. The findings from “A walk in the park: what’s community got to do with it?”, suggest sense of community in a public park is an important factor associated with the group walk, exceeding self-efficacy as a factor to improve physical activity.
Chronic diseases such as heart disease, diabetes, and obesity continue to plague adults in the United States at a rate that exceeds the ability of public health interventions to mitigate their deleterious effects. Sedentary behavior, in particular, is a contributing factor and can be reduced by promoting the use of open spaces such as public parks, facilitating access to leisure time physical activities (LTPA) such as walking (Coombes, Jones, & Hillsdon, 2010). Spending time in public open spaces (e.g., nature) can improve health outcomes by lowering stress hormones
(Ewert & Chang, 2018) and improving individuals’ health and wellbeing. For this study, both
Sentinel Peak and Tumamoc Hill provided walkable areas for adults to engage in LTPA
(Bedimo-Rung, Mowen, & Cohen, 2005). Additionally, there was a statistically significant increase in the sense of community index (SCI-2) among the individuals at the intervention site
(Sentinel Peak) as compared to the individuals in the comparison condition (Tumamoc Hill) over time. To this end, health promotion initiatives such as walking groups hold promise to improve physical activity and optimize health for users of public open spaces.
78 A WALK IN THE PARK
Chapter 4: Study Summary for a Walk in the Park: what’s community got to do with it?
This study used the constructs of education and research to investigate individuals’ perceptions on sense of community, self-efficacy for physical activity, and sense of well-being and health, in the context of leisure time physical activity in public open spaces. The sites selected, a public park and ecological reserve (both public open spaces), are popular locations for adults (and children) to engage in leisure time physical activities such as walking, jogging/running, and bicycling.
To capture the type of activities and energy expenditure taking place within these geographic locales, the System of Observing Play and Recreation in Communities (SOPARC) was employed as the primary instrument for measurement. The amount of data required for analysis to determine which site had the lower expenditure of energy required additional human resources to collect the data in a timely, efficient manner. This opportunity was the impetus to develop an undergraduate “mini-course” in field research for public health students. The pedagogical approach incorporated a backward design, using a high inter-rater reliability score as evidence of sound data collection, which supported the internal validity of the study. After various phases of training and assessments, the undergraduate students collected the necessary data required to compare activity levels between sites. The data show there were high inter-rater reliability scores. Thus, Chapter 1 illustrates a successful approach of incorporating undergraduate students into ongoing university research and student development through a learner-centric approach.
Following the semester-long process of collecting data with undergraduate students, the data were analyzed to inform the next phase of the study: site selection. The data collected from each site were analyzed, according to SOPARC protocols, to calculate the physiological
79 A WALK IN THE PARK expenditure of energy. Sentinel Peak, the site with the lower physiological expenditure of energy score (METs and kcals) served as the intervention site for the walking group. Essentially, the
SOPARC tool served to bridge the educational piece with the research study to investigate methods to enhance sense of community in public open spaces, in a relation to a longer-term goal to promote greater physical activity among community members using public spaces.
The investigation of adults’ perceptions of sense of community in public open spaces was instigated by direct observation and intuition. A visit to Tumamoc Hill in June 2013 gave initial impressions of community connections among the walkers. These impressions prompted the pilot study conducted on November 6, 2013. The findings of that pilot study supported and informed the research project that followed. This study has revealed that adults’ perceptions of sense of community increased over time with participation in a walking group such that sense of community was significantly greater at Sentinel Peak (intervention) as compared to Tumamoc
Hill (comparison) at study end.
Using sense of community as an indicator that supports leisure time physical activity has the potential to influence health behavior. As an indicator, the sense of community index provides the means to record and evaluate changes in adults’ perceptions over time. Further studies are needed to determine if sense of community can influence the duration and frequency of leisure-time physical activity to achieve the recommendations set forth by the American Heart
Association (Pate et al., 1995), thus reducing the burden of chronic disease and adult morbidity and mortality attributed to physical inactivity (Blair & Brodney, 1999; CDC, 1999).
The following hypotheses were addressed over the course of the study:
Hypothesis 1: Tumamoc Hill’s SOPARC score for physical activity behavior will be greater than Sentinel Peak’s SOPARC score for physical activity behavior. A direct observation
80 A WALK IN THE PARK evaluation of the physical activity levels at both sites was conducted (Chapter 2). The results support hypothesis 1: Tumamoc Hill’s score (8615 METs) was greater than Sentinel Peak’s score (METs=4281).
