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 需要作出广泛的努力，在低收入国家提高人口的体育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。低收入群体的利率更高 肥胖和糖尿病的发病率比一般人群高，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。主动交通是一种未充分利用的 这是一个重要的经济来源，但与低收入群体特别相关。一个主要的和一致的相关性， 积极的交通是使用公共交通，公共交通用户每天多花5 - 15分钟的公共交通时间 这些非用户。公共交通也可以支持获得健康饮食和保健服务。全市政策， 增加使用公共交通有希望改善健康指标，但 探索不足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次公共汽车旅行）已成为美国唯一一个永久 实行零票价公交政策。这项政策取消了全市所有的公共汽车票价。这 提供了一个难得的机会，研究这些政策对公共汽车乘客的影响， 公交车使用者的身体活动、健康饮食和体重状况。在这项研究中，我们将收集巴士 KCMO和多个比较城市ZBT之前和之后3年的乘客量数据。探讨 健康信息，研究参与者将从一个大型初级保健卫生系统招募， 收入社区。参与者将完成巴士使用的措施，身高和体重信息将被 在ZBT之前和之后3年内从卫生系统的电子健康记录中获得。的子样本 参加者将完成为期七天的客观体力活动评估及问卷调查， 饮食，对ZBT政策的看法，以及乘坐公共汽车的障碍/促进因素。社区居民将收集 公交车站周围的邻里环境信息，作为公交乘客和支持的障碍进行测试 宣传工作。一个国家的最先进的综合控制方法将被用来比较乘客量的趋势， 城市和体重状态轨迹之间的后ZBT巴士用户和非巴士用户。合成控制器将 可以是多个控制参与者的加权组合，以提供比任何单个控制参与者更好的比较。 独自控制。这项研究对于推进关于潜在的知识和证据具有重要意义。 ZBT政策的健康影响。调查结果将产生可供其他自然资源使用的信息。 实验研究人员和医疗保健实体，以及地方，州和联邦政府， 确定使用公共政策方法，如ZBT作为肥胖和糖尿病相关的杠杆 降低低收入社区的风险。