Screening for Park Access during a Primary Care Social Determinants Screen

Int J Environ Res Public Health. 2020 Apr 17;17(8):2777. doi: 10.3390/ijerph17082777.


While there is evidence that access to nature and parks benefits pediatric health, it is unclear how low-income families living in an urban center acknowledge or prioritize access to parks.

Methods: We conducted a study about access to parks by pediatric patients in a health system serving low-income families. Adult caregivers of pediatric patients completed a survey to identify and prioritize unmet social and economic needs, including access to parks. Univariate and multivariate analyses were conducted to explore associations between lack of access to parks and sociodemographic variables. We also explored the extent to which access to parks competed with other needs.

Results: The survey was completed by 890 caregivers; 151 (17%) identified "access to green spaces/parks/playgrounds" as an unmet need, compared to 397 (45%) who endorsed "running out of food before you had money or food stamps to buy more". Being at or below the poverty line doubled the odds ( Odds ratio 1.96, 95% CI 1.16-3.31) of lacking access to a park (reference group: above the poverty line), and lacking a high school degree nearly doubled the odds. Thirty-three of the 151 (22%) caregivers who identified access to parks as an unmet need prioritized it as one of three top unmet needs. Families who faced competing needs of housing, food, and employment insecurity were less likely to prioritize park access (p < 0.001).

Conclusion: Clinical interventions to increase park access would benefit from an understanding of the social and economic adversity faced by patients.

Keywords: built environment; health inequity; mental health; park use; pediatrics; poverty; social determinants of health; stress; urban greenspace; urban nature.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Housing
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Parks, Recreational*
  • Poverty
  • Primary Health Care*
  • Residence Characteristics*
  • Social Determinants of Health*
  • Young Adult