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Public transit and depression among older adults: using agent-based models to examine plausible impacts of a free bus policy
  1. Yong Yang1,
  2. Brent A Langellier2,
  3. Ivana Stankov3,
  4. Jonathan Purtle2,
  5. Katherine L Nelson2,
  6. Erica Reinhard4,
  7. Frank J Van Lenthe5,
  8. Ana V Diez Roux3
  1. 1School of Public Health, University of Memphis, Memphis, Tennessee, USA
  2. 2Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
  3. 3Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
  4. 4Department of Global Health and Social Medicine, School of Global Affairs, King’s College London, London, UK
  5. 5Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  1. Correspondence to Yong Yang, School of Public Health, University of Memphis, Memphis, TN 38152, USA; Yyang15{at}memphis.edu

Abstract

Background Daily transport is associated with mental health. A free bus policy (FBP) may be effective in promoting the use of public transit in older adults and be associated with reductions in depressive symptoms.

Methods We developed an agent-based model and grounded it using empirical data from England to examine the impact of an FBP on public transit use and depression among older adults. We also used the model to explore whether the impact of the FBP bus use and depression is modified by the type of income segregation or by simultaneous efforts to improve attitudes towards the bus, to reduce waiting times or to increase the cost of driving via parking fees or fuel price.

Results Our model suggests that improving attitudes towards the bus (eg, campaigns that promote bus use) could enhance the effect of the FBP, especially for those in proximity to public transit. Reducing wait times could also significantly magnify FPB impacts, especially in those who live in proximity to public transit. Contrary to expectation, neither fuel costs nor parking fees significantly enhanced the impact of the FBP. The impact of improving attitudes towards the bus and increasing bus frequency was more pronounced in the lower-income groups in an income segregation scenario in which destination and public transit are denser in the city centre.

Conclusion Our results suggest that the beneficial mental health effects of an FBP for older adults can be magnified when combined with initiatives that reduce bus waiting times and increased spatial access to transit.

  • AGEING
  • CHILD HEALTH
  • ENVIRONMENTAL HEALTH
  • EXERCISE
  • GEOGRAPHY
  • DIET
  • Health inequalities
  • Epidemiological methods
  • HEALTH POLICY
  • POLICY
  • PUBLIC HEALTH POLICY
  • SOCIAL SCIENCE
  • ACCESS TO HEALTH CARE
  • PSYCHOSOCIAL FACTORS
  • MENTAL HEALTH
  • SOCIAL EPIDEMIOLOGY
  • EPIDEMIOLOGY
  • Epidemiology of ageing
  • METHODOLOGY
  • Neighbourhood/place
  • CHRONIC DI
  • INEQUALITIES
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Footnotes

  • Contributors YY designed and implemented the model, analysed the simulated results and drafted the paper. LB, SI, PJ, NK and AVDR contributed to model design. LB, SI, PJ, NK, AVDR, RE and FJVL contributed to paper writing.

  • Funding This study was supported by the European Union Horizon 2020 Programme (grant number 667661) (Promoting mental well-being in the ageing population: MINDMAP). The study does not necessarily reflect the Commission’s views and in no way anticipates the Commission’s future policy in this area.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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