{"doi":"10.3389/fpubh.2024.1458137","title":"Impacts of zero-fare transit policy on health and social determinants: protocol for a natural experiment study","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.","journal":"Frontiers in Public Health","year":2024,"id":451879,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9527,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1103085,"name":"Jannette Berkley‐Patton","orcid":"0000-0003-0235-7057","position":1,"is_corresponding":false},{"id":1040636,"name":"Jenifer E. Allsworth","orcid":"0000-0001-6559-8638","position":2,"is_corresponding":false},{"id":1273278,"name":"Joseph S. Lightner","orcid":"0000-0002-8536-0085","position":3,"is_corresponding":false},{"id":461949,"name":"Keith Feldman","orcid":"0000-0001-6935-5844","position":4,"is_corresponding":false},{"id":1273279,"name":"Brent Never","orcid":"0000-0002-2919-940X","position":5,"is_corresponding":false},{"id":1101828,"name":"Betty M. Drees","orcid":null,"position":6,"is_corresponding":false},{"id":364526,"name":"Brian E. Saelens","orcid":"0000-0001-6998-6339","position":7,"is_corresponding":false},{"id":281794,"name":"Tiffany M. Powell‐Wiley","orcid":"0000-0001-9488-4131","position":8,"is_corresponding":false},{"id":1273772,"name":"Lauren Fitzpatrick","orcid":null,"position":9,"is_corresponding":false},{"id":1273280,"name":"Carole Bowe Thompson","orcid":"0000-0001-6633-3906","position":10,"is_corresponding":false},{"id":1273773,"name":"Madison Pilla","orcid":null,"position":11,"is_corresponding":false},{"id":1273774,"name":"Kacee Ross","orcid":null,"position":12,"is_corresponding":false},{"id":367290,"name":"Chelsea Steel","orcid":"0000-0002-7119-5840","position":13,"is_corresponding":false},{"id":392443,"name":"Emily Cramer","orcid":"0000-0001-7969-7522","position":14,"is_corresponding":false},{"id":1273281,"name":"Eric Rogers","orcid":"0000-0002-8622-0826","position":15,"is_corresponding":false},{"id":825074,"name":"Cindy F. Baker","orcid":"0000-0001-9480-4242","position":16,"is_corresponding":false},{"id":367295,"name":"Jordan Carlson","orcid":"0000-0002-6008-7983","position":17,"is_corresponding":false},{"id":1273277,"name":"Amanda Grimes","orcid":"0000-0002-0132-1696","position":0,"is_corresponding":true}],"reference_count":55,"raw_metadata":null,"created_at":"2026-07-19T02:02:45.951080Z","pmid":"39498108","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}