Hypothesis 2: After sixteen weeks (post-intervention), sense of community will increase significantly at the public space where the walking intervention was implemented (Sentinel
Peak). A sixteen-week, evidence-based walking group intervention was implemented at the site with the lower SOPARC score (Sentinel Peak). The results support hypothesis 2: At the conclusion of the study, Sentinel Peak (x̅ =75.77) participants indicated a greater sense of community compared to Tumamoc Hill (x̅ =55.15); with a p-value = 0.0001.
Hypothesis 3a: At baseline, adults’ self-efficacy related to physical activity and sense of health and wellbeing will be significantly greater for adults located at Tumamoc Hill compared to adults located at Sentinel Peak. The results indicate that at baseline there was no statistical difference in the adult participants’ perceptions on self-efficacy or reported health and wellbeing between Tumamoc Hill and Sentinel Peak participants (Table 12).
Hypothesis 3b: Post-intervention, adults’ self-efficacy related to physical activity and sense of health and well-being will not be different between the two study sites (intervention site will demonstrate increases in self-efficacy related to physical activity and sense of health and well-being). Post-intervention there were no statistically significant differences to report for self- efficacy related to physical activity and sense of health and wellbeing between sites (Table 13), supporting the hypothesis. However, the results indicate that the intervention site (Sentinel Peak) demonstrated an increase over time (baseline to post-intervention) in self-efficacy related to physical activity (Table 15), supporting the hypothesis; although there was an increase in sense
81 A WALK IN THE PARK of health and wellbeing at Sentinel Peak (baseline=38.69, post-intervention=40.23), there was a borderline statistically significant change (p=0.0518) (Table 16), supporting the hypothesis.
Hypothesis 3c: Sense of Community will be associated with an increase in self-efficacy for physical activity overall. “Sense of community will be associated with an increase self- efficacy for physical activity overall” was not statistically significant.
Implications
Two of the unintentional outcomes of the study were the organic manifestation of community-campus partnerships and the emergence of participatory research-type practices.
Cultivating relationships with various community partners was the first step in moving towards a commitment to work together and share resources. As each entity embarked in fulfilling their mission, overlaps emerged, activities were developed and implemented, and various outlets were used for community health promotion. For example, relationships were cultivated through community-based activities such as National Park Rx Day, held at Sentinel Peak, the Tumamoc
Hill Buffelgrass Abatement Day, and the Community Food Bank of Southern Arizona’s Santa
Cruz Farmers’ Market Get Healthy in 2018 Kick-Off Walk, held at the Mercado San Agustin.
Additionally, El Rio Community Health Center supported the NPS Park Rx program by engaging their health care providers to prescribe Park Rx. These efforts have led to the sustainability of the walking group. The development of these other relationships was not accounted for formally in the design of this study. However, the development of these relationships supports aspects of Bronfenbrenner’s and Sallis’ social-ecological models and tenets of participatory research. Moving forward, more research is needed to explore the magnitude of the community-based relationships and their impact on community-based health and wellness.
82 A WALK IN THE PARK
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Appendix A: Lewis, 2013; Unpublished Draft
A Comparative Analysis of Physical Activity Levels in a Designated Recreational Park Versus a Designated Open Space in the Tucson Mountain Ridge: A Closer Look at Sentinel Peak and Tumamoc Hill Users
Deanna Lewis, PA-C, MBA, Deirdre Demers, MPH, Robyn Blust, MPH, BS, Kristin Myren, BS, Hilary Rees, MPH and Denise
Roe, DrPH
Introduction:
Tucson is home to ~1M inhabitants, boasts an average 300 days of sunshine, is situated in the heart of the breathe taking Sonoran Desert, the landscape doting with exotic cacti to include the infamous Carnegiea gigantea also known as the Saguaro; towering at ~50 feet. Visitors to the “Old Pueblo” seek sunny skies, a variety of attractions including Sabino Canyon located in the Coronado National Monument, the world-renowned Sonoran
Desert Museum and Old Tucson Studios to name a few. Natives and semi-natives enjoy Tucson for the same reasons but they have inside information and regularly access gems like Sentinel Peak, also known as “A” Mountain and
Tumamoc Hill its sister peak. The main distinction between the two is “A” Mt. is a designated public park and
Tumamoc Hill is a land grant research site owned by the university of Arizona and is categorized as an open space.
