Background
Methods
Sampling design and participant recruitment
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Ghana: The in-country study sites include the town of Nkwantakese in the Afigya-Kwabre District of the Ashanti Region of Ghana and its surrounding villages. The town is situated to the southwest of Agona Ashanti the District Capital, and is about 20 km from Kumasi with a population of approximately 17,000.
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South Africa: Khayelitsha is the 3rd largest township in South Africa and is adjacent to the city of Cape Town. The population is about 500,000 with 80 percent of the residents living in temporary housing and 40 percent unemployed.
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Jamaica: The study site in Jamaica is in Kingston, the capital and largest city with a population of 651,880.
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Seychelles: In Seychelles, individuals have been recruited from the main island of the archipelago, Mahé, which includes approximately 75,000 inhabitants for a surface of 155 km2. Mahé can be qualified as semi-urban and its economy is mainly driven by tourism, industrial fishing and services. Seychelles is located approximately 1,600 km east of Kenya in the Indian Ocean, and approximately 2,000 km north of the island of Mauritius, and has a total population of about 87,000.
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USA (Maywood): Maywood is an African-American working class community adjacent to the western border of Chicago, Illinois, with a population of approximately 24,903 people.
Ethics approval
Measurements
Anthropometrics and body composition
Physical activity - accelerometer
Education, wealth, class, income and occupation questionnaire
Overall | USA | Seychelles | Jamaica | South Africa | Ghana | |
---|---|---|---|---|---|---|
Electricity | 97 | 100 | 100 | 99 | 96 | 89 |
Cell phone | 96 | 99 | 98 | 99 | 93 | 91 |
Television | 92 | 100 | 100 | 98 | 84 | 81 |
Electric iron | 90 | 99 | 100 | 94 | 90 | 68 |
Radio or CD player | 88 | 97 | 97 | 89 | 72 | 86 |
Refrigerator | 84 | 100 | 99 | 90 | 75 | 55 |
Watch or clock | 83 | 99 | 96 | 88 | 55 | 78 |
Modern stove | 81 | 99 | 98 | 97 | 83 | 28 |
DVD or VCR | 80 | 98 | 95 | 82 | 65 | 62 |
Sofa | 78 | 98 | 99 | 62 | 71 | 60 |
Fan | 72 | 98 | 93 | 96 | 14 | 59 |
Microwave oven | 52 | 99 | 49 | 67 | 36 | 10 |
Computer | 43 | 84 | 61 | 42 | 9 | 16 |
Satellite Dish or Cable TV | 40 | 83 | 56 | 48 | 7 | 4 |
Car or truck | 36 | 86 | 37 | 34 | 12 | 12 |
Telephone land line | 34 | 69 | 58 | 20 | 15 | 6 |
Bicycle | 30 | 68 | 16 | 38 | 10 | 16 |
Sewing machine | 29 | 23 | 43 | 16 | 26 | 37 |
Air conditioner | 23 | 93 | 7 | 8 | 2 | 2 |
Mean # Goods (SD)
|
11.3 (4.0)
|
15.9 (1.7)
|
13.0 (2.1)
|
11.7(2.8)
|
8.2 (2.8)
|
7.7 (3.2)
|
HH owns 13+ goods (%)
|
42.4
|
95.8
|
62.1
|
42.0
|
5.4
|
5.3
|
USA | Seychelles | Jamaica | South Africa | Ghana | p-value across sites | |
---|---|---|---|---|---|---|
(n = 427) | (n = 415) | (n = 379) | (n = 469) | (n = 411) | ||
PPI adjusted Gross National Income (GNI)1 per capita in US$ | 50,861 | 21,340 | 8,170 | 11,640 | 3,340 | |
Human Development Index (HDI), 2010 | 0.934 | 0.799 | 0.727 | 0.621 | 0.540 | |
Age (SD) | 35.5 (6.3) | 36 (5.6) | 34.6 (6.1) | 33.6 (5.8) | 34.6 (6.6) | <0.001 |
Male sex (%) | 48.0 | 48.7 | 51.2 | 47.8 | 42.3 | 0.15 |
Body mass index (kg/m2) (SD) | 32.1 (8.7) | 26.8 (5.4) | 26.3 (6.3) | 27.5 (8.2) | 24.1 (4.4) | <0.001 |
Obese (BMI > =30) (%) | 53.6 | 23.9 | 25.6 | 31.8 | 9.5 | <0.001 |
Years of education (SD) | 13.3 (2.2) | 12.9 (2.3) | 10.7 (2.0) | 9.8 (2.3) | 8.4 (4.0) | <0.001 |
Household income1 per person in US$ (SD2) | 11,652 (10,700) | 10,779 (7,505) | 7,042 (8,761) | 886 (1,251) | 1,272 (6,205) | <0.001 |
