AUTHOR=Grimes Amanda , Berkley-Patton Jannette , Allsworth Jenifer E. , Lightner Joseph S. , Feldman Keith , Never Brent , Drees Betty M. , Saelens Brian E. , Powell-Wiley Tiffany M. , Fitzpatrick Lauren , Bowe Thompson Carole , Pilla Madison , Ross Kacee , Steel Chelsea , Cramer Emily , Rogers Eric , Baker Cindy , Carlson Jordan A. TITLE=Impacts of zero-fare transit policy on health and social determinants: protocol for a natural experiment study JOURNAL=Frontiers in Public Health VOLUME=12 YEAR=2024 URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1458137 DOI=10.3389/fpubh.2024.1458137 ISSN=2296-2565 ABSTRACT=

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.