Health Impacts of City-Wide Zero-Fare Bus Transit: A Natural Experiment

全市零票价公交车对健康的影响：一个自然实验

• 批准号: 10609064
• 负责人: Jannette Yvonne Berkley-Patton
• 金额: $ 66.76万
• 依托单位: UNIVERSITY OF MISSOURI KANSAS CITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-15 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609064
• 关键词: Accelerometer; Address; Adopted; Advocacy; Authorization documentation; Body mass index; COVID-19 pandemic; Characteristics; Chronic Disease; Cities; Communities; Crime; Data; Diabetes Mellitus; Diabetes prevention; Economic Conditions; Economics; Electronic Health Record; Environment; Evaluation; Federal Government; Focus Groups; General Population; Health; Health Food; Health Services; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Healthy Eating; Height; Income; Infrastructure; Kansas; Knowledge; Lead; Local Government; Low Income Population; Low income; Measures; Methods; Natural experiment; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Participant; Patients; Perception; Physical activity; Policies; Policy Maker; Population; Primary Health Care; Public Policy; Quasi-experiment; Questionnaires; Research Personnel; Risk Reduction; Sampling; Selection Bias; Source; State Government; Surveys; Testing; Transportation; Weight; authority; behavioral economics; built environment; comparison control; density; design; experience; experimental study; health economics; improved; pandemic disease; pandemic impact; pre-pandemic; recruit; sociodemographics; socioeconomics; tool; trend; usability; walkability

PROJECT ABSTRACT Wide-reaching efforts are needed to increase population levels of physical activity and healthy eating in low- income groups for obesity- and type 2 diabetes prevention/control. Low-income groups experience higher rates of obesity and diabetes than the general population and the COVID-19 pandemic has made these groups even more vulnerable to developing these preventable chronic diseases. Active transportation is an underused source of physical activity but is particularly relevant to low-income groups. A major and consistent correlate of active transportation is use of public transit, and transit users engage in 5-15 more minutes/day of overall PA that non-users. Public transit may also support access to healthy eating and health services. Citywide policies to increase use of public transit have promise for improving health markers but have been substantially underexplored. As an effort to improve economic conditions among low-income groups, Kansas City, MO (KCMO; 500K residents; 43,000 daily bus trips) has become the only major city in the U.S. to permanently adopt an ongoing zero-fare bus transit (ZBT) policy. The policy has eliminated all bus fares across the city. This provides an extraordinary opportunity to examine impacts of such policies on bus ridership and subsequently on bus users' physical activity, healthy eating, and weight status. In this proposed study, we will collect bus ridership data before and up to 3 years after ZBT in KCMO and multiple comparison cities. To investigate health information, study participants will be recruited from a large primary care health system serving low- income communities. Participants will complete measures of bus use, and height and weight information will be obtained from the health system's electronic health record before and up to 3 years after ZBT. A subsample of participants will complete a 7-day objective physical activity assessment and questionnaires on their healthy eating, perceptions of the ZBT policy, and barriers/facilitators to riding the bus. Community residents will collect neighborhood environment information around bus stops to test as barriers to bus ridership and support advocacy efforts. A state-of-the-art synthetic control approach will be used to compare ridership trends across cities and weight status trajectories between post-ZBT bus users and non-bus users. The synthetic controls will be a weighted combination of multiple control participants to provide a better comparison than any single control alone. This study has significant implications for advancing knowledge and evidence on the potential health impacts of ZBT policies. Findings will produce information that will be usable by other natural experiment researchers and healthcare entities, as well as by local, state, and federal governments in making determinations on use of public policy approaches such as ZBT as a lever for obesity- and diabetes-related risk reduction in low-income communities.

项目摘要 需要做出广泛的努力来提高低收入人群的身体活动和健康饮食水平 肥胖和 2 型糖尿病预防/控制的收入群体。低收入群体的比率更高 肥胖和糖尿病的发病率高于一般人群，而 COVID-19 大流行使这些群体甚至 更容易患上这些可预防的慢性疾病。主动交通尚未得到充分利用 身体活动的来源，但与低收入群体尤其相关。主要且一致的相关性 主动交通是指使用公共交通，并且交通使用者每天的总体 PA 时间多花 5-15 分钟 那个非用户。公共交通还可以支持健康饮食和健康服务。全市政策 增加公共交通的使用有望改善健康指标，但效果显着 尚未充分探索。为了改善低收入群体的经济状况，密苏里州堪萨斯城 （KCMO；50 万居民；每天 43,000 趟公交车）已成为美国唯一一个永久 采用持续的零票价公交（ZBT）政策。该政策取消了全市所有公交车票价。这 提供了一个绝佳的机会来研究此类政策对公交车乘客量的影响，以及随后的影响 公交车乘客的体力活动、健康饮食和体重状况。在这项拟议的研究中，我们将收集总线 KCMO 和多重比较城市的 ZBT 之前和之后 3 年的客流量数据。调查 健康信息，研究参与者将从服务低收入人群的大型初级保健卫生系统中招募 收入社区。参与者将完成公交车使用测量，身高和体重信息将被记录 从 ZBT 之前和之后 3 年内的卫生系统电子健康记录中获取。的子样本 参与者将完成为期7天的客观身体活动评估和健康状况调查问卷 饮食、对 ZBT 政策的看法以及乘坐公交车的障碍/促进因素。社区居民将收集 测试公交车站周围的社区环境信息作为公交车乘坐和支持的障碍 宣传工作。将使用最先进的综合控制方法来比较各个地区的客流量趋势 ZBT 后公交车用户和非公交车用户之间的城市和体重状态轨迹。综合控制将 是多个控制参与者的加权组合，以提供比任何单个参与者更好的比较 单独控制。这项研究对于推进有关潜力的知识和证据具有重要意义 ZBT 政策对健康的影响。研究结果将产生可供其他自然现象使用的信息 实验研究人员和医疗保健实体以及地方、州和联邦政府在制定 决定使用 ZBT 等公共政策方法作为肥胖和糖尿病相关的杠杆 降低低收入社区的风险。