Proportion in relative poverty3 (%) | 89.7 | 59.5 | 49.6 | 98.5 | 85.6 | <0.001 |
Manual laborer or farmer (%) | 48.7 | 41.4 | 63.9 | 87.4 | 75.7 | <0.001 |
Statistical analysis
Results
Demographics
Household goods score
Physical activity by socioeconomic characteristics across sites
USA | Seychelles | Jamaica | South Africa | Ghana | |
---|---|---|---|---|---|
(n = 427) | (n = 415) | (n = 379) | (n = 469) | (n = 411) | |
Mean MVPA | 24.3 (29.8) | 29.7 (21.3) | 24.6 (20.7) | 37.6 (31.1) | 35.3 (23.1) |
Years of education (overall tertiles) | |||||
Lowest tertile | 48.2 (49.6) | 29.9 (22.4) | 27.5 (20) | 37.9 (33) | 36 (23.3) |
Middle tertile | 27.1 (33.1) | 34.5 (26) | 23.4 (20.1) | 37.3 (29.2) | 32.1 (19.7) |
Upper tertile | 19.7 (22.1) | 26.8 (17.1) | 20.5 (24.8) | <5 obs | 32.4 (23.8) |
p for continuous
|
<0.001*
|
0.037*
|
0.0143*
|
0.508
|
0.526
|
Unskilled manual, skilled manual vs. non-manual | |||||
Non-manual occupation | 16.6 (18.1) | 24.9 (17.4) | 20.4 (18.8) | 30.2 (21.0) | 29.7 (20.2) |
Skilled manual | 23.0 (23.7) | 37.1 (23.8) | 26.5 (25.0) | 49.7 (33.0) | 41.8 (22.8) |
Unskilled manual | 30.4 (35.6) | 33.3 (23.5) | 25.8 (20.2) | 38.4 (32.0) | 35.2 (23.2) |
p for difference (F-test)
|
<0.001*
|
<0.001*
|
0.089
|
0.159
|
0.033*
|
Employment status | |||||
Employed | 26.0 (28.0) | 30.4 (22.5) | 26.5 (22.2) | 38.5 (29.5) | 35.3 (25.3) |
Unemployed | 32.6 (36.4) | 26.9 (16.9) | 18.8 (16.4) | 34.0 (27.4) | 22.5 (14.2) |
p for difference
|
<0.001*
|
0.285
|
<0.001*
|
0.136
|
<0.001*
|
Relative poverty | |||||
Poverty | 23.8 (29.8) | 31.6 (21.5) | 23.8 (18.7) | 37.4 (31) | 35.8 (23) |
Not poverty | 28.9 (29.8) | 27.0 (20.8) | 25.4 (22.5) | 54.5 (38.5) | 32.7 (23.3) |
p for continuous
|
0.282
|
0.033
|
0.442
|
0.150
|
0.354
|
Material goods scale | |||||
0 to 11 | 52.5 (64.3) | 32.3 (21) | 27.8 (20.9) | 37.7 (31.5) | 35.5 (23) |
12 to 18 | 23.7 (28.5) | 28.8 (21.4) | 22.1 (20.2) | 37.1 (28.5) | 33.8 (23.5) |
p for continuous
|
<0.001*
|
0.001*
|
0.005*
|
0.345
|
0.056
|
Car ownership | |||||
No | 46.6 (45.4) | 33.7 (20.1) | 26.8 (20.7) | 38.2 (31.7) | 36.6 (23.2) |
Yes | 20.4 (24.2) | 23.0 (21.8) | 20.5 (20) | 33.8 (26.5) | 25.8 (19.3) |
p for difference
|
<0.001*
|
<0.001*
|
0.005*
|
0.316
|
0.002*
|
Adjusted measures of association between socioeconomic characteristics and PA
MVPA | Univariate | Model 1 | Model 2 |
---|---|---|---|
(Car + material goods) | (BMI + model 1) | ||
Site (vs. USA) | |||
Seychelles | 5.5 (1.8)* | −1.8 (1.8) | −4.3 (1.8)* |
Jamaica | 0.4 (1.8) | −8.3 (1.9)* | −10.7 (1.9)* |
South Africa | 13.4 (1.7)* | 1.3 (2.3) | −0.22 (2.3) |
Ghana | 11.0 (1.8)* | 0.0 (2.3) | −3.5 (2.4) |
Female (vs. male) | −19.0 (1.1)* | −20.6 (1.0)* | −18.0 (1.1)* |
Age (per year) | −0.1 (0.09) | −0.14 (0.08) | 0.00(0.08) |
Income per person ($10 k) | −2.6 (0.69)* | 0.52 (0.78) | 0.52 (0.77) |
# Goods owned | −1.3 (0.15)* | −0.47 (0.22)* | −0.36 (0.22) |
Car owned (vs. no) | −12.0 (1.2)* | −12.6 (1.4)* | −12.5 (1.4)* |
BMI (per kg/m2) | −1.02 (0.08)* | −0.53 (0.08)* | |
Constant | 24.3 (1.3) | 77.7 (5.0) | 87.0 (5.1) |
Car ownership by site
No interactions1,2 | No confounders | Adj. confounders2 | Confounders2 + BMI | |
---|---|---|---|---|
No car | ||||
US |
ref.
|
ref.
|
ref.
|
ref.
|
Seychelles | −1.8 (1.8) | −13.6 (2.6)* | −12.2 (3.3)* | −14.1 (3.3)* |
Jamaica | −8.3 (1.9)* | −19.1 (2.7)* | −19.3 (3.4)* | −21.2 (3.3)* |
S. Africa | 1.3 (2.3) | −8.8 (2.6)* | −9.9 (3.5)* | −10.9 (3.4)* |
Ghana | 0.0 (2.3) | −13.4 (2.6)* | −10.4 (3.5)* | −13.5 (3.5)* |
Car | ||||
USA | −12.6 (1.4)* | −26.1 (3.5)* | −24.3 (3.2)* | −23.7 (−3.2)* |
Seychelles | −10.7 (2.6)* | −12.1 (2.4)* | −12.2 (−2.4)* | |
Jamaica | −6.3 (2.7)* | −9.9 (2.6)* | −10.1 (−2.6)* | |
S. Africa | −4.3 (3.5) | −5.6 (3.3) | −5.7 (−3.3) | |
Ghana | −10.8 (3.8)* | −11.8 (3.6)* | −11.3 (−3.6)* |