Understanding transportation-related health determinants and their interrelationships in rural U.S.

Abstract

Background

Transportation and health are undeniably related topics. Transportation choices impact our physical and mental health, affecting our activity levels and access to different opportunities. In recent years, research on the transportation and health domain has mainly focused on urban settings, while the rural population has been overlooked. Research is needed to explore the complex relationships across transportation-related health determinants in the rural context and support policies prioritizing health in these areas.

Methods

A conceptual framework is proposed based on an extensive literature review to identify the factors representing the transportation and health relationships in the rural U.S. Confirmatory factor analyses are employed to identify the variables representing each transportation-related health determinant. A structural equation model (SEM) is then estimated to quantify the relationships between these determinants in the rural U.S. For this endeavor, we collected individual data from an online survey and available secondary spatial data. A policy approach, the ABC PATH, is also proposed to support community health through transportation changes.

Results

We find strong and significant associations across all transportation-related health determinants, particularly with physical activity. Decreasing car usage and providing alternative transportation options can increase health and well-being. The proposed ABC PATH policy approach comprehensively promotes a healthy lifestyle and identifies potential interventions, with particular attention to vulnerable groups.

Conclusions

This paper presents a conceptual framework and quantifies the complex interrelationships between transportation and health in rural areas. The policy implications suggest that decision-makers must identify all-inclusive solutions and promote active lifestyles, considering the interlinked connections of the transportation-related determinants examined herein.