This study sets out to identify the differences, if any, between public and open space use for physical activity by walkers and runners.
Thirty-eight % of Arizonans have access to parks. Sixty-two percent of Arizona adults are overweight or obese, only 24 percent of Arizona residents meet the criteria of aerobic activity and weight, and 47 percent of
Arizona residents do not participate in any physical activity at all. Although a large population of Arizona residents do not participate in the recommended amount of physical activity, many individuals in the Tucson community that are physically active can often be seen exercising at Tucson’s Tumamoc Hill or Sentinel Peak. Tumamoc Hill is a
3,108 foot tall National Historic Landmark, located on the west side of Tucson. Tumamoc Hill is not registered as a national park and is used as a public open space. This hill is also used as a National Environmental Study Site Area and is owned by the University of Arizona. Tumamoc Hill lies directly west of Sentinel Peak, also known as “A”
Mountain, which, unlike Tumamoc Hill, is registered as a recreational park. Sentinel Peak has a smaller incline than
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Tumamoc and rises 2,897 feet above Tucson. Both peaks are used for numerous outdoor activities throughout the year in Tucson, the most common being hiking. The amount of studies, as well as visitors of Tumamoc Hill, has overshadowed those of Sentinel Peak throughout history. Copious amounts of data have been collected from this location pertaining to conservation, ecology and archaeology. Though Tumamoc is used as a study site, there have been no epidemiological studies using either Tumamoc or Sentinel Peak. Below is a graph representing preliminary data that was used to compare the demographics of Tumamoc Hill to those of the city of Tucson, which was found to be very similar to each other.
Background
The enigmatic “A” that lays due west of the city of Tucson is a symbol of the birthplace of Tucson.
Annually residents and visitors enjoy a magnificent 4th of July fireworks display and every year hundreds of community members drive, bike or walk to the top for a view of the Sonoran Desert. Sentinel Peak also known as
“A” Mountain serves its community members as a public park and is an icon to beholden. To the northwest is
Tumamoc Hill, the sister peak to “A” Mountain. Tumamoc Hill, owned by The University of Arizona, is also a popular destination attracting hundreds of walkers and runners. Unlike “A” Mountain Tumamoc is not accessible to vehicular traffic and unlike its sister peak Tumamoc is not a public park, yet hundreds of walkers and runners flock to Tumamoc daily. As a member of the Tucson community for 36 years and having run Tumamoc Hill far more often than “A” Mountain over the past 10 years, I‘ve observed there’s an attraction to Tumamoc Hill, for runners and walkers that far outweigh “A” Mountain usage. The Tumamoc Walkers are an informal group of community members whose mission is to ensure continued access to Tumamoc Hill for walkers and joggers, makes a claim
“The ethnicity of walkers is about the same as that of the City of Tucson.” In June 2013 over a period of three hours, my colleague and I sat at the top of Tumamoc and made 262 unique observations. Table 1 represents our demographic findings. We also decided to conduct a brief comparison of our findings with U.S. Census data (see
Table 2.). It was the data in Table 2 that prompted us to conduct a pilot study in November 2013 to further investigate our informal June 2013 findings.
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Table 1. Tumamoc Hill Observational Demographics
Tumamoc Hill Observations June 4, 2013 Total Male Female Run Walk 0430-0730 hrs. 262 79 183 25 237 Total Male Female (%) (30.1) (69.9) Caucasian 123 36 87 (47.0) Hispanic 113 34 79 (43.1) African American 7 2 5 (2.7) Native American 6 2 4 (2.3) Asian 10 2 8 (3.8) Other (missing data) 3 3 0 (1.1) Total 262 79 183 (100)
Table 2. Comparison between Tumamoc Hill and the 2010 U.S. Census2.
Tumamoc Hill observations Tucson racial composition
June 4, 2013, % 2010 U.S. Census, %
Caucasian 47.0 47.2
Hispanic 43.1 41.6
African American 2.7 5.0
Native American 2.3 2.7
Asian 3.8 2.9
Hypotheses
1. There is no statistical difference between the demographics of Tumamoc Hill compared to the City of Tucson. 2. There is no statistical difference between the demographics of Sentinel Peak compared to the City of Tucson. 3. There is no statistical difference between the demographics of Tumamoc Hill compared to Sentinel Peak.
