Structural & Programmatic Effects of Bus Rapid Transit on Physical Activity

描述(由申请人提供)：缺乏足够的体育锻炼会对健康造成许多负面影响，但大多数美国成年人甚至无法达到每日推荐的最低体力活动水平。大多数方案干预措施侧重于增加娱乐性体力活动，但初期效果不大，长期效果甚至更弱，只招收少数有积极性的人，随后对公共卫生的影响有限。另一种方法是以影响日常体力活动的方式改变环境、基础设施或政策。一种有希望的方法，尽管不是专门针对体力活动而设计的，但试图增加交通工具的使用(例如，公共汽车、轻轨)。横断面研究结果表明，公共交通使用者通过步行往返公共交通接入点(如公交车站)积累了大量的体力活动，慢性病风险较低。不幸的是，美国的交通使用率很低，但人们越来越有兴趣增加交通运输成本，以减少化石燃料的能源消耗和交通拥堵。快速公交(BRT)正在成为一种越来越受欢迎的战略，试图在美国和其他地方增加公共交通的使用。这种替代常规公共汽车服务的服务减少了通勤时间，提高了服务可靠性，而且启动和实施起来也比轻轨便宜得多。2014年春季，金县地铁将在其BRT系统的最后两条线路上开始BRT服务。这项研究利用这一自然实验，目的是在前瞻性队列设计中检查体力活动的变化，特别是与交通相关的步行，其中包括居住在快速公交附近的个人(n=342)和居住在离快速公交较远的个人(n=342)，但在人口统计和初始建成环境方面相似。在BRT开始之前、之后不久以及两年后，参与者将佩戴加速计和全球定位系统(GPS)设备7天，并记录出行行为。这些数据被整合在一起，为身体活动、步行和旅行行为提供可靠和有效的衡量标准。这项研究还将研究BRT暴露和体力活动之间关系的潜在中介因素。对旅行的态度(通过调查来衡量)有可能从BRT之前到BRT之后发生变化，就像在移动中一样，这是一个基于社区的社会营销和激励计划，鼓励居民减少自驾游，将由当地交通机构沿着这些新的BRT线路实施。此外，BRT车站附近和建筑环境的变化，特别是已知的影响步行的环境因素，将作为潜在的调解因素进行调查。最后，这项研究试图获得决策者所需的关键成本效益信息，输入实施快速公交的成本(相对于常规公共汽车服务)与增加体力活动和减少伤害可能带来的好处。这次以健康为导向的快速公交评估的结果将让决策者了解基础设施变化可能影响体力活动的关键健康行为，以及这些变化的相对成本和与健康相关的好处。 公共卫生：体力活动不足在美国成年人中很常见，也是慢性疾病的重要诱因。从健康的角度评估重大交通基础设施变化对体力活动的影响及其成本效益至关重要。这样的评估将指导未来改善公共卫生的战略。

DESCRIPTION (provided by applicant): Lack of adequate physical activity has numerous negative health consequences, but the majority of U.S. adults fail to attain even minimal recommended levels of daily physical activity. Most programmatic interventions focus on increasing recreational physical activity, but have modest initial and even weaker long-term effects, enroll only the motivated few, and subsequently have limited public health impact. An alternative approach is changing environments, infrastructure, or policies in ways that affect daily physical activity. One promising approach, although not designed specifically to target physical activity, are attempts to increase transit use (e.g., bus, light rail). Cross-sectional findings suggest that transit users accumulate significant amounts of physical activity by walking to/from transit access points (e.g., bus stops) and have lower chronic disease risk. Unfortunately, transit use in the U.S. is low, but there is growing interest in increasing transit se to reduce fossil fuel energy consumption and congestion. Bus rapid transit (BRT) is becoming an increasingly popular strategy to try to increase transit use in the U.S. and elsewhere. This alternative to regular bus service reduces commute times, improves service reliability, and is also markedly cheaper to initiate and implement than light rail. In spring 2014, King County Metro Transit will begin BRT service on the final two lines of its BRT system. This study takes advantage of this natural experiment and aims to examine the change in physical activity, specifically transit-related walking, in a prospective cohort design involving individuals living close to BRT (n=342) versus those living farther away from BRT (n=342) but who are otherwise similar demographically and in initial built environment. Before, soon after, and >2 years after BRT begins, participants will wear accelerometer and global positioning systems (GPS) devices for 7 days and record travel behavior. These data are integrated provide reliable and valid measures of physical activity, walking, and travel behavior. This study will also examine potential mediators of the relationship between BRT exposure and physical activity. Attitudes about travel (to be measured by survey) have the potential to change from before to after BRT as In Motion, a neighborhood-based social-marketing and incentive program that encourages residents to decrease drive- alone travel, will be implemented by the local transit agency along these new BRT lines. In addition, the change in built environment near and at BRT stations, particularly environmental factors known to influence walking, will be investigated as potential mediators. Finally, this study seeks to obtain critical cost effectiveness information needed by decision makers, inputting the costs of BRT implementation (relative to regular bus service) versus the likely benefits of increased physical activity and lower injury. Findings from this timey health-oriented evaluation of BRT will inform decision makers about the potential for infrastructure changes to impact the critical health behavior of physical activity, as well as the relative costs and health-related benefits of such changes. PUBLIC HEALTH: Inadequate physical activity is common among U.S. adults and is a significant contributor to chronic disease. It is critical to evaluate the impact of major transportation infrastructure changes on physical activity and their cost effectiveness from a health perspective. Such evaluation will guide future strategies to improve public health.