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

项目摘要 需要广泛的努力，以提高低收入人口的体力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。低收入群体经历了更高的利率 肥胖和糖尿病的发病率高于普通人群，而新冠肺炎的流行使这些群体甚至 更容易患上这些可预防的慢性病。积极的交通是一种未得到充分利用的 这是体力活动的来源，但与低收入群体特别相关。一个重要的和一致的关联 积极的交通是使用公共交通，交通使用者每天多花5-15分钟的时间 那些不使用的人。公共交通还可以帮助人们获得健康饮食和健康服务。全市范围的政策 增加使用公共交通有望改善健康指标，但已取得实质性进展 开发不足。作为改善低收入群体经济状况的努力，密苏里州堪萨斯城 (KCMO；50万居民；每天4.3万次公交车出行)已成为美国唯一一个永久 采取持续的零票价公交政策。这项政策取消了全市所有的公交车票价。这 提供了一个非同寻常的机会来检查这些政策对公交车乘客的影响，并随后 关于公交车使用者的身体活动、健康饮食和体重状况。在这项拟议的研究中，我们将收集公共汽车 KCMO和多个比较城市ZBT前和ZBT后3年的客流量数据。去调查 健康信息，研究参与者将从一个大型初级保健系统招募，为低- 收入群体。参与者将完成公交车使用情况的测量，身高和体重信息将被 从ZBT前和ZBT后最多3年的卫生系统电子健康记录中获得。的一个小样本 参与者将完成为期7天的客观体力活动评估和关于他们健康的问卷调查 饮食，对ZBT政策的看法，以及乘坐公交车的障碍/促进者。社区居民将收取 公交站点周围的社区环境信息作为公交乘车和支持的障碍进行测试 宣传努力。将使用最先进的综合控制方法来比较不同地区的乘客趋势 ZBT后公交乘客和非公交乘客之间的城市和体重状态轨迹。合成控制系统将会 是多个对照参与者的加权组合，以提供比任何单个参与者更好的比较 一个人控制。这项研究对于促进对潜在的知识和证据具有重要的意义 ZBT政策对健康的影响。这些发现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、州和联邦政府在制定 关于使用ZBT等公共政策方法作为肥胖和糖尿病相关杠杆的决定 降低低收入社区的风险。

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.