Document Type

Article

Publication Date

10-21-2024

Identifier

DOI: 10.3389/fpubh.2024.1458137; PMCID: PMC11532055

Abstract

Population-level efforts are needed to increase levels of physical activity and healthy eating to reduce and manage chronic diseases such as obesity, cardiovascular disease, and type 2 diabetes. Interventions to increase public transit use may be one promising strategy, particularly for low-income communities or populations of color who are disproportionately burdened by health disparities and transportation barriers. This study employs a natural experiment design to evaluate the impacts of a citywide zero-fare transit policy in Kansas City, Missouri, on ridership and health indicators. In Aim 1, comparison to 9 similar cities without zero-fare transit is used to examine differential changes in ridership from 3 years before to 4 years after the adoption of zero-fare. In Aim 2, Kansas City residents are being recruited from a large safety net health system to compare health indicators between zero-fare riders and non- riders. Longitudinal data on BMI, cardiometabolic markers, and economic barriers to health are collected from the electronic health record from 2017 to 2024. Cross-sectional data on healthy eating and device-measured physical activity are collected from a subsample of participants as part of the study procedures (N = 360). Numerous baseline characteristics are collected to account for differences between Kansas City and comparison city bus routes (Aim 1) and between zero-fare riders and non-riders within Kansas City (Aim 2). Evidence on how zero-fare transit shapes population health through mechanisms related to improved economic factors, transportation, physical activity, and healthy eating among low-income groups is expected.

Journal Title

Front Public Health

Volume

12

First Page

1458137

Last Page

1458137

MeSH Keywords

Humans; Transportation; Missouri; Social Determinants of Health; Female; Male; Adult; Exercise; Cross-Sectional Studies; Middle Aged

Keywords

natural experiment; physical activity; social determinants of health; transportation; zero-fare transit

Comments

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Environmental Protection Agency (EC -97791001-0) and the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (R01DK132350). Powell-Wiley was funded by the Division of Intramural Research in the National Heart, Lung, and Blood Institute and the Intramural Research Program of the National Institute on Minority Health and Health Disparities. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Publisher's Link: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1458137/full

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