2 Retrieved on July 2, 2013 from http://quickfacts.census.gov/qfd/states/04/0477000.html 104 A WALK IN THE PARK
Pilot Study Methods:
This IRB approved research pilot study was conducted on Saturday, November 9, 2013 using a non- equivalent group design (NEGD) using two geographically similar areas for demographic and physical activity level comparisons. Using survey questionnaires we collected data from runners and walkers between the hours of 4:00
AM – 7:00 PM.
Participant Selection
Study participants were required to be at least 18 years of age and had the option to take the survey in either
English or Spanish. Surveys were completely voluntary and each participant was read and/or also had the option of having the survey read to them in their preferred language and signed an informed consent agreement before participating in the study.
Measures
A sentry-style count was obtained at the entrance of each site from 4:00 AM – 7:00 PM. A total of 1008 users (both sites) passed through the entrance into each geographic area; of the 1008 users, 396(39.3%) participated in the survey questionnaire (24 at Sentinel Peak and 372 at Tumamoc Hill). The questionnaire survey was designed to obtain basic demographic information of the users, the length/duration of use, and primary reason for use.
Data Analysis/Statistical Methods: All data analyses were performed using SAS, version 9.4.
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Table 3: Demographic Characteristics by Sentinel Peak Tumamoc Hill Site (n = 24) (n = 369) (Missing Data Included) Year of Birth, mean ± SD 1975 ± 17 1969 ± 14
Gender, n (%)
Male 11 (45.8%) 110 (29.8%)
Female 11 (45.8%) 246 (66.7%)
Other 1(4.2%) 0 (0.0%)
Missing 1 (4.2%) 13 (3.5%)
Race, n (%)
White 12 (50.0%) 166 (45.0%)
African American 0 (0.0%) 12 (3.3%)
Asian 0 (0.0%) 7 (1.9%)
American Indian/Alaska Native 0 (0.0%) 10 (2.7%)
Native Hawaiian/Pacific Islander 0 (0.0%) 1 (0.3%)
Latino/Latina 7 (29.2%) 119 (32.3%)
Two or more 0 (0.0%) 7 (1.9%)
Other 0 (0.0%) 8 (2.2%)
Missing 5 (20.8%) 39 (10.6%)
Ethnicity, n (%)
Hispanic or Latino 8 (33.3%) 156 (42.3%)
Non Hispanic or Latino 14 (58.3%) 183 (49.6%)
Missing 2 (8.3%) 30 (8.1%)
Table 4: User Characteristics by Site (Missing Data Included)
Variable Sentinel Peak Tumamoc Hill
(n = 24) (n = 369)
Difficulty (1-10), mean ± SD 5.2 ± 1.6 6.7 ± 2.0
Length of use, n (%)
Less than 6 months 12 (50.0%) 109 (29.5%)
6 months to 1 year 0 (0.0%) 37 (10.0%)
1 to 5 years 4 (16.7%) 108 (29.3%)
5 to 10 years 4 (16.7%) 81 (22.0%)
10 years or more 2 (8.3%) 34 (9.2%)
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Missing 2 (8.3%) 0 (0.0%)
Frequency of use, n (%)
Almost every day 7 (29.2%) 75 (20.3%)
Once or twice per week 7 (29.2%) 196 (53.1%)
Once per month 7 (29.2%) 48 (13.0%)
Once every 6 months 3 (12.5%) 21 (5.7%)
Once a year or less 0 (0.0%) 22 (6.0%)
Missing 0 (0.0%) 7 (1.9%)
Duration, n (%)
Less than 30 minutes 0 (0.0%) 10 (2.7%)
30 minutes to 1 hour 18 (75.0%) 226 (61.3%)
1 to 2 hours 3 (12.5%) 120 (32.5%)
2 to 4 hours 2 (8.3%) 6 (1.6%)
More then 4 hours 0 (0.0%) 2 (0.5%)
Missing 1 (4.2%) 5 (1.4%)
Summit, n (%)
Yes 18 (75.0%) 348 (94.3%)
No 3 (12.5%) 18 (4.9%)
Missing 3 (12.5%) 3 (0.8%)
Pilot Study Results:
Tumamoc Hill
Of the data collected, 29.8 %of participants were male and 66.7 % were female. The data also indicated that approximately 70 % of participants (261 people) selected English as their first language, and 20.7 % (70 people) spoke Spanish as a first language. 44.6 %confirmed they were Caucasian, and 32.3 % were of Latino/Hispanic decent-directly correlating with the racial background of Tucson, and was similar to the data found in the preliminary study and Tucson census.
