Frontiers in Public Health (Oct 2024)

Impacts of zero-fare transit policy on health and social determinants: protocol for a natural experiment study

  • Amanda Grimes,
  • Jannette Berkley-Patton,
  • Jenifer E. Allsworth,
  • Joseph S. Lightner,
  • Keith Feldman,
  • Keith Feldman,
  • Brent Never,
  • Betty M. Drees,
  • Betty M. Drees,
  • Betty M. Drees,
  • Betty M. Drees,
  • Brian E. Saelens,
  • Brian E. Saelens,
  • Tiffany M. Powell-Wiley,
  • Lauren Fitzpatrick,
  • Lauren Fitzpatrick,
  • Lauren Fitzpatrick,
  • Carole Bowe Thompson,
  • Madison Pilla,
  • Madison Pilla,
  • Madison Pilla,
  • Kacee Ross,
  • Kacee Ross,
  • Kacee Ross,
  • Chelsea Steel,
  • Chelsea Steel,
  • Chelsea Steel,
  • Emily Cramer,
  • Emily Cramer,
  • Eric Rogers,
  • Cindy Baker,
  • Jordan A. Carlson,
  • Jordan A. Carlson,
  • Jordan A. Carlson,
  • Jordan A. Carlson

DOI
https://doi.org/10.3389/fpubh.2024.1458137
Journal volume & issue
Vol. 12

Abstract

Read online

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.

Keywords