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METHODS article

Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1458137

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

Provisionally accepted
AMANDA GRIMES AMANDA GRIMES 1*Jannette Berkley-Patton Jannette Berkley-Patton 2Jenifer E. Allsworth Jenifer E. Allsworth 2Joseph S. Lightner Joseph S. Lightner 1Keith Feldman Keith Feldman 3,4Brent Never Brent Never 5Betty M. Drees Betty M. Drees 2,6,7,8Brian E. Saelens Brian E. Saelens 10,9Tiffany M. Powell-Wiley Tiffany M. Powell-Wiley 11Donna K. Ginther Donna K. Ginther 12,13Lauren Fitzpatrick Lauren Fitzpatrick 14Carole Bowe Thompson Carole Bowe Thompson 2Maddy Pilla Maddy Pilla 14Kacee Ross Kacee Ross 14Chelsea Steel Chelsea Steel 14Emily Cramer Emily Cramer 15,3Eric Rogers Eric Rogers 16Cindy Baker Cindy Baker 17Jordan A. Carlson Jordan A. Carlson 14,15
  • 1 School of Nursing and Health Studies, University of Missouri–Kansas City, Kansas City, United States
  • 2 Department of Biomedical and Health Informatics, School of Medicine,, University of Missouri–Kansas City, Kansas City, United States
  • 3 Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, United States
  • 4 Department of Pediatrics, School of Medicine,, University of Missouri–Kansas City, Kansas City, United States
  • 5 Bloch School of Management, University of Missouri–Kansas City, Kansas City, United States
  • 6 Department of Internal Medicine, School of Medicine, University of Missouri–Kansas City, Kansas City, Kansas, United States
  • 7 Graduate School, Stowers Institute for Medical Research, Kansas City, Missouri, United States
  • 8 University Health, Kansas City, United States
  • 9 Seattle Children's Research Institute, Seattle, Washington, United States
  • 10 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, Washington, United States
  • 11 Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, Blood Institute, and Intramural Research Program,, National Institutes of Health, Bethesda, United States
  • 12 University of Kansas, Lawrence, Kansas, United States
  • 13 National Bureau of Economic Research, Cambridge, Massachusetts, United States
  • 14 Center for Children’s Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, Missouri, United States
  • 15 Department of Pediatrics, School of Medicine, University of Missouri–Kansas City, Kansas City, United States
  • 16 BikeWalkKC, Kansas City, United States
  • 17 Kansas City Area Transportation Authority, Kansas City, United States

The final, formatted version of the article will be published soon.

    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 2017-2024. 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: zero-fare transit, Natural experiment, physical activity, Social determinansts of health, Transportation

    Received: 12 Jul 2024; Accepted: 13 Sep 2024.

    Copyright: © 2024 GRIMES, Berkley-Patton, Allsworth, Lightner, Feldman, Never, Drees, Saelens, Powell-Wiley, Ginther, Fitzpatrick, Bowe Thompson, Pilla, Ross, Steel, Cramer, Rogers, Baker and Carlson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: AMANDA GRIMES, School of Nursing and Health Studies, University of Missouri–Kansas City, Kansas City, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.