title: Association of car ownership and physical activity across the spectrum of human development: Modeling the Epidemiologic Transition Study (METS).
abstract: BACKGROUND
  Variations in physical activity (PA) across nations may be driven by socioeconomic position. As national incomes increase, car ownership becomes within reach of more individuals. This report characterizes associations between car ownership and PA in African-origin populations across 5 sites at different levels of economic development and with different transportation infrastructures: US, Seychelles, Jamaica, South Africa, and Ghana.
  
  
  METHODS
  Twenty-five hundred adults, ages 25-45, were enrolled in the study. A total of 2,101 subjects had valid accelerometer-based PA measures (reported as average daily duration of moderate to vigorous PA, MVPA) and complete socioeconomic information. Our primary exposure of interest was whether the household owned a car. We adjusted for socioeconomic position using household income and ownership of common goods.
  
  
  RESULTS
  Overall, PA levels did not vary largely between sites, with highest levels in South Africa, lowest in the US. Across all sites, greater PA was consistently associated with male gender, fewer years of education, manual occupations, lower income, and owning fewer material goods. We found heterogeneity across sites in car ownership: after adjustment for confounders, car owners in the US had 24.3 fewer minutes of MVPA compared to non-car owners in the US (20.7 vs. 45.1 minutes/day of MVPA); in the non-US sites, car-owners had an average of 9.7 fewer minutes of MVPA than non-car owners (24.9 vs. 34.6 minutes/day of MVPA).
  
  
  CONCLUSIONS
  PA levels are similar across all study sites except Jamaica, despite very different levels of socioeconomic development. Not owning a car in the US is associated with especially high levels of MVPA. As car ownership becomes prevalent in the developing world, strategies to promote alternative forms of active transit may become important.
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. dshoham@luc.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Shoham
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. ldugas@luc.edu.
authors.forename: Lara R
authors.initials: LR
authors.lastname: Dugas
authors.affiliation: Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. pascal.bovet@chuv.ch.|Unit for the Prevention and Control of Cardiovascular Disease, Ministry of Health, Victoria, Mahe, Seychelles. pascal.bovet@chuv.ch.
authors.forename: Pascal
authors.initials: P
authors.lastname: Bovet
authors.affiliation: Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica. terrence.forrester@uwimona.edu.jm.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Forrester
authors.affiliation: Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa. Vicki.Lambert@uct.ac.za.
authors.forename: Estelle V
authors.initials: EV
authors.lastname: Lambert
authors.affiliation: Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. jprhule@africaonline.com.gh.
authors.forename: Jacob
authors.initials: J
authors.lastname: Plange-Rhule
authors.affiliation: University of Wisconsin, Madison, WI, USA. dschoell@nutrisci.wisc.edu.
authors.forename: Dale A
authors.initials: DA
authors.lastname: Schoeller
authors.affiliation: MRC Epidemiology Unit, Addenbrooke's Hospital, Cambridge, UK. soren.brage@mrc-epid.cam.ac.uk.
authors.forename: Soren
authors.initials: S
authors.lastname: Brage
authors.affiliation: MRC Epidemiology Unit, Addenbrooke's Hospital, Cambridge, UK. Ulf.Ekelund@mrc-epid.cam.ac.uk.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. rdurazo@luc.edu.
authors.forename: Ramon A
authors.initials: RA
authors.lastname: Durazo-Arvizu
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. rcooper@luc.edu.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Cooper
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. aluke@luc.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Luke
mesh_terms: D000328:Adult; D001336:Automobiles / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D016021:Epidemiologic Studies; D015444:Exercise; D005260:Female; D005869:Ghana; D006801:Humans; D007182:Income; D007563:Jamaica; D008297:Male; D008875:Middle Aged; D010067:Ownership; D015995:Prevalence; D012750:Seychelles; D012959:Socioeconomic Factors; D013019:South Africa