Of the total amount of people on Tumamoc Hill who participated in this study, women were the most common users- with more than double the amount of women than men. Of the total amount of female participants, 33.5 % were Caucasian and 30.5 % were Latino or Hispanic. The most prevalent racial groups among men were Caucasian
107 A WALK IN THE PARK males (13.9%) and Hispanic males (13%). Of the total Tumamoc Hill respondents, 47.4 % were white, and 43.5 percent were Hispanic. This directly correlates to the racial demographic of Tucson, which is comprised of
47.2 % non-Hispanic Caucasians and 41.6 % Hispanic/Latino. The Native American demographic of Tumamoc Hill and Tucson mirror each other closely; Native Americans make up 2.2 % of the sample population, compared to the
Native American demographic of Tucson, which was 2.7 %. Of the participants on Tumamoc Hill, 2.6 % were
African American compared to 5.0 percent of African Americans in the Tucson area. The Asian population in
Tucson is 2.9 % compared to Tumamoc Hill, which was 3.7 %.
Reasons for coming to Tumamoc Hill varied among participants. However, when asked why they chose Tumamoc
Hill, the most common reasons were to improve health (46.51%) and walk (15.05%). The most common second ranking reasons as to why they chose Tumamoc were to enjoy the beauty (20.43%), to get fresh air (10.28%), and to relax or think (9.14%). This could indicate that Tumamoc Hill is a crucial public space for physical, mental, spiritual health and wellness of the community. The majority of participants surveyed at Tumamoc Hill were accompanied by friends or a partner and stayed for an average of thirty to sixty minutes (61.29%) about once or twice a week
(53.23%). Young adults and adults visited Tumamoc Hill more often than the elderly, with adults comprising the majority of the sample population. The majority of participants came to walk rather than to run up Tumamoc Hill.
Of those who use Tumamoc, the majority came with friends, while about 17 percent prefer to come alone. The peak time for attendance of participants was approximately eight A.M.
Graph 1. Number of users on Tumamoc Hill from 0400hrs - 1900hrs.
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Sentinel Peak
To be added/work in progress.
Discussion
Limitations
Conclusions
Collection of more data could support our findings that Tumamoc Hill’s demographics are similar to
Tucson’s, and is an effective representative sample of the Tucson population. Feedback from participants of the survey, especially their reasons for using Tumamoc Hill, reveals that it is an important area for physical and emotional health, as well as spirituality and overall wellbeing among community members. More data collection and analysis is needed for Sentinel Peak, however the demographic results and overall response of participants indicate a preference of the Tumamoc Hill public space compared to the Sentinel Peak designated recreational park.
In order to assess the benefits of public/open space for physical activity among the community, we conducted our studies using the following measures: model development, inform policy, and asset mapping.
Model Development: Using a representative sample of both Sentinel Peak and Tumamoc Hill users, we were able to gain insight into Tucson’s health and wellness index.
Inform Policy: Information is gained from users on existing community assets used for physical activity and can also inform stakeholders on best use practices.
Asset Mapping: The users of such public/open spaces informed us (public health practitioners and other interested stakeholders) of similar assets in the community used for physical activity.
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Appendix B: Letters of Support
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Nicolette Teufel-Shone, PhD., Professor & Section Chair, Family & Child Health Section, Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, 1295 North Martin Avenue, Tucson, AZ 85724 May 27, 2015
Dr. Teufel-Shone: Re: Deanna Lewis’ Tumamoc Walkers Community Research
For the last 10 years, I’ve walked Tumamoc Hill 5-6 mornings/week and have assumed the role of Head of the Tumamoc Hill Walkers. We are most intrigued and supportive of Ms. Lewis’ investigation of the health and motivational determinates of Tumamoc participants. Some factors certainly may be recently added assets such as the bike racks, benches, port-a-john and water fountain. Other holistic rewards are more “spiritual” such as the shrine at the lower gate, pictographs or the indigence animal and plant life sightings.
I realize that many more Tucsonans walk the Hill in the evening but likely the analysis may prove similar to the pilot data. Her planned interview collection data set would help us in our immediate and future planning of the most effective use of the Hill’s assets.
I noticed that an “A” (Sentinel Peak) Mountain walker sample was used as a comparable group. My own opinion is that walking up “A” Mountain is a very dissimilar experience because of the abundant physical appointments, car and bike traffic, gradual slope path and comparatively barren terrain. Because of these determinants the number of “A” Mountain walkers is assuredly less.
We are delighted to assist in this welcomed research and will savor even the early and preliminary data sets.
Sincerely yours,
Ronald P. Spark, M. D. Clinical Associate Professor, Department of Pathology, U of AZ College of Medicine
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November 30, 2016
To Deanna Lewis Dissertation Committee Fr: Mac Hudson, Friends of “A” Mountain at Sentinel Peak Park Re: Support for Deanna Lewis’s project at Sentinel Peak Park and Tumamoc Hill
I am writing in strong support of Deanna Lewis’ dissertation project. Since 2006, I have been part of a group of local residents and neighbors who have been working to improve Sentinel Peak and get more people active at this city park. My advocacy started in 2006, and continued when I worked on the campaign for Tucson City Councilor Regina Romero and became one of her chief advisors.
Working for the City, we made Sentinel Peak Park one of our park priorities and worked to get the Master Plan approved and get improvements included in the Pima County bond package. While that bond package failed, there is still strong support to keep momentum moving forward for this iconic Tucson landmark. Visit us on our Facebook page – Friends of “A” Mountain at Sentinel Peak Park for more information about our volunteer group.
Deanna’s project fits into the goals of the neighborhoods in the area, and helps to reinforce the goals of the Sentinel Peak Park Master Plan. I am the past President of the Menlo Park Neighborhood Association, and we worked closely with Panorama Estates and Barrio Kroeger Lane Neighborhoods as active partners with the City and the Friends of “A” Mountain, participating in bi- annual events since 2008 to pull buffelgrass and have cleanup days at the park. It also fits into development efforts for the westside as a whole – creating walking connections from the Mercado San Agustin, the proposed Caterpillar headquarters, the county riverpark “Loop” path, Mission Garden and other proposed new developments by Rio Nuevo.
Creating a safe walking connection from the westside development area up to Sentinel Peak and beyond to Tumamoc Hill has been a dream of many of our coalition. Deanna’s project will call attention to the area and give us a chance to analyze the community health benefits of this park, and help make this project a reality. Feel free to call me at (520) 405-3524 or email me at [email protected] if you have questions.
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Michele Scanze Community K inetics 2721 N. Warren Ave Tucson, AZ 85719 484-947-3261 [email protected]
December 4, 2016
Dear Deanna Lewis’ Dissertation Committee,
I am writing to voice my strong support of Deanna Lewis’ dissertation project. Since 2014, Community Kinetics has worked with Deanna to help move Tucson and Pima County to create healthier communities. Community K inetics recognizes that health is impacted by place; where we live, work learn and play impacts our physical and mental health. Armed with public health, land use planning and geospatial technologies knowledge, Community K inetics promotes sustainable and healthy social and physical change in communities. Deanna’s dissertation project about A-Mountain and Tumamoc Hill has the overall goal of engaging community members, leveraging assets and improving community health. Community K inetics is proud to work with Deanna to develop a firmer understanding of the relationship between health and place.
Since 2014, Community K inetics has supported Deanna with her preliminary research regarding health and place. We provided Deanna with GIS analysis of survey data from Tumamoc Hill users, depicting the spatial distribution of users. Additionally, Community K inetics has worked with Deanna to train volunteers and collect data using the Systems for Observing Play in Recreation Areas (SOPARC) methodology on physical activity at La Madera Park. T his observation study highlighted the multitude of demographics and physical activity levels at a neighborhood park that benefitted from being renovated through grant funds. More importantly, the volunteers who collected data for this study came from a mix of undergraduate disciplines, including mathematics, psychology and pre-med. Our work helped these future professionals understand how health outcomes relates to access to safe places for physical activity.
Throughout her entire professional career, Deanna has tirelessly worked to improve the quality of life for Tucson residents. Community K inetics is thrilled to see her dissertation project produce not only a dissertation to meet the requirements of her DrPh, but also a project that aligns with her passions and gears Tucson towards a health in all policies framework.
Sincerely yours,
Michele A. Scanze, MPH, MS Planning Candidate
Founder of Community K inetics
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P O ST ER F R O S T M I R T O
A R C H I T E C T U R E P L A N N I N G P R E S E R V A T I O N
DATE: December 6, 2016
TO: Deanna Lewis Dissertation Committee
FROM: Corky Poster, Architect and Planner
RE: Support for Deanna Lewis project at Sentinel Peak and Tumamoc Hill
My name is Corky Poster. I am an architect and planner, a Distinguished Professor Emeritus (University of Arizona), former Director of the Drachman Institute, and the former Acting
Dean of the College of Architecture, Planning, and Landscape Architecture. I have practiced
community architecture and planning in Tucson since 1974. I am a principal with Poster Frost Mirto.
I have known Deanna Lewis for the last ten years. I know her to be an extraordinarily
diligent and dedicated worker, student, academic, and practitioner.
I am writing in support of Deanna Lewis’ dissertation project, Com parative analysis and
intervention to support Physical activity in a recreational park versus an open space in Tucson, AZ.
I know a fair amount about her topic.
First, I have twenty years of experience on her site with first-hand knowledge of Tumamoc
Hill. Second, as Director of the Drachman Institute, I was the recipient and manager of a $400,000 three-year grant in 2006 from US HUD University Outreach program, Community
Outreach Partnerships Centers Program (COPC) [Com m unity Outreach Partnerships Centers grants help colleges and universities apply their hum an, intellectual, and institutional
resources to the challenge of revitalizing distressed com m unities.] The project was entitled “Building Healthy Neighborhoods” and it explored the relationship between community
and neighborhood spaces and health. Third, I am on the Board of Director of the Living Streets Alliance, a 501c3 corporation here in Tucson. Our goal and mission is to promote health by utilizing alternative mode systems to make our community healthier and safer.
Ms. Lewis’ concept and program will be an excellent addition to the study and literature of open space, design and health. It is well-conceived and well-structured.
I am happy to support her efforts in any way that would be useful to her work.
31 7 North Court Av enue T ucso n, Arizo na 8 5 7 01 P H 5 2 0 . 8 8 2 . 6 3 1 0 F A X 5 2 0 . 8 8 2 . 0 7 2 5 www.posterfrostmirto.com
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212 South Avenida del Sembrador – Tucson, Arizona 85745 – 520.971.2348
December 8, 2016
TO: Deanna Lewis Dissertation Committee FROM: Gene Einfrank RE: Deanna Lewis project at Sentinel Peak
On behalf of the Menlo Park Neighborhood Association (MPNA) I fully support Deanna Lewis’ proposal to utilize Sentinel Peak for her dissertation project. For the past 4 years I have served as both president of MPNA and co-chair of the Downtown Neighborhoods and Residents Council. In addition, I reside in the Mercado District of Menlo Park where I have lived for the past 9 years. With friends and neighbors I have walked from Menlo Park to the top of Sentinel Peak countless times. The mountain, with varied terrain and wonderful views of the city and the surrounding desert, is a powerful draw for anyone seeking outdoor exercise and recreation. For these reasons and more, Sentinel Peak appears to be an ideal location to study the hypotheses as stated in Deanna’s proposal.
I strongly believe that, if called upon, many residents in Menlo Park would be delighted to participate in Deanna’s study and I would work to involve the neighborhood to the best of my ability.
Please do not hesitate to contact me with any questions you may have in this regard.
Best,
Gene Einfrank, president Menlo Park Neighborhood Association 520-971-2348
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P.O. Box 210006 Tucson, AZ 85721-0006 Tel: (520) 621-6901 Fax: (520) 621-8655 www.honors.arizona.edu
December 9, 2016
Dear Deanna:
I very much enjoyed meeting you and learning more about Dequenesh. I believe that Dequenesh’s outreach and education mission to promote health and wellness through experiential learning opportunities is a great fit with our Health and Human Values Minor.
The HHV internship is specifically geared toward providing students with the opportunity to observe and participate in health care interventions and medicine in the field, or to learn about health care policy. In practice, this means that emphasis will be placed on clinical or other opportunities that will teach students skills and provide background for understanding the challenges and opportunities in providing health services to a broad range of populations and in a variety of contexts.
Your projects at Sentinal Peak and Tumumoc Hill in particular will provide our students with uniquely valuable experiences that will allow them to gain knowledge and skills in the interdigitated fields of disease prevention, health promotion, and community development.
We are very excited to partner with you and to develop internship opportunities that can benefit Dequenesh and our HHV students.
Sincerely,
Victor Braitberg
Victor Braitberg, Ph. D Assistant Professor University of Arizona Honors College Honors Interdisciplinary Faculty [email protected] 520-621-0175
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Scanned by CamScanner
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MOBILE MEDICATS 1614 E. 1st Street Tucson, AZ, 85719
To: Deanna Lewis’ Dissertation Committee From: Andrew Good, President of Mobile Medicats Regarding: Deanna Lewis’ Research at Sentinel Peak and Tumamoc Hill Date: December 14th, 2016
I write this letter to formally state my support for the research project conducted by Deanna Lewis at Sentinel Peak and Tumamoc Hill. As she analyzes interventions promoting physical wellness at these locations, she is actively creating an insight into how those studying public health can help their community.
Not only will this be a service to the Tucson community, it will also serve the students at the University of Arizona. With pre-health students looking to follow their passions and gain experience in health-related fields, this research opportunity actively educates them in research design, taking vitals and communicating effectively.
Further, this research project will undoubtedly be of service to Mobile Medicats, which is currently creating a mobile clinic for the homeless of this community. As Mobile Medicats and Dequenesh are two organizations that cooperate consistently, this project will both train our members and develop connections in the community. In short, this research project will have implications beyond its intended goal.
Should any individual desire to ask further questions, I can always be reached at [email protected].
Sincerely, Andrew Good University of Arizona Honors College '17 - Physiology, Public Health Banner University Medical Center - Patient Transport, Mobile Clinic Volunteer Mobile MediCats - Founder, President Pace Laboratory - Assistant Physiology Honors Academy - Adviser
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December 22, 2016
To Deanna Lewis Dissertation Committee Fr: Diana Rhoades, National Park Service Urban Fellow for Tucson and Saguaro National Park
I am writing in support of Deanna Lewis’ health project at Sentinel Peak Park and Tumamoc Hill.
The National Park Service has been part of the urban parks movement from the e arliest days of the agency’s founding in 1916. In preparation for its 100 year anniversary in 2016, NPS Director Jon Jarvis launched an “Urban Agenda” to help increase the relevancy of the National Park Service to city dwellers. Tucson, Arizona and Saguaro National Park are one of 10 cities and affiliated National Parks chosen to help launch the Urban Agenda, and one of 50 cities selected by the Department of Interior to launch the Let’s Move Outside initiative to get more young people moving and volunteering outside.
Part of that relevancy is the National Park Service’s increased focus on highlighting parks and public lands as a place for exercise, relaxation and stress relief, and partnerships with health care prov iders. The National ParkRx Initiative (www.parkrx.org) is a community of practitioners advancing the use of parks and public lands to improve health and wellness among individuals and communities. The NPS has created a Parks, Trails and Health Workbook to share with local communities about best practices (https://www.nps.gov/public_health/hp/hphp/resources.htm).
As the NPS Urban Fellow, I have been working with the City, the Regional Transportation Authority, health care providers, neighborhoods, and public land agencies to find strategic ways to collaborate to help solve health challenges. In 2016 we launched our first National Park Prescription Day, and applied for a $650,000 grant from the federal government to get a prescription trail launched in Tucson in partnership with Banner University Medical Center. We are still waiting to hear back about this important grant.
We see Deanna’s project as an important link to getting data on trails, health and wellness, and look forward to working with her and our other partners to make park prescriptions a reality in Tucson. Doing this phase of the project at Sentinel Peak Park, a rarely used hiking resource in the heart of Tucson and located adjacent to the popular Tumamoc Hill – will help inform City of Tucson parks officials of the need to improve the trail access. Park Prescriptions will provide physicians and other healthcare providers with a new set of tools to inspire patients to improve their health.
Thank you all for your leadership on this important project.
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Appendix C: SOPARC Instrument
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Appendix D: Sense of Community Index-2 (SCI-2) Instrument
Sense of Community Index 2 (SCI-2): © Background, Instrument, and Scoring
Instructions
Community Science 438 N. Frederick Avenue, Suite 315 Gaithersburg, MD 20877 301-519-0722 voice 301-519-0724 fax www.communityscience.com www.senseofcommunity.com
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Appendix E: Self Efficacy Instrument
Exercise Self Efficacy Marcus 1992
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Appendix F: Health and Wellbeing Instrument
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